Delayed Sleep Phase Disorder
Delayed sleep phase disorder (DSPD), also known as delayed sleep phase syndrome, involves delay when trying to fall asleep. This is caused by an irregularity in a person’s circadian rhythm. In other words, the body’s natural, internal body clock is affected.
People with DSPD have trouble falling asleep as soon as they go to bed, or have difficulty falling asleep at the acceptable and recommended time:
- 7:00 p.m. to 9 p.m. for children.
- 9:00 p.m. to 10 p.m. for teenagers.
- 10 p.m. to 11 p.m. for adults.
People with DSPD cannot drift into sleep after getting in bed like most healthy people can — it may take them two or more hours before they can finally fall asleep, even if they feel tired.
While people with DSPD have trouble falling asleep, they should not be confused with being a night owl. People with this condition have a genuine challenge. The biggest issue with DPSD is that it can cause difficulty with being able to wake up at a certain time, which in turn leads to issues with lateness at school and in the workplace.
DSPD can develop in a person at any age and is quite common. It affects about 15% of teenagers and younger adults.
What Are the Signs of DSPD?
You are more likely to have DSPD if you are an adolescent who has sleep issues or trouble waking up in the morning. This can cause social, academic and occupational difficulties in your life. However, it is important to remember that some adolescents may intentionally delay their sleep. DSPD is not by choice but rather a genuine inability to sleep at the time you choose to, even if you have removed all distractions.
There are several signs and symptoms of delayed sleep phase disorder. The most common ones will be listed and explained below.
1. Delayed Sleep/Difficulty Going to Sleep
Having DSPD makes it difficult to fall asleep at the time you want. If you find it consistently difficult to sleep several hours (two hours or more) after going to bed, it might be an indication that you could be experiencing DSPD. It is important to remember that this depends on several factors, such as if you have caffeine a few hours before bed, if you were occupied with something else or if you are not tired.
2. Difficulty Waking Up in the Morning
People with DSPD often find it difficult to wake up in the morning, especially when they plan to wake up at a certain time. This happens because people with DSPD end up sleeping later than expected but they still require the recommended amount of sleep for their age (see above) and end up not being able to wake up at the time they intend to.
This can cause negative consequences at school and at work (although DSPD in adults is rare). If you find that you might be experiencing daily difficulties with waking up at a certain time because you are not able to sleep at a desired time, it might be a sign you are experiencing symptoms of DSPD.
3. Feeling Sleepy During the Day
Because people with DSPD have trouble falling asleep and waking up a certain time, they often end up not getting the amount of sleep they need, especially for children, as children need quite a bit of sleep (more than adults). This can lead to trouble staying awake during the day and daytime sleepiness. If you find yourself consistently tired and sleepy during the day due to not sleeping early, this might be a sign of DSPD. However, this sign is dependent on whether you find it difficult to sleep, not whether you choose to stay awake to do something else.
4. No Other Sleep Disorders
DSPD occurs independent of other sleep disorders, so it is not usually accompanied by any other disorders. This is a clear indication of DSPD. If you do not have any other diagnosable sleeping conditions, such as sleep apnea, narcolepsy, or insomnia, but have trouble sleeping at your desired time, this might be a sign.
5. Quality of Sleep Isn’t Affected
It’s also good to keep in mind, that people with DSPD generally have a good-quality sleep. For most of the other sleep conditions, the quality of sleep is greatly affected. So, if you still find your sleep quality is unaffected by the time you sleep, it might be another indication of DSPD.
6. May Not Appear Consistently
Someone with DSPD might not experience the inconveniences that the disorder can cause to their lives on certain occasions. For example, during the weekends when most people do not need to wake up early or during the holidays (including school holidays). However, other sleep disorders can cause several other adverse consequences to the person’s quality of life at any point. This is also another clear sign that it is not like other sleep disorders.
7. Stress and Anxiety
People with DSPD may find it difficult to be on time and manage their time due to waking up late. They may consistently be late, miss appointments or have difficulty concentrating. This can lead to high levels of stress and anxiety. If you find yourself stressed and anxious because you are always late, it might be a sign that you have symptoms of DSPD.
8. Depression and Behavior Problems
People with DSPD might experience constant issues at school and at home, which might lead to low moods and depression. Their grades and school performance might also be affected, leading to more feelings of depression. This might also have a negative effect on how they view school and responsibilities and end up engaging in truant behavior as a result. This is mostly an effect of DSPD and not a symptom. However, if you identify with the life challenges caused by DSPD that leads to depression, it might be a sign to seek medical help.
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What Causes DSPD?
There is not enough research yet to determine what causes DSPD. Some scientists have suggested that the condition can be due to an exaggerated reaction to the shift in the internal body clock that happens during puberty, as DSPD mainly affects adolescents.
Genetics has been found to be a possible factor, as having a relative or parent with DSPD increases a person’s likelihood of having this disorder.
Environmental factors have also been associated with DSPD — mainly too little exposure to morning sunlight or too much exposure to bright lights in the evening.
DSPD has also been found to affect at least 10% of people who suffer from chronic insomnia. DSPD has also been linked to mental health conditions, such as attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), anxiety and depression.
Irregular Sleep Schedule
This disorder can also be caused by an irregular sleep schedule due to constant exposure to jet lag or brain damage through stroke, injury, or a neurodegenerative disorder.
When Should You Seek Medical Help?
DSPD often goes undiagnosed or is misdiagnosed. This happens because people with the condition try to lead regular lives and follow strict routines, which can make them feel tired and depleted. This can often lead to depression and can be mistaken for depression. Often people with DSPD are also diagnosed with insomnia.
If you have been having delayed sleep for seven days in a row it might be good to discuss whether you are at risk of DSPD with your doctor. It might be good to discuss these concerns with your doctor if you have a family member with DSPD too. You could also seek out a sleep specialist or technician if you or your child have issues with sleep. A sleep specialist will do tests and request medical information, or ask for a sleep chart to be done. The tests usually include actigraphy, which tracks your sleep patterns through a device placed on your wrist, or a polysomnogram, which is an overnight sleep test that monitors your brain waves.
Most treatment options for DSPD are designed to adjust the internal body clock to normalize the persons sleep schedule.
- Going to bed 15 or 30 minutes earlier to advance the internal body clock.
- Chronotherapy to delay the internal body clock every six days by one to two hours. This is meant to reset the internal circadian body clock.
- Low dose melatonin supplements to regulate sleep and induce sleepiness
- Bright light therapy, a technique that changes the body’s circadian rhythm.
- Cognitive behavioral therapy to change thoughts and actions that might affect sleep.
- Stanford Health Care (Treating Delayed Sleep Phase Syndrome)
- Healthline (What Is Delayed Sleep Phase Syndrome?)
- Sleep Education (Delayed Sleep-Wake Phase)
- Cleveland Clinic [Delayed Sleep-Wake Phase Disorder (DSWPD) in Children and Adolescents]
- American Sleep Association (Delayed Sleep Phase Syndrome: Symptoms, Causes and Treatments)