Ashwin Lewis
Delayed sleep phase disorder, also known as delayed sleep-wake phase disorder (DSWPD) or delayed sleep phase syndrome (DSPS), is a sleep disorder that affects the sleep-wake cycle, causing it to shift to later hours. This disorder is characterised by the inability to fall asleep at a socially acceptable time and difficulty waking up in the morning. While it is more prevalent in adolescents and teenagers due to changes in their circadian rhythm, it is possible for a 10-year-old to experience this disorder as well. If you suspect your child is suffering from this condition, it is recommended to seek advice from a doctor to discuss potential treatment options.
| Characteristics | Values |
|---|---|
| Common in | Teenagers, adolescents, and young adults |
| Symptoms | Staying awake past bedtime, needing to sleep in, difficulty falling asleep, difficulty waking up, daytime sleepiness, trouble focusing, mood swings, low energy, social impairment, academic and behavioral problems, depression |
| Diagnosis | Detailed history of symptoms, physical examination, sleep log, sleep journal, actigraph, sleep study |
| Treatment | Chronotherapy, melatonin supplements, light therapy, improving sleep hygiene, resetting sleep routine |
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What You'll Learn
Symptoms of delayed sleep phase syndrome (DSPS)
Delayed sleep phase syndrome (DSPS) is a disorder in which a person's sleep is delayed by two hours or more beyond what is considered an acceptable or conventional bedtime. The delayed sleep then causes difficulty in being able to wake up at the desired time. For example, a person with DSPS may fall asleep after midnight instead of at 10 pm and then will have trouble getting up in the morning for school or work. People with DSPS may describe themselves as "night owls" or "evening people", but they are not. If you have DSPS, you are unable to regulate when your body tells you to fall asleep.
DSPS is a type of sleep disorder called a circadian rhythm sleep disorder. Circadian rhythm refers to the body's internal clock that tells it when it should wake up and go to sleep. This circadian clock controls many different genes and processes in the body that need to be switched on and off at different times, so it is very important for our health. The body clock is usually synchronized with our environment, but sometimes there is a mismatch, just like when you have jet lag when you travel to a different time zone. However, your body clock won't adjust itself back into the right pattern when you have DSPS as it does with jet lag.
The main symptoms of DSPS include:
- Difficulty falling asleep at a conventional bedtime.
- Difficulty waking up at the desired time.
- Severe daytime sleepiness.
- Trouble with memory, focus, and concentration.
- Behavioural and/or mood changes, like irritability.
DSPS can affect people of all ages, including children and adolescents, although it is particularly common in teenagers. If you think your child may have DSPS, it is a good idea to seek advice from a doctor. A doctor may recommend strategies such as improving sleep hygiene, shifting the body clock to an earlier sleep-wake schedule, or taking melatonin supplements.
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Diagnosing DSPS
Delayed Sleep Phase Syndrome (DSPS) or delayed sleep-wake phase disorder (DSWPD) is a type of sleep disorder called a circadian rhythm sleep disorder. It is characterised by a delayed sleep cycle, where individuals fall asleep and wake up much later than what is considered conventional. This can cause difficulty in waking up at the desired time and can impair a child's functioning during the day, leading to social impairment, academic and behavioural problems, and depression.
DSPS is not a deliberate behaviour, and it is estimated that 7-16% of adolescents exhibit symptoms of DSPS. It is more common in adolescents and young adults, and there is a big difference between a child who wants to stay up and play and one who has DSPS. A child with DSPS will be lying awake because they cannot get to sleep, not because they do not want to go to bed.
If you think your child might have DSPS, you should seek advice from a doctor. A sleep specialist will then evaluate the problem using the following techniques:
- Taking a detailed history of your child's symptoms, including any medical, mental health, or developmental issues.
- Doing a complete physical examination.
- A sleep log kept by parents, caregivers, or the child for several weeks. This helps track your child's sleep patterns and amounts of sleep over an extended period.
- Tracking your child's sleep patterns over two to three weeks using a wristwatch-like device called an actigraph.
- In rare cases, an overnight sleep study may be required if the sleep specialist suspects additional problems such as sleep apnea or excessive movements during sleep.
DSPS can be treated, and the goal is to reset the internal clock to a more normal schedule compatible with the demands of school or work. Treatment methods include:
- Adjustment of sleep schedules: If sleep is delayed by less than three hours, shift bed and wake times earlier in the day. If sleep is delayed by more than three hours, shift bedtime and wake times by two to three hours later each day until the target schedule is achieved.
- Light therapy: Expose the child to a broad-spectrum light source each morning.
- Medication: In some cases, a small dose of melatonin may be prescribed to be taken about an hour before bedtime.
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DSPS treatment options
Delayed Sleep Phase Syndrome (DSPS) is a type of sleep disorder called a circadian rhythm sleep disorder. People with DSPS experience a delay in their sleep schedule of at least two hours, causing difficulty falling asleep and waking up at desired times. This can lead to severe daytime sleepiness, mood swings, and low energy. While DSPS is more commonly seen in teenagers, it can also develop in early childhood.
- Chronotherapy: This technique gradually shifts the individual's bedtime later each night until a normal sleep time is achieved. This method aims to reset the body's circadian clock by slowly delaying bedtime and the sleep period. However, this approach can be challenging to implement, especially during school term time, as it may require sleeping during the day.
- Bright Light Therapy: This approach uses light to gradually shift the individual's sleeping pattern towards a more conventional schedule. Bright light therapy can help reset the body's internal clock.
- Melatonin Supplements: Melatonin is a hormone that plays a crucial role in regulating the body's sleep-wake cycles. Taking melatonin supplements about an hour before bedtime can help individuals with DSPS feel sleepier and shift their internal clock.
- Cognitive Behavioral Therapy (CBT): CBT is a type of talk therapy that can help individuals with DSPS manage their symptoms and improve their sleep habits.
- Sleep Hygiene: Improving sleep hygiene involves creating an optimal environment for sleep. This includes keeping the bedroom cool, dark, and quiet. Reducing exposure to bright light at night can also help, as too much light can disrupt the body's internal clock.
- Gradual Shift in Bedtime: For mild cases of DSPS, shifting the bedtime earlier by 15-30 minutes each night for one to two weeks can help achieve the desired bedtime.
It is important to note that treatment for DSPS is ongoing and requires consistency. While there is no cure for DSPS, effective treatment can improve sleep and reduce symptoms. Seeking advice from a doctor or a sleep specialist is recommended to develop an individual treatment plan.
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DSPS and mental health
Delayed Sleep Phase Syndrome (DSPS), also known as delayed sleep-wake phase disorder (DSWPD), is a type of sleep disorder called a circadian rhythm sleep disorder. This disorder is characterised by a delayed sleep schedule, typically by several hours, which conflicts with daily obligations such as school or work. Children with DSWPD are unable to fall asleep at the appropriate time, usually after midnight, and experience a similar delay in their natural morning wake time, often struggling to become alert before late morning or early afternoon.
DSPS can affect a person's mental health and emotional state. Over 60% of people diagnosed with DSPS experience depression. Patients with DSPS may also exhibit emotional features such as nervousness, lack of control of emotional expression, defensiveness, and inhibition. DSPS can also lead to social impairment, academic and behavioural problems, and substance use disorder. Many people with DSPS overuse caffeine, sedatives, or alcohol to help them stay awake or fall asleep.
If you think your child may be suffering from DSPS, it is advisable to seek advice from a doctor or sleep specialist. A sleep log or sleep diary can be useful for tracking your child's sleep patterns and amounts of sleep over an extended period. Treatment for DSPS aims to "reset" the internal clock to a more normal schedule compatible with the demands of daily life. Treatment options may include chronotherapy, light therapy, or melatonin medication.
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DSPS and substance use
Delayed Sleep Phase Syndrome (DSPS) is a type of sleep disorder called a circadian rhythm sleep disorder. People with DSPS may have trouble falling asleep at their desired bedtime and have difficulty waking up in the morning. This can cause tardiness or missed attendance at school or work.
Substance use disorder (SUD) is a mental health condition characterized by a problematic pattern of substance use that affects one's health, well-being, and quality of life. It can range from mild to severe (addiction) and commonly involves substances such as alcohol, opioids, and marijuana. SUD can impact emotional well-being, relationships, education, and career prospects.
There appears to be a link between DSPS and substance use. Many people with DSPS turn to substances such as caffeine, sedatives, or alcohol to help them stay awake or fall asleep. This can lead to the development of SUD if substance use becomes a problematic pattern.
Additionally, substances can affect the body's natural sleep cycle and circadian rhythm. They can release dopamine, making one feel good, but when the substance wears off, it can lead to withdrawal symptoms, including difficulty sleeping. This can further exacerbate sleep issues for those with DSPS.
Treating DSPS and substance use concurrently is crucial. Healthcare providers can help reset the body's internal clock and improve sleep habits, while also addressing any substance use concerns. Treatment for DSPS may include chronotherapy, light therapy, or melatonin supplementation. SUD is also a treatable condition, and individuals can seek help from healthcare professionals or support groups to manage their substance use.
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Frequently asked questions
Delayed sleep phase disorder (DSPD), or delayed sleep-wake phase disorder/syndrome (DSWPD/DSPS), is a sleep disorder where the sleep-wake cycle is shifted to later hours, causing difficulty falling asleep and waking up early. This can impact daily life, work, school, and social activities.
Symptoms include difficulty falling asleep and waking up early, daytime sleepiness, trouble focusing or paying attention, and feeling depressed or cranky.
Diagnosis involves taking a detailed history of symptoms, a physical examination, and tracking sleep patterns over several weeks using a sleep diary or a wrist-worn device called an actigraph.
Yes, delayed sleep phase disorder can occur in children, although it is more prevalent in adolescents and teenagers. The circadian rhythm changes during puberty, causing delays in the sleep-wake phase.
Treatment aims to reset the internal clock to a more normal schedule compatible with school or work demands. This may involve shifting bed and wake times earlier, light therapy, melatonin supplements, and improving sleep hygiene by avoiding devices with light before bedtime.
