Delayed sleep phase disorder: Mechanisms and treatment approaches: Mechanisms and treatment approaches

This chapter will introduce the basic characteristics of delayed sleep phase disorder and provide an overview of the current methods for diagnosis. Current theories on the etiology and mechanisms of the disorder are described, and a review of treatment options is presented. In summary: DSPD is characterized by a delay in the timing of the sleep-wake cycle, such that sleep onset is difficult to achieve at a desired or required time. Difficulty waking is also experienced, particularly when sleep is attenuated to maintain required schedules. DSPD is associated with a number of negative health consequences, including a high prevalence of comorbid depression. Significant functional impairments are associated with DSPD, including poor school or job performance, dysfunctional relationships, and negative health behaviors such as smoking and excessive alcohol use. Prevalence rates vary between cultures and between adolescents and middleaged adults. It is likely multiple factors, such as genetic, environmental, and physiological, contribute to the etiology of the disorder, although the underlying basis of the disorder has not been fully elucidated. Assessment of circadian phase is an important diagnostic tool and may improve treatment outcomes. Exogenous melatonin and bright light therapy, both separately and combined, are emerging as effective treatments for DSPD, while further research is required for other promising pharmacological approaches.