Tuesday, March 3, 2009

‘Night owls’: Reset the physiologic clock in delayed sleep phase disorder

Robert Auger, MD

Assistant professor of psychiatry and medicine, Mayo Clinic College of Medicine Consultant, Mayo Center for Sleep Medicine, Rochester, MN

Delayed sleep phase disorder (DSPD)—characterized by a pathological “night owl” circadian preference—is seen most commonly in adolescents and is associated with psychiatric morbidity, psychosocial impairment, and poor academic performance. Proper identification of the condition can be enhanced with a variety of assessment tools, and successful treatment requires an awareness of potential endogenous and exogenous contributors.

This article describes what is known about DSPD and uses the case example to illustrate diagnostic assessment and treatment choices. Intriguing data support various pathophysiologic explanations for DSPD. Facilitating the adjustment of patients’ physiologic clocks is the overall goal in managing DSPD.

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