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Delayed sleep-wake phase disorder (DSWPD) is a circadian rhythm sleep disorder associated with misalignment of the circadian pacemaker and the desired sleep-wake cycle, and manifests as delayed sleep-wake timing relative to societal norms.
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Approximately 10% of patients with chronic insomnia are reported to have DSWPD, suggesting the requirement of strict diagnostic criteria to differentiate DSWPD from sleep onset insomnia.
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Current treatment options have short-term efficacy, but relapse to a
Diagnosis, Cause, and Treatment Approaches for Delayed Sleep-Wake Phase Disorder
Section snippets
Key points
Classification of delayed sleep-wake phase disorder
The International Classification of Sleep Disorders, 3rd Edition (ICSD-3), defines DSWPD as having the following criteria: “(a) there is a significant delay in the phase of the major sleep episode in relation to the desired or required sleep time and wake-up time, as evidenced by a chronic or recurrent complaint by the patient or a caregiver of inability to fall asleep and difficulty awakening at a desired or required clock time; (b) the symptoms are present for at least three months; (c) when
Diagnostic Issues
Differing interpretations of diagnostic criteria and the similarity of DSWPD symptoms to other disorders presents clinicians with challenges in the accurate diagnosis of DSWPD. Although individuals with DSWPD have delays in their habitual sleep timing, other factors, such as depression or poor sleep hygiene, can contribute to sleep abnormalities that present similarly to DSWPD.19 Diagnosing DSWPD in adolescents also presents challenges, because this period of development is associated with many
Cause
Mechanisms that may contribute to the cause of DSWPD can be classed into 3 categories: physiologic, behavioral, and genetic (Fig. 2).
Treatment options
Current DSWPD treatment options place emphasis on advancing circadian and sleep timing in order to increase sleep duration and improve daytime functioning74; however, treatment regimens vary in efficacy. Chronotherapeutic, chronobiotic, photic, and other treatment approaches to DSWPD are summarized in Table 2 and Fig. 3.
Summary
DSWPD is a circadian rhythm sleep disorder that should be differentiated from sleep onset insomnia. According to the ISCD-3, sleep diaries and wrist actigraphy (when available) are relied on to document the consistent pattern of delayed sleep onset and waking (when sleep is unrestricted), in order to confirm a DSWPD diagnosis in clinical practice. Circadian phase markers are not routinely assessed, but should be considered. Treatment of DSWPD has mainly focused on advancing the circadian
Disclosure Statement
M. Magee and E. Marbas report no conflicts of interest. K.P. Wright, Jr, reports grants from National Institutes of Health and the Office of Naval Research and Philips Inc, and personal fees from the American College of Chest Physicians, The Obesity Society, the Obesity Medicine Association, and Torvec, Inc during the preparation of this work. He has also served as a consultant for Takeda Pharmaceuticals North America. S.W.M. Rajaratnam has served as a consultant through his institution to
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Disclosure Statement: See last page of article.
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These authors equally contributed to the article.