‘Night owls’: Reset the physiologic clock in delayed sleep phase disorder

Vol. 8, No. 3 55 R. Robert Auger, MD Assistant professor of psychiatry and medicine Mayo Clinic College of Medicine Consultant, Mayo Center for Sleep Medicine Rochester, MN C A R L M EN Z FO R C U R R EN T PS YC H IA TR Y Jason, age 16, has had diffi culty with sleep initiation for 2 years. He describes going to bed at 10:30 PM on school nights but falling asleep no sooner than midnight and typically after 1:30 AM. He denies contributions from an “active mind” or environmental disturbances, and his bedroom contains no TV, computer, or other media devices. He does not sleep better with a change in environment. He denies pervasive low mood symptoms and believes his mood hinges predominantly on his ability to achieve suffi cient sleep. Once asleep, Jason generally enjoys good sleep consolidation until he needs to arise at 6:30 AM. His mother awakens him with diffi culty, as he often sleeps through his alarm. He sleeps approximately 5 hours nightly during the school week, endorses impaired concentration, and often dozes during his fi rst several classes. When he returns home from school, he fi nds it very diffi cult to resist napping. On weekends he retires at 1 AM or later and typically falls asleep within 30 minutes. He usually awakens at noon but can sleep as late as 4:30 PM. He feels slightly more refreshed on weekends and describes his mood then as improved. During a recent spring break, he felt much better when allowed to sleep as much as he wanted.