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Your alarm goes off again, and you reach over to hit snooze for the umpteenth time that day. Another night of falling asleep too late and struggling to get out of bed may have you wondering if there is hope for you ever not to feel tired at work.
If it’s hard for you to get to sleep and you struggle to wake up, this could be a sign your “internal clock” is off, and you may have delayed sleep phase syndrome.
What is delayed sleep phase syndrome?
Delayed sleep phase syndrome (DSPS) is a condition where you fall asleep and wake up later than you want to. It is one of the circadian rhythm sleep disorders. DSPS is also known as delayed sleep-wake phase disorder and delayed sleep phase disorder (DSPD).
Circadian rhythm sleep-wake disorders are problems with your internal clock that cause trouble falling asleep or staying asleep. A typical circadian rhythm is based on a 24-hour sleep-wake cycle. With circadian rhythm disorders, that sleep-wake cycle doesn’t work quite as it should.
Some people with DSPS think they have always just been a “night owl,” but it is more than that. Night owls may choose to stay up later, while people with DSPS often wish that they could fall asleep earlier—but can’t.
DSPS causes trouble waking up, and people with it often sleep late into the day. When people with DSPS have to wake up early for work or school, they often lose a minimum of two hours of sleep per night (Basit, 2021).
On days off and weekends, people with DSPS tend to get enough sleep because they follow their natural sleep-wake cycle and sleep later into the morning, rather than forcing themselves to wake up earlier than their internal clock wants to.
Signs of delayed sleep phase syndrome
Because people with DSPS get inadequate sleep, they often have trouble focusing on daily responsibilities. Work or school performance often suffers because people with this disorder are sleep-deprived.
The symptoms of DSPS include (Basit, 2021):
- Trouble falling asleep and waking up early in the morning
- Excessive daytime sleepiness
- Difficulty concentrating
- Poor memory and forgetfulness
- Waking up late
- Decreased work or school performance
- Dependence on caffeine to stay awake or sleep aids to fall asleep
- May develop depression symptoms
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Causes of delayed sleep phase syndrome
Multiple factors can contribute to a disruption in the natural rhythm of your biological clock, including (Karna, 2021):
- Alcohol or drugs: Alcoholic drinks, nicotine, and other drugs can interrupt your natural sleep cycle.
- Hormone changes: Menopause, pregnancy, thyroid disease, and other hormonal changes can impact your sleep.
- Psychological conditions: Mental health conditions like depression, anxiety, post-traumatic stress disorder, and panic attacks may lead to sleep pattern changes.
- Poor sleep hygiene: Unhealthy sleep habits can increase your risk for sleep disorders. Irregular bedtimes, a noisy room, too much light, and other practices can all make it more difficult for you to fall asleep.
- Age: DSPS is more common in young adults and adolescents.
- Medical conditions: Certain medical conditions, such as diabetes, heart disease, and sleep apnea increase the risk of circadian rhythm sleep disorders.
- Genetics: You are at a higher risk for sleep-wake cycle disorders if you have a family history of them (Seghal, 2011).
- Light exposure at night: The circadian rhythm is most sensitive to blue light. That means too much time in front of the television, computer screen, or your phone at night can make it harder for you to fall asleep. All of those screens emit melatonin-crushing blue light (Auger, 2015).
- Caffeine: About 85% of people in the U.S. drink at least one caffeinated drink every day (Mitchell, 2014). Caffeine can help people feel more alert during the day, but it can also interrupt sleep if you drink it too late in the day.
Diagnosis of delayed sleep phase syndrome
If sleep disturbances interfere with your life, it may be time to talk with your healthcare provider. They’ll likely start by gathering a history of your symptoms to rule out any other medical conditions or sleep disorders that could be causing your sleeping problems.
Typically, a diagnosis of DSPS is based on a history of persistent issues with falling asleep and waking up. These issues interfere with your desired sleep times and daytime performance at work or in your personal life.
Your healthcare provider may ask you to complete a sleep log or sleep diary for a week or two to track delays in sleep and document your wake times. In some cases, your healthcare provider may request an overnight sleep study. They might ask you to wear a device on your wrist at night, called actigraphy, to monitor your sleep. Your healthcare provider may also refer you to a sleep specialist for diagnosis and treatment (Basit, 2021).
Delayed sleep phase syndrome treatment
If you have DSPS, you might feel at your wit’s end, exhausted and frustrated by your lack of sleep. The good news is there are things you can try to improve your situation.
Good sleep hygiene
The habits you have around sleeping are called your sleep hygiene. You can improve your sleep hygiene by doing the following (Karna, 2021):
- Maintain a regular sleep schedule by going to bed and waking up at the same time every day, even when you have days off.
- Exercise regularly, avoid caffeine later in the day, and eat a healthy diet to promote better sleep.
- Keep your bedroom dark, quiet, and at a cool temperature when you are sleeping.
This type of therapy aims to adjust your sleep schedule to your desired time slowly. Chronotherapy uses a combination of light therapy to wake you up during the day and sleep aids to help you fall asleep an hour or two earlier than your current schedule.
Over time, you will continue to move your schedule backward by a couple of hours until you reach your preferred times to fall asleep and wake up. This practice helps reset your biological clock and aims to resolve your circadian rhythm sleep disorder (Auger, 2015).
Substances like caffeine, alcohol, nicotine, and others can interfere with your body’s natural rhythms. You should limit caffeine in the late afternoon and evening to avoid it interfering with your sleep. Alcohol should be limited. Avoid nicotine and other illicit drugs, as they can disturb your sleep (Basit, 2021).
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Limit daytime naps
Frequent naps during the day may interfere with your circadian clock (Basit, 2021). Try to limit napping, especially longer naps, to promote better sleep at night.
Melatonin is a hormone that plays an essential role in our sleep-wake cycles. Many people find it helpful to take it in supplement form for falling and staying asleep. Check with your healthcare provider first to help determine a dose that’s safe and appropriate for you. Your provider may also recommend prescription sleep aids to help you fall asleep more quickly.
Try bright light therapy
This type of therapy uses a lightbox to help stimulate the brain, similar to sunlight. For DSPS, morning light therapy can help you feel more awake during the day and prevent daytime sleepiness (Figueiro, 2016).
Limit blue light exposure
Televisions, computer screens, tablets, and phones give off blue light, which can interfere with sleep. Try to limit your time in front of screens before bed, ideally turning them off 30–60 minutes before bedtime.
You can also reduce the blue light exposure from devices by using “night mode” functions on devices that give the screen an orange tint. Wearing blue light blocking glasses while using electronic devices for the three hours before you usually go to bed can also help improve your quality of sleep (Auger, 2015)
Sleeping troubles are common. If your tiredness is interfering with your life, don’t hesitate to speak with your healthcare provider. There are many options available to help you sleep better and feel more alert throughout the day.
- Auger, R. R., Burgess, H. J., Emens, J. S., Deriy, L. V., Thomas, S. M., & Sharkey, K. M. (2015). Clinical practice guideline for the treatment of intrinsic circadian rhythm sleep-wake disorders: advanced sleep-wake phase disorder (ASWPD), delayed sleep-wake phase disorder (DSWPD), non-24-hour sleep-wake rhythm disorder (N24SWD), and irregular sleep-wake rhythm disorder (ISWRD). An update for 2015: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine, 11(10), 1199–1236. doi: 10.5664/jcsm.5100. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582061/
- Basit H, Damhoff TC, Huecker MR. (2021). Sleeplessness and circadian disorder. [Updated 2021 Apr 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK534238/
- Figueiro M. G. (2016). Delayed sleep phase disorder: clinical perspective with a focus on light therapy. Nature and Science of Sleep, 8, 91–106. doi: 10.2147/NSS.S85849. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4830627/
- Karna B, Gupta V. (2021). Sleep disorder. [Updated 2021 Feb 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK560720/
- Mitchell, D. C., Knight, C. A., Hockenberry, J., Teplansky, R., & Hartman, T. J. (2014). Beverage caffeine intakes in the U.S. Food and Chemical Toxicology: An International Journal Published for the British Industrial Biological Research Association, 63, 136–142. doi: 10.1016/j.fct.2013.10.042. Retrieved from https://pubmed.ncbi.nlm.nih.gov/24189158/
- Sehgal, A., & Mignot, E. (2011). Genetics of sleep and sleep disorders. Cell, 146(2), 194–207. doi: 10.1016/j.cell.2011.07.004. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3153991/