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A7286 - Delayed Sleep-Wake Phase Disorder and a New College Roommate
Author Block: H. Baig1, B. Colaco2; 1Pulmonary, Mayo Clinic, Jacksonville, FL, United States, 2Mayo Clinic, Jacksonville, FL, United States.
Introduction Delayed sleep-wake phase disorder (DSWPD) is a type of circadian rhythm sleep-wake disorder that is most commonly seen in adolescents and young adults and is characterized by a significant delay in sleep-wake timings.1 Affected individuals may experience significant insomnia, difficulty waking up and/or excessive daytime sleepiness when adhering to a more socially acceptable sleep-wake schedule. Several pathophysiologic mechanisms have been proposed, including genetic, social and environmental factors as well as changes associated with puberty and increased light exposure in the late evening.2-4 Description An 18 year-old gentleman in relatively good health presented for evaluation of sleep difficulties ongoing for several months. Detailed sleep history revealed that the problems had begun insidiously after starting college. At home, he had been sleeping from midnight to 9 AM consistently without any complaints. After settling into his college dormitory, he noted difficulty adjusting to his new roommate. He did not have siblings and had never co-slept with anyone in the same room. He believed that his roommate’s lifestyle and habits had created a “toxic environment.” The patient began avoiding going to his room and tried to spend as much time outside. He would listen to music in his car and even drive back to his parent’s house on some days. As a result, his chores and school work were delayed. He would eventually go to bed at 3 AM and wake up by 2 PM. He endorsed daytime fatigue, and his school performance suffered to such an extent that he was failing most of his courses. On weekends, his sleep schedule remained the same. Overnight oximetry was not suggestive of sleep-disordered breathing. He had a previous history of major depressive disorder but did not report symptoms suggestive of a mood disorder. Discussion Our patient met clinical criteria for DSWPD . The major contributing factor to his delayed sleep-wake schedule seemed to be a change in his living condition and the interaction with his new roommate. Prior to this transition, his delayed sleep schedule had not caused any impairment. This case highlights the importance of social and environmental factors in the development and/or persistence of DSWPD in adolescents. The role of a constrained living situation as caused by a new environment and roommate has not been studied and may be a potential mechanism of DSWPD.