Delayed Sleep-Wake Phase Disorder | Diagnosis and Treatment

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How is delayed sleep-wake phase disorder diagnosed?

If your child seems to have symptoms suggestive of delayed sleep-wake phase disorder (DSWPD), a sleep specialist can evaluate the problem using the following techniques:

  • Taking a detailed history of your child's symptoms, including any medical, mental health or developmental issues.
  • Doing a complete physical examination.
  • A sleep log kept by parents, caregivers or the child (if he or she is old enough) for several weeks. Keeping a log helps track your child's sleep patterns and amounts of sleep over an extended period of time. 
  • Tracking your child’s sleep patterns over two or three weeks using a wristwatch-like validated device called an actigraph. 
  • In rare cases, an overnight sleep study, if the sleep specialist suspects additional problems such as sleep apnea or excessive movements during sleep. (Sleep studies are unnecessary in the vast majority of patients with DSWPD.)

What are the treatments for delayed sleep-wake phase disorder?

If your child or adolescent has been diagnosed with DSWPD, there are several treatment options, depending on the severity of the problem, your child's general health and other factors. It requires significant effort and commitment on the part of the child or adolescent. The goal of treatment is to “reset” the internal clock to a more normal schedule that is more compatible with the demands of school or work. Because DSWPD can be complex, treatment should usually be handled by a sleep medicine specialist.

Treatment of DSWPD may involve some or all of the following:

  • Adjustment of sleep schedules. If your child’s sleep is delayed by less than three hours, shifting bed and wake times to earlier in the day may solve the problem. If the child is falling asleep more than three hours later than the desired bedtime, shifting bedtime and wake times two to three hours later each day may be the best option until your child reaches a target bedtime/wake time schedule.
  • Light therapy. This method involves exposing your child or teen to a broad-spectrum light source (typically a light box) for a period of time each morning. We also advise avoiding melatonin-suppressing blue light, especially from screens, in the evening hours.
  • Melatonin. This is a synthetic form of your body’s natural biological sleep signal. When taken late in the day, melatonin may help shift the fall asleep time earlier. The dose of melatonin and the time that it is taken are both important, so this should be discussed with your child’s provider before starting melatonin.
  • Sleep hygiene. It's critical that children understand the importance of a regular sleep schedule and principles of healthy sleep, such as maintaining consistent sleep schedules on weekends and weekdays, avoiding naps and caffeine, having a bedtime routine that is calm and sleep-inducing, and turning off electronic media an hour before bedtime.

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