In a world of nine to five, it’s easy to take sleeping through the night and waking up early in the day for granted. In a world largely constructed based on this default way of living, it can be hard for those that don’t fit the mold – night owls, new parents, and Netflix binge watchers all have it tough. But for some individuals, an inability to sleep through at night and be wakeful for most of the day is due to a medical issue called Delayed Sleep Phase Disorder (DSPD).
For these people, their sleep cycle is a completely shifted from the social standard sleep pattern. Without treatment, people suffering from Delayed Sleep Phase Disorder can have significantly decreased quality of life.
It may not affect a large proportion of the population, but DSPD is a highly relatable disorder. Most people have had a day when they would have preferred or sleeping a later into the day because of a necessary or preferred late night. Whether you have DSPD or are just curious, this article will take a look at Delayed Sleep Phase Disorder, giving you a basic understanding of what it is, how it is treated and how to adapt to life as someone who suffers from Delayed Sleep Phase Disorder.
What is Delayed Sleep Phase Disorder?
Before jumping into Delayed Sleep Phase Disorder, let’s begin with how sleep actually works.
Our ability and motivation to sleep is regulated by a complex neurological system known as the circadian rhythm. The circadian rhythm has various triggers, but the predominant force is the type and intensity of light which the body and eye are exposed to. Light with a shorter wavelength, like that coming out of the sun and computer screen, is interpreted by the brain as daylight. This means daylight and electronics screens make people feel more awake and keep them awake.
Delayed Sleep Phase Disorder is like jetlag, with two important differences. First, instead of the body adjusting after a few days as with jet lag, the condition persists indefinitely. Second, Delayed Sleep Phase Disorder is not caused by sudden shifts in daily routines, but is thought to be caused by genetic mutations or due to injury. In DSPD, the circadian rhythm is permanently shifted and out-of-sync with the rest of the population. Some researchers believe that the circadian cycle in these patients is simply longer than 24-hours, which is why it seems out of sync with the rest of the world’s daily routines.
Those with DPSD find themselves unable to sleep until hours after midnight. Unable to wake up early, they sleep well into the morning or afternoon. Unlike with other sleep disorders, patients sleep well and need the same amount of hours of sleep as other people.
The percent of people experiencing Delayed Sleep Phase Disorder varies widely based on age. An estimated 7 to 16% of the adolescent population experiences symptoms, compared to 0.17% of the general adult population. It is often a condition that a person will grow out of once they pass adolescence.
Many sleep disorders share similar symptoms, such as persistent fatigue or difficulty sleeping at normal hours. DPSD distinguishes itself with these primary symptoms:
- Delay in the phase of sleep relative to the rest of the population and socially-accepted norms
- Excessive daytime sleepiness
- No issues falling asleep and staying asleep when within the hours of the patient’s circadian rhythm
- Great difficulty or complete inability to self-correct one’s sleep cycle
It is not uncommon for people to ignore these issues when the condition first arises. Sometimes people naturally adapt, selecting lines of work that offer evening or flexible hours so the person can continuously “sleep in” and work during their wakefulness hours in the evening and night. It is not until they are forced to assume a normal lifestyle, with its early wake-up times, that it becomes apparent their prior schedule was a coping mechanism.
Other times, a person simply accepts the fatigue and sleep deprivation during weekdays, and sleeps in during weekends to compensate for the lack of hours.
How Is Delayed Sleep Phase Disorder Diagnosed?
Thanks to increased awareness and a standard testing methodology, diagnosing Delayed Sleep Phase Disorder has become vastly easier to diagnose over the last couple of years. Someone suspecting that they may have a sleep disorder will usually be referred to a sleep therapist, who will perform a set of tests on the patient to come to a diagnosis:
A sleep diary is a journal where a patient will record the times they fall asleep, wake up, and how they feel upon waking up. The specialist will look for marked shifts in the patient’s sleep cycle relative to the norm, and attempt to measure the average shift. For example, she may find that your sleep cycle is shifted by 3 hours relative to everyone else. Seeing a consistent delay over the course of 2 weeks is an important marker for DPSD, and helps rule out other issues.
This in-hospital test is used in situations where there is an uncertainty as to what sleep disorder the patient is suffering from. The test involves hooking the patient up to a variety of tools to measure breath, blood pressure, heart rate, and more. It measures:
- Activity During Night
- Blood Oxygen Levels
- Eye Movements
- Heart Rate
It is one of the most effective tests available for screening out issues like narcolepsy or sleep apnea.
This test can be conducted from home. It involves having the patient go through their daily routine wearing a small sensor. This sensor will automatically record reduced levels of activity, and interprets them as either periods of wakefulness or sleep. The test reveals the patient’s sleeping pattern without having to depend on them manually recording it themselves in a diary. It also enables the medical practitioners to rule out other sleep disorders.
DPSD can cause other conditions connected to the body’s wake/sleep cycle. Seasonal Affective Disorder (SAD) is a condition of seasonal depression with the advent of shorter days and less sunlight. This those with DSPD are 3.3 times more likely to report SAD episodes. Generalized depression is also linked to DSPD. The decreased quality of life and general exhaustion brought on by someone with DPSP trying to navigate through the world often causes severe depression.
Sufferers of DSPD often to turn to medications, both legal and illegal, in attempts to fall asleep earlier, increasing the likelihood of secondary symptoms or overdose.
It is important to seek professional treatment instead of self-medicating in order to prevent the evolution of the comorbidities listed above.
There are a variety of treatments available which are commonly used in combination for greater effectiveness. There is no cure for DSPD, and an individual who develops DSPD should expect the condition to re-occur persistently throughout their lives. Some of the most common treatments used by sleep specialists include:
Melatonin is naturally secreted by the pineal gland located near the brain, and serves as the body’s principal stimulator and regulator of sleep. It is often used as a first line treatment before stronger sleep medications are prescribed. Melatonin is cheap and widely available without a prescription.
There are two forms of light therapy which can be used either in conjunction or on their own. The first is light deprivation. This is the intentional blocking of short wavelengths light. These short light wavelengths, also known as blue light, are known to suppress melatonin production. This can help enhance sleepiness at desired times. The other therapy involves exposing the patient to shortwave light at the times that they would like to wake up or be awake. This can involve exposing someone to specialized bright light lamp which produces light which mimics the wavelengths produced by the sun.
Creating a Peaceful Environment
A mind cannot rest in an active environment. By removing obstacles to sleep, for instance electronic devices, it is possible help the patient relax and fall asleep. Additionally, strenuous activities like weight lifting should be avoided, due to the increase in heart rate that results from exercise. The general rule of thumb is to avoid anything that will make a patient feel more energetic before bed.
It can be helpful to incorporate stress-relief and relaxation into your daily routine with the help of Spire. Spire tracks your breathing rhythms to detect when your body is falling into a state of stress, and sends you a notification through your phone or computer to let you know it’s time to take a break and relax, using meditation for example. People using Spire report feeling calm and centered all thought the day and into the night, making it easier to fall asleep.
Patients are advise their diets to avoid substances that increase energy or stimulates the brain throughout the day, but especially in the evening. Substances such as caffeine and alcohol should be reduced or eliminated from a person’s diet.
A variety of sleeping pills are prescribed in order to help patients obtain short-term relief. Due to the risk of addiction or development of a resistance to the medication, most doctors avoid these prescriptions unless there is no alternative.
DSPD is a lifelong condition that requires lifestyle changes. It is possible, with treatment, to live a full and complete life with this disorder. All it takes is a willingness to work with medical professionals to determine which treatments and lifestyle adjustments maximizes relief and promote long-term health.