Risk of relapse A strict schedule and good<unk>  hygiene are essential in maintaining any good effects of treatment. With treatment, some people with mild<unk>  may<unk>  and function well with an earlier<unk>  schedule. Caffeine and other stimulant drugs to keep a person awake during the day may not be necessary and should be avoided in the afternoon and evening, in accordance with good<unk>  hygiene. A chief difficulty of treating<unk>  is in maintaining an earlier schedule after it has been established. Inevitable events of normal life, such as staying up late for a celebration or deadline, or having to stay in bed with an illness, tend to reset the<unk> ing schedule to its intrinsic late times. Long-term success rates of treatment have seldom been evaluated. However, experienced clinicians acknowledge that<unk>  is extremely difficult to treat. One study of 61<unk>  patients, with average<unk>  onset at about 3:00 am and average waking time of about 11:30 am, was followed with questionnaires to the subjects after a year. Good effect was seen during the six-week treatment with a large daily dose of melatonin. After ceasing melatonin use over 90% had relapsed to pre-treatment<unk> ing patterns within the year, 29% reporting that the relapse occurred within one week. The mild cases retained changes significantly longer than the severe cases. Adaptation to late<unk> ing times Working the evening or night shift, or working at home, makes<unk>  less of an obstacle for some. Many of these people do not describe their pattern as a<unk> ". Some<unk>  individuals nap, even taking 4–5 hours of<unk>  in the morning and 4–5 in the evening.<unk> -friendly careers can include security work, the entertainment industry, hospitality work in restaurants, theaters, hotels or bars, call center work, manufacturing, healthcare or emergency medicine, commercial cleaning, taxi or truck driving, the media, and freelance writing, translation, IT work, or medical transcription. Some other careers that have an emphasis on early morning work hours, such as bakers, coffee baristas, pilots and flight crews, teachers, mail carriers, waste collection, and farming, can be particularly difficult for people who naturally<unk>  later than is typical. Some careers, such as over-the-road truck drivers, firefighters, law enforcement, nursing, can be suitable for both people with<unk><unk><unk>  syndrome and people with the opposite condition, advanced<unk><unk><unk> , as these workers are needed both very early in the morning and also late at night. Some people with the<unk>  are unable to adapt to earlier<unk> ing times, even after many years of treatment.<unk>  researchers Dagan and Abadi have proposed that the existence of untreatable cases of<unk>  be formally recognized as a<unk> -wake schedule<unk>  (SWSD) disability", an invisible disability. Rehabilitation for<unk>  patients includes acceptance of the condition and choosing a career that allows late<unk> ing times or running a home business with flexible hours. In a few schools and universities, students with<unk>  have been able to arrange to take exams at times of day when their concentration levels may be good. In the United States, the Americans with Disabilities Act requires that employers make reasonable accommodations for employees with<unk> ing<unk> s. In the case of<unk> , this may require that the employer accommodate later working hours for jobs normally performed on a "9 to 5" work schedule. The statute defines "disability" as a "physical or mental impairment that substantially limits one or more major life activities", and Section 12102(2)(a) itemizes<unk> ing as a "major life activity". Impact on patients Lack of public awareness of the<unk>  contributes to the difficulties experienced by people with<unk> , who are commonly stereotyped as undisciplined or lazy. Parents may be chastised for not giving their children acceptable<unk>  patterns, and schools and workplaces rarely tolerate chronically late, absent, or<unk> y students and workers, failing to see them as having a chronic condition. As<unk>  is so little-known and so misunderstood, peer support may be important for information, self-acceptance, and future research studies. People with<unk>  who force themselves to follow a normal 9–5 workday "are not often successful and may develop physical and psychological complaints during waking hours, e.g.,<unk> iness, fatigue, headache, decreased appetite, or depressed mood. Patients with circadian rhythm<unk><unk> s often have difficulty maintaining ordinary social lives, and some of them lose their jobs or fail to attend school."
Delayed sleep phase disorder
Insomnia
Circadian rhythm sleep disorder
Non-24-hour sleep–wake disorder
Advanced sleep phase disorder
Shift work sleep disorder
Nightmare disorder
Rapid eye movement sleep behavior disorder