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A Chronobiological Disorder With Sleep-Onset Insomnia

Elliot D. Weitzman, MD; Charles A. Czeisler, MD, PhD; Richard M. Coleman, PhD; Arthur J. Spielman, PhD; Janet C. Zimmerman, PhD; William Dement, MD, PhD; Charles P. Pollak, MD

Arch Gen Psychiatry. 1981;38(7):737-746.

Abstract
• We describe a new syndrome called "delayed sleep phase insomnia." Thirty of 450 patients seen for a primary insomniac complaint had the following characteristics: (1) chronic inability to fall asleep at a desired clock time; (2) when not on a strict schedule, the patients have a normal sleep pattern and after a sleep of normal length awaken spontaneously and feel refreshed; and (3) a long history of unsuccessful attempts to treat the problem. These patients were younger than the general insomniac population and as a group did not have a specific psychiatric disorder. Six patients' histories are described in detail, including the successful nonpharmacological chronotherapy regimen (resetting the patients' biological clock by progressive phase delay). Delayed sleep phase insomnia is proposed to be a disorder of the circadian sleep-wake rhythm in which the "advance" portion of the phase response curve is small.

Author Affiliations
With the Assistance of Gary Richardson

From the Sleep-Wake Disorders Center, Laboratory of Human Chronophysiology, Department of Neurology, Montefiore Hospital and Medical Center, Albert Einstein College of Medicine, Bronx, NY (Drs Weitzman, Czeisler, Spielman, Zimmerman, and Pollak); and the Sleep Disorders Program, Department of Psychiatry, Stanford University School of Medicine, Stanford, Calif (Drs Coleman and Dement and Mr Richardson).

Footnotes
Accepted for publication Feb 16, 1981.

Read in part before the Third International Congress of Sleep Research, Tokyo, Aug 30, 1978.

Reprint requests to Department of Neurology, Montefiore Hospital and Medical Center, 111 E 210th St, Bronx, NY 10467 (Dr Weitzman).

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