We commonly see teenagers in our sleep medicine practice who have a difficult time waking in the morning for school. Sleep hygiene problems are often the culprit, however, sometimes these patients have delayed sleep phase syndrome.
Delayed sleep phase syndrome (DSPS) is a misalignment of a patient’s internal biological clock and societal expectations. In other words, these patients have difficulty living in a nine to five world. Patients with DSPS have sleep onset and wake times that are delayed about three to six hours compared with conventional sleep-wake times. These patients often refer to themselves as “night owls.”
DSPS prevalence is as high as 7% in teenagers. Young adults have a tendency to stay up later and sleep later, which can advance their internal clock. If patients with DSPS were given the opportunity to sleep how they feel comfortable, they generally would fall asleep between 2 am and 6 am, and wake between 10 am and 1 pm.
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Making the diagnosis is based on the patient’s history of chronic recurrent problems with waking in the morning and being able to fulfill their school and work obligations. Adult patients may visit a health-care provider after they have lost a job from being late to work multiple times. Patients with DSPS are often labeled as lazy, and being out of sync with the rest the world can lead to frustration and depression.
The goal of therapy is to resynchronize the circadian rhythms. This can be done through light therapy, pharmacotherapy or chronotherapy. Bright light exposure in the morning is usually effective in advancing sleep-wake cycle timing. Promoting good sleep hygiene is also very important. Also be sure to rule out other health issues including restless leg syndrome, depression and substance abuse.
Some patients adapt by the finding situations that allow them to sleep as they feel comfortable. These patients often try to find occupations where they can work at home. Interestingly, more artists, writers and musicians suffer from DSPS. They often feel more productive and creative in the early morning hours.
Sharon M. O’Brien, MPAS, PA-C, works at Presbyterian Sleep Health in Charlotte, N.C. Her main interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.
