What Is Delayed Sleep-Wake Phase Syndrome?

delayed sleep phase syndrome

Some people feel their best physically and mentally during the night. They function better and are in a more productive frame of mind to study, work, and socialize late at night, regardless of how tired they are during the day, or how little sleep they had the night before. Subsequently, they also struggle to fall asleep naturally at night. As a result, they sleep throughout the day and wake up in the afternoon. 

They are commonly known as night owls or “night people.” However, medically speaking, that is pretty inaccurate. Night owls can purposely stay up late for work, to study, or to socialize. They may wake up later than usual, but when it comes to their normal routine, they can get back to their normal sleep schedule naturally. People who cannot sleep naturally at night have a disrupted “circadian rhythm,” and this is called Delayed Sleep Phase Syndrome, also known as Delayed Sleep-Wake Phase Syndrome, or Delayed Sleep-Wake Disorder. 

 

What is Delayed Sleep Phase Syndrome

Delayed Sleep-Wake Phase Syndrome (DSPS) is a form of disorder in a person’s “circadian rhythm.” The circadian rhythm is best described as the body’s natural clock – it follows a 24-hour cycle and regulates the body’s sleep-awake pattern. It also controls the body’s temperature, release of specific hormones (melatonin – the sleep hormone), hunger, digestion, and when you fall asleep and wake up. Darkness and light can affect circadian rhythms, that is why using electronics that produce blue light (TV, smartphones, etc.) and jet lag from traveling across different time zones can easily disrupt one’s sleep schedule. 

With DSPS, the circadian rhythm is “delayed” for two hours or more than what is considered “acceptable” or a normal bedtime schedule. This disorder can be a problem if it interferes with the person’s social and work demands. 

People with DSPS find it difficult to sleep at night, thus they prefer late bedtimes. Consequently, they wake up later too.

There are two basic types of DSPD, both are characterized by melatonin onset:

  • Circadian aligned – the onset of melatonin takes place less than three hours before the onset of sleep
  • Circadian misaligned – the onset of melatonin takes place more than three hours before bedtime, or the onset of melatonin does not take place until after the sleep onset.

 

Signs and Symptoms of Delayed Sleep Phase Syndrome

Since the disorder affects the circadian rhythm of the body, the most common sign is the inability to fall asleep at the time that is socially considered “normal.” Obviously, this also makes waking up early in the morning difficult, if not impossible. Other signs of this disorder include:

  • Difficulty falling asleep at desired time
  • Difficulty waking up in the morning
  • Normal quality and duration of sleep when there is no need to sleep or wake up at a certain period of time
  • Consistently delayed sleep-wake pattern for at least seven days

Subsequently, the lack of quality sleep can trigger a number of symptoms and problems, including:

  • Excessive drowsiness – difficulty staying awake during the day, nodding off throughout the day
  • Difficulty staying focused and remembering – not getting enough sleep can cause anyone to struggle to concentrate or think clearly and remember certain details
  • Difficulty performing simple and usual tasks – sleep disorders can make it difficult to perform simple tasks that you normally do as part of your day
  • Alcohol and/or drug abuse – to fall asleep or stay awake, people struggling from DPSD may end up abusing alcohol and/or stimulant drugs 

symptoms of delayed sleep phase syndrome

Who Is at Risk of Delayed Sleep Phase Syndrome

Experts are yet to pinpoint the risk factors of DSPS in the general population. However, it is believed to be very common among teens and adults. It occurs in about 7% of teens, and more than 16% of young adults. Experts also estimate the condition is likely found in 10% of people with clinically diagnosed insomniaAlso, night owls or “night people” are likely to be at risk of this disorder. 

DSPS also appears to 40% of people with genetic-component related disorders. 

DSPS is also believed to be caused by environmental factors; the lack of exposure to natural sunlight and too much screen time disrupts the body’s circadian rhythm. 

 

How to Know If You Are Suffering from DSPS

If the inability to sleep and wake up at certain times of the day, and constant fatigue and drowsiness affect your occupation and other important areas of your life, then you need to see your doctor. DSPS can easily be confused with other types and forms of sleep disorders, that is why it is important to have it checked by a qualified doctor to understand what is actually going on. 

DSPS is a common issue during early childhood, but it can appear or get worse during adolescence. 

 

Diagnosing DSPS

DSPS is one of the most misdiagnosed sleep disorders because its symptoms are pretty common among other forms of disorders. Also, many people with DSPS force themselves to follow a “normal routine” and they end up frustrated because they simply cannot get to sleep at night. People who report difficulty falling asleep are often diagnosed with insomnia. Those who are always fatigued are sometimes misdiagnosed with depression. 

If you suspect you are suffering from DSPS, then it is extremely important that you see a sleep specialist to get the right diagnosis. 

A sleep specialist will perform different tests to determine whether the problem is actually DSPS or not. This may include:

  • Collecting medical history (family history, symptoms, etc.)
  • Request for your sleep log (your sleep and waking time for each day)
  • Actigraphy – a device worn on your wrist that tracks your sleep-wake cycle
  • Polysomnogram – an overnight sleep test to monitor your heart rate and brain waves 

Treatment for Delayed Sleep Phase Syndrome

Treatment for DSPS usually involves a combination of different methods. The main purpose of treatments is to normalize your disrupted sleeping pattern by adjusting your circadian rhythm. A common course of treatments include:

  • Internal clock advancement (going to bed about 15 minutes earlier, waking up early
  • Delaying internal clock – better known as chronotherapy, this method delays your bedtime for an hour to 2.5 hours every six days. Repeat until you can have a normal sleeping schedule.
  • Melatonin supplements – to control your sleep-wake cycle, and to promote sleep, your doctor may recommend the use of melatonin. Obviously, your doctor will give you the right dose. Make sure you follow the dosage and instructions from your doctor
  • Bright light therapy – sitting near to a light box for 30 minutes is believed to be helpful in advancing internal clocks.
  • Cognitive behavioral therapy – this helps someone change the thoughts and actions that keep them awake at night
  • Have good sleep hygiene – invest in a quality mattress, pillows, and sheets. Avoid electronics before bedtime. 
  • Avoid vigorous exercise – this can overwork the body
  • Avoiding alcohol, caffeine, tobacco. 

delayed sleep phase syndrome treatment

Bottom Line

As said earlier, DSPS is a circadian rhythm disorder. Putting your circadian rhythm back to normal or what is considered acceptable can help. However, it is still best to seek professional advice and treatment from sleep doctors. 

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Dr. Manish Shah tmj and sleep specialist

Dr. Manish Shah

  • BDS, MBBS, MMED (Sleep Medicine)
  • Masters in Sleep Medicine
  • General Medical Practitioner
  • General, Implant and Cosmetic Dentist
  • Certified in TMJ & Craniofacial Pain Management
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