Mother describes a long-standing history of difficulties with
sleep onset. As an infant the patient would remain awake until
11 PM and awaken spontaneously at 10:30 AM the following
day. Her mother is ready to go to sleep long before the patient.
At the time the sleep log and actigraphy were completed, sleep
onset varied from as early as 11 PM to as late as 3:00 AM, with
the average of 2:00 AM. Arousal time varied from as early as
7:30 AM to as late as noon, with the average of 11 AM, and a total
sleep time of about 9 hours. She does not take daytime naps. A
comprehensive learning evaluation was consistent with attention
deficit hyperactivity disorder. The DSPS has led to 31
absences and tardies during her last academic year and put a
severe strain on the parent-child and parent-school relationships.
The patient completed a sleep log before the visit (Fig 5,
sleep log in DSPS). Actigraphy confirmed the sleep log findings