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Delayed Sleep Phase Syndrome
How in Tune is Your Circadian Rhythm?
It could be affecting you more then you know...
Written by Josh Stone with contributions from Kevin Morton, Spring 2010
It is a quiet Sunday night on Anyold University's campus, and Julian is just finishing up the last of his schoolwork for Monday. Knowing that he has a 9:00 am class the next day, he decides he is going to get in bed at 11:30.
However, although Julian crawls into bed right on schedule, he finds that he is still completely alert and awake, and lies in bed all the way until 3:00 am before he ever actually falls asleep. The next morning, Julian awakes to his alarm at 7:30 having gotten less then five hours of sleep the night before. He groggily drags himself out of bed, not feeling the least bit refreshed. Not a promising start to his school day.
Julian is stuck in the middle of a very common and often harmful pattern in his circadian rhythm, a pattern known in the sleep circle as Delayed Sleep Phase Syndrome (DSPS).
It's important to note before moving forward that this article and the anecdotes within are targeted towards delayed sleep phases in students and adolescents. Much of the information will also apply to cases during adulthood, but it will not always be as applicable to all chronic or severe cases of DSPS.
Delayed sleep phase syndrome, common in many adolescents and college students, shifts the body clock so it is hard to fall asleep at night.
DSPS is a sleep disorder in which the cycle of sleep and wakefulness in a person's 24-hour day is significantly delayed. As a result, the clock-dependent alerting mechanism in our brains that releases the hormones that give us energy gets activated a lot later at night than we may like it to.
This then translates to a person having trouble falling asleep at a desired time, instead either up and awake for too long or laying in bed with a racing mind. You can essentially think of it as jet lag--the exact same mechanisms are in play--minus the actual airplane flight.
The other side to DSPS is of course the morning, where it's all too often a difficult endeavor to wake up on time for work or school.
Naturally, being up very late can make it VERY difficult to wake up within the parameters of the person's daily schedule, i.e. a sufferer of delayed sleep phase syndrome who is unable to sleep before 2 to 4 am will subsequently have a real difficulty, or even complete inability, to wake up at a "normal" time the following day (or the necessary time for work or school).
Of course, this then turns into into lost sleep if the individual does have to wake up early in the morning, perpetuating a cycle that can have serious consequences for everything from mood to alertness to productivity.
Read more about the effects of sleep deprivation.
Who Does Delayed Sleep Phase Syndrome Affect?
Although delayed sleep phase syndome can occur in just about anyone, it is extremely common among young adults and college students, largely due to the schedules they maintain. Yup, behavior as simple as having a frequent late-night schedule is enough to shift the circadian rhythm and bring on DSPS. Dr. D has more on this:
Dr. D's Sleep Book Says...
"In delayed sleep phase syndrome, there is a theoretical implication that the ability of the circadian system to phase advance may be sluggish or actually abnormal. In most cases, however, it is more likely that the delayed phase of the rhythm is also maintained by the behavior of the person, together with the tendency of the major clock-dependent period of alerting to occur late in the day rather than early."
Of course, this makes it rather easy for a college student to develop DSPS and somewhat difficult to get rid of. College students are often up until late hours of the night working on papers or studying for tests, and in such a schedule their body clocks adjust to this so they can be alert at these times.
DSPS in young people can typically look something like the scenes above. Low clock-dependent alerting in the afternoon causes them to be tired during parts of the day, but when the alerting mechanism kicks in at night it makes them alert, wired, and ready to have fun at times when most people are asleep.
Staying awake until the early hours of the morning, of course leads to a higher tendency to sleep-in late. This can lead to two outcomes. Depending on his or her schedule the student will either sleep late every day, shifting his or her biological clock and circadian rhythm to this new pattern; or, say if the student has classes early in the mornings during the week and has to get up for them, he or she will begin accumulating large amounts of sleep debt.
This, combined with late night activities over the weekend leads to students sleeping well into the afternoons on Saturday and Sunday, but as a result, it then becomes very difficult to fall asleep at a "reasonable" time (when I say reasonable I simply mean at a time that allows the student to wake up fully rested on time for classes the next day) on Sunday. And so the process repeats.
Officially Diagnosing Delayed Sleep Phase Syndrome
According to an article from the Archives of General Psychiatry, there are three main criteria for officially diagnosing DSPS:
- Patient has chronic difficulty falling asleep at desired time to meet their daily schedules - work, school, etc. Typically patient reports inability to sleep before 2 to 6 am.
- The patient reports having dealt with these symptoms for at least six months, mostly for multiple years.
- When not required to maintain their schedule--i.e. weekends, holidays, etc.--patient sleeps without difficulty, and will awaken spontaneously after a sleep period of normal length.
Although these are the criteria for officially diagnosing, obviously a delayed sleep phase can be present in individuals for a period less than 6 months and still have a profound effect. For that reason, take the above with a grain of salt, and if you think this is something that is affecting you, look at the treatment options below.
Treatment of Delayed Sleep Phase Syndrome
Some patients diagnosed with DSPS who are frustrated with the condition and want to wake up well rested at a reasonable time in the morning report having tried various unsuccessful methods of trying to fall asleep earlier.
There are so many myths out there for helping people sleep. But there are also proven ways to shift your sleep schedule back to normal. Because delayed sleep phase syndrome involves the same mechanisms as jet lag, these treatments work well for both:
Many older adults with chronic delayed sleep phase syndrome often lament that behavioral treatments do little to nothing for them. Indeed, some sufferers have much more difficulty phase advancing their biological clocks than others. For stories of this, check out the visitor-submitted DSPS experiences.
Bright Light Therapy
Often the most successful treatment of DSPS is a method known as Bright Light Therapy.
Bright light therapy, used strategically in the morning, can help shift the biological clock back so you can sleep at night.
Researchers have discovered that it is possible to reset the human biological clock via exposure to bright light. Essentially, through strategic use of bright enough light you can shift when your clock-dependent alerting occurs, and therefore how early you are tired.
This method was not discovered for some time because the light in fact needs to be of a sufficient luminosity, similar to outdoor light, in order to work (above 10,000 lux). Most standard indoor lighting is significantly below the 10,000 lux mark needed for this to be effective. But the treatment can be easily administered in a clinic or by getting your own light box.
A light box is a box of fluorescent lights above the necessary brightness of 10,000 lux. The individual positions the box so that the most intense light is shined into the periphery of the retina, where the majority of eye receptors are located.
Bright light in the morning will help to advance the biological clock, which is exactly the way you would use it for treating delayed sleep phase syndrome, and treatment continues until the resetting is achieved. If you're interested in this treatment, the light box to the right from Amazon offers an affordable option.
What do you think? Any questions or comments? Let us know!
Sleeping Pills
Sleeping pills, it can be said, have a bit of a taboo in our society. Some see them as dangerous or addictive. But in reality, if used properly, they can are an extremely effective tool for healthy sleep and are not in the least bit addictive.
Addictive? No!
It is a very common mythology that sleeping pills are addictive. In fact, they are not and the top three or four on the market can be great aids to a healthier life.
So how can they be used to combat delayed sleep phase syndrome? In theory, it's pretty simple really. Take a dose a bit before your desired bedtime, let the sleeping pill overweigh your clock-dependent alerting, fall asleep at the time you want, and then wake up refreshed at an early time in the morning. Then, once night rolls around again, you'll have been awake for a longer period of time since you woke up earlier, and will be more prone to fall asleep at the time you want again.
In practice, the sleeping pill technique can have mixed results depending on the severity of the DSPS. For some extreme cases, the pills may still not overpower the clock-dependent alerting, leading easily to more frustration. Despite this, do keep the following metaphor from Dr. Dement in mind.
Dr. Dement often equates keeping a bottle of sleeping pills in your medicine cabinet to having a fire extinguisher. In cases of sleep emergencies (prolonged, unwanted DSPS is definitely a sleep emergency) they are there to help you put out the fire. All you have to do is just make sure to follow the dosage instructions on the bottle and your body will thank you in the morning, and again the next night when your body clock is shifted that much closer to how you'd like it.
Sleep Debt
Ironically, even though sleep debt is one of the negative consequences of delayed sleep phase syndrome, it can also be a cure. Sleep debt increases the biological tendency to go to sleep (a fancy way of saying it makes you tired), so accumulating enough of it to outweigh your clock-dependent alerting can make it easier to fall asleep earlier in the night.
This method works best for mild cases of delayed sleep phase syndrome, in particular in cases involving adolescents who tend to sleep in very late in the morning or afternoon and thus don't have a huge sleep debt anyway.
Proceed With Caution!
If trying the sleep debt method, be careful going throughout your day, especially when driving, that your compromised alertness does not put you in harms way. Remember still that Drowsiness Is Red Alert!
An example of how you would do this might be to go to sleep when you can at night (for the sake of our example let's say that time is 3 AM). Then set an alarm for 7 AM the next morning. It will probably be quite hard to get out of bed, but it's all part of the strategy. After most likely being tired for a good part of the day, heed your body's desire for sleep as soon as you can in the evening, before the clock-dependent alerting kicks in. From there, you'll be well on your way to resetting your clock sustainably.
However, do bear in mind that this is a less perfect way of curing delayed sleep phase syndrome than the two methods above. A decently strong late-night dose of clock-dependent alerting could easily be enough to make it very difficult to fall asleep still, just leaving you awake and frustrated with the mind-numbing effects of sleep debt late at night.
But in any case, having a bit of sleep debt can make it easier to fall asleep earlier and earlier each night, so that over time and with some strategy you can shift your biological clock back to a time that lets you sleep when you want to.
A Quick Conclusion
In essence, circadian rhythm sleep disorders are reoccuring patterns that are extremely difficult to break or alter without proper treatment. For many who suffer from delayed sleep phase syndrome or other related disorders, the sleep pattern becomes a viscous circle, often leading to the accumulation of more and more sleep debt, which in turn negatively affects performance, mood, and other factors during the day.
According to Dr. D's sleep book, however, once scientists have had their crack at it, there will likely one day be quick and extremely effective treatments for major and minor biological clock related disorders, such as jet lag or shift work syndrome. Until this day, we will have to wait patiently for the "jet lag pill," and strive to maintain a normal sleep rhythm with a healthy lifestyle and the solid methods described above.
What do you think about delayed sleep phase syndrome or other circadian rhythm disorders? Share your thoughts and post your comments below.
Your Thoughts On Delayed Sleep Phase Syndrome?
What do you think about delayed sleep phase syndrome? Do you think you have it yourself? Is it getting in the way of your life? How do you plan to fix it?
Share your thoughts, feelings, or concerns with us and our visitors below. You could gain valuable suggestions for your situation and your insight could aid others who can relate to what you're experiencing.
Read Other Thoughts About Delayed Sleep Phase
Click on the links below to read the submissions of others about delayed sleep phase syndrome. They were all written by other visitors to this page, just like you.
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Incredible.
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Never Recovered From Jet Lag
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Broken Sleep
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My Sleep = 2/4am - 9am
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I Have It
(This visitor-submitted comment refers to this page on delayed sleep phase syndrome )
Things that don't work for it:
-Sleep Debt
Forget it. Your …
Difference Between Delayed Sleep Phase (DSP) & Delayed Sleep Phase Syndrome (DSPS)
An informative article , but it falls into the usual "daywalker" trap that DSPS is caused by poor sleep hygiene and bad habits. It can be, but for a …
Asleep 3-4 AM to 11-12 AM If I'm Lucky & Nothing To Do In Morning
Wow, I can't believe I didn't see this before. I was surfing Wikipedia this morning when I came across this by accident. It may as well have been written …
Slept Debt Doesn't Work With DSPS
See the paper "Poor Compensatory Function for Sleep Loss as a Pathogenic Factor in Patients with Delayed Sleep Phase Syndrome" Uchiyama, et al. (2000) …
I can tell the author of this article does not suffer from DSPS
I have done all of the above many times as I have tried to be in sync with the daytime world. By getting up early and depriving myself of sleep, I find …
Good 'Nights' Sleep is 3/4am til Midday
Or it would be if I didn't have to get up for work at 6 am. After a day of this I'm whacked, never mind a whole working week. Get home from work, eat, …
I Sleep From 2-4am and 11-3pm
I want to cure this so bad.
Kevin's Answer
Ah, the segmented sleep schedule that's even more unorthodox than the typical delayed sleep phase syndrome …
Can DSPS Ever Really Be "Cured"?
My question is, can someone with DSPS ( delayed sleep phase syndrome ) ever really change their schedule successfully?
I’m 38 years old, and have been …
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About This Site
Welcome! This site is continuously being created by students of Dr. William C. Dement's Sleep And Dreams course at Stanford University.
We made this site as a call to action for people all over the world to live healthier, happier, safer, and more productive lives by learning about their own sleep. We have faith that reading the information provided on this site will motivate you to be smart about your sleep deprivation and strategic about your alertness in order to live life to your fullest, most energetic potential.
In fact, we challenge you to do so! What do you say, are you up for the challenge?
Interviews With Sleep Specialists: Insights Into the Worlds of Sleep Medicine & Sleep Business
America's Most Dangerous Disorder: What Is Sleep Apnea Doing To Your Sleep?
Sleep Debt: How Much More Will You Achieve When You Reduce Yours?
The Stages Of Sleep: The Journey Through The Night
Delayed Sleep Phase: You Want To Sleep But You're Not Tired Yet
Paralyzed at Night: Is Sleep Paralysis Normal?
Sleep In Words: Smart, Strange, and Funny Quotes About Sleep
Sleep Disorders In Children: What's Keeping Your Child From A Full Night's Rest?
Attacks of Pavor Nocturnus (a.k.a. Sleep Terrors, Night Terrors, or Incubus Attacks)
The Stanford Sleep Book
Dr. Dement's pioneering textbook has been the core text for Sleep and Dreams since 1980, but it has just recently been made available to the wider public for the first time.
In it you'll find a more detailed account of the most important things you need to know about sleep, alertness, dreams, and sleep disorders. Studies, statistics, plus plenty of Dr. Dement's classic anecdotes painting the history of sleep medicine.
Preface | Intro | Contents | Get A Copy
More Sleep Resources
The Zeo
A revolution in personal sleep tracking, the Zeo is a wireless headband that transmits your brainwaves in realtime to a dock (pictured here) or your smartphone. The result? You can wake up and see exactly what stages of sleep you were in during the night! Unprecedented personalized sleep knowledge.
Sleep Paralysis: A Dreamer's Guide
Ever woken up paralyzed? A surprising number of us have, believe it or not. But few know the actual causes of this phenomenon, and fewer still how to exert control over it. Dream researcher and sleep paralysis expert Ryan Hurd shares breakthrough insights into how to do just that.
Important Disclaimer
Please Note:
The information found on this page and throughout this site is intended for general information purposes only. While it may prove useful and empowering, it is NOT intended as a substitute for the expertise and judgments of healthcare practitioners.
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