Delayed Sleep Phase Syndrome (DSPS)
A child or teenager who remains awake at least two hours past their usual bedtime because they are unable to fall asleep may have Delayed Sleep Phase Syndrome (DSPS). For example, if a teen’s normal bedtime is 10 PM, the teen with DSPS may not fall asleep until midnight or as late as 2 AM. Often, it is hard for someone with DSPS to wake up in the morning. If allowed to sleep until the late morning or early afternoon, the child or teen feels rested and can function well. Many teens with DSPS describe themselves as being at their best in the evening and at night. They tend to “catch up” on their sleep during weekends.
What Causes DSPS?
DSPS usually starts during the teen years and affects about 7 % (1 out of 15) of teens. The cause is not known. We do know that young children tend to go to bed early and awaken early in the morning. Sometime after puberty, most teens start staying up later at night and sleeping later in the morning. This natural shift of bedtime tends to be two hours or less. It is thought that DSPS may be an exaggerated shift. That is, instead of shifting two hours or less, individuals with DSPS may shift three or more hours. For the child who is allowed a very late bedtime, their natural shift of bedtime as a teen may take their bedtime past midnight as well. This shift in waking and sleeping is not intentional, nor is it ‘laziness’. It is a change in the sleeping and waking cycle that teens cannot control at first. They rarely feel tired in the evening and have difficulty getting up in the morning. If allowed to awaken naturally, these teens tend to sleep a normal amount (8 – 10 hours) and do not appear to have other sleep problems.
What are the Symptoms of DSPS?
- Trouble falling asleep at a usual bedtime
Teenagers with DSPS simply are unable to fall asleep at a reasonable bedtime. They are able to fall asleep late at night or in the early morning, when they finally feel sleepy. - Difficulty with awakening in the morning
Since they fall asleep so late, they are often deeply asleep when it is time to get up. They have great difficulty getting up and getting ready on time in the morning. - Daytime sleepiness
Often teens who fall asleep late at night and awaken early for school suffer from feeling tired and sleepy during the day - Other symptoms during the day
Sleepiness during the day and lack of energy may be mistakenly interpreted as depression. In addition, these teens may suffer from poor attention and motivation, sometimes diagnosed as attention deficit disorder. Lack of sleep can affect thinking, judgment, and organizational skills.
How is DSPS Diagnosed & Treated?
There is no simple diagnostic test for DSPS. Keeping a sleep diary for a week gives enough information about when a person goes to sleep and wakes up to make the diagnosis.
The goal of treatment is to reset the internal clock to establish the habit of being sleepy at a normal bedtime. If the teen is not motivated, it is very difficult to change the pattern. To get back into a more regular schedule:
Improve Sleep Habits and Hygiene
- Establish a schedule and go to bed and wake up the same time every day, including weekends.
- Do things that are calming before bedtime, such as reading. Avoid stimulating activities before bedtime such as playing video games, viewing television, and working on a computer. These activities should stop at least an hour before bedtime.
- Do not smoke and avoid caffeine or other drugs that may be stimulating.
- Limit daytime sleeping to one 15- to 20-minute nap, if any.
Change the Internal clock
- Go to bed earlier
Gradually move back the bedtime by 15 minutes intervals. So if the teen is going to bed at midnight, set bedtime at 15 minutes earlier at 11:45 PM for one or two nights, then 11:30 PM for one or two nights. If you shift 15 minutes every two nights, it will take two to three weeks to shift a midnight bedtime back to 10 PM. - Go to bed later
It is easier for the body to get used to a later bedtime than an earlier one. Using a technique called “phase delay,” bedtime is delayed by 2 to 3 hours each night. For example, if a teenager usually falls asleep at 2 AM, bedtime is delayed until 4 AM. one night, 6 AM the next night. Once you get into the phase where bedtime is during the bright light of day, you can shift 3 to 4 hours. So if they go to bed at 8 AM one day, you can shift quickly to noon the next day and 4 PM the day after, and so on until the desired bedtime is reached. - Early Sunlight
Open blinds or shades after sunrise and allow the sleeper to be exposed to sunlight for 15-20 minutes in the morning prior awakening. - Bright-light therapy
Sometimes bright-light therapy is used to help reset the body’s internal clock. The teenager is exposed to bright light in the morning for about 20 to 30 minutes and avoids bright light in the evening. Special light boxes must be purchased for this treatment. - Melatonin
There is limited evidence to support use of melatonin an hour prior bedtime and this therapy should be used in consultation with your clinician.
Once the desired bedtime is reached, the teen must stick with their schedule every night for several months. Even one night of late night studying or socializing can return the internal clock to the delayed state.