A Complete Guide to Delayed Sleep Phase Syndrome

A lot of people are suffering from delayed sleep phase syndrome and they don’t know that they’re suffering from it. They’re under the impression that they’re just having a hard time sleeping probably because they had too much coffee or they’re too stressed. If you feel that there’s something wrong with your sleeping patterns, it’s a good idea to familiarize yourself with this condition. Find out what it is so you can know what the symptoms are. Of course, know how to treat it.

What is Delayed Sleep Phase Syndrome?

Also known as DSPS, it’s one of the most common circadian rhythm sleeping disorders. This means that it affects the timing of your bedtime. The International Classification of Sleep Disorders classifies this group of sleeping disorders as disorders that delay your bedtime for a few hours after you really want to fall asleep.

What is delayed sleep phase syndrome? Simply put, it’s a condition wherein someone can’t go to bed when they want or need to. It’s a disorder that affects your biological clock which is the timing system of your body. This explains why it’s hard to get some shuteye when you’re expected to do so as dictated by the norm. This explains its name.

Speaking of its name, it’s also referred to as delayed sleep-phase syndrome or delayed sleep-phase type. It’s also known as the “social jetlag” because sufferers describe living with the condition as living with a six hour jetlag.

Diagnosing the Condition

The ICSD has provided clear-cut criteria in order for the delayed sleep phase syndrome to be diagnosed as such:

  • There is a considerable delay in between the time you’re supposed to go to bed and the time that you actually fall asleep. In some studies, respondents fell asleep at around 2:00 AM.
  • Once asleep, it’s all normal from there. Expect to be asleep for the normal duration depending on your age. The quality of your shuteye is also normal. However, don’t be surprised if you are in dreamland longer than the usual.
  • Since you’ve fallen asleep at an unconventional time, you will wake up at an unconventional time as well. Remember, the duration is normal. As an important note, you’ll find it hard to wake up earlier.
  • There may be days wherein it’s impossible to get any shuteye at all. In fact, it can be more than a day. This happens in cycle and will be followed by days wherein you’ll be in dreamland for up to 18 hours.

What is the process of diagnosis? The specialist usually starts with an interview. The specialist will ask questions regarding the sleeping patterns. In most cases, the patient will be asked to come back after about three weeks. The patient will go home with a diary that will be used to take down notes regarding the sleeping patterns. Alternatively, the specialist will conduct actigraphic monitoring.

During the three weeks, it will be checked if the patient can wake up normally using an alarm clock. If the patient can wake up in a normal waking hour, then he won’t be diagnosed with delayed sleep phase syndrome.

In some cases, the specialist will conduct a polysomnography. This is not really to diagnose the disease per se, but it’s important because it will rule out other sleeping disorders like sleep apnea and narcolepsy.

Unfortunately, this condition is often diagnosed incorrectly. In fact, it’s commonly misdiagnosed as a primary psychiatric disorder. Specialists may confuse it with psychiatric disorders like ADHD or schizophrenia. It can also be misdiagnosed as depression or insomnia. With the high occurrence of misdiagnosis, specialists are calling for improved education on delayed sleep phase syndrome among practitioners.

can't sleep

You are not the only one having issues getting proper rest at night…

How Common is this Condition?

This is a very common condition affecting 3 out of 2000 adults or .15%. Using the criteria listed above, a study was done back in the early 90s in Norway on 7700 adults aging from 18 to 67 years old. According to the study, .17% of them have DPSD.

This illness is more common among teenagers. In a study, it was shown that this illness affects up to 7% of adolescent boys and girls. Adolescent boys seem to be more affected with this illness unlike in adults wherein men and women are equally affected.

Why is it common among teenagers? It’s because it’s part of the development of adolescents. This is according to Mary Carskadon who is an authority on circadian rhythms especially among adolescents.

Can this Illness be Managed?

There’s a specific set of management strategies that is followed for treatment. This set of strategies is unique from the other techniques used on other sleeping disorders. Basically, these strategies are developed with the idea that patients can sleep well on their own. There’s just the issue of timing.

There are basically two types of treatments – pharmacologic and non-pharmacologic. Either way, the treatment will usually start at least one week before the scheduled treatment. The patient will be asked to go to bed regularly for at least one week without naps. The patient will go to bed when he or she is most comfortable to ensure that the patient will start the treatment well-rested.

Here are the different options for the pharmacologic form of treatment:

  • Melatonin

Patients will be asked to take it around an hour before they want to get some shuteye. This will cause the patients to be sleepy.

  • Modafinil

To be more specific, this option is for shift work sleep disorder sufferers. This is actually an approved treatment for the disorder, at least in the US. Since shift work sleep disorder has similar traits and characteristics with delayed sleep phase syndrome, sleep specialists are also prescribing Modafinil to the latter’s sufferers. This is because it’s been proven to help sufferers go through the day even with the disorder.

  • Trazodone

This has actually treated one man of the disorder. While that’s a really small sample size, it’s one of the few options that have shown real promise in treating delayed sleep phase syndrome.

In addition, a lot of sleep specialists still prescribe vitamin B12. This vitamin was very popular as a prescription for DSPS in the 90s, but was later on debunked as a treatment option since it was proven that it doesn’t present any benefits when it comes to managing or treating the disease. But still, it’s a common prescription.

There are also non-pharmacologic options that can help with management and treatment:

  • Light therapy

Also known as phototherapy, this treatment is done using a portable visor or a full spectrum lamp. The specialist will use 10,000 lux for anywhere from half an hour to an hour and a half. This treatment will be done in the time when the patient usually awakes on his or her own. In some cases, the treatment will be done shortly before the time of the usual awakening.

To shorten the length of treatment, LED light can be used. If this is used, the treatment will only last for 15 to 30 minutes.

This process is meant to mimic natural sunlight. If there’s a healthy amount of sunlight, then sunlight can also be used.

For best results, patients are expected to continue with the process as needed. Even if treatment is successful, the patient should still do it, although not every day and on a shorter amount of time.

To increase its effectiveness, this technique can be complemented by restricting the light at night. This is because bright lights at night will just encourage delayed sleep phase syndrome. It’s recommended to dim the light at home, especially in your room, a few hours before your bedtime. In addition, wearing sunglasses can also help.

  • Sleep phase chronotherapy

In this process, the patient will manipulate the time he or she goes to bed the patient can hit the reset button on his or her body clock. There are two types. The more common type will require the patient to go to bed a couple of hours later and more every day. This will be done for several days until the patient is going to bed when wanted/needed.

The second type is called controlled sleep deprivation with phase advance or SDPA. This is a modified version of the first type wherein you’ll stay up for a whole day and night and you’ll go to bed an hour and a half earlier than your preferred bedtime. Do this for a week. Repeat the process every week until you’re sleeping normally.

Whether pharmacological or non-pharmacological options, it’s essential to stick to the schedule that will be given by the expert. You will be given tips by the specialist and it’s important to follow them in order to be successful with your chosen delayed sleep phase syndrome treatment.

Aren’t You Simply a Night Owl?

It’s important to note that if you’re suffering from DSPS, it’s not your choice to stay up late. While night owls simply prefer to go to bed late and wake up late, DSPS sufferers have no option but to stay up late and they’ll wake up late. Yes, even if they’re already very tired.

In addition, night owls can adjust their sleeping patterns if needed. If they need to go to bed early for an early call time, they can do so. The same can’t be said with DSPS sufferers.

What are the Problems Encountered by Sufferers?

Here are some of the most common problems that they encounter:

  • They find it hard to wake up in time for school or work.

This is a given since sufferers go to bed late. In addition, they’ll find it hard to wake up to the sound of the alarm.

  • Sufferers waste a lot of time just lying in bed.

Just like normal people, most sufferers will go to bed at a normal time like 9 or 10 PM. However, they’ll just lie there, tossing and turning, for hours. Sometimes, they’ll just lie there until 3 AM. That’s a lot of time wasted without the sufferer being productive. The sufferers will also wake up late, so that’s another hit to their productivity. It will create a snowball effect that will lead to a lot of time wasted.

  • They tend to be sleepy all throughout the day.

This is a major problem especially for students and employees. They find it hard to focus at school or work because they feel sleepy. They feel sleepy because they didn’t get enough sleep (because they needed to wake up even if they went to bed late) and their body clock is messed up.

  • They tend to be depressed.

This is especially true among teenagers. Delayed sleep phase syndrome can also cause depression because of all the effects of missing time in school. They also tend to be bullied because of the condition and its after-effects like drowsiness.

People around them will also not consider their condition. They’ll say that they’re lazy or uninspired, not understanding that they’re suffering from a disorder. This leads to depression.

  • Their performance suffers.

This is an obvious result of this condition. As mentioned, it creates a snowball effect. Deadlines and appointments are missed. They lose focus. They find it hard to concentrate. They miss a lot of days. If they do show up at school or at work, a lot of times they’re late.

Living with the Condition

Even with the treatment options available, it’s not clear as to whether sufferers are able to be treated in the long term. Even experienced specialists are acknowledging that DSPS is very hard to treat.

In one study, a six week treatment program using melatonin proved to be successful among patients who were sleeping at 3 am and waking up at around 11:30 am. Unfortunately 9 out of 10 of the patients went back to their old sleeping patterns within one year. Worse, almost 30% of the patients relapsed within a week of finishing treatment.

It’s not impossible to live with delayed sleep phase syndrome. It’s hard, but it’s possible. Here are some tips that can help you live with the condition:

  • Undergo treatment.

Sure, there are no clear long term benefits, but you can take advantage of available treatment options to improve your quality of life. You can start with the non-pharmacological options and just consult a specialist on the best pharmacological option for you.

  • Take naps.

While this won’t really help you treat the condition, it will help lessen daytime drowsiness. Take a couple of power naps if possible – one in the morning and one in the afternoon.

  • Adjust your schedule.

This is helpful if you’re an adult. You can choose a job that allows you to work the night shift. You can choose a schedule when you’re awake. This way, you can go straight to bed after your shift. You can refer to the Americans with Disabilities Act that requires employers to make the necessary adjustments for employees with sleeping disorders.

There are several career options that allow you to do this. You can work in the security industry. You can also work in movie theaters or 24 hour restaurants. You can also build a career in the call center industry.

You can also explore working from home. You can join a company that encourages their employees to work from home. You can also consider doing freelance work.

What to Do Now

Get diagnosed properly. See a specialist today.

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