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, grumpy, and have difficulty 'getting going' when forced to wake up earlier than our normal 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.
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 takes into account 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 in such a way that individual sleep-wake cycles are shifted two or more hours. This is also sometimes referred to as the sleep-wake phase disorder. You can think of it as a delayed clock, which is constantly lagging behind.
As individuals with DSPS have a delayed sleep-wake cycle, some local/foreign time-specific obligations and rhythms might be difficult to follow. Symptoms of DSPS include:
- Late bed times and late wake up times, such as falling asleep at 3 AM and waking up at 10–11 AM
- 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 is different from jet-lag or poor sleep hygiene; individuals with DSPS can't get used to a different schedule. Whereas, 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 the environmental cues and adapts the internal rhythm accordingly. The most important 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, most commonly, the disorder 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 in order 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. There are several strategies that may improve the well-being of individuals with DSPS:
- Maintaining social hygiene.
- Avoiding 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.
- Avoiding stimulating social interactions, entertainment (e.g., computer games), and blue light late in the evening.
- Keeping a sleep diary may help with identifying sleep patterns and triggers that result in poor sleep or insomnia.
- Seeking professional help from a sleep specialist if necessary.
When to seek professional help
It can be difficult to know when to seek professional help with DSPS, especially if the symptoms aren't extreme, like having a phase shift of 6 or more hours. However, if 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), 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 want to consider shifting sleep and wake up times for couple of hours. However, this can be challenging with school having set start schedules.
- Educate yourself and your child on sleep hygiene.
- 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 the sleep quality; the days where your child falls asleep and wakes up at the desired time, they will feel rested.
DSPS, a circadian rhythm disorder, can have effects on personal well-being, social relationships, and work/school performance. The delay in sleep and wake-up times 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 treatment options available that have been shown to be successful. In addition, nowadays, with remote work or school options, living with DSPS is easier and more manageable.
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?
Two most commonly used approaches to treat DSPS are light therapy and melatonin supplements.
How long does the sleep phase delay last?
With treatment, many individuals with DSPS manage to shift their sleep and wake times to appropriate hours. However, in the case of persistent DSPS, it can be a lifelong disorder. Luckily, with digital advances, and remote work opportunities, the social/professional schedules have become more flexible, meaning that individuals with DSPS can live fulfilling lives.
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 difficult to recognize when professional help is needed for DSPS, but there are successful treatment options available for this disorder.
- The Journal of Child Psychology and Psychiatry. Delayed Circadian Rhythm Phase: A Cause of Late-Onset ADHD among adolescents?
- Frontiers in Psychiatry. A literature review of sleep problems and neurodevelopment disorders.
- Science Direct. Delayed Sleep Phase Disorder.