DSPS

[1041]

zoocrewphoto, I'm enjoying reading your posts about your life with DSPS. Thanks for typing them.

Question: I read a theory that there are two types of DSPS: one is due to a disorder in the light entrainment system of the brain, and the other is due to an improper level of serotonin in the brain.

The second type seems to come along with psychological issues: bipolar disorder and other afflictions related to high serotonin.

The first type seems better to have because one can overcome it by a system of rigidly embracing light in the early morning and avoiding it at night.

What do you think of this theory? (others' opinions also welcome)

[zoocrewphoto]

I suspect there are multiple causes as there are definitely multiple types. For example, some people have an internal clock that is not 24 hours. It tends to be set at 25-26 hours. So, over time, their sleep gets later and later. And they cycle through it. So, for awhile, they will be normal, then night owl, then early bird, then normal, etc. The problem is that it is very difficult to work a normal job with the sleep time constantly changing.

I know that a lot of people have tried meds, and have some improvement, but they typically don't feel good. I don't think the meds are able to adjust ALL the rhythms, so they get out of sync with their own system.

I am also aware of many people trying the light therapy. It sounds to me about as successful as the dental devices. Some people have improvement, but very few have long lasting success.

That said, I have tried neither. Most of my bad struggle with dsps was before I knew what it was, or even realized that I had a problem. I was young and invincible. I didn't realize I had a problem until I quit college, and the problem cleared up for the first time. And it felt so much better that I didn't want to go back. I also joined an email mailing list, and most of the people there were trying to improve their treatment (much like here), except very few were having any kind of success. It seemed to be a choice between trying to be normal (suffer, and all you can really do is vent with others who understand), or give in and accept it.

In many ways, it is very similar to sleep apnea since it causes sleep deprivation and other health problems. But there isn't a real treatment that works consistently. If it were truly possible to alter somebody's natural rhythms to something else, then normal people who must work late shifts could use the same treatment to do so. We have very important jobs that need to be worked at all times, including overnight - police, fire, hospitals, nursing homes, etc.

I do think that we probably have more cases of it since we have electricity, computers, tv, etc. But we had night owls back before electricity too. Somebody had to stay up and stand guard back in the old days, and I'm sure some people were better at than others. I think it is natural, like the bell curve. There will be a lot of people in the normal range, and a small amount of people at each end of the extremes.

[deltadave]

For example, some people have an internal clock that is not 24 hours.

Arguably, no one has an internal clock that is 24 hours.

"Normal" is 24.18 hours.

http://www.cscb.northwestern.edu/jcpdfs/czeisler99.pdf

[deltadave]

Arguably, no one has an internal clock that is 24 hours.

After all, why do you think they call it "circadian" (from the Latin diem ("a day") and circa ("give or take")).

[kteague]

Arguably, no one has an internal clock that is 24 hours.

After all, why do you think they call it "circadian" (from the Latin diem ("a day") and circa ("give or take")).

Hmmm. Started the day off learning something new. It's gonna be a good day!

Regarding DSPS, does that label fit even when the later sleep hours are secondary to another sleep disorder, like OSA or PLMD? Or does it apply to all delayed sleep regardless of cause? It was suggested by a sleep doc that I might be dealing with DSPS, but aside from working on sleep hygiene it was not brought up again. I still sleep better when I sleep much much later, but find myself falling asleep early enough to consider myself fairly normal. Moving to the west coast helped that.

[zoocrewphoto]

I would suggest that even if it is secondary, you would still have it until it was eliminated (if ever).

I know mine started long before the sleep apnea, but it's possible that it won't be as extreme after awhile since it wasn't always this extreme. And whether my timing ever changes or not, I am sure that my ability to adjust will improve simply because I am sleeping better. I have also noticed that I sleep better in hotels now. I have had 3 stays in hotels since starting cpap treatment. I have to go to bed earlier than I normally would, by several hours. And normally, I do listen to music, get bored, doze on and off, toss and turn, etc. Most nights in hotel, I can remember seeing the clock at least once an hour. I may go to bed at 1am, still awake at 3am, then wake up at 4 something, 5 something, and get up at 6. Horrible night. My last hotel stay was one night. I was in bed for almost 6 hours. I fell asleep quickly. I remember waking up, rolling to my other side, feeling uncomfortable, and rolling back. That was it. I slept most of the night really well. My hotel stay in July was 4 nights, and I was sleeping on a short couch. It was actually a hide a bed, but I didn't want to open it up. So, I had an ottoman next to it to let me feet hang off the side. Not a great bed by any means, but I slept pretty well most of each night. I had to get up early each day, but I still averaged about 6 hours each night. That has been a definite improvement for me, and traveling is when I get shorted on sleep, so quality is even more important then.

[1041]

I don't think the meds are able to adjust ALL the rhythms, so they get out of sync with their own system

Thinking of it that way really puts one off of trying the med route.

I am sure that my ability to adjust will improve simply because I am sleeping better.

Which should come first, the chicken (sleep) or the egg (DSPS)? Answer: the chicken.

[deltadave]

I still sleep better when I sleep much much later, but find myself falling asleep early enough to consider myself fairly normal. Moving to the west coast helped that.

So! Treating DSPS with E --> W Jet Lag? Perhaps a little inconvenient as a treatment approach for most folks, but certainly effective, as all the circadian influences instantly fall into place:

[zoocrewphoto]

I don't understand these graphs. What I see is that the actual lines stay the same, but the sleep time is changed. That doesn't make real sense to me.

In other words, it shows that a normal person has their temp go down in sleep, and a dsps person has their temp go down after sleep. That is not true in my experience. What is different between me and a normal person is the time on the clock. My temp still goes down when I go to sleep.Both rhythms are delayed (as well as the others), not just the sleep delayed. People seem to think that sleep is the only rhythm that is different. That may be for a normal person who works a late shift. But for somebody is actually out of sync with the normal world, they are still in sync with their own body.

[deltadave]

Regarding DSPS, does that label fit even when the later sleep hours are secondary to another sleep disorder, like OSA or PLMD?

Do you mean treated or untreated?

It strkes me if they are untreated (and of course, PLMD would really need to be elevated PLMAI), then one would really have to work hard to be a DSPS because the EDS would insure short Sleep Latency, so it would be simply poor Sleep Hygiene (they are ignoring the signal to fall asleep at the socially-accepted bedtime). DSPS requires "inability to fall asleep at the desired clock time".

http://webcache.googleusercontent.com/s ... clnk&gl=us

[SleepingUgly]

What do you call it if the person CAN fall asleep but, for example, 8 hours of sleep that ends at 9am is more refreshing (albeit, not refreshing) than 8 hours of sleep that ends at 7am?

[zoocrewphoto]

DSPS requires "inability to fall asleep at the desired clock time".

That definition sounds subjective. More like insomnia.

For example, I used to try to sleep at midnight or 1am, but I could not. It would take me hours to fall asleep. Now, I go bed between 4 and 6am, and I usually fall asleep within 10 minutes. And I am happy with that. Since my desired clock time is 4-6am, does that mean I no longer have delayed sleep phase syndrome? Am I cured even though I am even more delayed than years ago?

I checked the wikipedia article, which is actually quite good. It has a bit more detailed explanation of the ICSD criteria.

"There is an intractable delay in the phase of the major sleep period in relation to the desired clock time, as evidenced by a chronic or recurrent complaint of inability to fall asleep at a desired conventional clock time together with the inability to awaken at a desired and socially acceptable time."

It clarifies a bit better that the desired clock time is a conventional time or socially acceptable time, not necessarily the person's desired time.

I really like this part:

"People with normal circadian systems can generally fall asleep quickly at night if they slept too little the night before. Falling asleep earlier will in turn automatically help to advance their circadian clocks due to decreased light exposure in the evening. In contrast, people with DSPD are unable to fall asleep before their usual sleep time, even if they are sleep-deprived. Sleep deprivation does not reset the circadian clock of DSPD patients, as it does with normal people."

This is so true for me, and something that other people struggle to understand. I cannot go to bed early just because I am sleep deprived. I can sleep later easily. But I can't seem to go to bed earlier. It's like there is a certain time frame that I simply can't sleep well. My dad could never understand this. He would get so frustrated that I would simply not go to bed and be unconscious. As if I intentionally refused to fall asleep.

For example, when I have a cat show weekend, I will probably go to bed Thursday night around 4 or 5am and get up at 7am to load the van and leave (I don't drive, so no worries there). Friday is the travel and set up day, very busy. I might doze off in the hotel room while watching tv in the evening. But only for an hour or so. Then I am up, and I have trouble getting to sleep. I will usually try around 1am or so. Usually still awake at 3am. (although a bit better with my apap machine now). I tend to wake up frequently, toss and turn, etc. I can usually remmeber waking up at least once an hour. I get up around 6am to get ready and get to the show early. I am a vendor, so I have to be there early. The day is long and busy. Some shows, I have a dinner meeting to go to, so I have to hurry to the hotel, get the cats taken care of then go to the meeting. Back to the hotel around 8 or 9pm. If I was busy at the show taking photos, then I need to get the proofs done, so I could be working on that until midnight or so. No time for a nap. Definitely low on sleep, but still not ready to go to bed early. I just toss and turn. Up again the next morning at 5 or 6am. It's a checkout day, so getting ready takes longer, and the show starts earlier. After the show, is the takedown, so we don't leave until about 7pm. We stop for dinner with friends and then drive home. Sometimes a short drive, usually a 2-3 hour drive. We tend to get home between 9 and 11pm. It is a fun, but exhausting weekend. I then haul a few important things in, check email, watch tv, etc. And usually stay up until 3am or so. Then I crash. I always request the day off after a show. I will usually get up around 4 or 5pm, unload the van, take a nap, watch some tv, etc, and back to my standard 4-6am sleep time.

[zoocrewphoto]

What do you call it if the person CAN fall asleep but, for example, 8 hours of sleep that ends at 9am is more refreshing (albeit, not refreshing) than 8 hours of sleep that ends at 7am?

I would call it mild dsps

Many people who try to treat their dsps do this. They do manage to sleep at the "right" time, and they function. But they don't feel as good as they do when they sleep at their own natural time.

[deltadave]

I don't understand these graphs. What I see is that the actual lines stay the same, but the sleep time is changed. That doesn't make real sense to me.

Yeah, on first glimpse, they do appear AFUed.

However, upon closer examination, it appears that the gray area is "desired" (as noted in the graph title) and the arrows represent the disorder. This becomes more apparent in dysynchrony, where sleep times are all over the place.

[SleepingUgly]

What do you call it if the person CAN fall asleep but, for example, 8 hours of sleep that ends at 9am is more refreshing (albeit, not refreshing) than 8 hours of sleep that ends at 7am?

I would call it mild dsps

Many people who try to treat their dsps do this. They do manage to sleep at the "right" time, and they function. But they don't feel as good as they do when they sleep at their own natural time.

Dave, do you agree this is DSPS if someone has more difficulty falling asleep early, but can usually do it (perhaps not quite as early as they would like), but that 8 hours of sleep that ends later feels more sufficient than 8 hours that ends earlier? If so, is there a solution to this problem where the person ultimately feels as good getting up early as getting up late? Or am I destined to feel crappier getting up early, even if I had the same amount of sleep?