Most of us have experienced an early flight or meeting, which means we have to kick ourselves out of the comfort of our bed way earlier than we are used to—not a pleasurable experience. We feel poorly rested and grumpy and have difficulty ‘getting going’ when forced to wake up earlier than our regular schedule. While most of us experience this once in a blue moon, people with delayed sleep phase syndrome (DSPS) have to encounter this daily due to societal, academic, or professional obligations.
Key takeaways
- DSPS is a circadian rhythm disorder that can affect the well-being and functioning of an individual.
- The causes for DSPS are unclear; however, evidence points to biological and behavioral factors.
- Individuals with DSPS are likely to have a coexisting diagnosis of ADHD, even though the relationship between the two disorders is unclear.
- It can be challenging to recognize when professional help is needed for DSPS, but there are successful treatment options available for this disorder.
Delayed sleep phase
All humans have an internal clock, which is governed by a structure in our brain called the suprachiasmatic nucleus (SCN) or simply the master clock of our bodies. The master clock considers external cues, such as daylight, and is responsible for our circadian rhythms — a name derived from Latin, meaning ‘around a day.’ This is why we have more or less steady sleep-wake cycles and experience jet lag; it is hard to override our naturally running circadian rhythms and go to sleep on demand based on the current time zone.
In the case of DSPS, the internal clock is affected so that individual sleep-wake cycles are shifted for two or more hours. This is also sometimes referred to as sleep-wake phase disorder. You can think of it as a delayed clock that is constantly lagging.
Symptoms
Individuals with DSPS have a delayed sleep-wake cycle, so some local/foreign time-specific obligations and rhythms might be challenging to follow. Symptoms of DSPS include:
- Late bedtimes and late wake-up times, such as falling asleep at 3 AM and waking up at 10–11 AM
- Insomnia
- Difficulty waking up at a desired time
- Difficulty concentrating and staying alert during the day
- Extreme drowsiness or fatigue during the day
It is important to understand that DSPS differs from jet lag or poor sleep hygiene; individuals with DSPS can’t get used to a different schedule. In contrast, in the case of jet lag, eventually, we tend to align with the new time zone.
Causes and risk factors
The exact cause of DSPS is unknown. It appears to be a disruption in the circadian timing system, where the SCN does not respond to environmental cues and adapts the internal rhythm accordingly. The most significant environmental cue for our circadian rhythms is the light-dark cycle—the exchange between day and night; however, eating and physical activity can also affect our circadian rhythms.
DSPS can affect people of all ages, but the disorder most commonly develops during adolescence. Our circadian rhythms are not static throughout our lifetime, with a natural shift toward later bed and wake times during teenage years and early bed and wake times during elderly years. It is suggested that this natural variability in circadian rhythms contributes to the development of DSPS in some individuals.
Besides that, there might be a genetic component to DSPS; however, more research is needed to confirm the exact biological component of this disorder. In addition, persistent poor sleep hygiene and substances (caffeine) or behaviors that increase alertness, such as exposure to blue light via smartphones, computers, and TV, can contribute to developing DSPS.
ADHD and DSPS
Attention deficit and hyperactivity disorder (ADHD) is a developmental disorder that affects an individual’s ability to focus, manage time, and control impulsive behaviors. It has been observed that up to 75% of individuals diagnosed with ADHD are also suffering from DSPS.
However, the relationship between ADHD and DSPS is not clear, and there does not seem to be a causal link between the two. Still, DSPS appears to worsen some ADHD symptoms, especially hyperactivity. If DSPS symptoms are treated with, for example, light therapy, ADHD symptoms may lessen in their intensity.
Strategies for coping with this syndrome
Suffering from DSPS can be challenging; the phase shift interferes with individual social life and school or work performance. This can also cause social jet lag as we are bound to a social and professional schedule. Several strategies may improve the well-being of individuals with DSPS:
- Maintaining social hygiene.
- Avoid caffeinated drinks and alcohol before bed.
- Setting a clear, defined, and consistent bedtime schedule.
- Sleeping in a sleep-promoting environment, such as a dark, quiet, low-temperature bedroom.
- Avoid stimulating social interactions, entertainment (e.g., computer games), and blue light late in the evening.
- Keeping a sleep diary may help identify sleep patterns and triggers that result in poor sleep or insomnia.
- Seeking professional help from a sleep specialist if necessary.
- Using grounding bed sheets. Grounding bed sheets are designed to connect you to the earth’s electrical energy, which may help reduce stress and improve sleep quality.
When to seek professional help
Knowing when to seek professional help with DSPS can be challenging, especially if the symptoms aren’t extreme, like having a phase shift of 6 or more hours. However, suppose you are experiencing persisting difficulties with waking up when needed, falling asleep at an appropriate socially/professionally required time, daytime sleepiness/drowsiness, or falling asleep at inappropriate times (during the day). In that case, you might want to consider contacting a healthcare professional. There are several treatment options available for individuals with DSPS, such as melatonin (sleep-promoting hormone) supplements and light therapy.
Children and DSPS
DSPS in children is often referred to as pediatric DSPS. It is characterized the same as DSPS, where the sleep schedule is shifted by 2 or more hours. DSPS is rarely diagnosed in children below the age of 10, and it can be tricky to notice due to a naturally occurring circadian phase shift during adolescence. However, if you notice that your child is unable to fall asleep at a school-appropriate time (e.g., 9–10 PM, depending on the age) while maintaining a regular schedule, has trouble waking up in the morning, and experiences daytime drowsiness, it can be beneficial to consider seeking professional help.
Tips for Parents
If you have a child diagnosed with pediatric DSPS, your clinician will offer appropriate treatment options, such as light therapy or melatonin supplements. However, there are some things you can do to address it:
- If the child’s schedule permits, you might consider shifting sleep and wake-up times for a few hours. However, this can be challenging for schools that have set start schedules.
- Educate yourself and your child on sleep hygiene.
- You can keep a sleep journal of your child’s rest, or if the child is old enough, they can keep one themselves.
The upside of DSPS is that it does not affect sleep quality; when your child falls asleep and wakes up at the desired time, they will feel rested.
DSPS, a circadian rhythm disorder, can affect personal well-being, social relationships, and work/school performance. Sleep and wake-up time delays can result in daytime sleepiness, attention difficulties, and social jet lag. This syndrome is often diagnosed in those who suffer from ADHD and can worsen its symptoms. However, there are successful treatment options available. In addition, nowadays, with remote work or school options, living with DSPS is easier and more manageable.
FAQ
Is DSPS a disability?
DSPS can be recognized as a disability if none of the treatment options prove successful long term. However, this can also depend on the country/state of residence.
How do you handle DSPS?
Light therapy and melatonin supplements are the two most commonly used approaches to treat DSPS.
How long does the sleep phase delay last?
With treatment, many individuals with DSPS shift their sleep and wake times to appropriate hours. However, persistent DSPS can be a lifelong disorder. Luckily, with digital advances and remote work opportunities, social/professional schedules have become more flexible, meaning individuals with DSPS can live fulfilling lives.