Whoever Wanted to Catch a Worm, Anyway?

Delayed sleep/wake phase disorder (DSWPD) is the most common circadian rhythm disorder. It is characterized by persistently delayed sleep onset and wake times relative to conventional norms. Individuals usually present in young adulthood with symptoms of sleep-onset insomnia, sleep inertia, and excessive daytime sleepiness due to sleep deprivation when societal commitments require significantly earlier than desired sleep and wake times. Sleep quality itself is normal. The diagnosis can usually be made by history and sleep diaries. The exact cause of DSWPD is unknown, but genetics, abnormal circadian physiology, and perpetuating behaviors all contribute. Treatment consists of morning phototherapy and evening melatonin at times individualized to the patient’s circadian rhythm. Strict adherence to standard sleep hygiene practices increases the chance of success.