Have you always considered yourself to be a “night owl,” keeping to a very different sleep schedule than your friends and family? Are you someone who has trouble waking up on time to get to work or other obligations because you couldn’t fall asleep until late the night before? If so, you might be suffering from Delayed Sleep Phase Disorder (DSPD).
DSPD is a sleep disorder that’s commonly mistaken with insomnia, though both can be effectively treated using different methods. In DSPD, patients notice that they routinely 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.
Patients with insomnia, however, may have trouble falling asleep, staying asleep or awakening 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.
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Many patients with DSPD consider themselves to be “night owls,” with some rearranging their lives around jobs that fit into their sleep schedules (e.g. jobs that work the evening shift such as bartending, etc.). 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, and once they do so, they naturally want to sleep later in the morning.
DSPD is a product of a sleep cycle that’s delayed overall. The circadian rhythm is essentially 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 to have certain hormones secreted in our body. In some people, the circadian rhythm can shift either too early or too late, causing one to sleep and wake outside of what is considered to be a more normal schedule. In DSPD, the circadian rhythm drifts later, leading to both later sleep and wake times.
DSPD is commonly seen during the teenage years, but can occur in adults too. Younger children typically have a bedtime of 8 or 9pm, and once adolescence arrives, the bedtime naturally shifts to as late as 11pm or 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 then 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 awakening in the morning for school and are very sleepy during the day. When this circadian shift creates major problems with functioning during the day, DSPS is suspected and treatment may be warranted.
There are a number of effective treatments of 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.
One option for DSPD is chronotherapy. Essentially, 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. Although this is a very effective treatment, it is limited in terms of practicality. This treatment 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.
A second treatment option is bright light therapy given in the morning. This requires the use of a bright light box (or sunlight). 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 consulting with a specialist first would prove helpful.
The last treatment option 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.
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Although it is naturally found in our bodies, over the counter melatonin does 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.
In sum, if you’re someone who enjoys being a night owl and it doesn’t interfere with your life overall, there’s no problem. But, if you find you can’t fall asleep late and have trouble getting to that 9am meeting on a regular basis, you might want to see if there’s a treatment that can help.
