More severe forms of the disorder require progressive sleep phase delay in 3-hour steps round the clock until a satisfactory timing is achieved which then has to be fixed. Additional measures to maintain
the improved sleep schedule include early-morning exposure to bright light and firm agreement with the adolescent to maintain a new pattern of social activities and sleep. Melatonin in the evening might also help. Difficulties achieving and maintaining an improved sleep-wake schedule by these means are compounded Inhibitors,research,lifescience,medical if there is a vested interest in maintaining the abnormal sleep pattern, for example, to avoid school (“motivated sleep phase delay”). Psychological problems, including depression, may well also make successful treatment less likely. Inhibitors,research,lifescience,medical The teenager’s reluctance to go to bed earlier and to get up at the required time is often misinterpreted as “typical difficult adolescent behavior” causing trouble in the family. Otherwise the condition might be mistakenly viewed as the usual form of school non attendance, primary depression, or substance misuse. Differential diagnosis of childhood parasomnias Parasomnias are repetitive unusual behaviors or strange experiences
that occur just before, during, or arising Inhibitors,research,lifescience,medical out of sleep, or on waking. The many parasomnias (some primary sleep disorders, others secondary to medical or psychiatric conditions) now officially recognized (over 30 in ICSD-2)
indicate how commonly and in many ways (some subtle, others dramatic) sleep can be disturbed by episodic events. Confusion between the different parasomnias seems to be common. For Inhibitors,research,lifescience,medical example, in pediatric textbook accounts, sleep terrors and nightmares (two very different types of parasomnia) are mistaken for each other. Indeed, sometimes there is a tendency to call any dramatic parasomnia a nightmare. Correct diagnosis is important Inhibitors,research,lifescience,medical because different parasomnias each have their own significance and call for contrasting types of advice and treatment. The following brief account is concerned with the main features to be recognized in reaching the correct diagnosis. Fiiiphasis is placed on just some nearly of the more dramatic parasomnias (namely arousal disorders, nightmares, and sleep-related epileptic seizures) as these often cause most confusion and concern. Detailed accounts of these parasomnias and others are provided elsewhere.24 Often an accurate diagnosis can be made by means of a detailed account of the subjective and objective sequence of events from the onset of the episode to its resolution, and of the circumstances in which the episode occurred, including its duration and timing. Audiovisual recording (including by means of home recording by parents) can be very selleck inhibitor informative and often adds details that are missed in descriptions given in the clinic.