Delayed sleep phase syndrome (DSPS): signs, causes, treatment

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.

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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. 

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

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.

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).

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.

Chronotherapy

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).

Limit substances

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).

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.

Take melatonin

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.

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

June 14, 2021

Written by

Ashley Braun, RD, MPH

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.