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ORIGINAL ARTICLE | https://my.clevelandclinic.org/health/articles/delayed-sleep-phase-syndrome

DATE PUBLISHED | March 3, 2017
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HEALTH LIBRARY | ARTICLES | DELAYED SLEEP PHASE SYNDROME ( DSPS)

Delayed Sleep Phase Syndrome (DSPS)

DELAYED SLEEP PHASE SYNDROME (DSPS)

What is delayed sleep phase syndrome?

Delayed sleep phase syndrome (DSPS) is a disorder in which a persons sleep is delayed by 2 or more hours beyond the socially
acceptable or conventional bedtime. This delay in falling asleep causes dif culty in waking up at the desired time. As an
example, rather than falling asleep at 10:00 pm and waking at 6:30 am, an adolescent with DSPS will fall asleep well after
midnight and have great dif culty getting up in time for school.

Most children and adolescents with DSPS describe themselves as "night owls" and say they function best or are most alert
during the evening or night hours. If they were to keep a sleep log it would show short sleep periods during the school/work
week (with few or no awakenings during the night) and lengthy sleep-ins (late morning to mid afternoon wake up times) on the
weekend.

What causes DSPS?

The exact cause of this disorder is not completely known. However, approximately 7 percent to 16 percent of adolescents
have DSPS. Thus, it is a common disorder. Scientists think DSPS may be an exaggerated reaction to the normal shift in the
internal clocks that is seen in adolescents after puberty (https://my.clevelandclinic.org/sitecore/content/Sites/childrens-hospi
tal/Home/health-info/ages-stages/adolescence/hic-Adolescent-Development). It is important to understand that this is not
deliberate behavior, but that certain habits can make this condition worse. DSPS most commonly occurs during adolescence,
but cases have been reported during childhood.

What are the signs and symptoms of DSPS?

Symptoms of DSPS include:

Inability to fall asleep at the desired time. This usually presents as insomnia (https://my.clevelandclinic.org/services/neur
ological_institute/sleep-disorders-center/disorders-conditions/hic-insomnia) complaints. It may be exacerbated by the
social pressures teenagers feel to stay up late (homework, internet or cell phone use).
 Inability to wake up at the desired time and excessive daytime sleepiness. Usually this is the most common complaint
because it is more readily evident to parents than the nighttime insomnia. Because of the delay in falling asleep and yet

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still needing to get up at the required time for work or school, children or adolescents with DSPS often experience
excessive daytime drowsiness as a result of not getting enough sleep (most evident on weekdays). The delayed rhythm is
coupled with a delay in the cycle of the night hormone melatonin, which lingers in the morning and makes it harder to
wake up.
Generally no other sleep problems. If uncomplicated by other sleep disorders, children and adolescents with DSPS sleep
well through the night with few or no awakenings once they fall asleep. They simply suffer from a shift in their internal
clock or sleep-wake cycle pushing it later by 2 or more hours. Sleep maintenance is not an issue. When allowed freedom
to keep their delayed bed and wake times, they wake up without help, refreshed and without any problems with
sleepiness.
Depression and behavior problems. Children and adolescents with DSPS may experience depression (https://my.clevelan
dclinic.org/health/diseases_conditions/hic_Depression/hic_Treatment_Options_for_Depression/hic_Depression_Medicin
es) and other psychiatric problems including behavioral problems as a result of daytime drowsiness and missing school.
Daytime drowsiness can also lead to lowered academic performance from missed school days or tardiness and
inattention. Dependency on caffeine, sedatives or alcohol may also be seen.

How is DSPS diagnosed?

DSPS is diagnosed based solely on a description of the symptoms and sleep logs. Sometimes a non-invasive wrist-watch-like
device called an autograph may be used to con rm rest-activity rhythms. An overnight sleep study (polysomnogram) may be
recommended to rule out the presence of any other sleep disorders if the history is suggestive. Sophisticated tests of
melatonin or core temperature rhythms are generally reserved for research purposes.

How is DSPS treated?

Treatment for DSPS involves the following:

Good sleep habits. Children and adolescents with DSPS need to do everything they can to develop and maintain good
sleep habits and a steady sleep schedule. Habits should include going to bed and waking up at the same times on
weekends as on weekdays; avoiding caffeinated (https://my.clevelandclinic.org/health/drugs_devices_supplements/hic-ca
ffeine-tips-for-breaking-habit) products (eg, coffees, teas, colas, some non-cola pops, energy drinks, chocolates, and some
medications [Excedrin]); avoiding other stimulants and products that can disrupt sleep (eg, alcohol, sleeping pills (http
s://my.clevelandclinic.org/health/drugs_devices_supplements/hic-sleeping-pills), nicotine); maintaining a cool, quiet and
comfortable bedroom; and avoiding activities before bedtime that are stimulating (eg, computer games and television).
Shifting the bedtime schedule. Treatment for DSPS can involve one of two methods: advancing or delaying the internal
clock.
Advancing the internal clock. This method simply moves the bedtime a bit earlier on each successive night until the
desired bedtime is reached. For example, setting the bedtime at midnight on one night, 11:45 p.m. on the next night, 11:30
 p.m. on the following night and so on. This is facilitated by concomitantly moving the wake time to allow this transition to
occur with more control. These methods are best individualized with the help of a sleep specialist.

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Delaying the internal clock (Chronotherapy). This method moves the bedtime sequentially 1-3 hours or more later on
successive nights until the desired bedtime is reached. This requires several days free from social activities and may be
best attempted during a long school break or vacation period. The thinking behind this strategy is that it is much easier for
the body to adjust to a later bedtime than an earlier one. Again, this is best done with advice from a sleep specialist.
Staying motivated to stick with the schedule. It is especially important not to lose sight of the goals during holidays and
weekends. Adhering to strict bed and wake times keeps the bodys clock under control but does not "cure" the tendency
for delayed sleep phase. Once the desired bedtime/wake time is reached, your child or adolescent must stay motivated
and stick with going to bed at the desired bedtime on a nightly basis in order to reset the internal clock. Only after several
months of adhering to the schedule can there be some exibility allowed on special occasions. However, efforts should be
made to wake up close to the prescribed wake time to keep the rhythm going, regardless of when the adolescent goes to
sleep.
Bright light therapy. Some physicians recommend bright light therapy, which requires the purchase of special light box.
Exposing your child to bright light for approximately half an hour in the morning helps to reset the bodys internal clock.
Reduced exposure to bright light in the evening also helps. Your sleep doctor will be able to suggest commercially
available light boxes and the correct method of use.
Avoidance of light at night. Any screen time with a back light (hand held devices, computers, TV etc.) can theoretically
delay the sleep rhythm and make it harder to go to sleep. These should be avoided in the few hours prior to bed time,
especially when trying to shift the rhythm.
Medications. Melatonin or other natural sleep-inducing drugs are another option that may be tried with the help of a
sleep specialist.

Additional Sleep Information and Suggested Readings

Mindell, JA and Owens, JA. A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems.
Philadelphia, PA: Lippincott Williams and Wilkins, 2003.
Sleep Education (http://www.sleepeducation.com) and other educational links on the American Academy of Sleep
Medicine (http://www.aasmnet.org.) website. Accessed 5/17/2013.
The National Sleep Foundation (http://www.sleepfoundation.org). Accessed 5/17/2013

References

American Sleep Association. Delayed Sleep Phase Syndrome (http://www.sleepassociation.org/index.php?p=delayedsleep

phasesyndrome). Accessed 5/16/2013.
Bjorvatn Bj, Pallesen Sta, A practical approach to circadian rhythm sleep disorders, Sleep Medicine Reviews (2008),
doi:10.1016/j.smrv.2008.04.009. www.cmse.ch. Accessed 5/16/2013.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care
provider. Please consult your health care provider for advice about a speci c medical condition. This document was last reviewed on:

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