Sleep is a normal activity that connects all sentient beings. Except for whales and dolphins, which practice unihemispheric sleep, almost all animals need to sleep. The sleep cycles vary between species. The duration of sleep can vary depending upon the season and the bodily needs. Human beings need sleep just like any other mammals. While koalas are on one end of the sleep spectrum with a 20 hour per day sleep schedule and giraffes are on the other with about 2 hours per day sleep necessities, human beings are somewhere in the middle. The average human adult needs about 7 to 8 hours of sleep on a daily basis.
Due to work pressure and social responsibilities, we often fall short on time for resting. Increasing screen time and lack of enough exercise often cause a lack of proper rejuvenating sleep in the urban youth. Being a “night owl” maybe the cool thing to do right now, but what is the price for it? Most of the people who suffer from delayed sleep onset are not going to bed later than usual on purpose. They suffer from delayed sleep phase disorder (DSPD or DSPS) that causes them to fall asleep beyond the socially acceptable bedtime.
People suffering from DSPS usually fall asleep after 12 am and find it extremely difficult to wake up in time for school or work. Delayed sleep phase syndrome affects 1 in 600 adults in the USA. The percentage prevalence of this sleep disorder in the total population of the country is still not accurate, but investigations indicate that the numbers could be somewhere between 7% in adolescents and young adults.
What is Delayed Sleep Phase Syndrome?
Delayed sleep phase disorder occurs when the internal clock of a person is not a 9 to 5 schedule. It is understandable why they cannot fall asleep by 11 pm or why they cannot wake up fresh as a daisy at 7 am. Their internal clocks are not in sync with the external clocks. Our body’s circadian rhythm is responsible for keeping our biological clocks responsive to the external light and dark cues. However, for people with minute changes in the clock genes or the circadian rhythm, it becomes difficult to process the light signs from their environment. It is almost as if their bodies have sleep-wake cycles that control their bedtime and wake-time.
Doctors and sleep specialists used to believe that delayed sleep onset usually occurs in the elderly or working adults. That was because this age group typically reported feeling sleepless during the socially acceptable sleeping hours. However, modern research has shown that the recurrence of delayed sleep onset is a common “ailment” among the youth, adolescents and urban children as well. A large number of kids stay up beyond 10 pm to 11 pm engaging in gaming, web surfing or watching TV. There is thus a loss of individual productivity among children and the young adults alike.
For instance, Tammy is a bright young girl, who could not fall asleep before 3 am. No matter how hard she tried to wake up by 7 am each morning, she missed her school bus almost 4 days a week, and her father had to drive her to school reluctantly. She was tired nearly every day. She was tired of her legs hurting and her back killing her before and after PE.
Recently, she started binge eating and putting on a lot of weight, so her parents took her to the doctor. Her test results showed that her blood pressure was up, her cholesterol levels were off the charts, but her thyroid levels were normal! That is when they got in touch with a sleep specialist who diagnosed her with delayed sleep phase syndrome.
The incident is a real case study from one of many famous clinics around the country. Tammy is one of the few lucky ones who get the correct diagnosis before the sleep disorders took over their life. To many parents, teachers, and employers, delayed phase syndrome is just a fancy name for “staying up late.” Sadly, that is not at all the case. There are several genetic factors, neurological aberrations, and external factors that contribute to a skewed sleeping cycle in individuals of all ages.
Contrary to popular belief, individuals suffering from delayed sleep onset cannot engage in more laborious activities and tire themselves to restorative sleep each night on time. It is NOT a sign of laziness or an excuse to skip out on responsibilities. American Sleep Association recognizes it as a real ailment that requires diagnosis, therapy, and treatment. Right now, reports from clinicians state that over 400,000 Americans suffer from delayed sleep phase syndrome. While a number of them face symptoms of social jet lag, others face more dire results including loss of jobs.
The Leading Causes of Delayed Sleep-Wake Phase Syndrome
The pathophysiology of delayed sleep phase syndrome is varied. The heterogeneity of the syndrome mainly comes from the variation in the age of the affected groups, occupations, regions and other intrinsic factors. Several genetic factors play significant roles in the cause and onset of the disorder.
Developmental changes. Over the years several studies have shown the role of changing bodies in adolescents as the primary cause of sleep-wake cycles among them. Both psychological and social changes during puberty can become the reasons for DSPS in the teenagers. Several teens show high brain activity during the evening till about 20 years of age. This “eveningness” usually declines after the early 20s.
Intrinsic circadian rhythms. You cannot ignore the action of the intrinsic clock genes in the change of sleep-wake cycles in individuals. It usually happens when the intrinsic circadian periods are longer than 24 hours. When an individual’s biological clock takes more than 24 hours to complete a cycle, it demands more adjustments to a 24 hour day. Patients with DSWPD often have a longer circadian period as compared to the usual control individuals.
Light exposure alterations. Working in artificially lit offices often lead to alternations in the biological clocks. For example, people who work in laboratories or closed environments devoid of natural light suffer from aberrant circadian rhythm changes. The excessive blue light from the CFLs and cold LED lighting causes suppression in the normal melatonin synthesis process. Pre-sleep high intensity light exposure often causes people to feel more awake at night than the control groups that did not experience high intensity light exposure before bedtime. Blue light blocking glasses often help to suppress the symptoms of DSPS in patients.
Hyper-sensitivity to light exposure. Alterations in sensitivity to nocturnal light can lead to DSPD in people. Hypersensitivity is a leading cause among people working in artificially lit environments for long hours. Lights emitting more than 2000 lux per hour can suppress melatonin in adults, which can potentially lead to delayed onset of sleep and long term sleep disorders including DSPS.
Several other factors like increase in screen time, fidgeting with electronic devices before sleep, use of particular antipsychotics like haloperidol and fluvoxamine and several genetic causes like the mutations in the Clock Genes can contribute to DSPS in all age groups. Adolescents often experience worse effects of delayed sleep onset due to peer pressure, social demands, and the rising use of blue light emitting devices like touchscreen phones, tablets, laptops, computers, and gaming consoles. Sleeping disorders are not acquired habits among kids and young adults. It is a serious condition that demands medical attention.
If you Have Trouble Falling Asleep: Could it be a Case of Delayed Sleep-Wake Phase Disorder?
There are several telltale signs of DSPS that people often confuse with other sleeping disorders like insomnia. There have been several cases when children and adolescents have been diagnosed with depression instead of DSPS due to overlapping symptoms. You might be 100% sure that you have a case of delayed sleep onset, but you should always rely on an expert for confirmed diagnosis.
- The leading symptom of almost all sleep disorders is feeling tired throughout the day and physically feeling the lack of sleep. As the bedtime pushes back, the individuals are less likely to get more than 4 or 5 hours of sleep per night, and this leads to a lack of restorative sleep due to a decrease in the number of REM and non-REM cycles. Chronic sleep restriction is one of the leading symptoms of delayed sleep phase syndrome.
- The affected individuals have bedtimes that are significantly later than the socially accepted sleep time. They also have delayed wake time that can be 9 pm or even later. Their weekend sleep time and wake time are usually more delayed than their weekday sleep time and wake times.
- They do not experience restorative sleep during early sleeping cycles. They encounter good quality of sleep according to their intrinsic circadian preference.
- Inability to fall asleep during an acceptable bedtime is often the primary symptom of both DSPS and insomnia. However, people with DSPS do not experience the lack of proper quality sleep or wake up before completing their 7 to 8-hour sleep unless they have to wake up for school or work on weekdays.
- Children, adolescents, and young adults often report feeling isolated and depressed as a result of the social aloofness, delayed sleeping hours cause. Depression is usually a result of the lack of enough restorative sleep and the odd sleeping hours, people keep. Unless the person already has a diagnosis of depression and is taking psychoactive drugs, it is unlikely that delayed sleep phase syndrome is a result of their depressive disorders.
Interestingly, people with DSPS usually do not report any other problems with sleep or the quality of sleep.
Why Should you Always go to a Reputable Sleep Expert for Delayed Sleep Phase Diagnosis?
You may want to think that not sleeping properly for a couple of days might be completely fine, or that sleeping at 1 am for months automatically makes you an insomniac, but you could not be more wrong. There are several sleep disorders, and with the rising variations in work environments, the diversity is increasing every day.
Confusing DSPS with insomnia and other sleep disorders is easier than you think. Therefore, there are systematic examinations and studies that are necessary to diagnose a person with any DSPS.
- The sleep expert usually insists that the subject maintain a regular sleep log that contains the daily bedtimes, waking times and sleep experiences.
- The doctor will also give the subject a thorough physical examination and run blood tests to see if there are any other underlying physiological causes of the sleep “disturbances.”
- If the doctor or sleep specialist sees fit, they can ask you to participate in sleep studies which will involve several sessions of sleep observations including your breathing rate, heart rate, and brainwaves. It usually helps rule out sleep apnea from the process.
- Several clinics also use salivary melatonin based immunoassays to determine the levels of melatonin secretion and suppression in the concerned patient.
The integral parts of any DSPS diagnosis are the sleep logs, polysomnogram and the description of the symptoms by the patient. In some cases, doctors use an autograph (a wearable tech device that can confirm the activity-rest rhythms of the body) to note the signs and symptoms associated with DSPS.
There are five conditions each patient must meet to qualify for DSPS treatments.
- The problem of sleep onset delay must be recurrent. It should reflect during both sleep time and wake-up time.
- The presence of the symptoms must be at least 3 months long.
- The maintenance of a sleep log and actigraphy monitoring for one week at least.
- Sleep disturbances should not be explainable by other disorders such as medical, psychological or neurological.
- When patients have the liberty to adjust their schedule as per their natural biological clock, they should exhibit a 24-hour cycle. They should also show better sleep quality.
Only when a subject meets all these five defining traits, they shall qualify for DSPS treatment. It is as per the requirements of the International Classification of Sleep Disorders (third edition).
Insomnia vs. DSPS: Why Do You Need an Expert to Help you Find out What Sleep Disorder You Have?
Many erroneously believe that DSPS and insomnia are the same. However, they could not be more wrong. People with delayed sleep phase disorder often stay in bed up until late unless it is a school day or a weekday. Many of them adjust their work schedules according to their intrinsic circadian rhythms by working from home offices. Insomniacs often cannot find sufficient rest or sleep without the help of sleep medication, irrespective, of their level of tiredness or the time of the day.
Merely feeling lethargic and out of energy during the day is not reason enough to believe that you suffer from DSPS. Several sleep disorders can lead to similar effects. Sleep apnea and circadian rhythm disorders often leave people feeling tired and sleepy throughout the day. Sleep disorders like these shorten the duration of sleep and interfere with sleep quality. Therefore, it is common to feel breathless, fatigued, tired and lethargic even when you do not have DSPS.
Even experts misdiagnose insomnia as DSPS and vice versa. Over the years, experts have characterized insomnia as the lack of sleep. Having insomnia means your body does not let you fall asleep or remain asleep for enough time necessary for healing actions, which is quite similar to not getting enough sleep due to late sleep onset time.
One way clinicians often distinguish DSPS from insomnia is by asking the patients what happens when they fall asleep according to the needs of their body. The patient’s sleep-wake schedules often determine the quality of sleep and help the doctors distinguish between overlapping signs of sleep disorders. Sleep onset insomnia is quite similar to DSPS in its symptoms and signs. It is the inability to fall asleep immediately after going to bed. The delay in sleep can be up to 1 hour. People often need to consult a sleep expert or a physician for the diagnosis, since the similarity of DSPS and insomnia leave them confused.
Management of Delayed Sleeping Phase Disorder: Is There a Way to Combat DSPD Without Medication?
Thousands of people shy away from medicinal help when it comes to sleep disorders. People are becoming more aware of the deleterious effects of sleep medication that can potentially give them a grip on their sleep schedules. The situation has spearheaded some studies aimed at the evolution of behavior modification techniques that can manage delayed sleep onset in subjects.
The ultimate goal is to advance the bedtime gradually and push the wakeup time that aligns with social necessities. It helps growing children, adolescents, and young adults, who cannot afford to take the chance of experiencing the strange side effects of sedatives and tranquilizers.
- The behavioral modification involves avoidance of caffeine-containing drinks and food.
- Avoiding naps during the day.
- Minimize consumption of alcohol and nicotine in adults.
- Making the right dietary choices.
- Avoiding poor sleep habits that can exacerbate the delay in sleep onset.
- The inclusion of physical activities and moving away from a sedentary lifestyle.
It is true that mobilizing your body can help you with several sleeping disorders. Not working out cannot only exacerbate DSPS but it can also worsen the problems that come with it. Arthritis, muscle fatigue, and weight gain become serious issues when a person refrains from all sorts of physical exercise.
What are the Modern Treatments of DSPS That can Work for all Age Groups?
While behavior modification, of course, helps in the correction of sleep-wake time in adults and children, in case of adults who have been suffering from DSPS for a long time, simple behavior modification can be difficult without external aid. To treat the chronically delayed onset of sleep, you will need a treatment plan. Your treatment plan will require.
Bright light therapy. This is when a patient needs a bright blue light of around 2000 lux hour in the morning. The exposure to bright light causes wakefulness and alertness in the mornings. It drives away sleepiness to a considerable degree. Doctors usually determine the frequency of the light contact in the patients. During the evening, the patients usually refrain from all kinds of light exposure.
For better effects, expert therapists often complement bright light therapy in the morning with no-bright light exposure in the evenings. The lack of enough light in the evening time prevents melatonin secretion. Experts usually ask their patient to opt for warm white lights or yellow lights (monochromatic non-blue light LEDs) in their bedrooms and evening hangouts. The stimulation with bright light helps in the suppression of melatonin in the mornings and the regulation of exposure in the evenings prevents the exposure. Melatonin stimulates proper sleep onset at the correct time.
Melatonin therapy. Oral consumption of melatonin for correcting sleep schedules is a time-tested therapy. Although melatonin consumption over long periods of time can have serious side effects, doctors prescribe it for adult and youngsters, who suffer from chronic sleeplessness during the desired bedtime. Taking melatonin supplements in the early evenings can help you fall asleep earlier than you do since DSPS caught a hold of you.
In case you are already undergoing melatonin therapy, but you are not experiencing an improvement in sleep onset time, you should consult your doctor immediately. You should never self-administer melatonin or increase the dosage without consultation. A sudden increase in melatonin levels can cause severe nausea, hair loss and weight loss in people. Children, adolescents, and pregnant women need to be very cautious about the dosage and the duration of the therapy. Always stay in constant touch with your doctor, while taking melatonin supplements in oral or injection form.
Chronotherapy. The name might sound quite intimidating, but it is a simple and wholesome therapy for those suffering from DSPS. It includes the modulation of your routine that allows the delay of your routine by 1 to 2.5 hours each six days. The delay stops when you achieve your desired bedtime and wake-up time. The key to successfully overcoming your DSPS with the help of chronotherapy is sticking to the new schedule once you establish it. Nonetheless, this method only works for those showing mild symptoms of DSPS or DSPD. For those suffering from more chronic cases, chronotherapy often requires complementary hormone treatments and light therapy.
Many research papers show that the administration of multiple treatment procedures together often yields better results. Chronotherapy along with light-box therapy and melatonin supplements elicit the best effects among patients suffering from chronic DSPS for years. The rate of recovery depends a lot on the patient physiology, duration of the disorder and the patient’s compliance with the new treatment. Not all people exhibit the same recovery responses.
What other Diseases Occur Exclusively with Delayed Sleep Onset Syndrome?
DSPS in adolescents and adults usually does not occur alone. Comorbid depression is recurrent among individuals with DSPS. In a study involving 205 adults, over 51% of them reported having severe depression or depressive episodes in their lifetime. About 7% of the population suffers from depression, but a study of people (a cohort) having DSPS shows a much higher co-occurrence rate. There are several reasons you should be aware of this familiar yet lesser-known syndrome and its signs.
The occurrence of comorbid depression or depressive episodes is less responsive to anti-depressant therapy as compared to the cases of depression in the general population. You could say that DSPS almost makes depression resistant to certain anti-depressants and anti-psychotics. People suffering from dysthymia or persistent depressive disorder (PDD), report building resistance to certain antidepressants much faster when PDD occurs with delayed sleep phase syndrome.
Delayed circadian rhythm often correlates with bipolar disorder in children, obsessive-compulsive disorder (OCD) in adults and attention deficit hyperactivity disorder (ADHD) in children. It is very common for children falling within the autism spectrum disorder to suffer from several sleep disorders, but the most predominant among them is delayed sleep phase syndrome.
Although the clinical history of DSPD is not well-known, it can be undoubtedly said that people irrespective of their age and gender can suffer from it. It usually begins during the young adolescent years and grows into early adulthood and beyond, if it remains without diagnosis or treatment. At the moment, doctors and dieticians are often relating delayed onset of sleep with other comorbid conditions like elevated blood cholesterol levels, higher blood pressure levels, and obesity. Several people have the habit of binging when unable to sleep and this often leads to the consumption of thousands of extra calories that contribute to high-fat deposits in the body.
DSPS paves the way for several other ailments that may not even be related to the common person. However, an investigation into the underlying causes, signs and diagnostic requirements of it are providing the scientists and doctors more information on the syndrome and its comorbid disorders.
In Case you Have Forgotten why Sleep is Essential for You
Sleep is necessary for people of all genders ages and professions. Irrespective of how much energy you consume and expend per day, your body needs time to heal itself. Your brain needs enough time to convert the short-term memories to long-term memories, process the information you have already collected throughout the day and to form new links between the data sets you have created. You can think of sleep as the time your body needs to do away with the day’s exhaustion and injuries and prepare itself for a brand new day’s work.
Sleep is also necessary to fight off immunity challenges, which is why you are more likely to feel sleepy during viral diseases. Without sound sleep, it is almost impossible to function properly. The record for going the longest without sleep is 11 days and 25 minutes, but Randy Gardner, the record holder, showed severe cognitive changes and mood swings in the later days. Sleep deprivation can also lead to behavioral changes in the subjects as the initial study by researcher William Dement showed.
Investigators have associated sleep deprivation with problems in concentration, incidences of paranoi, and hallucinations, short-term memory, loss and increasing fatigue. In fact, chronic fatigue syndrome is one of the most common effects of insomnia and DSPS among all patients. Evolution has designed our brains so that during sleep our body uses minimal energy, and a considerable part of the energy becomes available for repair, restoration, and rejuvenation.
Most of the new neural connections usually form when you are asleep. It is probably the reason why getting 8 hours of sleep before a test often gets you better scores as compared to a whole night of revisions.
Why Should you Pay More Attention to Your Sleep Schedule?
Circadian rhythm sleeping disorders usually occur when your body clock is out of sync with the external clock. Melatonin secretion and several other genetic processes that control sleep depend on external light cues. Night owls usually feel sharper and more active during the evenings. They are likely to fall asleep between 1 am, and 4 am, and they naturally wake up between 8 am, and 11 am. Advancing their sleep-wake cycles not only disrupts their normal body rhythms, but it also causes poor restorative sleep.
Several scientists suggest that in case an individual’s natural circadian rhythm is not interfering with their regular work, it is better to leave them alone in their usual routine. Sadly, a lot of adolescents miss out on schoolwork and adults suffer in their professional field due to DSPS. A lot of patients suffers from diagnosed cases of DSPS and report social isolation and the lack of a social life altogether due to their odd sleeping schedules. It is one of the significant challenges the youth of the country are facing right now. In fact, over 10% of the chronic insomnia cases are cases of a misdiagnosed delayed sleep phase syndrome.
Co-founder of Counting Sheep and Sleepaholic