Delayed sleep phase syndrome (DSPS) is a condition in which someone’s sleep is delayed by 2 or more hours beyond the regular acceptable or conventional bedtime. This delay in falling asleep produces challenges when waking up at the desired moment. For instance, rather than falling asleep at 10:00 p.m. and waking at 6:30 a.m., a youngster with DSPS will fall asleep well after midnight and have great trouble getting up in time for school.
Most adolescents and children with DSPS describe themselves as “night owls” and claim they work operate best or they are most alert during the twilight or night hours. If they were to keep a sleep log, it would show short sleep periods through the school/work week (with few or no awakenings throughout the night) and long sleep-ins (late morning to mid-afternoon wake up times) on the weekend.
What produces delayed sleep phase syndrome (DSPS)?
The exact reason for this disorder is not entirely understood. However, approximately 7% to 16% of adolescents have DSPS, making it a widespread disorder. Scientists think DSPS may be an excessive response to the regular shift in the internal clocks that is seen in youths after puberty. It is imperative to recognize that this is not deliberate behavior, but that certain habits can make this condition worse. DSPS most generally occurs during adolescence, but cases have been recorded during childhood.
What are the symptoms and signs of DSPS?
Symptoms of DSPS include:
Inability to fall asleep at the desired time. This usually presents as insomnia complaints. It may be heightened by the social pressures adolescents feel to stay up late (homework, cell phone, internet use).
Inability to wake up in the desired timeframe and excessive daytime sleepiness. Usually this is the most prevalent complaint since it is more readily evident to parents than nighttime insomnia. Due to the delay in falling asleep and yet still requiring to get up at the time needed for work or school, children or teenagers with DSPS often encounter excessive daytime drowsiness as a result of not getting enough sleep (most evident on weekdays). The postponed rhythm is coupled with a delay in the cycle of the night hormone melatonin, which remains in the morning and makes it more difficult to wake up.
Generally no other sleep problems. If uncomplicated by other sleep disorders, children and adolescents with DSPS sleep well throughout the night with few or no awakenings once they fall asleep. They suffer from a shift in their internal clock or sleep-wake cycle – pushing it later by 2 or more hours. Sleep maintenance is not an issue. When allowed freedom to keep their delayed bed and wake times, they wake up without help, refreshed and without any problems with sleepiness.
Depression and behavior problems. Children and adolescents with DSPS may experience depression and other psychiatric problems including behavioral problems as a result of daytime drowsiness and missing school. Daytime drowsiness can also lead to a lowered academic performance from missed school days or tardiness and inattention. Dependency on caffeine, sedatives or alcohol may also be seen.
How is delayed sleep phase syndrome (DSPS) diagnosed?
DSPS is determined based solely on a classification of the symptoms and sleep logs. Sometimes a non-invasive wrist-watch-like device called an autograph might be used to confirm rest-activity rhythms. An overnight sleep study (polysomnogram) may be recommended to rule out the presence of any other sleep disorders if the history is suggestive. Sophisticated tests of melatonin or core temperature rhythms are generally reserved for research purposes.
Good sleep habits. Children and teenagers with DSPS need to do as much as they can to develop and support good sleep habits and a steady sleep schedule. Practices should include going to bed and waking up at the same times on weekends as on weekdays; avoiding caffeinated products (eg, coffees, teas, colas, some non-cola pops, energy drinks, chocolates, and some medications [Excedrin®]); avoiding other stimulants and products that can disrupt sleep (eg, alcohol, sleeping pills, nicotine); maintaining a calm, quiet and comfortable bedroom; and avoiding activities before bedtime that are stimulating (eg, telelivison and computer games).
Shifting the bedtime schedule. Treatment for DSPS can include one of two methods: developments or delaying the internal clock.
Advancing the internal clock. This method moves the bedtime a bit earlier on each successive night until the desired bedtime is reached. For example, setting the bedtime at midnight on one night, 11:45 p.m. on the next night, 11:30 p.m. on the following night and so on. This is facilitated by concomitantly moving the wake time to allow this transition to occur with more control. These methods are best individualized with the help of a sleep specialist.
Delaying the internal clock (“Chronotherapy”). This method moves the bedtime sequentially 1-3 hours or later on successive nights until the desired bedtime is reached. This requires several days free from social activities and may be best attempted during an extended school break or vacation period. The speculation behind this approach is that it is much simpler for the body to change to a later bedtime than an earlier one. Again, this is best completed with advice from a sleep specialist.
Staying motivated to stick with the schedule. It is especially imperative not to lose sight of the goals throughout the holidays and weekends. Adhering to strict bed and wake times retains the body’s clock under control but does not “cure” the tendency for postponed sleep phase. Once the desired bedtime/wake time is reached, your child or teenagaer needs to stay motivated and adhere to going to bed at the desired bedtime on a nightly basis in order to reset the innate or internal clock. Only after several months of sticking to the schedule can there be some versatility allowed on special occasions. Nonetheless, efforts should be made to wake up close to the prescribed wake time to keep the rhythm going, regardless of when the adolescent goes to sleep.
Bright light therapy. Some physicians prescribe bright light therapy, which requires the purchase of a special light box. Exposing your child to bright light for roughly half an hour in the morning helps to reset the body’s internal clock. Decreased susceptibility to bright light in the evening also helps. Your sleep specialist /physician will be able to suggest commercially available light boxes and the correct method of use.
Avoidance of light at night. Any screen time with a backlight (handheld devices, computers, TV, etc.) can probably delay the sleep cadence and make it hard to go to sleep. These should be avoided in the few hours prior to bedtime, especially when trying to shift the rhythm.
Medications. Melatonin or other natural sleep-inducing drugs are another option that may be tried with the help of a sleep specialist.