Delayed sleep phase syndrome
Delayed sleep phase syndrome or DSPS is a sleep disorder characterized by going to bed late at night—at least two hours after most people go to sleep. Because these are often people who need to get up at a reasonable hour, they are often chronically tired during the day and have a hard time becoming fully awake when the alarm goes off.
This is a disorder primarily of childhood and adolescence; however a person can suffer from DSPS at any age. The age at onset is usually childhood, however. These are people who often are called night owls because they do their best work and function best during the hours of approximately 10:00 pm and 1:00 am. They feel no urge to fall asleep until at least midnight or later no matter how much recent sleep they have had. Sleep/wake logs of these kinds of people show that they suffer most during the weekdays when they have to get up in the morning but allow themselves to sleep in on the weekends, often as late as the middle of the afternoon following a late night up
Causes of DSPS
No one really knows what causes this type of sleep disorder but it is relatively common, affecting 7-16 percent of teenagers. It usually gets worse after puberty when the internal sleep-wake cycle is affected by the growing person’s hormones and a bad cycle of going to bed late and struggling to awaken in the morning is set up.
Symptoms and Signs of Delayed Sleep Phase Syndrome
These people often feel they have insomnia and cannot go to bed at a socially-acceptable time. It is made worse by stressors brought on by their peers, internet-related activities, school work and staying up to talk to like-minded friends who also tend to suffer from DSPS. Because they still need to awaken at a reasonable hour for work and for school, this is the most frustrating time for the adolescent and their parents when trying to raise the patient for daytime activities. Sleep deprivation is usually more prominent on the week days and better on the weekends.
Scientists have found abnormalities in these people’s melatonin spike. Rather than spiking early in the evening, the level of melatonin spikes later on in the nighttime with leftover elevations in melatonin during the waking hours (especially in the morning) so that getting up is especially hard.
When sleeping, most who suffer from DSPS sleep well at night when they do fall asleep and don’t find themselves getting up frequently at night. It is as though their sleep-wake cycle naturally is shifted toward later hours getting to sleep and later hours of waking up spontaneously without the use of an alarm system to awaken them. When they get up from a night’s sleep in which they are allowed to wake up when they want to, most report feeling completely refreshed and suffer from no real daytime somnolence. It is only when DSPS interferes with socially-acceptable patterns of sleep that the person suffers from being too sleepy during the day.
DSPS is often associated with behavioral problems and depression. These are teens who miss school more often than others and do more poorly in school than their peers. They may drift into patterns of using excessive amounts of caffeine, alcohol or depressants like sedatives in an attempt to override what the body and brain naturally want to do—which is to go to sleep late and wake up late in the morning.
The Diagnosis of DSPS
The diagnosis of DSPS is strictly related to symptoms the patient has. Often the doctor will have the patient keep a brief sleep and wakefulness log which will show the pattern of late nights awake and sleepy or late mornings awake. Sometimes, the doctor will schedule the patient for a sleep study or polysomnogram in which the patient sleeps at a sleep laboratory to better identify the pattern. There is no practical way of measuring the levels of melatonin in the system and so this is reserved for research studies on the condition.
The Treatment of DSPS
DSPS can be treated without medications by developing a set of good sleep habits. Try to keep a set time to go to bed at night that will give you between 7 and 9 full hours of sleep. Do not try to push it by using sedatives, stimulants, nicotine or caffeine and make an attempt to have the same sleep-wake cycle on the weekends as well as on the weekdays. Keep your room cool, which promotes sleep and avoid doing activities that stimulate your system during the late evening hours, such as video games and watching television.
Try shifting your nighttime sleep time by fifteen minutes every few days or so that you eventually reach a more beneficial pattern of sleep. Talk to a sleep specialist about when the optimal time is to go to sleep in order to awaken refreshed the next morning. Other people just give into the symptoms and get up later during the day as their schedule allows. It is not a disorder if it doesn’t somehow interfere with the pattern of your wakeful activities.
Try to stay on task, persisting in forcing yourself to gradually approach a normal sleep pattern. Keep a regular daytime schedule in which you are awake during daytime hours and sleep well at night. Do not take late afternoon naps which only further decrease the level of fatigue when the bedtime hour approaches. Wake up at the appropriate time, even if you have slipped and stayed up late the night before.
There is a therapy using natural bright light in which you purchase a special box that emits natural light. Expose the child or teen to the bright light for about one half hour in the morning. This is in an attempt to reset the body’s natural wake-sleep cycle. Lessen the exposure to bright light in the evening, avoiding light when it is time to sleep. Try not to play video games, use your cell phone or watch intense television programs right before retiring for the night.
Some people use melatonin in the evenings to force the natural sleep-wake cycle to include sleeping earlier in the nighttime and getting up refreshed in the early morning.