Delayed sleep phase syndrome (DSPS), also referred to as Delayed Sleep Phase Disorder (DSPD), is a debilitating illness affecting millions of people worldwide. The International Classification of Sleep Disorders designates DSPS/D as a Circadian Rhythm Sleep Disorder. Circadian Rhythms are responsible for signaling our bodies to sleep and awaken. In time, rhythms become so ingrained that changing sleeping schedules can be very difficult.
DSPS/D leads to sleep cycles that are consistently delayed by two or more hours beyond the socially acceptable or conventional bedtime. This delay in falling asleep causes difficulty in waking up at the desired time. For example, rather than falling asleep at 10:00 pm and waking at 6:30 am, a DSPS sufferer will fall asleep well after midnight and have great difficulty getting up in time for school or work. Many of those who suffer from this syndrome must learn time management skills in order to lead a normal life.
Most people with DSPS self-identify as “night owls”, claiming they function best and are most alert during the evening or night hours. Keeping a sleep log can be very revealing, as sufferers stereotypically experience short naps during the week and lengthy sleep-ins on the weekends or days off. Without obligations, those with DSPS will naturally sleep in every day until 11 am or later.
Is DSPS a Psychological Disorder?
No. DSPS is a neurological sleep disorder that can cause psychological problems, such as depression. Once psychological problems develop, a cycle of sleep loss triggering psychological disorders triggering sleep loss etc. is formed. Again, once they are established, circadian rhythms can be hard to adjust.
What are the Symptoms?
Patients and their families often find that it is overwhelmingly challenging to cope with the symptoms of DSPS. Without a thorough understanding of the disorder, families, friends, employers and peers quickly grow weary of life-disrupting symptoms. Those closest to the patient may notice him or her withdrawing from society and sinking into a depressive state.
Most people do not understand that abnormal sleep hours may be inflexible and out of a person’s control. This lack of acceptance and understanding have the ability to seriously undermine employment, relationships, and self-esteem of a person suffering from DSPS. Other symptoms of DSPS include:
- Insomnia or excessive sleepiness
- Inability to fall asleep at the desired time
- Inability to wake up at the desired time
- This sleep pattern has been present for 3 months or more
- Lowered immune response
- Depression and anxiety disorders
- Weight gain or loss
Trying to cope with DSPS without treatment unsuccessfully try to force themselves to keep a normal schedule. This typically results in symptoms that can mimic depression, Attention Deficit Hyperactivity Disorder (ADHD), Chronic Fatigue Syndrome, fibromyalgia, anxiety or exhaustion. A patient complaining about not being able to fall asleep may be misdiagnosed with primary insomnia, and may be prescribed sleeping pills by a doctor.
A patient who often complains about being tired all the time may be misdiagnosed as suffering from depression, and prescribed antidepressant medication. The patient usually is suffering from depression, as a result of the underlying cause: DSPS. It is common for patients to feel that they wage an unending war with fatigue.
Missing a lot of work or school or an inability to be on time is a byproduct of the disorder. Unfortunately, many of those who seek medical help are given medications to help them sleep. It takes more than sleeping pills to treat this syndrome. Light therapy and meditation for dealing with the psychological aspects of the syndrome is a far more effective weapon against DSPS than sleeping medications. Meditation for Depression and Anxiety
Who gets DSPS?
Many DSPS patients report that difficulties began after a long night of working, studying or otherwise being unable to sleep. Even one night of staying up until dawn can lead to problems with sleep cycles. Once the cycle is off kilter, patients found it impossible to sleep on a normal schedule, even when they resumed normal work or school hours. Adolescence tend to have the largest recognized onset of DSPS, but childhood cases have been reported. It is very rare for DSPS to begin after age 30.
Why is DSPS a Problem?
Those with DSPS who attempt to work or go to school during normal business hours face very difficult problems. It is possible to awaken someone with delayed sleep phases, but if done regularly this will lead to sleep deprivation and a rash of consequences and symptoms.
Dangerous accidents, failing health and mental disorders develop very quickly when sufferers are deprived of proper amounts of sleep. Developing and maintaining relationships new relationships is difficult and old ties be difficult to maintain, resulting in destroyed social lives.
Two studies in the 1990s found that DSPS affected more than 1 in 1000 adults, though it is much more common in adolescents and children. Most teenagers eventually grow out of it, but others may require treatment. Most with DSPS begin experiencing symptoms in teen years, though it is also possible to develop the disorder in infancy or early childhood. It usually ends in the early twenties, though some may have it for their entire lifetime. Learn about how to keep babies happy and put them back to sleep before circadian rhythms are disrupted.
How is DSPS Diagnosed?
A sleep specialist will begin with a patient’s medical history and complaints to determine if a circadian rhythm disorder is suspected. The attending physician will need patient’s sleep to be monitored closely and recorded into a sleeping log or diary.
Some doctors will prescribe a wrist activity monitor, a device worn like a wristwatch which tracks movement. The sleep history is most useful if it can be obtained when the patient is sleeping on their natural schedule, without attempting to meet the requirements imposed by work or school.
Often, the sleep doctor will order an overnight polysomnogram (sleep study), to rule out other disorders, such as sleep apnea or PLMD (Periodic Limb Movement Disorder). In people with DSPS, this test should be performed when the patient can sleep normally. Some doctors will ask for a Multiple Sleep Latency Test (MSLT) to be conducted during the patient’s day, to evaluate the possibility of narcolepsy. In some patients, multiple disorders may be present or another disorder may be the cause of the reported symptoms.
How is DSPS Treated?
Sleep doctors will attempt to treat DSPS by prescribing bright light in the morning, restricting light exposure in the evening, and/or prescribing the hormone melatonin in the evening. This may be effective for some people, but not all DSPS sufferers. Many doctors prescribe medications to help people sleep. Sleep doctors may suggest chronotherapy, delaying the sleep schedule by moving it later and later to go around the clock until the desired sleep time is reached.
For many with DSPS, sleeping on a normal schedule may be difficult or impossible. Self-treatment can lead to a number of issues, including drug and alcohol addiction, sleep deprivation, stress, high blood pressure, chronic pain, depression and more. Treating symptoms at home should be done so under the direction of a skilled sleep professional or teacher who helps students adjust their sleep cycles, boost happiness and improve healthy.
Is DSPS a Disability?
For those for whom treatment is ineffective, DSPS can make it impossible to maintain a normal 9 am to 5 pm work schedule. This syndrome can absolutely be considered debilitating, especially for those who are required to attend work or school at a 9 am to 5pm job. If treatment fails, DSPS is considered an official disability.
Under the Americans with Disabilities Act, public schools and places of employment in the U.S. are required to provide reasonable accommodations, including part-time or modified work schedules. Sleep disorders qualify students for a Section 504 plan.
Does DSPS Affect Learning?
Though DSPS does not affect intelligence, it can certainly affect studying, concentration, memory and attention span. Adjustments in study habits may be necessary. This can best be accomplished with the cooperation of school personnel. It is important to identify children with DSPS at the earliest possible age to prevent a pattern of failure from developing.
Little is Known about Sleep
Studies are currently underway to better understand nature and function of sleep. Progress has been made on the genetic, neurological and chemical pathways involved in the circadian clock. Researchers and scientists continue to learn about the effects of light, dark and melatonin on circadian rhythms and make strides regularly.
With a deeper understanding of sleep, physicians will be better able to help patients adjust their circadian rhythms with as few consequences and symptoms as possible. Delayed sleep phase disorder sufferers should educated themselves about their problem and learn skills that help them master their sleep cycles properly, because a normal, productive life requires a good night’s rest.