Delayed Sleep Phase Disorder – Symptoms, Diagnosis, Treatment

Delayed Sleep Phase Disorder

When was the last time you dozed off on the scheduled bedtime without having to take sleep medications? Are you able to go to sleep at the same time every night?

Not everyone can fall asleep at 10 pm every night and wake up at 6 am the next morning. Some people stay awake till midnight, and at about 2 am-4 am, their internal biological clock signals them to go to bed. Nevertheless, they sleep well, and the quality of the sleep is not compromised. The only problem is that — to feel fresh and rejuvenated the next day — they have to sleep till 12 pm-1 pm.  

This might not be a problem for someone who works evening shifts, but most jobs require you to be present at the workplace at 9 am. This is where delayed sleep-wake phase disorder (DSPD) becomes a problem. 

People who suffer from this condition struggle to wake up early in the morning and hence often do not show up at work or school on time. They simply get labeled as lazy or irresponsible, while the fault may not always be theirs.

What is Delayed Sleep Phase Syndrome 

Delayed sleep-wake phase syndrome or delayed sleep-wake phase disorder (DSPD) is a condition that dysregulates a person’s circadian rhythm or the internal biological clock. In addition to this, it also affects a person’s core body temperature and hormonal cycles. 

DSPD does not affect a person the same way as other sleep disorders like sleep apnea or shift work sleep disorder do. It merely delays the sleep-wake cycle by a few hours. Having said that, the symptoms may affect the health of an individual depending on the severity of the condition. 

More on delayed sleep-wake phase disorder (DSPD), this condition was first discovered in the year 1981 by Elliot D. Weitzman at Montefiore Medical Center, Bronx, New York City. He, along with his two associates, published a paper in the same year after 30 of 450 patients that they had treated for primary insomnia showed the following characteristics:

1) Chronic inability to fall asleep at the desired clock time.

2) When not on a strict schedule, the patients have a normal sleep pattern, and after a sleep of normal length, awaken spontaneously and feel refreshed.

3) A long history of unsuccessful attempts to treat the problem.

Furthermore, Dr. Weitzman does believe that this condition can be managed with treatment methods similar to those of insomnia. Still, in some cases, sleep-wake phase syndrome is genetic, in which case, a patient has to resort to sleep medications like melatonin supplements and other herbal sleep remedies. 

In the later section, we have discussed some effective treatment methods for delayed sleep-wake phase disorder (DSPD).

Delayed Sleep Phase Disorder Symptoms

1) Depression

Depression is a mental health disorder that changes the neural circuits in the brain, and as a result, makes the patient feel sad and exhibit a lack of interest in activities of the day to day living. Changes in biological, psychological, or social structures can cause a person to feel depressed. 

According to a report by the International Classification of Sleep Disorders (ICSD), nearly half of the patients diagnosed with DSPD show symptoms like clinical depression or other psychological problems. 

Other than depression, the patients do not seem to be exhibiting a particular type of psychiatric problem. This is what makes it so difficult to identify a DSPD patient from other patients who show symptoms of psychiatric problems due to reasons other than DSPD.

2) Attention Deficit Hyperactivity Disorder (ADHD)

Bear in mind that these symptoms only show up when the individual suffering from DSPD tries to fight the condition by waking up earlier than regular waking hours. 

ADHD is another primary symptom of delayed sleep-wake phase disorder (DSPD). Waking up earlier than usual can make a person suffering from DSPD make impulsive decisions, get distracted easily, and also think in a sporadic or unorganized manner.

3) Excess Weight Gain

Moving further, when a DSPD patient tries to fight the condition by sleeping only for 4-5 hours (as they have to get up early to go to work or school), they slowly begin to get deprived of sleep.

If the loss of proper sleep is not compensated at the weekends, the metabolic rate drops, causing the DSPD patient to gain more weight. Hence, obesity is also associated with DSPD.

4) Obsessive-Compulsive Disorder (OCD)

Delayed Sleep Phase

Sleep deprivation (as a result of DSPD) can also lead to the patient indulging in abnormal activities like obsessively rearranging the contents in their wardrobe, fear of being contaminated by germs, fear of losing control over their emotions and potentially harming others, excessive focus on religion or a particular ideology, etc. 

These are all symptoms shown by someone suffering from Obsessive-compulsive disorder (OCD) induced by DSPD. 

Delayed Sleep Phase Syndrome Diagnosis and Tests  

Delayed sleep phase syndrome is generally diagnosed by the doctor based on the patient’s self-reported symptoms. Although, in some cases, advanced sleep monitoring procedures like actigraphy or polysomnography are also needed. 

For instance, polysomnographic monitoring is used to make sure that the symptoms exhibited by the patient are not due to other sleep disorders like sleep apnea or narcolepsy. Also, the doctor may ask a patient to maintain a sleep diary for the next two weeks.

Furthermore, DSPD is also quite often misdiagnosed as a psychiatric disorder. If you have DSPD, you will likely also be tested for psychological illnesses like psychophysiological insomnia, depression, and schizophrenia. So, be prepared to undergo some thorough examinations and tests.

Subsequently, children suffering from DSPD are deemed as troubled or challenging to deal with. You will be surprised to learn that there is a condition known as “school refusal,” which indicates child-motivated refusal to attend school. Often school refusal is confused with DSPD.

Delayed Sleep Phase Syndrome Treatment Options

As in most cases, if your condition is genetic, no treatment can help you cure this condition permanently. However, as Dr. Weitzman said, some management techniques can help you correct the delay in the sleep-wake cycle by a few hours. 

For instance, if you currently wake up at 12 pm-1 pm, after consistent treatment and follow-up, you can manage to wake up at 10 am without incurring the symptoms.

Here are the treatment methods or the management techniques for delayed sleep-wake phase disorder (DSPD):

1) Light Therapy or Phototherapy

Light therapy or Phototherapy can be performed by exposing the DSPD patient to either natural daylight or artificial equipment emitting specific wavelengths of light. Lasers, light-emitting diodes, fluorescent lamps, dichroic lamps, etc. are used in cases where natural light treatment is not feasible. 

Ideally, a bright white lamp emitting light of 10,000 lux is used. Moreover, even wearables devices can be worn while sleeping to let the patient know that when it’s time to wake up. Also, the light warms a person up so they can smoothly transition from unconscious to wakened state. 

2) Darkness Therapy or Scototherapy

Darkness therapy or Scototherapy is a tried and tested method to regulate the Circadian rhythms in individuals with DSPD. This method was discovered by a German anthropologist by the name of Holger Kalweit. 

The principle idea behind dark therapy is to block blue wavelength lights, which hinder the production of Melatonin (a sleep-inducing hormone). 

In traditional dark therapy, the patient is kept in the darkroom for several days. However, someone with DSPD has to refrain from artificial light after sunset.

3) Chronotherapy  

If you don’t get the desired result with light therapy or darkness therapy, you can try a tried and tested way to reset the circadian clock– that is, by manipulating bedtimes. In chronotherapy, bedtime is systematically delayed or advanced by 2 hours each day. 

For a DSPD patient, it is tough to advance the bedtime by two hours each day. They simply cannot fall asleep before their usual bedtime. But what they can do is go to sleep two hours late each day until the desired bedtime is met. 

Don’t worry if you do not get results within a week; you might have to try resetting the circadian cycle by repeating this method several times. However, it would help if you also manage your work or school schedules accordingly. A few days of discomfort can give you months of break from DSPD.

Conclusion

Delayed sleep-wake phase disorder (DSPD) is a type of circadian rhythm sleep-wake disorder (CRSDs), which is often confused with insomnia. The symptoms of DSPD might seem similar to insomnia, but they are both different conditions. 

One is a result of genetic predisposition, while the other is caused by stress, anxiety, and depression. We hope you got some critical insights about DSPD from this post. Let us know if you have any questions or queries regarding this condition.