National Sleep Foundation

Chapter 5: Circadian Rhythm Sleep Disorders

Assessment and Diagnosis

Assessment and Diagnosis of advanced sleep phase disorder (ASPD)

All circadian rhythm sleep disorders require a similar clinical assessment that includes a complete sleep history.
The patient’s sleep-wake schedule should be collected and analyzed, using a sleep log and/or actigraph, for at least one week (preferably 14 days). This will identify potential variations in sleep timing and rule out other sleep disorders, such as insomnia, that are often mistaken for circadian rhythm sleep disorders.33 Polysomnography can also be used to assess ASPD and rule out other sleep disorders.34  

Dim light plasma melatonin onset (DLMO) may also be used to diagnose ASPD, assessed by melatonin measurements taken from saliva or plasma. Patients with ASPD have DLMO times that are advanced compared to normal individuals.35

Diagnosis of ASPD is made based on clinical history; individuals with ASPD “have a chronic or recurrent complaint of difficulty staying awake until the desired time in the evening and inability to remain asleep until the desired and socially acceptable time for awakening.”36

References

33.  Silber MH, Krahn LE, Morgenthaler TI. Circadian rhythm disorders. In: Silber MH, Krahn LE, Morgenthaler TI, eds. Sleep medicine in clinical practice. London, Eng: Taylor and Francis; 2004:253-276.

34. Reid KJ and Zee PC. “Circadian disorders of the sleep-wake cycle,” in Kryger M, Roth T, Dement W (ed.), Principles and Practice of Sleep Medicine (5th Edition), St. Louis: Elsevier Saunders, 2011, pages 470-482.

35. Reid KJ and Zee PC. “Circadian disorders of the sleep-wake cycle,” in Kryger M, Roth T, Dement W (ed.), Principles and Practice of Sleep Medicine (5th Edition), St. Louis: Elsevier Saunders, 2011, pages 470-482.

 

36. Reid KJ and Zee PC. “Circadian disorders of the sleep-wake cycle,” in Kryger M, Roth T, Dement W (ed.), Principles and Practice of Sleep Medicine (5th Edition), St. Louis: Elsevier Saunders, 2011, pages 470-482.