This retrospective study describes the effects of long-term treatment with melatonin in 33 adolescents (age range, 10-18 years) with delayed sleep phase syndrome (DSPS). Patients were treated with oral melatonin, 3 to 5 mg/day for an average period of 6 months. During the treatment, sleep onset was advanced and sleep duration was longer. Treatment was also associated with a decrease in the proportion of patients reporting school difficulties. No adverse effects of melatonin were noted. This study indicates that long-term treatment with melatonin can be beneficial for adolescents with DSPS in terms of sleep-wake schedule and school performance.
"Based on the fact that both delayed sleep phase syndrome (DSPS, an extreme form of Eveningness) and SAD have evidence of delayed circadian rhythm and both can be effectively treated by interventions aiming to phase advance circadian rhythms, such as light in the morning. (Eastman et al., 1998; Lewy et al., 1998; Szeinberg et al., 2006; Terman et al., 1998; Wasdell et al., 2008). Research in diurnal animals confirms that morning and not evening light reverses depression like behavior induced by short photoperiod (Krivisky et al., 2012), However, there is also an evidence against circadian phase changes as being a primary mechanism in SAD as well as a necessary and sufficient mediator of light treatment (Checkley et al., 1993; Eastman et al., 1993; Koorengevel et al., 2003; Murray et al., 2005; Rosenthal et al., 1990; Thompson et al., 1997). "
[Show abstract][Hide abstract] ABSTRACT: Several studies documented that lower scores on the Morningness-Eveningness Questionnaire (MEQ) are associated with a higher global seasonality of mood (GSS). As for the Modern Man artificial lighting predominantly extends evening activity and exposure to light, and as evening bright light phase is known to delay circadian rhythms, this chronic exposure could potentially lead to both lower Morningness as well as higher GSS. The aim of the study was to investigate if the MEQ-GSS relationship holds in the Old Order Amish of Lancaster County, PA, a population that does not use network electrical light.
489 Old Order Amish adults (47.6% women), with average (SD) age of 49.7 (14.2) years, completed both the Seasonal Pattern Assessment Questionnaire (SPAQ) for the assessment of GSS, and MEQ. Associations between GSS scores and MEQ scores were analyzed using linear models, accounting for age, gender and relatedness by including the relationship matrix in the model as a random effect.
GSS was inversely associated with MEQ scores (p=0.006, adjusted).
include a potential recall bias associated with self-report questionnaires and no actual light exposure measurements.
We confirmed the previously reported inverse association between MEQ scores and lower seasonality of mood, for the first time in a population that does not use home network electrical lighting. This result suggests that the association is not a byproduct of exposure to network electric light, and calls for additional research to investigate mechanisms by which Morningness is negatively associated with seasonality.
Published by Elsevier B.V.
"Melatonin improves the sleep-wake rhythm and endogenous melatonin rhythm in delayed sleep phase disorder . Several studies have evaluated the efficacy and safety of melatonin for the treatment of insomnia in pediatric patients with ADHD, with melatonin doses ranging between 3 and 6 mg being administered within a few hours of a scheduled bedtime  . In conclusion, we suggest that circadian rhythmic disorders in children with ADHD-SOI should be treated with melatonin and/or light therapy so as to avoid the use of stimulants, particularly in those at risk of developing bipolar disorder; the administration of second-generation antipsychotic drugs, such as aripripazole or risperidone, be preferred in the latter group of patients  . "
[Show abstract][Hide abstract] ABSTRACT: About 25-50% of children and adolescents with attention-deficit hyperactivity disorder (ADHD) experience sleep problems. An appropriate assessment and treatment of such problems might improve the quality of life in such patients and reduce both the severity of ADHD and the impairment it causes. According to data in the literature and to the overall complexity of the interaction between ADHD and sleep, five sleep phenotypes may be identified in ADHD: (i) a sleep phenotype characterized mainly by a hypo-arousal state, resembling narcolepsy, which may be considered a "primary" form of ADHD (i.e. without the interference of other sleep disorders); (ii) a phenotype associated with delayed sleep onset latency and with a higher risk of bipolar disorder; (iii) a phenotype associated with sleep disordered breathing (SDB); (iv) another phenotype related to restless legs syndrome (RLS) and/or periodic limb movements; (v) lastly, a phenotype related to epilepsy/or EEG interictal discharges. Each sleep phenotype is characterized by peculiar sleep alterations expressed by either an increased or decreased level of arousal during sleep that have important treatment implications. Treatment with stimulants is recommended above all in the primary form of ADHD, whereas treatment of the main sleep disorders or of co-morbidities (i.e. bipolar disorders and epilepsy) is preferred in the other sleep phenotypes. All the sleep phenotypes, except the primary form of ADHD and those related to focal benign epilepsy or focal EEG discharges, are associated with an increased level of arousal during sleep. Recent studies have demonstrated that both an increase and a decrease in arousal are ascribable to executive dysfunctions controlled by prefrontal cortical regions (the main cortical areas implicated in the pathogenesis of ADHD), and that the arousal system, which may be hyperactivated or hypoactivated depending on the form of ADHD/sleep phenotype.
Medical Hypotheses 05/2012; 79(2):147-53. DOI:10.1016/j.mehy.2012.04.020 · 1.07 Impact Factor
"Numerous exogenous factors, such as increased autonomy with respect to sleep time, employment, and involvement in extracurricular activities have been identified as factors contributing to the general changes in the sleep patterns of adolescents, but have not been studied specifically among DSPD-A cohorts (Carskadon 1990; Wyatt 2004). The failure to address these variables systematically may contribute to poor treatment outcomes, which emphasize presumed innate underpinnings (Okawa et al., 1998; Sack et al., 2007; Szeinberg et al., 2006) and ignore external factors. "
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to compare light exposure and sleep parameters between adolescents with delayed sleep phase disorder (DSPD; n=16, 15.3±1.8 yrs) and unaffected controls (n=22, 13.7±2.4 yrs) using a prospective cohort design. Participants wore wrist actigraphs with photosensors for 14 days. Mean hourly lux levels from 20:00 to 05:00 h and 05:00 to 14:00 h were examined, in addition to the 9-h intervals prior to sleep onset and after sleep offset. Sleep parameters were compared separately, and were also included as covariates within models that analyzed associations with specified light intervals. Additional covariates included group and school night status. Adolescent delayed sleep phase subjects received more evening (p< .02, 22:00-02:00 h) and less morning (p .05, 08:00-09:00 h and 10:00-12:00 h) light than controls, but had less pre-sleep exposure with adjustments for the time of sleep onset (p< .03, 5-7 h prior to onset hour). No differences were identified with respect to the sleep offset interval. Increased total sleep time and later sleep offset times were associated with decreased evening (p< .001 and p= .02, respectively) and morning (p= .01 and p< .001, respectively) light exposure, and later sleep onset times were associated with increased evening exposure (p< .001). Increased total sleep time also correlated with increased exposure during the 9 h before sleep onset (p= .01), and a later sleep onset time corresponded with decreased light exposure during the same interval (p< .001). Outcomes persisted regardless of school night status. In conclusion, light exposure interpretation requires adjustments for sleep timing among adolescents with DSPD. Pre- and post-sleep light exposures do not appear to contribute directly to phase delays. Sensitivity to morning light may be reduced among adolescents with DSPD.
Chronobiology International 12/2011; 28(10):911-20. DOI:10.3109/07420528.2011.619906 · 3.34 Impact Factor
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