Syndrome in advance of phase of the sleep

The syndrome in advance of phase of the sleep is a disorder of the Sommeil which belongs to the disorders of the rate/rhythm day before-sleep, the rate/rhythm known as circadian. It is about a Dyssomnie.

Diagnosis

Clinical demonstrations

In this disorder, the schedules of the sleep are very advanced compared to the usual schedules (to lay down 18-21h, alarm clock 1-3h) and a somnolence appears in end of the afternoon. The complaint is thus that of a morning Insomnie associated with a somnolence in second part of day. One does not speak about SAPS if the sleep proceeds at the unconstrained selected hours.

Examinations paraclinic

One asks the patients to ideally carry out a diary of the sleep held for one month, with possibly of the holiday periods included. If the behavior of the diary poses problems, one can carry out a Actimétrie (the actimeter is a kind of watch which records the movements on the 24:00, which makes it possible to objectify the schedules of sleep of the person). Lastly, in the best of the cases, one can record the patient in Polygraphie of the sleep and make proportionings with intervals regular of the rate of Mélatonine (showing a shift of the peak of Mélatonine).

Epidemiology

The frequency of the disease is evaluated to 1% of the general population of Middle Age and with the top (much rarer than the Syndrome delay of phase of the sleep). The revelation of the SAPS is often late, contrary to the Syndrome of delay of phase of the sleep. There exist family forms of SAPS, a genetic anomaly could be responsible about it (dominant change of gene PER2 on the chromosome 2q)

Treatment

Chronothérapie

The principle consists in advancing the schedules to lay down 3:00 every 2 days until a retiming (to lay down 22-23h). The protocol is rather constraining and requires a great motivation. The chronothérapie, rather often is made within the framework of a hospitalization. It gives enough good performances.

Luxthérapie

The principle consists in exposing the patient to a source of light in end-of-day to readjust the internal clock. One will also ask to avoid exposing itself to the light the morning. The improvements exist, but often transitory when the luxthérapie is stopped.

Behavioral measurements

To make the nap after midday and to avoid the exposure to the light the morning.

Mélatonine

Taken with a precise schedule, it would make it possible to shift the peak of the rate of mélatonine. However no really convincing results were shown.

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