Delayed Sleep Phase Syndrome (DSPS): Causes, Symptoms, and Treatments 

Sleep disorders, though mostly common, can complicate one’s life. Delayed Sleep Phase Syndrome (DSPS and also known as delayed sleep-wake phase disorder) is a fairly common sleep disorder.

DSPS is characterized by a sleep pattern that is “delayed” by two or more hours beyond socially acceptable or conventional bed time. This is caused by a delayed timing in the body’s internal sleep clock or circadian rhythm. Usually those suffering from DSPS fall asleep later and wake up later in the morning.

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According to sleep researcher, Dr. Renske Lok, “Humans have an inner timekeeping system that guides us to sleep at night and be awake and alert in daytime. This biological clock has a rhythm of approximately, but not exactly 24 hours. When this rhythm is longer than 24 hours,  the internal clock time (dictated by the biological rhythm) does not correlate to actual clock time, resulting in delayed sleep and wake times.”

Currently, if treatment for DSPS has failed, Section 504 of the American Disabilities Act recognizes it as a disability.

Causes

Though common, it is currently unknown Verified Source Healthline Offers well-researched articles on all areas of health, and every post is peer-reviewed by a team of medical experts. View source what causes DSPS. Recent research shows that there may be certain genetic factors that play a role in the pathogenesis of DSPS, including a common genetic mutation that impacts cryptochrome proteins. Cryptochrome proteins are 1 of 4 main clock proteins.

For those who suffer from DSPS, investigators have found that two of the proteins form a complex that turns on the genes for the other two proteins. Essentially, the activity of the first pair is repressed – the feedback loop is key to the body’s biological clock. The mutation causes a small segment of the protein to be left out and this interference causes issues with sleep.

Due to the genetic history link, doctors may ask for medical history and may look for links in family history to DSPS and other sleep disorders.

According to the American Sleep Association, DSPS often develops in adolescence but continues through adulthood. Roughly 7-16% of adolescents are impacted, primarily due to:

• Social pressures from school
• Excessive computer or phone usage
• Media/TV consumption
• Changes in hormones

Some even attribute DSPS to excessive jet lag, Verified Source Cleveland Clinic Ranked #2 hospital by U.S. News & World Report and one of the largest academic medical centers in America. The Cleveland Clinic serves patients from all over the world. View source due to long air travel time from the home destination and traveling between different time zones.

A 2019 study Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source also showed that this condition is more prevalent in young men and in middle aged women, but overall, there is no significant difference between genders.

There are a number of signs and symptoms that individuals may experience before being diagnosed with DSPS.

• Difficulty Falling Asleep: The most common is difficulty falling asleep which often presents itself as insomnia complaints, unless going to bed very late. Typically, most people with DSPS can’t fall asleep until after midnight and usually between the hours of 2 a.m. and 6 a.m.
• Difficulty Waking Up: Because most people with DSPS don’t fall asleep until late, they struggle to get up in the morning because their internal clock is not producing alerting signals yet and sleep in late. Some even find themselves nodding off during the day. Disruption in the sleep cycle can lead to exhaustion and grogginess.
• Depression and Behavioral Problems: Sleep is crucial to maintaining a healthy and active lifestyle. In the absence of good sleep health, many children and adolescents with DSPS struggle to perform or concentrate in school (and get lower grades), work, or extracurricular activities throughout the day.

DSPS can cause sleep deprivation or inconsistent sleeping patterns which has (in the long-term) a greater impact on other aspects of the body, including:

• Lowered immune response Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source
• Anxiety disorders Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source
• Weight gain Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source
• Fibromyalgia Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source
• Diabetes Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source
• Metabolic syndrome Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source
• Hypertension Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source
• Coronary heart disease Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source
• Schizophrenia Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source
• Autism Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source
• Depression Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source
• Cancer Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source

Diagnosis

There are a few ways in which DSPS can be diagnosed.

Polysomnography

If a doctor suspects that one has a different sleep disorder, he or she may order a polysomnogram Verified Source Medline Plus Online resource offered by the National Library of Medicine and part of the National Institutes of Health. View source (or commonly known as sleep study) which monitors brain activity, heart rate, oxygen levels, eye movements and breathing function as the patient sleeps. This test is usually done at a hospital or sleep center, and on some occasions, at home. It also encompasses a patient to be hooked up to multiple electrodes that are attached to the scalp.

Sleep Diary

Individuals who suspect they have DSPS can maintain their own sleep log or sleep diary to keep track of their sleeping pattern. Doctors usually advise patients to keep a sleep diary for at least a week Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source and to record things like wake-up time, how many awakenings occurred, bed time, any medication or exercise, and diet and consumption.

Going to a healthcare provider is encouraged as he or she will also be able to determine whether a disruption in sleep is caused by DSPS or other sleep disorders that have similar symptoms such as narcolepsy.

Treatment

Treatment of DSPS by sleep physicians is focused on improving and changing light, melatonin and wake time in their patients.

Bright Light Therapy

Bright light therapy is used to gradually shift sleeping patterns. Through a technique called phototherapy, light is delivered to a patient’s retina to help patients shift their sleep period to an earlier time. The light is usually high intensity (2,000 to 9,500 lux) Verified Source Cleveland Clinic Ranked #2 hospital by U.S. News & World Report and one of the largest academic medical centers in America. The Cleveland Clinic serves patients from all over the world. View source and the duration and timing of exposure varies from one to two hours, though it is usually given early in the morning to signal ‘daytime’ to the circadian clock.

Once that desired time is achieved, those with DSPS are encouraged to maintain a fixed wake up time and to continue using morning light exposure daily.

Chronotherapy

The chronotherapy Verified Source Cleveland Clinic Ranked #2 hospital by U.S. News & World Report and one of the largest academic medical centers in America. The Cleveland Clinic serves patients from all over the world. View source treatment approach uses progressive advancement or delay of sleep time (usually three hours) to achieve a better sleep-wake cycle. For example, if normal bedtime is midnight, then one would wait until 3 a.m. to go to sleep on the first day.

On the second day, the sleep time is delayed until 6 a.m. and so on, until the cycle is completed once and bedtime is achieved at a desired time. It is then crucial to maintain that sleep time on a daily basis.

Improved Sleep Hygiene

Good sleep habits are crucial to help offset the effect of DSPS. Here are some tips for better sleep hygiene:

• Before sleep, try to avoid stimulants and caffeinated products like coffee, (certain) tea, or soda.
• Sleep in a cool, comfortable environment. Experts believe that the ideal sleep temperature is 65 degrees Fahrenheit (18.3 degrees Celsius).  Hotter bedrooms or sleep environments are not only uncomfortable but can cause night sweats.
• Avoid noise disturbances and loud sounds. For some, even noise at low levels can cause one to wake up.
• Comfortable sleepwear. Figure out what type of fabrics and materials are preferable and buy the right pajamas for a good night’s sleep. Some examples include cotton, silk, flannel or bamboo. Don’t forget to wear socks while sleeping; cold feet are often linked to sleeplessness while excessive hot feet can cause the entire body to be hot.
• Ensure that bedding and mattress are comfortable: each individual varies on what type of mattress they prefer (hard, soft, somewhere in the middle, etc.), but the key is figuring out what type of mattress and bedding is optimal.
• Minimize light exposure (especially light that is perceived as more blue) in the evening and maximize light exposure in the morning.
• Maintain a stable feeding-fasting rhythm. Don’t eat in the late evening, or in the very early morning.

In some rare situations, DSPS can go away by itself, though that isn’t the case for everyone. Find what treatment option works best and then maintain a consistent sleep schedule.

Misconceptions

There are some misconceptions and myths around DSPS.

• Those impacted by DSPS can’t just make themselves go to sleep earlier, because the sleep won’t be restorative or complete. Dr. Lok adds, “And individuals won’t be able to fall asleep, since their (internal) circadian clock is still promoting wakefulness.”
• Naps are not always helpful. Though naps can shift circadian rhythm phases and relieve feelings of sleepiness, it depends on how and when the nap is taken. A timed napping system (depending on darkness and sleep exposure) can be helpful but a sleep specialist or medical provider would be best suited in advising how best to reap the benefits of napping.
• Moving to another time zone may not help regulate one’s internal clock, though this does differ person to person. The same goes for shift work. There’s this misconception that shift workers can adapt to a new schedule easily, but that’s not always the case. Shift work sleep disorder is common among such employees.

Research and Clinical Trials

Still much needs to be learned about DSPS and the impacts on sleep health. There are a number of sleep studies and clinical trials around various sleep disorders that the Mayo Clinic administers. For a complete list, visit here. Verified Source Mayo Clinic Ranked #1 hospital by U.S. News & World Report and one of the most trusted medical institutions in the world. The staff is committed to integrated patient care, education, and research. View source

There are also organizations like the Circadian Sleep Disorders Network, a 501(c)(3) nonprofit, that promotes awareness, accommodation, support, and research for Circadian Rhythm Sleep Disorders. This organization helps spread awareness within the medical community and general public on sleep issues and aims to help improve the lives of those affected. Membership is open for as little as $5.

Frequently Asked Questions

Is delayed sleep phase syndrome related to ADHD?

People with Attention-Deficit/Hyperactivity Disorder (ADHD) commonly find it difficult to fall asleep at night, a tendency that can be worsened by things like caffeine Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source (though this is also true for all other folks as well). The exact relationship between delayed sleep phase syndrome and ADHD is still being studied, but ADHD can be considered Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source a risk factor for DSPS.

One 2017 study Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source concluded that bright light therapy could help alleviate ADHD symptoms and delayed sleep phase syndrome.

How is delayed sleep phase syndrome treated?

Treatments for delayed sleep phase syndrome include chronotherapy, bright light therapy for sleep, melatonin supplements, and improved sleep hygiene.

People with DSPS should remain vigilant about their sleep schedule once they’ve achieved their ideal sleep-wake times. If they begin to slack on their good sleep habits, they may slide back and find themselves falling asleep too late.

How do you get diagnosed with delayed sleep phase syndrome?

Your doctor or a sleep specialist can run a variety of tests to determine the likelihood that you have delayed sleep phase syndrome. Potential tests include a polysomnogram and actigraphy.

A polysomnogram is an overnight study at a sleep center, with electrodes attached to the scalp, face and body to monitor your brain activity, heart rate, and other vital signs. Actigraphy involves a wristwatch-like device (comparable to smart tracking devices) capable of tracking sleep-wake patterns during an individual’s daily routines.

Are delayed sleep phase syndrome and insomnia the same?

No, while delayed sleep phase syndrome can be mistaken for insomnia, the two conditions are not interchangeable. General insomnia can be treated with behavioral therapy, particularly therapy to address any underlying mental illnesses.

However, delayed sleep phase syndrome requires a patient to work at establishing conventional sleep patterns.

How do I know if I have delayed sleep phase disorder?

Common symptoms of delayed sleep phase disorder include difficulty falling asleep at ‘normal’ hours, going to bed and waking up very late (or much later than the targeted bed time) and excessive daytime sleepiness. What’s key is that these symptoms shouldn’t be accompanied by another sleep disorder, such as sleep apnea (repeatedly stopping and starting of breathing).

Conclusion

Delayed sleep phase syndrome can cause individuals to feel out of sync with the workings of society, given how it affects their lifestyle. It’s not uncommon for patients to feel stressed about their late bedtimes and wake times.

Still, the condition isn’t impossible to manage with the help of a sleep specialist. Therapy treatments and better sleep hygiene can reduce the effects of DSPS and bring a person’s life back under their control.