Delayed sleep phase syndrome (DSPS) is a chronic circadian rhythm disorder that causes a person to sleep late and wake up late. People with DSPS can have trouble functioning due to sleep deprivation.

Some doctors may refer to DSPS as delayed sleep phase disorder. The condition may cause an inability to fall asleep at a conventional bedtime or difficulty waking up easily in the morning.

This article looks at DSPS, its symptoms, causes, and more.

A man with delayed sleep phase syndrome trying to sleep.Share on Pinterest
Marko Geber/Getty Images

DSPS is a disorder that causes persistent difficulty falling asleep at night and waking up in the morning.

It is more prevalent in adolescents and young adults. A person with DSPS may have difficulty waking up on time for work or school, feel sleepy during the day, and find it difficult to fall asleep at night despite feeling tired.

For example, people with DSPS may be unable to sleep until around 3 a.m. and, if left to wake naturally, may sleep past 10 a.m.

Some researchers associate adolescent DSPD with lower grades in school, alcohol use, smoking, and higher rates of depression and anxiety.

Melatonin imbalances may be a potential cause of DSPS. For treatment, a doctor may recommend bright light therapy, melatonin supplements, or sleep hygiene improvements.

Circadian rhythms

Circadian rhythms are natural cycles in the human body. They help a person’s body with sleep, digestion, hormone regulation, and more.

One of these circadian rhythms is known as the sleep-wake cycle. This is the body’s natural way of telling a person when to sleep and wake up.

This cycle enables the body to respond to external cues, such as light. As the day progresses to night, the body senses the decrease in light and prepares for sleep by releasing the hormone melatonin.

In a person with a circadian rhythm disorder, such as DSPS, a person’s sleep-wake cycle may be disturbed. This can cause difficulty sleeping and waking at appropriate times.

People with DSPS may experience side effects. These may include:

  • Daytime sleepiness: When a person cannot fall asleep at a reasonable time and still needs to be up by a specific time, they may experience daytime drowsiness.
  • Difficulty concentrating: People with DSPS may find it difficult to focus on tasks due to tiredness.
  • Behavior problems: Children and adolescents with DSPS may “act out” due to excessive sleepiness. These behavioral issues can affect personal and social relationships.
  • Mental health issues: Adolescents with DSPS tend to score higher on tests for anxiety and depression.
  • Reduced attendance: Difficulty waking up at a reasonable or set time can cause people with DSPS to repeatedly run late or miss work or school.
  • Performance at work or school: Being frequently late, absent, or tired and unable to focus often leads to reduced performance at work or school. This can have a knock-on effect, potentially causing mental health issues.

According to the National Center for Complementary and Integrative Health, children with certain conditions, such as attention deficit hyperactivity disorder (ADHD), are more prone to sleep problems than other children.

People with ADHD are more likely to have DSPS than people without ADHD. They may also experience difficulty staying awake during the day or falling asleep at night. This may be due to hyperactivity and trouble regulating emotions, behavior, and attention span.

People with DSPS may have trouble going to sleep at a conventional time. They typically have no issues with duration and quality of sleep. It is getting to sleep at a convenient or acceptable time that they find difficult.

According to older research, most people with DSPS typically have difficulty with the following:

  • Falling asleep: Because their internal clock sends alerting signals until later than is typical, people cannot fall asleep for several hours after a typical bedtime. This means they often end up staying awake until hours after midnight.
  • Waking up: People with DSPS do not receive alerting signals from their internal clock until later than most people. This makes it difficult for them to wake up at a conventional time.

A doctor may diagnose DSPS based on the description of symptoms. They may also ask a person to record their sleeping behavior for a few weeks before they make a diagnosis.

Doctors may ask questions regarding:

  • how long a person has had the problem
  • how often the delayed sleep occurs
  • how refreshed a person feels when they wake up, and how tired they feel during the day

Other diagnostic tools for DSPS may include:

  • Actigraphy: This is where a person wears a small device similar to a wristwatch. It records movement and light to determine whether they are awake or asleep. This can take place at the person’s home.
  • Polysomnograph: People may wish to participate in a sleep study to find out whether they have DSPS. This involves staying overnight at a facility where experts monitor their sleep.

The process of treating DSPS is known as chronotherapy.

Chronotherapy aims to restore a typical circadian sleep-wake cycle pattern using several treatment options. Healthcare professionals can work with people who have DSPS to devise a suitable treatment plan.

This plan may include any of the following:

  • Advancing the internal clock: People can help advance their internal clock by going to bed 15 minutes earlier each night and waking up 15 minutes earlier than they typically would. By making the changes in 15-minute increments, people may be able to change their sleep patterns over a number of days.
  • Delaying the internal clock: To delay an internal clock, a person delays their bedtime by 1 to 2.5 hours every 6 days until they reach a suitable sleeping pattern.
  • Melatonin: Melatonin is a hormone that the body naturally produces. It helps regulate a person’s circadian rhythms and sleep patterns. Healthcare professionals may prescribe melatonin supplements to aid in the treatment of DSPS.
  • Bright light therapy: Sitting near a light box or bright window for 30 minutes upon waking can help advance a person’s internal clock and regulate their circadian rhythms.
  • Sleep hygiene improvements: There are a number of things people can do to improve their sleep hygiene. These include:
    • following a regular sleep schedule
    • avoiding electronics before bed
    • abstaining from alcohol before bed
    • refraining from consuming caffeine before bed
    • avoiding vigorous exercise before bed

Is it curable?

There is no permanent cure for DSPS. However, people can take steps to manage it using the treatment methods above.

The most important thing a person can do is maintain their new sleep schedule and sleep habits.

People should contact a doctor if they believe that they have (or their child has) a sleep disorder.

Keeping a sleep diary and recording the time of sleep, duration of sleep, and the number of times they wake up during the night, as well as the time they wake up, can be useful to take to healthcare professionals as evidence.

Keeping this diary for a few weeks can help doctors to make an accurate diagnosis.

People should seek medical advice if their lack of sleep is interfering with their quality of life and safety.

People with DSPS can work with a healthcare professional to develop a treatment plan for their condition.

As long as they stick to the treatment plan, it is often possible to achieve and maintain an appropriate sleeping pattern.

It is important to adhere to the treatment plan even on weekends and holidays, as disrupting it can cause a person to revert to a dysfunctional sleep schedule.

DSPS is a sleep disorder that delays a person’s natural sleep-wake cycle. It is prevalent in adolescents, young adults, and people with ADHD.

A person with DSPS may fall asleep later than intended and feel sleepy during the day. They might have trouble concentrating or staying awake during the day, even though they slept through the night.

Following a treatment plan developed with a healthcare professional can help people with DSPS remedy their sleep patterns.