How to Identify and Treat Delayed Sleep Phase Syndrome

If you find yourself struggling to fall asleep at a normal hour, sleeping in until the afternoon, and feeling groggy throughout the day, it’s possible you have Delayed Sleep Phase Syndrome. With this neurological disorder, also known as Delayed Sleep-Wake Phase Disorder, sleep is delayed by at least two hours, although it can be much longer. This circadian rhythm sleep disorder makes it impossible for people to fall asleep at a normal time.

If your sleep is delayed, the time at which you wake is also delayed. While the general population may sleep from 10 p.m.to 6 a.m., people with Delayed Sleep Phase Syndrome might get their most restful sleep from 4 a.m. to 1 p.m. While they get enough sleep, the timing of sleep isn’t ideal and can result in that groggy feeling.

While some may dismiss later sleepers simply as “night owls,” Delayed Sleep Phase Syndrome is completely different. And the exact cause of Delayed Sleep Phase Syndrome? It’s actually unknown, although one idea being floated around by scientists is that people with it don’t operate on the typical 24-hour circadian rhythm.

“Sleep timing is very individual and varies vastly between people,” notes Dr. Nayantara Santhi. “Each of us has a preferred sleep timing. A few of us prefer to go to bed late, a few prefer early bedtime while the vast majority fall in-between.”

“However, there is a rare condition called delayed Sleep Phase Syndrome which results in a very delayed bedtime and waketime. Research suggests that this may occur due to abnormalities in the circadian system (that is in our body clock physiology).”

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Symptoms and Signs of Delayed Sleep Phase Syndrome

The most common symptom that people with Delayed Sleep Phase Syndrome report later sleep and wake times. Other symptoms include falling asleep much later than when you went to bed and being unable to wake up at the desired time.

If you feel like you may have Delayed Sleep Phase Syndrome, it’s important to note that these symptoms need to happen on a consistent basis. While people with Delayed Sleep Phase Syndrome struggle to fall asleep, they do achieve a normal amount of sleep. The big difference is that they do so on their own schedule.

If it’s difficult to wake up in the morning, it’s possible your body doesn’t adhere to a typical sleep cycle. If you have excessive daytime sleepiness for an extended period of time, it’s possible you have Delayed Sleep Phase Syndrome. Sleep scientists have also compared the feeling of living with jet lag. The big difference is that jet lag goes away, whereas Delayed Sleep Phase Syndrome is here to stay.

What is important to recognize is that Delayed Sleep Phase Syndrome is not being a “night owl.” Someone acting as a “night owl” is more of a choice. A night owl is able to fall asleep earlier if they’re tired. With Delayed Sleep Phase Syndrome, you can feel tired and not actually be able to fall asleep. In fact, you might not fall asleep until the late morning.

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Causes of Delayed Sleep Phase Syndrome

While the causes of Delayed Sleep Phase Syndrome are not completely known, scientists have been able to narrow down the potential reasons. Ultimately, it is a disorder of your body’s internal clock. Most people operate on a 24-hour clock, which coordinates with the rising and setting of the sun.

One possible explanation is that Delayed Sleep Phase Syndrome could be a reduced response to light in the morning. This means your body isn’t properly reacting when it gets hit with warm sunlight in the early morning. A general lack of morning sunlight exposure could also result in having a hard time waking up. Scientists also believe it could be a reduced response to the lack of light in the evening. If your response is reduced or delayed, it would take much longer to fall asleep. One final possibility is that it is an overstimulated response to longer exposure to light. Living in a place with lots of sunlight or a place with long summer hours can make this disorder even more difficult to live with.

Scientists have also drawn a potential link with clinical depression, even though Delayed Sleep Phase Syndrome is a neurological issue and not a psychological one. Having trouble sleeping could result in a decrease of serotonin, which helps regulate people’s moods.

While not a direct cause, people diagnosed with obsessive-compulsive disorder (OCD) are diagnosed with Delayed Sleep Phase Syndrome at a much higher rate than those without OCD. It has also been shown to develop after a serious head injury.

Overall, there is no clear, specific cause that scientists can point to. Scientists have begun to identify the important genes that it is associated with, which means that Delayed Sleep Phase Syndrome could be hereditary.

Impact of Delayed Sleep Phase Syndrome

Delayed Sleep Phase Syndrome can be quite harmful to a person, especially someone who is trying to hold down a normal job. People with the disorder have difficulty falling asleep, usually feeling quite restless. This is because their body clock is set differently than most people.

If you have Delayed Sleep Phase Syndrome, you don’t usually fall asleep until 2 a.m. or later. This results in people being incredibly tired if they are forced to wake up with a normal 9 to 5 schedule. In the long run, this can lead to sleep deprivation if they can’t fix their sleeping pattern.

Unsurprisingly, people with Delayed Sleep Phase Syndrome are often late to work. A job that starts at 9 a.m.would feels like a job that starts at 5 a.m. for most people. Not to mention, people with the syndrome also report feeling sleepy during the day while on the job.

A lack of a good sleep schedule can lead to depression. To counteract this, people with Delayed Sleep Phase Syndrome often try to “make up” sleep on weekends or days off. Almost all sleep scientists agree that it isn’t possible to catch up on sleep. By sleeping in on the weekend, the inconsistent sleep schedule likely worsens their symptoms throughout the week.

Diagnosing Delayed Sleep Phase Syndrome

In order to diagnose Delayed Sleep Phase Syndrome, it’s important to seek professional help. It would be difficult to do so by yourself, as it’s not easy to monitor your own sleep. A somnologist, or sleep doctor, would likely choose one of three ways to diagnose a person who might have Delayed Sleep Phase Syndrome.

The first way is through a process called actigraphy. This requires you to wear a small sleep monitor. These are often a wristwatch that tracks your sleep and movement during sleep. While helpful for tracking how you sleep, actigraphy may not lead to the most accurate data of when you actually fall asleep.

A somnologist may also ask you to keep a sleep log. This would require you to track what time you wake up and when you went to bed.  One obvious problem is that a person cannot track what time they fall asleep, so a sleep log would likely be an initial step in the diagnosis. However, identifying your sleep pattern and sleep duration can be a very helpful first step for your doctor.

Finally, your doctor might recommend a polysomnogram. This requires you to spend a night at a sleep center. You would bring your own clothing and follow your normal routine prior to going to bed. You are essentially put in a hotel room to complete a polysomnogram. While not quite as comfortable as being in your own home, these tests still help doctors better understand your sleeping issues.

The big difference between an overnight stay and actigraphy or a sleep log comes with the sensors that the doctors use. They place sensors on your scalp, temple, chests, and legs in order to track you while you sleep. These monitor your brain activity, heartbeat, oxygen levels, eye movements, and breathing. All of these produce helpful information for doctors to use. These overnight experiences aren’t just for Delayed Sleep Phase Syndrome. A polysomnogram is actually used to diagnose most sleep disorders.

Treating Delayed Sleep Phase Syndrome

While not perfect, there are potential treatments for Delayed Sleep Phase Disorder. A good first step to do at home is the work on improving your sleep hygiene. Having daily routines and controlling environmental factors can make this much easier. Making sure you have a consistent sleep schedule can be beneficial for everyone. Be sure to seek professional advice before trying light therapy or chronotherapy.

Improve Sleep Hygiene

• Follow a consistent sleep routine so you go to bed and wake up at a specific time each day, even on weekends and days off. While a schedule likely won’t fix Delayed Sleep Phase Syndrome, it will help reduce any irregularities you may experience.
• Limit your caffeine consumption. The stimulant often keeps individuals awake longer than desired.
• Avoid exercising or any rigorous movement prior to bed. Working out causes your heart rate to spike and core temperature to rise, making it more difficult to relax and drift off after the fact. It’s best to exercise early in the day, or at least 4 or 5 hours before bedtime.
• Keep the lights dim. This helps to relax your body and get it ready to fall asleep.
• Ditch your electronics or throw them on night mode. The blue light from screens mimics sunlight and impedes melatonin—the sleep hormone—production, keeping your brain active and awake.

Light Therapy

A doctor may also recommend bright light therapy as a treatment method for Delayed Sleep Phase Syndrome. Light therapy is exposure to light that is brighter than your average indoor light. This would require the use of a light box for a specific amount of time every day.

These boxes contain hundreds of bright lights that you sit next to. These are often used to treat Seasonal Affective Disorder and jet lag. They’re used because it’s thought to help fix a disruption in your body’s circadian rhythm.

Light therapy is used in the morning to advance circadian rhythm. Your circadian rhythm is the internal process that regulates the sleep-wake cycle. In most people, it repeats on each rotation of the Earth roughly every 24 hours. Light therapy likely won’t fix the neurological disorder, but it helps treat some of the symptoms.

Chronotherapy

One final treatment type is chronotherapy. Chronotherapy intentionally delays a person’s sleep schedule by hours on successive days. Participating in this treatment is not ideal for adults because most people can’t take off a week of work. To make this demanding treatment easier, doctors often do it at a sleep center and not in a patient’s home.

Chronotherapy follows a strict sleeping regimen for a week, attempting to reset a person’s internal clock. It is most often used in teens, likely during the summer. In order for it to be carried out correctly, an adult needs to be there to help teens fix their sleep schedule. This makes it more challenging for adults who may have a partner who has to go to work.

A chronotherapy schedule requires moving back a person’s bedtime by 2 to 3 hours each day until they reach their desired bedtime. Ideally, the person with Delayed Sleep Phase Syndrome would start at their usual bedtime. Let’s say that’s 5 a.m. From there, they would follow the schedule below until they are able to maintain a consistent sleep and wake time.

• Day 1: Bedtime 5 a.m.
• Day 2: Bedtime 8 a.m.
• Day 3: Bedtime 11 am
• Day 4: Bedtime 2 p.m.
• Day 5: Bedtime 5 p.m.
• Day 6: Bedtime 8 p.m.
• Day 7 and after: Bedtime 11 p.m.

Common Questions

Is Delayed Sleep Phase Syndrome a disability?

In its most severe form, Delayed Sleep Phase Syndrome is a disability. It can lead to a loss of a job due to its most severe symptoms. If a person is too groggy or sleepy to complete their job, or they show up late too often, it’s possible they could lose it. It’s very difficult for people with Delayed Sleep Phase Syndrome to set an earlier schedule, and so the use of professional help is important to overcome it.

How common is Delayed Sleep Phase Syndrome in adults versus teens?

Delayed Sleep Phase is most common in teens or young adults. They often grow out of it, especially once their body is finished going through puberty. Statistically, 7 to 16 percent of teens have Delayed Sleep Phase Syndrome. This is compared to .17 percent, or 1 in 600, adults who have it. While it mostly goes away, it can be incredibly debilitating for adults who try to function within a normal 9 a.m. to 5 p.m. schedule.

How do you live with Delayed Sleep Phase Syndrome?

The best thing to do is to seek treatment for Delayed Sleep Phase Syndrome. You should also make sure your employer and/or school is aware that you have it. A good start with treating it is to log times and see when you’re going to sleep and waking up. This can be helpful to show your doctor. You should also avoid filling mornings with important activities if possible.

How do you test for Delayed Sleep Phase Syndrome?

A sleep log can help. In the log, you can write down what time you went to bed, when you woke up, and how rested you feel. It would be beneficial to stick to a schedule and keep track of this information. That being said, the best thing to do is see a professional. They will likely set up an overnight stay at a sleep center.

What is the difference between Delayed Sleep Phase Syndrome and Insomnia?

Insomnia is the habitual lack of sleep. This means that a person with insomnia does not sleep much, if at all. Delayed Sleep Phase Syndrome allows for sleep to occur, but it happens much later than what is considered normal. A person who has Delayed Sleep Phase Syndrome can still get the recommended amount of sleep. It’s just that they need to do so at a different time than most other people.

What are good accommodations for Delayed Sleep Phase Syndrome?

A flexible work schedule that focuses on accomplishing projects rather than hourly work is a good place to start. If you’re a teenager, online school would be a good option. You also want to avoid morning responsibilities if possible, especially meetings or classes.

A diet that avoids large spikes in caffeine at night can be beneficial. You would also want to reduce the amount of visual stimulants prior to going to bed. Turning off electronics or anything that generates blue light an hour before going to bed can be helpful. In terms of work, a job on the night shift can be helpful. That being said, it’s not the best long-term solution.

Conclusion

If you’re an adult, Delayed Sleep Phase Syndrome can be really difficult to live with. It’s important that you seek out medical help in order to get your sleep problems addressed. The difficulty stems from having to operate outside of society’s typical hours. As a result, there are fewer professional and social opportunities.

If you’re a teen, the good news is there’s a good chance that it will eventually go away. The short term solutions include trying to adjust your schedule and avoid important activities in the morning. This may be difficult for most teenagers who have to go to typical high schools. The best advice then is to seek medical advice from a professional who can try to help you overcome the disorder.