Delayed Sleep Phase Disorder

Do you have trouble falling asleep at a time society at large would consider “normal”? Do you stay up till past midnight before you even consider giving the old shuteye a chance?

If so, you may have delayed sleep phase disorder, a condition which is as annoying as it is incurable.

Delayed Sleep Phase Disorder

While most of the time, adult presence of this condition goes on to be a lifelong problem, it can indeed be managed and its impact on your quality of life completely eliminated.

This is a Dream...

Before we delve any deeper into the ins and outs of delayed sleep phase disorder (DSPD) let us try to conjure up a more or less proper definition of the condition.

Also known as delayed sleep phase syndrome and delayed sleep-wake phase disorder, DSPD is a sleep disorder characterized by the delay of a person’s bedtime, by 2 or more hours. The result of this delay is that the affected person only manages to hit the sack at around 2-3 AM, to then wake up at around noon.

That said, the sleep phases are normal, and unless there is another condition in the picture, the quality of sleep remains satisfactory as well. The biggest issue with this sort of delayed sleep schedule is that it goes against societal norms, and thus it forces its bearers to forcefully modify it, or attempt to do so. Such attempts will result in the sufferer living in a constant jet-lag-affected state. Long story short: it is not pleasant.

DSPD can also be defined as a chronic dysregulation of one’s circadian rhythm.

A far higher percentage of teenagers suffer from DSPD than adults. A typical DSPD-affected teenager will be prone to catching a nap during the afternoon, after which he/she will feel energized and ready to tackle life. This state extends far into the night. In fact, such “night owls” will be exceptionally active, energized and productive even around midnight. The following day though, they will find it nearly impossible to wake up in time for school.

What are the symptoms of DSPD?

Its most obvious symptom is obviously the above-discussed inability to go to bed at the desired time. As specified above, this comes coupled with the inability to wake up at the desired time. The second one of these is considered the most obvious symptom of the condition, since that’s the first clue parents get about the circadian troubles their offspring is facing.

To complete the palette, the above two symptoms are not accompanied by any other sleeping problems. When a DSPD  sufferer is allowed to complete his/her sleep cycle on his/her own terms, he/she will awaken without problems, and the quality of sleep will be adequate as well. This does not mean that DSPD cannot be present together with other sleep disorders, but it usually is not.

Last but not least – especially in sufferers unable to get their desired sleep on their own terms – the condition can unfortunately trigger depression and various behavioral problems. These issues are usually not directly attributable to DSPD, but rather to the attempts made to “correct” it, and to various societal pressures.

What causes delayed sleep phase syndrome?

Unfortunately, the exact causes of delayed sleep phase disorder are not known. What’s science fact at this point is though that it is much more frequent in teenagers than it is in adults and even children. Some 5-16% of this age-group is affected by the condition, compared with around 0.15% in adults. What that means is that it is probably linked to puberty and the changes in one’s circadian rhythm that it triggers.

The behavior is definitely NOT deliberate, although it may indeed seem exactly that at times.

What I can personally tell you is that there are behaviors which can aggravate the condition. I experienced DSPD-like symptoms myself on several occasions, following months of delayed sleep schedule. In my case though, simply putting down work/curtailing other activities around normal bedtime, and going to sleep corrects the problem every time. For a true DSPD sufferer, such an approach does not work.

How to manage DSPD?

There are two main avenues of approach to delayed sleep phase disorder: a non-pharmacologic approach and a medication-based one.

In my opinion the most logical approach to the management of DSPD involves light therapy and darkness therapy (which is about restricting evening light). It is believed (and I personally believe it too) that DSPD sufferers may exhibit a sort of genetic oversensitivity to evening light. Thus, even mild forms of such light stimulate their brains, fooling it into delaying the sleep phase.

In this regard, eliminating all sources of evening light, such as artificial light, computer and mobile phone screens and even wearing goggles that block blue light, is generally considered a good idea. I have personally experimented with this approach and it worked well for me, whenever I had my sleep phase delayed for limited periods of time. Again: I’m not a DSPD sufferer, so my experiments hardly mean anything in regards to the condition.

Light therapy is obviously the opposite of darkness therapy, and as such, it consists of the stimulation of the sufferer’s eyes with light around the time when his/her spontaneous awakening is due. This therapy takes 30-90 minutes, its drawback being that it contributes to the further lengthening of the patient’s morning routine.

Phase delay chronotherapy is another non-pharmacological approach to the management of DSPD, but it is no longer popular, on account of its rather intrusive nature, and the fact that may indeed end up worsening the condition, even triggering non-24-hour sleep-wake rhythm disorder, which is quite a bit worse than “simple” DSPD. Phase delay chronotherapy is about the gradual delaying of the onset of sleep, by around two hours at a time, until the desired bedtime is reached.

Used in a controlled manner, sleep deprivation may be a treatment tool as well. One such treatment path prescribes the staying awake of the patient for a full day and night, after which he/she is put to bed 90 minutes earlier than before. The patient is then required to stick to the new bedtime for a week, after which the process can be repeated.

Other ways to promote more conventional bedtimes call for earlier exercise and earlier mealtimes.

The medication-based approach of delayed sleep phase disorder management is mostly focused on melatonin – no big surprises there…Melatonin is known as a hormone that can influence the circadian rhythm, and taken about an hour before bedtime, it can indeed induce drowsiness. Smaller doses of melatonin can be taken earlier too, in an effort to reset the body’s internal clock.

Melatonin is not side-effect free, but sticking to smaller doses can eliminate most of these side-effects. The bottom line in this regard is that it is certainly worth a shot, if DSPD has a big negative impact on the quality of your life.

While melatonin supplements are widely available, alternative medications can be used for the management of DSPD as well. The drug Rozerem comes to mind here, which is a melatonin agonist (acts in a way similar to melatonin and binds to the same receptors). Science still hasn’t cast a definitive verdict on the suitability of melatonin for DSPD-management though. There are studies out there which confirm the link, while others deny it.

Yet another medication-based solution is presented by drugs used to treat shift-work sleep disorders. Indeed, this disorder shares a many similarities with DSPD, therefore it makes sense that sometimes drugs such as Modafinil are prescribed for sufferers.

Vitamin B12 used to be considered an alternative for DSPD management, but it was later proven to be completely ineffective.

Negative impact of DSPD

Most of the negative impacts of the condition are societal in nature. Someone with DSPD will find it impossible to function at an optimal level, within the daily time-frames required by society. Thusly, such people will often be labeled lazy, incompetent and generally inadequate.

One of the biggest problems is this regard is lack of awareness. DSPD – as weird as that may seem – is extremely difficult to diagnose, and indeed, it seldom gets recognized for what it is. Most of the time, the bare diagnosis contributes enormously to the coping-capacity of a sufferer. Misdiagnoses is also frequent, and it often leads to the administration of psychoactive drugs to patients.

How can I cope with the effects of DSPD?

As said above, if you are properly diagnosed with the condition, you are already on the right path. Working the night or evening shifts at your job can be the solution to your woes, and knowing what you’re dealing with, you can actively seek out such solutions. Working from home is obviously also a potential path to management.

The good news is that DSPD awareness is on the rise. There are indeed schools and universities out there which have begun allowing DSPD-sufferers to take exams at hours more appropriate for their needs.

What is advanced sleep phase syndrome?

ASPD is a circadian rhythm disorder, much like DSPD, but with symptoms that can best be described as the opposites of DSPD’s. People suffering from this disorder will feel extremely drowsy early in the evening (as early as 6 PM), and they go to bed early, only to awaken around 2-3 AM, and not be able to go back to sleep.

The societal implications of this condition are quite similar to those of DSPD, at least on a theoretical level. Due to the actual sleep/wake times involved though, ASPD is without a doubt much less disruptive than DSPD.

ASPD is treated with light- and chronotherapy.

Conclusion

Delayed sleep phase disorder is an incurable condition, often referred to as an “invisible disability.” Given proper diagnosis and management though its disruptive effects on the sufferer’s life can be almost completely eliminated.

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