How to Identify and Treat Delayed Sleep Phase Syndrome

Does it seem impossible to wake up in the morning? Do you have trouble falling asleep? You’re not alone. However, what you might not realize, is that your extreme exhaustion and difficulty sleeping could be more than just “bad sleeping habits” and actually be a sign of something more severe.

Delayed Sleep Phase Syndrome is a sleep disorder caused by a circadian rhythm, or sleep cycle, that is off by two hours or more from your desired bedtime. This means that the beginning of a person’s sleep schedule is thrown off, causing trouble waking up in the morning and persistent exhaustion. DSPS is especially common in children and adolescents, and it is prevalent among approximately 7-16% of that group.

Delayed Sleep Phase Syndrome (DSPS) is a sleep disorder that may interfere with a person’s social and work life because it can cause persistent fatigue, an inability to wake up on time, and even depression. While it is a disorder that should be taken seriously, it is also possible to cure with some persistence and help.

In this article, we talk about the signs and symptoms of Delayed Sleep Phase Syndrome so you can determine if your sleep troubles could be caused by this disorder, and we also walk through tips for improving your sleep-wake cycle to achieve better sleep.

What Is Delayed Sleep Phase Syndrome?

Delayed Sleep Phase Syndrome, also known as Delayed Sleep-Wake Phase Disorder, is a sleep disorder where a person’s natural sleep cycle is delayed or ahead of their ideal bedtime by at least two hours. However, for some, the difference may be much greater.

For example, your planned bedtime may be 10 p.m., but you may be unable to fall asleep until 4 a.m., despite having a regular 8 a.m. wake-up call. DSPS is largely affected by melatonin, a naturally occurring hormone released in cycles. The release of melatonin is a sign that it is time to sleep, so if it is released too late at night, a person may have trouble falling asleep on time.

Delayed Sleep Phase Syndrome is especially prevalent among children and adolescents, although it may appear in adulthood as well. This is due to the change in an adolescent’s sleep cycle that happens during puberty, causing them to stay awake for longer because melatonin is released later at night. DSPS is often misdiagnosed as depression, insomnia, or behavioral problems, due to the fact that it is not well known. However, researchers believe there are a few potential causes of DSPS.

What Causes Delayed Sleep Phase Syndrome

Many of the possible causes of Delayed Sleep Phase Syndrome mimic the symptoms of other disorders, such as insomnia, or depression. Because of this, DSPS can be hard to diagnose. Instead of trying to guess whether or not your sleepless nights are a sign of something more serious, we suggest talking with a sleep specialist who can provide a proper diagnosis and get you started on the right treatment plan.

Genetics

Genetics are widely believed to be linked to Delayed Sleep Phase Syndrome. A study on genetic polymorphism, the simultaneous reoccurrence of multiple alleles within a gene’s population, in 2003 showed strong genetic links to DSPS. Another study in 2017 found 40 patients from 7 unrelated families who all had DSPS confirmed by genetic analysis. Because of this, genetics are often used to help determine the presence of DSPS.

Changes After Puberty

During adolescence, the body’s 24-hour sleep cycle becomes longer; this simply means adolescents tend to fall asleep later at night and wake up later in the day, causing them to develop a delayed bedtime. This is because the brain releases melatonin at a reduced rate during puberty, meaning that adolescents will not feel tired until later in the evening. This is problematic because falling asleep well past nightfall can contribute to DSPS.

Mental Health Disorders

There are a few common psychological and neurological disorders linked to Delayed Sleep Phase Syndrome, including depression, anxiety, OCD, and ADHD. Excessive fatigue caused by DSPS may make matters worse for those who suffer from another disorder, or it may possibly exacerbate an existing disorder. Because some with DSPS have a sleep schedule that does not match with daylight hours, the same is true of the social isolation that could be a result of not being active during that time.

Depression

It has been shown that Delayed Sleep Phase Syndrome is twice as more prevalent in depressed young people as the general population. Though research has been done on the relationship between the DSPS and depression, it’s still not entirely clear how the two disorders influence one another. Persistent exhaustion may contribute to depression, as may social isolation or the stress from work or school that can result from DSPS. However, DSPS has sometimes been misdiagnosed as depression, due to symptoms such as fatigue, trouble concentrating, and irritability, which can all be caused by depression or exhaustion from DSPS.

Anxiety

Because of permanent fatigue and pressure from societal and work expectations, anxiety may accompany or be caused by Delayed Sleep Phase Syndrome. It is important to maintain a work-life balance to keep peace of mind, and this may be incredibly difficult for those who have DSPS. Fatigue from lack of sleep may make work more difficult, and if a person with DSPS must complete work during reduced hours due to not waking up on time, there may be pressure to do so more quickly.

Obsessive-Compulsive Disorder (OCD)

Complex rituals may leave a person with an Obsessive-Compulsive Disorder (OCD) homebound, and this includes even less exposure to light, which can contribute to Delayed Sleep Phase Disorder. Social isolation, lack of activity, and difficulty preparing regular meals due to ritualistic eating habits are also common in severe OCD. These may also be compounded by DSPS, especially if the person experiences a lack of light in the morning or too much light when going to sleep.

Attention-Deficit / Hyperactivity Disorder (ADHD)

While it is unclear why, many scientists believe Attention-Deficit / Hyperactivity Disorder (ADHD) and Delayed Sleep Phase Syndrome are linked. Some theorize an estimated 73-78% of children and adults with ADHD also have DSPS. Recently, scientists have also been investigating evidence that treating DSPS may help with ADHD symptoms. If you have ADHD and believe you may also have DSPS, speak with your doctor about your options.

Chronic Insomnia

While insomnia and Delayed Sleep Phase Syndrome are not the same, it is possible to suffer from both at the same time. DSPS affects approximately 10 percent of people with chronic insomnia. Because it is possible to have both DSPS and insomnia, or another sleep disorder, it is important to explore all of your options with a specialist.

Poor Bedtime Habits

Developing poor bedtime habits may also contribute to Delayed Sleep Phase Syndrome. Exposure to too little light in the morning or too much light in the evening could cause DSPS, meaning it is important to sleep at night when it is dark out if possible. It is important to follow good sleep hygiene stick to a bedtime routine, as having an irregular bedtime may additionally worsen DSPS.

Signs of Delayed Sleep Phase Syndrome

The list below contains possible signs of Delayed Sleep Phase Syndrome. These symptoms can fit the description of a number of other conditions, and can also sometimes happen in healthy people as well. Because of that, we recommend that you use this list in tandem with other signs of any disorder you feel you may have and talk with your doctor if you have any concerns.

Inability to Fall Asleep at the Necessary Time

If someone is incapable of falling asleep at the required time, this may be a sign of Delayed Sleep Phase Syndrome, especially if they are falling asleep late at night. This is because a person’s circadian rhythm is tied to their sleep-wake schedule, and regularly falling asleep well after dark could cause DSPS. Teenagers are especially susceptible, as they may feel higher pressure to stay up to due to their school or social life.

Inability to Wake Up and Excessive Daytime Exhaustion

This sign is easier to identify, as many who stay up late simply view themselves as “night owls”. However, the difference between a “night owl” and a person with Delayed Sleep Phase Syndrome is that a true “night owl” is able to adjust their sleep schedule and wake up on time if necessary. A person with DSPS will not be able to do so, and may regularly have difficulties waking up for work or school.

Depression and Psychological Problems

Excessive fatigue and stress caused by not being able to meet a person’s desired sleep schedule may cause or exacerbate mental health problems, including depression. Fatigue may also be misinterpreted as depression when instead of being depressed, a person is simply exhausted and not able to meet their goals due to fatigue. However, symptoms can be very similar. Other psychological disorders linked to DSPS include anxiety, OCD, ADHD, and behavioral problems in children.

No Sleep Problems if Allowed to Maintain Desired Schedule

Some people may be unaware they have Delayed Sleep Phase Syndrome because they are still able to maintain societal and work expectations, despite being constantly tired. Most people with DSPS have no trouble sleeping if allowed to sleep on their desired schedule (assuming there are no other sleeping disorders present). Those with DSPS will likely sleep well on weekends or breaks, and use that time to catch up on the sleep they missed during the rest of the week.

How to Find Out if You Have Delayed Sleep Phase Syndrome

If you believe you may have Delayed Sleep Phase Syndrome you must visit a doctor or sleep specialist, who will ask you questions and may run a series of tests to determine your best treatment options. A medical professional is the only person who will be able to determine whether or not you have DSPS. Are you wondering what your doctor or sleep specialist will ask of you? More information on what they may request is shown below.

Gathering Your Medical History

Because genetics have been shown to be linked to DSPS, you may be asked to gather your medical history. Doctors may look for links in your family history to DSPS and other sleep disorders. Combined with other steps, this will be helpful in determining if you have a sleep disorder.

Creating A Sleep Log

Creating a sleep log will help give you a bigger picture of your sleep cycle patterns, the most important factor to consider when determining if a person has Delayed Sleep Phase Syndrome. Generally, you will be asked to keep regularly updating your sleep log for at least 2 weeks. This will help your doctor better understand your sleep schedule and discover any irregularities.

Wearing A Wrist Tracking Device (Actigraphy)

Your doctor may have you wear a wrist tracking device, also known as actigraphy. Similar to creating a sleep log, this will help to discover your current sleep schedule. These devices use what is known as an accelerometer to record motion. Knowing your current sleep schedule is important to help determine how your schedule needs to be shifted, and what the proper course of action is.

Participate in a Sleep Study (Polysomnogram)

It is also possible your doctor will also ask you to participate in a sleep study, which is also referred to as a polysomnogram. During a sleep study, your brainwaves and heart rate will be monitored. While these will not prove Delayed Sleep Phase Syndrome, they are useful in eliminating other possible sleep disorders that may be present.

Treatment

Treatment for Delayed Sleep Phase Syndrome typically involves more than one method. Your doctor or sleep specialist will complete an evaluation to determine the next best steps. Possible treatments for DSPS, including good sleeping habits and bedtime changes, are listed below.

Practice Proper Sleeping Hygiene

Good sleeping habits are vital for treating Delayed Sleep Phase Syndrome. What are the best sleeping habits? Read below for a comprehensive list of what you can do to get a good night’s rest.

Go To Bed the Same Time Every Night

Going to bed and waking up at the same time every day will help you keep a regular sleep schedule, and consistency is extremely helpful for combating Delayed Sleep Phase Syndrome. This is because DSPS is influenced by your circadian rhythm. To regulate that rhythm, maintain a regular bedtime schedule.

Take A Shower Before Bed

If you have Delayed Sleep Phase Syndrome, taking a  warm shower each night before bed will help promote drowsiness. Your body will heat up during the shower, then cool quickly as water evaporates. This is a sign to your body that it is time to sleep.

Avoid Blue Light

Avoiding blue light, such as the screens on laptops or phones, will help you to fall asleep at the necessary time. Darkness is a sign to your body that it needs to produce melatonin, and if you are exposed to blue light, this can trick your brain into thinking it’s still light out, causing a delay in melatonin production.

Eliminate Caffeine

Caffeine is a stimulant that can keep you awake well past bedtime. Since those with Delayed Sleep Phase Syndrome already have trouble falling asleep on time, they’re advised to avoid caffeine entirely. Examples of caffeinated products include coffee, as well as tea or soda that contains caffeine.

Plan Stimulating Activities Earlier in the Day

Stimulating activities that may disrupt sleep, such as video games or exercise, should be scheduled earlier in the day to prevent hindering sleep at night.  Homework, and other stress-inducing activities, should also be avoided just before bed since stress can also make it hard to sleep.

Maintain A Cool, Comfortable Room

As you drift off and progress into deeper stages of sleep, your body temperature drops one or two degrees. A hot bedroom can make it hard to get good sleep by keeping your temperature elevated and causing night sweats. A lower bedroom temperature, around 60 to 67 degrees, facilitates faster sleep by keeping you cool.

Shift Your Bedtime Schedule (Phase Delay Chronotherapy)

Shifting your bedtime schedule is extremely important when treating Delayed Sleep Phase Syndrome. Also known as, “phase delay chronotherapy,” the process of shifting your sleep schedule will help your body become used to a new sleep-wake cycle. With your doctor, you can work to develop an appropriate bedtime schedule for your lifestyle and devise the best plan to shift your internal clock to match it.

Advancing Your Internal Clock

To advance your internal clock, simply go to bed earlier in increments each night. The most commonly recommended amount is 15-minute increments. For example, if you go to bed at 12 p.m. each night but want to go to bed at 9 p.m., the first night you would go to bed at 11:45 p.m., then the next night at 11:30 p.m., and so on until the desired time is reached. Attempting to shift back in larger increments is not recommended, as it will likely be much more difficult to fall asleep.

Delaying Your Internal Clock

Most people find it easier to stay up later than it is to fall asleep early, which means that delaying your internal clock may be another option. This technique works best for those who desire a later sleep time, but may be used by anyone with Delayed Sleep Phase Syndrome. To do so, go to bed 1-3 or more hours later each night until the desired bedtime is reached.

For example, if your bedtime is 4 a.m., go to bed the first night at 7 a.m., then 10 a.m. the next day, and so on. Be forewarned, this technique requires many free days to develop the habit and may cause temporary exhaustion. We recommend setting aside at least one free week if trying this method.

Bright Light Therapy

Bright light therapy is a method your specialist may recommend if they believe you have Delayed Sleep Phase Syndrome. This treatment would be used in tandem with some other treatments we have mentioned, such as enforcing a regular bedtime. This therapy involves the use of a light box or a lamp that emits light to mimic natural sunlight. To properly take advantage of your light box, we recommend using it for 30 minutes after first waking up.

Bright light in the mornings is believed to help to regulate your melatonin schedule so that you can fall asleep earlier at night.  However, for this method to be effective, you will also need to avoid bright lights at night that may disrupt your circadian rhythm.

Create a New Work Schedule

While this is generally considered a last option, it’s possible to create a new work schedule that revolves around your existing sleep schedule. Many self-proclaimed “night owls” simply choose a career that works for them. If using this method, take your social life into account as well; a proper work-life balance is essential for a happier life.

Natural Sleep Aids

Natural sleep aids may be recommended by your doctor if they suspect if you have Delayed Sleep Phase Syndrome, along with a regular bedtime schedule. Some natural sleep remedies include herbs such as chamomile, valerian, and St. John’s wort. These natural aids all promote relaxation and decreased anxiety, which may help if you are unable to sleep at the appropriate time.

Because of its links to DSPS, melatonin is also widely recognized as one possible treatment for the disorder. However, before opting for synthetic melatonin supplements, we suggest trying other natural sleep aids.

While melatonin is a popular go-to for people with sleep troubles, it’s not always used effectively. Improper use of melatonin can sometimes do more harm to your sleep cycle than good, so if you are considering this treatment method, we suggest talking with your doctor about the best practices for taking melatonin.

Stay Motivated and Stick to Your Schedule

Sticking to your new sleep schedule, once determined, will keep you on the right track. Don’t stray from your new sleep schedule for even one night, as this may cause you to lose your newly-created circadian rhythm.

As humans, life will probably require us to be flexible in our sleeping schedule every so often, but we advise sticking to your new schedule as strictly as possible for the first few months (or until you feel accustomed to falling asleep at an earlier bedtime).

FAQs

When does Delayed Sleep Phase Syndrome normally start?

Delayed Sleep Phase Syndrome often begins early in life. In a study, approximately 90% of patients with DSPS reported the onset of the syndrome in early childhood or adolescence.

It is possible for DSPS to begin at any time, but it rarely starts after early adulthood. It is important to recognize DSPS symptoms early since this sleep disorder can greatly affect a child’s or teenager’s school and social life if not treated.

Is Delayed Sleep Phase Syndrome the same as insomnia?

Delayed Sleep Phase Syndrome and insomnia are not the same, however, DSPS is often misdiagnosed as insomnia due to overlapping symptoms. Insomnia is believed to occur when a person is unable to fall asleep. People with DSPS are able to fall asleep if it matches their internal clock, and are only unable to sleep if the time doesn’t match their preferred schedule.

Could something else be causing my sleep problems?

It is possible that another sleep disorder may be affecting you as well. There are many symptoms of Delayed Sleep Phase Syndrome that are similar to other sleep disorders or issues, and sleep problems may also be a result of one of the following:

• A medical condition
• Medication use
• A mental health disorder

Because there are many possible underlying causes of fatigue as well as similar symptoms between DSPS and other issues, talk with your doctor to discuss any concerns.

Can I just move to a new time zone to get rid of Delayed Sleep Phase Syndrome?

While this may seem like a good option for those considering moving, living in a new time zone will not help. This is because a person’s circadian rhythm is tied to their sleep-wake cycle, based on when the sun is out. To truly adjust your sleep schedule, you will need to speak with a specialist and stick to the regime they recommend.

In what ways could Delayed Sleep Phase Syndrome be affecting me?

Delayed Sleep Phase Syndrome can have multiple side effects, including exhaustion, depression, behavioral problems in children, and extreme difficulty waking up in the morning. Because of the varied ways DSPS can affect your life, it is important to treat quickly and effectively.

Conclusion

Delayed Sleep Phase Syndrome is a disorder that can negatively impact your life if left untreated. By speaking with a sleep specialist and following their guidance, plus with a little resilience, DSPS is entirely possible to beat. Don’t give up hope, by sticking to a regular sleep schedule and practicing proper sleep hygiene, you will be well on your way to a healthier, happier you.