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Are you a night owl? Do you keep to a very different sleep schedule than your friends and family? Do you have trouble waking up on time to get to work or other obligations because you couldn’t fall asleep until late the night before? If the answer to the above questions is yes, and if it creates problems for you in your daily life, you may have Delayed Sleep Phase Disorder (DSPD).
Patients with DSPD notice that they often have trouble falling asleep, but once they finally fall asleep they obtain a full night’s sleep and usually awaken in the late morning or early afternoon. It is a different problem from insomnia. Patients with insomnia may have trouble falling asleep, staying asleep or waking up too early (or a combination of the three). With insomnia, a full night’s sleep is rarely obtained on a regular basis, even on days off. Those with DSPD typically sleep a full night when they don’t have to get up early in the morning.
Although it is normal for us to occasionally stay up later to socialize or work and sleep later the next day, those with DSPD tend to have significant difficulty returning to a more “normal” sleep-wake schedule despite repeated attempts. They usually lay in bed for hours before finally falling asleep at night, and once they do so, they naturally want to sleep later in the morning — which makes morning awakenings at a specific early time extremely challenging.
DSPD is essentially the result of a delayed circadian rhythm. The circadian rhythm is a biologically-driven alarm clock that runs our body. These rhythms tell us when to fall asleep, when to wake up, when to get hungry, and when certain hormones should be secreted in the body. In DSPD, the circadian rhythm drifts later, leading to delayed sleep and wake times.
Although teenagers often have DSPD, it can occur in adults too. Younger children typically have a bedtime of 8 or 9 pm, and once adolescence arrives, the bedtime naturally shifts to as late as midnight. Teens typically need 9-10 hours of sleep per night, but since they don’t naturally fall asleep until later and have to get up early for school, they’re often sleep-deprived and very tired throughout the day. On the weekends, teens tend to sleep even later in the morning or until the early afternoon.
Although it is completely normal for teens to naturally go to bed later and want to sleep in, some teens find that they go to bed too late and have significant trouble with waking up in the morning for school and are very sleepy during the day. When this circadian shift creates major problems with functioning during the day (e.g. trouble awakening in the morning, sleep deprivation, grogginess, irritability), DSPS is suspected and treatment may be warranted.
If you are someone who enjoys being a night owl and it doesn’t interfere with your life overall, there’s no problem. But if you can’t fall asleep until late and have trouble getting to that 9 am meeting on a regular basis, you might want to see if there’s a treatment that can help.
There are a few effective treatments available for DSPD, and consulting with a sleep specialist to rule out any other contributing factors is suggested. DSPD treatment is very different from insomnia treatment, and working with a sleep specialist can help you determine the best approach. Sedating medications (e.g. zolpidem, eszopiclone) typically don't have much effect on shifting the circadian rhythm and may only work as a band-aid.
One option for DSPD is chronotherapy. The patient goes to bed (and wakes up) later by 2-3 hours each day until the bedtime and wake time come fully around to the desired bed and wake times. This effective treatment can be hard for some to implement. It requires that the patient often spend large chunks of the day asleep and awake all night. During the treatment period, all daytime activities, light, and noise need to be limited to help the patient sleep, and ways to help the patient stay up later need to be addressed. Sometimes having a friend or family member keep the patient on schedule can be of use.
Option #2 is morning bright light therapy. This requires the use of a bright light box (or sunlight — though for many the sun isn't up early enough in the winter). It is very important, though, for patients to consult with a sleep specialist to figure out the appropriate timing of the bright light. If it is used at the wrong time, it can actually worsen the problem. Bright light therapy can also worsen a few psychiatric disorders, so consult with a specialist first.
Option #3 is melatonin. This natural hormone is made by the body’s pineal gland and is more effective for circadian rhythm disorders (DPSD, jet lag) than it is for insomnia. When the sun goes down, the pineal gland becomes active and begins to naturally produce melatonin. Commonly sold in health food and drug stores, melatonin is an over-the-counter dietary aid that is not regulated by the Food and Drug Administration. As a result, listed doses and ingredients aren’t always completely accurate. Try using a brand you trust.
Although it is naturally found in our bodies, over-the-counter melatonin can have some side effects including daytime sleepiness, confusion, abdominal pain, nightmares, sleepwalking, and dizziness. It can also have a negative interaction with certain medications such as diabetes medicines, immunosuppressants, birth control pills, and blood thinners.
Melatonin can be a very effective treatment for DSPD, but patients should seek the help of a sleep specialist to figure out the proper dose and timing of administration. Smaller doses (0.5 milligrams) are typically given earlier in the evening to help gently pull your circadian drive earlier, over time leading to earlier natural bed and wake times. Many people misuse melatonin (taking too much and taking it too close to bedtime) to treat DSPD.
If you think that you might suffer from DSPD, a consultation with a sleep specialist can help you devise a more appropriate, and helpful, treatment plan. In just a few short weeks, you may find that you fall asleep and wake up at times you have always wanted to!
