Delayed-sleep-phase syndrome

A number of clinical studies have now made use of the phase advancing property of melatonin for treating delayed sleep phase syndrome (DSPS). Melatonin, at a 5 mg dose, has been found beneficial in advancing the sleep onset time and wake time in DSPS subjects (Dahlitz et al. 1991 Nagtegaal et al. 1998 Kayumov et al. 2001). Melatonin was found to be effective when given five hours before its endogenous onset or seven hours before sleep onset. 

Dahlitz, M., Alvarez, B., Vignau, J. et al. (1991). Delayed sleep phase syndrome response to melatonin. Lancet 337, 1121-4. 

Kayumov, L., Brown, G., Jindal, R., Buttoo, K. Shapiro, C. M. (2001). A randomized, double-blind, placebo-controlled crossover study of the effect of exogenous melatonin on delayed sleep phase syndrome. Psychosom. Med. 63, 40-8. 

Nagtegaal, J. E., Kerkhof, G. A, Smits, M. G., Swart, A. C. van der Meer, Y. G. (1998). Delayed sleep phase syndrome A placebo-controlled cross-over study on the effects of melatonin administered five hours before the individual dim light melatonin onset. J. Sleep Res. 7, 135-43. 

The results obtained with the model for the mammalian circadian clock provide cues for circadian-rhythm-related sleep disorders in humans [117]. Thus permanent phase shifts in LD conditions could account for (a) the familial advanced sleep phase syndrome (FASPS) associated with PER hypopho-sphorylation [118, 119] and (b) the delayed sleep phase syndrome, which is also related to PER [120]. People affected by FASPS fall asleep around 7 30 p.m. and awake around 4 30 a.m. The duration of sleep is thus normal, but the phase is advanced by several hours. Moreover, the autonomous period measured for circadian rhythms in constant conditions is shorter [121]. The model shows that a decrease in the activity of the kinase responsible for PER phosphorylation is indeed accompanied by a reduction of the circadian period in continuous darkness and by a phase advance upon entrainment of the rhythm by the LD cycle [114]. 

N. Yamada, T. Nagase, N. OzaM, O. Ohara, N. Ishida, M. Okawa, K. Takahashi, and T. Yamauchi, Association of structural polymorphisms in the human periods gene with delayed sleep phase syndrome. EMBO Rep. 2, 342-346 (2001). 

Familial advanced and delayed sleep phase syndromes can both be attributed to mammalian per mutations in a region of the PER protein, presumably a CKIe binding domain (Ebisawa et al 2001, Toh et al 2001). Because a phosphorylation disorder might cause some sleep syndromes, the establishment of a system with which to assay post-translational modifications of PER protein has recently received considerable focus. 

Camacho F, Cilio M, Guo Y et al 2001 Human casein kinase Idelta phosphorylation of human circadian clock proteins period 1 and 2. FEES Lett 489 159-165 Delaunay F, Thisse C, Marchand O, Laudet V, Thisse B 2000 An inherited functional circadian clock in zebrafish embryos. Science 289 297-300 Dunlap J 1998 Circadian rhythms. An end in the beginning. Science 280 1548-1549 Ebisawa T, Uchiyama M, Kajimura N et al 2001 Association of structural polymorphisms in the human period3 gene with delayed sleep phase syndrome. EMBO Rep 2 342-346 Edery I, Zwiebel LJ, Dembinska ME, Rosbash M 1994 Temporal phosphorylation of the Drosophila period protein. Proc Natl Acad Sci USA 91 2260-2264 Ishida N, Kaneko M, AUada R 1999 Biological clocks. Proc Natl Acad Sci USA 96 8819-8820... 

Melatonin has been studied in the treatment of various sleep disorders, including insomnia and delayed sleep-phase syndrome. It has been reported to improve sleep onset, duration, and quality when administered to healthy volunteers, suggesting a pharmacologic hypnotic effect. Melatonin has also been shown to increase rapid-eye-movement (REM) sleep. These observations have been applied to the development of ramel-teon, a prescription hypnotic, which is an agonist at melatonin receptors (see Chapter 22). 

Shibui K, Uchiyama M, Okawa M. Melatonin rhythms in delayed sleep phase syndrome. J Biol Rhythms 1999 14 72-76. 

Weitzman ED, Czeisler CA, Coleman RM, Spielman AJ, Zimmerman JC, Dement W, Richardson G, Poliak CP. Delayed sleep phase syndrome a chronobiological disorder with sleep-onset insomnia. Arch Gen Psychiatry 1981 38 737-746. 

Pelayo RP, Thorpy MJ, Glovinsky P. Prevalence of delayed sleep phase syndrome among adolescents. J Sleep Res 1988 17 392. 

Regestein QR, Pavlova M. Treatment of delayed sleep phase syndrome. Gen Hosp Psychiatry 1995 17 335-345. 

Ancoli-Israel S, Schnierow B, Kelsoe J, Fink R. A pedigree of one family with delayed sleep phase syndrome. Chronobiol Int 2001 18 831-840. 

Rosenthal NE, Joseph-Vanderpool JR, Levendosky AA, Johnston SH, Allen R, Kelly KA, Souetre E, Schultz PM, Starz KE. Phase-shifting effects of bright morning light as treatment for delayed sleep phase syndrome. Sleep 1990 13 354-361. 

Regestein QR, Monk TH. Delayed sleep phase syndrome a review of its clinical aspects. Am J Psychiatry 1995 152 602-608. 

Oldani A, Ferini-Strambi L, Zucconi M, Stankov B, Fraschini F, Smime S. Melatonin and delayed sleep phase syndrome ambulatory polygraphic evaluation. Neuroreport 1994 6 132-134. 

Dagan Y, Yovel I, Hallis D, Eisenstein M, Raichik I. Evaluating the role of melatonin in the long-term treatment of delayed sleep phase syndrome (DSPS). Chronobiol Int 1998 15 181-190. 

Sleep disorders such as sleep apnea, narcolepsy, delayed sleep-phase syndrome (DSPS), and insomnia can cause problem sleepiness and difficulty functioning during the day for adolescents (103). Over the course of several studies, Roberts and colleagues have shown that insomnia and related sleep problems have adverse consequences for the future functioning of adolescents (107,108). In particular, insomnia symptoms such as nonrestorative sleep, difficulty initiating sleep, and daytime sleepiness predicted self-esteem difficulties, interpersonal relationship problems, and symptoms of depression, along with somatic complaints (108). 

Thorpy MJ, Korman E, Speilman AJ, Glovinsky PB. Delayed sleep phase syndrome in adolescents. J Adolesc Health Care 1988 9(l) 22-27. 

Zammit, G.K. Delayed sleep phase syndrome and related conditions. In Pressman MR, Orr WC, eds. Understanding Sleep The Evaluation and Treatment of Sleep Disorders. Washington, DC American Psychological Association (APA), 1997. 

Circadian rhythm sleep disorders jet lag insomnia experienced by shift workers and delayed sleep phase syndrome (sometimes seen in students who are enjoying their first experiences outside the family environment and who go to bed too late). This is something that should be discussed with the present client. 

Wasdell MB, Jan JE, Bomben MM, Freeman RD, Rietveld WJ, Tai J, Hamilton D, Weiss MD (2008) A randomized, placebo-controUed trial of controlled release melatonin treatment of delayed sleep phase syndrome and impaired sleep maintenance in children with neurodevelopmental disabilities. J Pineal Res 44 57-64. 

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