Mental health clinicians are extremely familiar with the problem of insomnia and, to a lesser extent, with hypersomnia (especially, hypersomnia due to obstructive sleep apnea). But, there is another kind of sleep problem that is, in my experience, frequently misdiagnosed as insomnia and inappropriately treated—Delayed Sleep Phase Disorder. As we will see below, that is not its official name, but that’s what I find most convenient to call it.
Why should we care about this condition? Because Delayed Sleep Phase Disorder is extremely common in adults with ADHD, I see patients with this problem all the time. And it causes considerable impairment in these patients.
We will discuss Delayed Sleep Phase Disorder on other pages on this website, but first, on this page, let’s take a very brief bird’s-eye view of the group of disorders to which it belongs.
Circadian Rhythm Sleep-Wake Disorders
In the chapter on Sleep-Wake Disorders in DSM-5, is a group of disorders called “Circadian Rhythm Sleep-Wake Disorders.” As the name suggests, these are sleep-wake disorders in which the primary problem is not in falling asleep, staying asleep, etc., but in the circadian rhythm.
There is a persistent or recurrent pattern of sleep disruption. (That’s what makes it a sleep-wake disorder.)
The problem is primarily due to either:
1. A change in the person’s circadian system or
2. A misalignment between the person’s circadian rhythm and what the outside circumstances require.
As a result of this problem, the person has either excessive sleepiness or insomnia, or both, and the problem is clinically significant.
The central feature of each of these subtypes of circadian rhythm sleep-wake disorders can be easily understood from its name.
G47.21 Delayed sleep phase type (It is a pain to refer to this as “Circadian rhythm sleep-wake disorder, Delayed sleep phase type.” Can’t we just call it “Delayed sleep phase disorder”? Anyway, this is the subtype that mental health clinicians commonly see in their patients.)
G47.22 Advanced sleep phase type
G47.23 Irregular sleep-wake type
G47.24 Non-24-hour sleep-wake type. In this subtype, typically, the person falls asleep and wakes up later and later as the days go by.
G47.26 Shift work type. Here, the problem is caused by shift work.
G47.20 Unspecified type
Delayed Sleep Phase Disorder: Management
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013.
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