Ashwin Lewis
Delayed sleep phase disorder, also known as delayed sleep phase syndrome (DSPS) or delayed sleep-wake phase disorder, is a condition that affects a person's ability to fall asleep and wake up at socially acceptable times. This disorder is characterised by a delay of two hours or more in an individual's sleep-wake cycle compared to conventional sleep times. The exact cause of DSPS is not well understood, but it is associated with disruptions to the body's circadian rhythm or biological clock. Diagnosis and treatment of DSPS are specific to the disorder and differ from those of insomnia, focusing on addressing the timing problem and realigning the circadian rhythm.
| Characteristics | Values |
|---|---|
| Formal Name | Delayed Sleep-Wake Phase Disorder |
| Common Names | Delayed Sleep Phase Disorder (DSPD), Delayed Sleep Phase Syndrome (DSPS), Delayed Sleep Phase Type (DSPT), Circadian Rhythm Sleep Disorder |
| Cause | Misalignment between the patient's sleep-wake pattern and the pattern that is desired or regarded as the societal norm |
| Diagnosis | Actigraphy, Dim Light Melatonin Testing (DLMO), Polysomnography (PSG or sleep study), Multiple Sleep Latency Test (MSLT) |
| Treatment | Bright Light Therapy, Adjusting Bedtime Schedule, Medication, Melatonin Supplements, Behavioural Interventions |
| Prevalence | 7-16% among adolescents and young adults |
| Development | May develop in early childhood but most commonly emerges or worsens during adolescence |
| Severity | Severe to absolute inability to advance the sleep phase to earlier hours |
| Symptoms | Severe daytime sleepiness, changes to mood and behaviour, occasional non-circadian days |
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What You'll Learn
Diagnosis and treatment
Delayed sleep-wake phase disorder (DSWPD) 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. Diagnosis and treatment can help reduce the effects of DSWPD and realign the circadian rhythm with the ideal sleep schedule.
Diagnosis
To diagnose DSWPD, a healthcare provider or sleep specialist will ask the patient to describe their symptoms and keep a sleep diary or sleep log. This log helps track sleep patterns and amounts of sleep over an extended period. In addition, providers might use the following techniques:
- Taking a detailed history of symptoms, including any medical, mental health, or developmental issues.
- Performing a complete physical examination.
- Tracking sleep patterns using a wristwatch-like device called an actigraph for seven to 14 days.
- Conducting a dim light melatonin test (DLMO), polysomnography (PSG or sleep study), or a multiple sleep latency test (MSLT).
Treatment
The goal of DSWPD treatment is to align the circadian rhythm with target sleep and wake times. Treatment typically involves:
- Improving sleep hygiene by avoiding devices with light, such as cell phones and TVs, in the hours before bedtime.
- Bright light therapy, which involves exposure to bright light in the first one or two hours of the morning to advance the circadian rhythm.
- Adjusting sleep schedules by gradually shifting bed and wake times earlier or later until the desired bedtime/wake-up schedule is achieved.
- Melatonin supplements, which can help shift sleep time earlier when taken late in the day.
- Cognitive behavioural therapy (CBT) for insomnia and DSWPD, as well as general sleep and circadian psychoeducation.
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Circadian rhythm disorders
Delayed sleep phase disorder, also known as delayed sleep phase syndrome (DSPS) or delayed sleep-wake phase disorder, is classified as a circadian rhythm disorder. Circadian rhythm disorders are sleep disorders that affect the timing of biological rhythms, including sleep, the peak period of alertness, core body temperature, and hormonal cycles.
DSPS is characterised by a delay in a person's sleep-wake cycle of two hours or more compared to conventional sleep times. This means that individuals with DSPS struggle to fall asleep at a socially acceptable time and subsequently have difficulty waking up for their daily commitments. For example, a person with DSPS may fall asleep after midnight and then struggle to wake up in time for work or school the next day. This disorder is not due to staying up late for social reasons and is not related to other sleep disorders such as sleep apnea or insomnia.
DSPS is thought to be caused by a disruption in a person's circadian rhythm or biological clock. This internal body clock is regulated by various factors, including light exposure and hormonal changes. For instance, exposure to bright light in the evening, especially from screens, can delay the body's circadian rhythm. Similarly, the stress hormone cortisol, which contributes to wakefulness and energy levels, follows a daily pattern that peaks in the morning. Maintaining a stable circadian rhythm is essential for overall health and well-being, and disruptions have been linked to various issues, including sleep disorders, mental health conditions, and an increased risk of chronic physical health conditions.
The diagnosis of DSPS is a point of contention among specialists, as circadian rhythm disorders and melatonin-related disorders are not yet fully understood by modern medical science. To diagnose DSPS, a healthcare provider may ask a patient to wear a device called an actigraph, which records cycles of rest and activity, for up to two weeks. Other diagnostic tests may include dim light melatonin testing, polysomnography (a sleep study), and a multiple sleep latency test.
Treatment for DSPS aims to realign the patient's circadian rhythm to a more conventional schedule. This can include light therapy, where exposure to bright light in the morning helps shift the circadian cycle earlier, and avoiding light exposure in the evening. Other treatments may include behavioural interventions, such as establishing a consistent sleep routine, avoiding stimulants, and creating a comfortable sleeping environment. In some cases, medication may be prescribed to help manage symptoms.
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Symptoms
Delayed sleep phase disorder (DSPD), also known as delayed sleep phase syndrome (DSPS), is characterised by a delay in a person's sleep-wake cycle compared to societal norms. This disorder affects the timing of biological rhythms, including sleep, peak alertness, core body temperature, and hormonal cycles.
- A person with DSPD may fall asleep significantly later than the conventional bedtime, often after midnight or in the early morning hours, and consequently, have difficulty waking up at the desired time. This delay in the sleep schedule is typically by two hours or more.
- The inability to fall asleep at a conventional time is accompanied by an inability to wake up at a socially acceptable time, leading to impairment in daily routines, social life, and occupational functioning.
- DSPD can cause severe daytime sleepiness, affecting an individual's focus and performance during the day.
- Changes in mood and behaviour are also associated with DSPD, and there may be links to mental health conditions such as anxiety and depression.
- The disorder can lead to occasional "non-circadian days," where an individual may skip sleep for an extended period, followed by a prolonged sleep period lasting 12 to 18 hours.
- DSPD is often associated with an unusually long circadian rhythm, a reduced response to the resetting effect of daylight, and increased sensitivity to evening light, which further delays the sleep phase.
- Individuals with DSPD may experience hormonal changes, such as alterations in the daily pattern of cortisol, the stress hormone, which can impact wakefulness and energy levels.
- DSPD can develop into a non-24-hour sleep-wake disorder, a severe condition where the individual's sleep phase progressively delays each day.
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Impact on daily life
Delayed Sleep Phase Disorder (DSPD), also known as Delayed Sleep Phase Syndrome (DSPS), is a condition that affects the timing of biological rhythms, including sleep, the peak period of alertness, core body temperature, and hormonal cycles. The disorder causes a person's sleep to be delayed by two hours or more beyond conventional bedtime. This delay can significantly impact various aspects of daily life, including:
Social life and relationships
The impact of DSPS on social life and relationships can be significant. The condition often leads to a person being labelled as a "night owl", which can create a sense of social isolation from those who follow more conventional sleep schedules. Social activities, events, and gatherings typically occur during the day or early evening, and people with DSPS may struggle to attend or participate fully due to their delayed sleep schedule. This can result in missed opportunities for social connection and a sense of exclusion.
School, work, and occupational functioning
The delayed sleep phase can make it extremely challenging for individuals to adhere to the typical schedules required for school or work. They may frequently arrive late or struggle to stay awake during the expected hours of productivity. This can lead to academic or professional difficulties, including poor performance, absenteeism, or challenges in finding and maintaining stable employment.
Mental health and well-being
DSPS can have a considerable impact on mental health and overall well-being. The disorder can cause changes in mood and behaviour, with individuals experiencing increased symptoms of anxiety and depression. The social and occupational challenges associated with DSPS can further contribute to these mental health concerns. Additionally, the chronic fatigue resulting from disrupted sleep can lead to irritability, difficulty concentrating, and decreased motivation, further affecting various aspects of daily life.
Physical health
The disruption of the circadian rhythm due to DSPS has been linked to an increased risk of developing chronic physical health conditions. These include obesity, diabetes, cardiovascular disease, and certain types of cancer. The exact mechanisms behind these associations are not fully understood, but the impact of DSPS on the body's natural rhythms and hormonal cycles may play a role in the development of these health conditions.
Treatment and management
The impact of DSPS on daily life can be mitigated through treatment and management strategies. Bright light therapy, melatonin supplements, behavioural interventions, and medication can help reset the internal clock and improve sleep patterns. Establishing a consistent sleep routine, avoiding stimulants, and creating a comfortable sleeping environment are also recommended. Treatment for DSPS aims to realign the circadian rhythm with more conventional sleep schedules, improving an individual's ability to participate in daily activities and lead a healthier life.
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Prevalence and demographics
Delayed sleep phase disorder (DSPD), or delayed sleep-wake phase syndrome, is characterised by the inability to fall asleep and difficulty waking up on time. It is a circadian rhythm disorder, with the sleep-wake cycle shifted to later hours. The true prevalence of DSWPD is hard to estimate due to varying diagnostic criteria and assessment methods, as well as the challenge of differentiating between extreme evening chronotypes and DSWPD.
DSWPD is more prevalent in young men and middle-aged women, although overall, there is no significant difference between genders. It is also quite common in adolescents and teenagers, with estimates ranging from 7% to 16% in this age group. The circadian rhythm naturally changes during the teenage years, causing delays in the sleep-wake phase. The onset of melatonin, the sleep hormone, occurs about an hour later in teens than in adults. Furthermore, 90% of adults with DSWPD report that their symptoms began in childhood or adolescence.
A recent small Swedish study found a DSWPD prevalence of 4.6% in adolescents and young adults (ages 16-26). In comparison, a study from Norway in 1983 reported a much lower prevalence of 0.17%. A more recent population-based study in New Zealand, evaluating adults aged 20-59, found the prevalence to be between 1.51% and 8.90%, depending on the definition used.
DSWPD is associated with various physiological, genetic, psychological, and behavioural factors. It is also linked to specific biological traits, socio-psychological backgrounds, sleep hygiene problems, and comorbid psychiatric diseases. The presence of elevated anxiety levels and absenteeism has been observed, with higher rates of school or work absence in those with DSWPD. Depression is also prevalent in patients with DSWPD, with up to 64% of affected individuals experiencing depression.
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Frequently asked questions
Delayed sleep wake phase disorder, also known as delayed sleep phase syndrome (DSPS) or delayed sleep-wake phase disorder, is a disorder that affects a person's ability to fall asleep and wake up at conventional times. The sleep disorder is characterised by a delay of two hours or more in a person's sleep cycle compared to societal norms.
The exact cause of delayed sleep wake phase disorder is not entirely understood. However, it is believed to be related to a disruption in a person's circadian rhythm or biological clock. This can be influenced by factors such as hormonal changes, light exposure, and underlying sleep disorders.
Delayed sleep wake phase disorder is typically diagnosed through a combination of methods, including sleep diaries, actigraphy monitoring, overnight sleep studies, and laboratory tests. These methods help track sleep patterns, activity levels, and circadian rhythms to differentiate DSPS from other sleep disorders.
Treatment for delayed sleep wake phase disorder aims to realign the patient's circadian rhythm to a more conventional schedule. This can include light therapy, behavioural interventions such as establishing a consistent sleep routine, and in some cases, medication. Consistency in treatment is crucial for success.
