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  • Print publication year: 2011
  • Online publication date: February 2011

Chapter 17 - Sleepiness in advanced and delayed sleep phase disorders

from Section 2 - Sleep Disorders and Excessive Sleepiness


The legal consequences of excessive sleepiness may impact patients, their physicians, and the public at large. Individuals with daytime sleepiness and/or known or suspected sleep disorders need to take precautions at work or when driving to ensure that they do not pose a risk to themselves or others. Physicians should inquire about excessive sleepiness or other symptoms of sleep apnea in any patient who drives, but especially in patients who are commercial vehicle drivers. Physicians and healthcare workers need to be aware of the accident risks associated with sleep disorders and the legal implications around this in their particular jurisdiction. The development of new guidelines and medical standards in the transportation industry will eventually have an impact on physicians, employers and drivers alike. Legislators must continue to work with practitioners and scientists to balance adequate protection of the public interest with individual rights.


1. AschoffJ.Circadian rhythms in man. Science, 1965; 148:1427–32.
2. WeverR A.The Circadian System of Man: Results of Experiments Under Temporal Isolation. New York, NY: Springer-Verlag, 1979.
3. ZulleyJ, WeverR, AschoffJ.The dependence of onset and duration of sleep on the circadian rhythm of rectal temperature. Pflugers Arch, 1981; 391:314–18.
4. CzeislerC A, ZimmermanJ C, RondaJ M, et al. Distribution of REM sleep in entrained 24 hour and free-running sleep–wake cycles. Sleep, 1980; 2:377–89.
5. American Academy of Sleep Medicine. International Classification of Sleep Disorders, revised: Diagnostic and Coding Manual. Revised Edition. Rochester, MN: American Academy of Sleep Medicine, 2001.
6. American Academy of Sleep Medicine. International Classification of Sleep Disorders: Diagnostic & Coding Manual (2nd ed.). American Academy of Sleep Medicine, 2005.
7. SchraderH, BovimG, SandT.The prevalence of delayed and advanced sleep phase syndromes. J Sleep Res, 1993; 2:51–55.
8. YazakiM, ShirakawaS, OkawaM, et al. Demography of sleep disturbances associated with circadian rhythm disorders in Japan. Psychiatry Clin Neurosci, 1999; 53:267–68.
9. WeitzmanE D, CzeislerC A, ColemanR M, et al. Delayed sleep phase syndrome. A chronobiological disorder with sleep-onset insomnia. Arch Gen Psychiatry, 1981; 38:737–46.
10. CarskadonM A, VieiraC, AceboC.Association between puberty and delayed phase preference. Sleep, 1993; 16:258–62.
11. ThorpyM J, KormanE, SpielmanA J, et al. Delayed sleep phase syndrome in adolescents. J Adolesc Health Care, 1988; 9:22–27.
12. DaganY.Circadian rhythm sleep disorders (CRSD). Sleep Med Rev, 2002; 6:45–54.
13. OhayonM M, RobertsR E, ZulleyJ, et al. Prevalence and patterns of problematic sleep among older adolescents. J Am Acad Child Adolesc Psychiatry, 2000; 39:1549–56.
14. SackR L, AuckleyD, AugerR R, et al. Circadian rhythm sleep disorders: part II, advanced sleep phase disorder, delayed sleep phase disorder, free-running disorder, and irregular sleep–wake rhythm. An American Academy of Sleep Medicine review. Sleep, 2007; 30:1484–501.
15. ShirayamaM, ShirayamaY, IidaH, et al. The psychological aspects of patients with delayed sleep phase syndrome (DSPS). Sleep Med, 2003; 4:427–33.
16. ItoA, AndoK, HayakawaT, et al. Long-term course of adult patients with delayed sleep phase syndrome. Jap J Psychiatry Neurol, 1993; 47:563–67.
17. HorneJ A, OstbergO.A self-assessment questionnaire to determine morningness–eveningness in human circadian rhythms. Int J Chronobiol, 1976; 4:97–110.
18. KripkeD F, RexK M, Ancoli-IsraelS, et al. Delayed sleep phase cases and controls. J Circadian Rhythms, 2008; 6:6.
19. MundeyK, BenloucifS, HarsanyiK, et al. Phase-dependent treatment of delayed sleep phase syndrome with melatonin. Sleep, 2005; 28:1271–78.
20. RegesteinQ R, MonkT H.Delayed sleep phase syndrome: a review of its clinical aspects. Am J Psychiatry, 1995; 152:602–08.
21. CzeislerC A, RichardsonG S, ColemanR M, et al. Chronotherapy: resetting the circadian clocks of patients with delayed sleep phase insomnia. Sleep, 1981; 4:1–21.
22. YamaderaW, SasakiM, ItohH, et al. Clinical features of circadian rhythm sleep disorders in outpatients. Psychiatry Clin Neurosci, 1998; 52:311–16.
23. de BeckT W. Delayed sleep phase syndrome – criminal offense in the military? Military Med, 1990; 155:1–14.
24. WatanabeT, KajimuraN, KatoM, et al. Sleep and circadian rhythm disturbances in patients with delayed sleep phase syndrome. Sleep, 2003; 26:657–61.
25. CampbellS S, MurphyP J.Delayed sleep phase disorder in temporal isolation. Sleep, 2007; 30:1225–28.
26.Diagnostic classification of sleep and arousal disorder, 1st edition prepared by the Sleep Disorders Classification Committee, H P Roffwarg, Chairman. Sleep, 1979; 2: 1–130.
27. JonesC R, CampbellS S, ZoneS E, et al. Familial advanced sleep-phase syndrome: a short-period circadian rhythm variant in humans. Nat Med, 1999; 5:1062–65.
28. SatohK, MishimaK, InoueY, et al. Two pedigrees of familial advanced sleep phase syndrome in Japan. Sleep, 2003; 26:416–17.
29. CampbellS S, GillinJ C, KripkeD F, et al. Gender differences in the circadian temperature rhythms of healthy elderly subjects: relationships to sleep quality. Sleep, 1989; 12:529–36.
30. CampbellS S, DawsonD, AndersonM W. Alleviation of sleep maintenance insomnia with timed exposure to bright light. J Am Geriatr Soc, 1993; 41:829–36.
31. CzeislerC A, DumontM, DuffyJ F, et al. Association of sleep–wake habits in older people with changes in output of circadian pacemaker. Lancet, 1992; 340:933–36.
32. MoeK E, PrinzP N, VitielloM V, et al. Healthy elderly women and men have different entrained circadian temperature rhythms. J Am Geriatr Soc, 1991; 39:383–87.
33. KameiR, HughesL, MilesL, et al. Advanced sleep phase syndrome studied in a time isolation facility. Chronobiologia, 1979; 6:115.
34. MoldofskyH, MusisiS, PhillipsonE A. Treatment of a case of advanced sleep phase syndrome by phase advance chronotherapy. Sleep, 1986; 9:61–65.
35. MonkT H, BuysseD J, ReynoldsC F, et al. Circadian temperature rhythms of older people. Exp Gerontol, 1995; 30:455–74.
36. LackL C, MercerJ D, WrightH.Circadian rhythms of early morning awakening insomniacs. J Sleep Res, 1996; 5:211–19.
37. LackL, WrightH.The effect of evening bright light in delaying the circadian rhythms and lengthening the sleep of early morning awakening insomniacs. Sleep, 1993; 16:436–43.
38. MonkT H. Aging human circadian rhythms: conventional wisdom may not always be right. J Biol Rhythms, 2005; 20:366–74.
39. LavieP.Ultrashort sleep–waking schedule. III. ‘Gates’ and ‘forbidden zones’ for sleep. Electroencephalogr Clin Neurophysiol, 1986; 63:414–25.
40. StrogatzS H, KronauerR E, CzeislerC A. Circadian regulation dominates homeostatic control of sleep length and prior wake length in humans. Sleep, 1986; 9:353–64.
41. UchiyamaM, OkawaM, ShibuiK, et al. Poor recovery sleep after sleep deprivation in delayed sleep phase syndrome. Psychiatry Clin Neurosci, 1999; 53:195–97.
42. UchiyamaM, OkawaM, ShibuiK, et al. Altered phase relation between sleep timing and core body temperature rhythm in delayed sleep phase syndrome and non-24-hour sleep–wake syndrome in humans. Neurosci Lett, 2000; 294:101–04.
43. OkawaM, UchiyamaM.Circadian rhythm sleep disorders: characteristics and entrainment pathology in delayed sleep phase and non-24-h sleep–wake syndrome. Sleep Med Rev, 2007; 11:485–96.
44. ChangA, ReidK J, GourineniR, et al. Sleep timing and circadian phase in delayed sleep phase syndrome. J Biol Rhythms, 2009; 24:313–21.
45. CarskadonM A, DementW C. Multiple sleep latency tests during the constant routine. Sleep, 1992; 15:396–99.
46. BesF, JobertM, SchulzH.Modeling napping, post-lunch dip, and other variations in human sleep propensity. Sleep, 2009; 32:392–98.
47. MorgenthalerT I, Lee-ChiongT, AlessiC, et al. Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. An American Academy of Sleep Medicine report. Sleep, 2007; 30:1445–59.
48. OrenD A, WehrT A. Hypernyctohemeral syndrome after chronotherapy for delayed sleep phase syndrome. N Engl J Med, 1992; 327:1762.
49. RosenthalN E, Joseph-VanderpoolJ R, LevendoskyA A, et al. Phase-shifting effects of bright morning light as treatment for delayed sleep phase syndrome. Sleep, 1990; 13:354–61.
50. LackL, SchumacherK.Evening light treatment of early morning insomnia. Sleep Res, 1993; 22:225.
51. CampbellS S, DijkD J, BoulosZ, et al. Light treatment for sleep disorders: consensus report. III. Alerting and activating effects. J Biol Rhythms, 1995; 10:129–32.
52. DahlitzM, AlvarezB, VignauJ, et al. Delayed sleep phase syndrome response to melatonin. Lancet, 1991; 337:1121–24.
53. OldaniA, Ferini-StrambiL, ZucconiM, et al. Melatonin and delayed sleep phase syndrome: ambulatory polygraphic evaluation. Neuroreport, 1994; 6:132–34.
54. KayumovL, BrownG, JindalR, et al. A randomized, double-blind, placebo-controlled crossover study of the effect of exogenous melatonin on delayed sleep phase syndrome. Psychosom Med, 2001; 63:40–48.
55. ZeeP, Wang-WeigandS, OgrincF, RothT.The use of ramelteon to advance sleep timing and melatonin phase in delayed sleep phase disorder. Sleep, 2009; 32(Abstract supplement):A47–48.
56. RajaratnamS M, PolymeropoulosM H, FisherD M, et al. Melatonin agonist tasimelteon (VEC-162) for transient insomnia after sleep-time shift: two randomised controlled multicentre trials. Lancet, 2009; 373:482–91.
57. OkawaM, MishimaK, NanamiT, et al. Vitamin B12 treatment for sleep–wake rhythm disorders. Sleep, 1990; 13:15–23.
58. UchiyamaM, OkawaM, ShibuiK, et al. Poor compensatory function for sleep loss as a pathogenic factor in patients with delayed sleep phase syndrome. Sleep, 2000; 23:553–58.