Table of ContentsView AllTable of ContentsWhat It IsSymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
What It Is
Symptoms
Causes
Diagnosis
Treatment
Delayed sleep phase syndrome (DSPS) occurs in people whosecircadian rhythms(cyclical sleep patterns) are set two hours or more later than in most people. It typically emerges during adolescence and affects between 7% and 16% of teens and young adults.
The DSPS symptoms of falling asleep and waking up late can be termed as “night owl” patterns. They can, however, also be similar to othersleep disorderswith significant health impacts, such assleep apnea. Delayed sleep phase syndrome also is closely linked with attention deficit hyperactivity disorder (ADHD), with some studies suggesting a higher risk of heart problems in these people.
This article presents information about DSPS causes, symptoms, and diagnosis. It explains delayed sleep phase syndrome treatment options available from asleep specialistor other providers.
What Is Delayed Sleep Phase Syndrome?
Delayed sleep phase syndrome (sometimes called a disorder) occurs when a circadian rhythm is set to a later sleep-wake time than in most people. The circadian rhythm is the internal clock that regulates your sleep. It can be disrupted when you travel, experience illness, or for other causes.
But in people with delayed sleep phase syndrome, the natural setting is to sleep two or more hours later than most people. In extreme cases, the sleep delay means going to sleep closer to sunrise.
These disruptions are common in teenagers but can persist into adulthood.DSPS can interfere with getting to work or school on time, or feeling connected and present in your relationships.
How to Balance Circadian Rhythms
Delayed Sleep Phase Syndrome Symptoms
People with delayed sleep phase syndrome (DSPS) will generally experience two symptoms: insomnia, and morning or daytime sleepiness associated with falling asleep late.Sleep deprivationis common because of the DSPS sleep pattern.
Insomnia
Most people experience significantinsomniaif they attempt to go to bed earlier than their natural desire for sleep onset. Trying to force an earlier time can result in hours of lying awake, tossing and turning. This can provoke anxiety, frustration, and anger—feelings that make insomnia worse.
When left to stay up late on weekends or during vacations, it suddenly becomes much easier to fall asleep. When sleep occurs, aside from being delayed, it can be normal and uninterrupted.
What Is Sleep Anxiety?Sleep anxiety occurs in people who become stressed about falling or staying asleep. There’s a strong connection between insomnia and anxiety, with an inability to sleep affecting about 40% of people who are diagnosed with anxiety.A DSPS diagnosis, often co-occurring with ADHD, can play a role in these symptoms.
What Is Sleep Anxiety?
Sleep anxiety occurs in people who become stressed about falling or staying asleep. There’s a strong connection between insomnia and anxiety, with an inability to sleep affecting about 40% of people who are diagnosed with anxiety.A DSPS diagnosis, often co-occurring with ADHD, can play a role in these symptoms.
What Causes Sleep Anxiety and How Can You Cope?
Morning Sleepiness
It can be difficult to wake a night owl in the morning. This morningsleepiness, depending on the hour, can be like waking someone with normal sleep timing in the middle of the night.
What Is Excessive Daytime Sleepiness?
Social Pressure and Sleep Deprivation
Delayed sleep phase syndrome leads to patterns that conflict with societal expectations about the appropriate times for productivity at school or work. Without accommodation, chronic tardiness and absenteeism can lead to educational and professional dysfunction.
If someone does not naturally fall asleep until 2 a.m. but has to wake at 6 a.m. to be to work on time, sleep deprivation inevitably results.Four hours of sleep is not enough to meet even basic sleep needs. DSPS can lead to symptoms associated withsleep deprivationincluding:
There is some evidence that extreme sleep deprivation can be fatal. This is likely due to the chronic effects it produces.
Can Sleep Deprivation or Insomnia Cause Hallucinations to Occur?
Delayed Sleep Phase Syndrome Causes
As researchers discover more about DSPS, they will identify more of these so-called “clock genes” that play a role in the syndrome. Current research shows a hereditary component in 40% to 50% of “clock types” whether you are a morning person or a night owl.
Beyond genetic programming, there are environmental factors that may unmask the condition. Most importantly, light has powerful effects on the timing of the circadian system. It may provoke the delay in sleep timing. However, it may also be used to correct the condition.
The Circadian System and Sleep
Exposure to natural light in the early morning hours is a signal to the brain for wakefulness. It makes it easier to wake up. It also slightly shifts the timing of sleep earlier, making it easier to fall asleep. This helps to align the desire for sleep to the natural period of darkness overnight. Without it, significant problems can develop with sleep and health.
For most people, this internal clock is programmed to run a little long, perhaps resetting every 24.5 hours. This natural drift in the circadian timing is reset with morning sunlight.
How Is Delayed Sleep Phase Syndrome Diagnosed?
In research settings, the measurement of melatonin levels can help to identify the circadian timing. In particular, the dim light melatonin onset (DLMO) measured via blood or saliva can establish the pattern.
Unfortunately, repeated sampling requires a carefully controlled laboratory environment. This is virtually never done in clinical practice. Currently, researchers are working on blood tests to allow healthcare providers to determine internal circadian time.
In some cases, sleep logs kept over several weeks may aid the recognition. Rarely is testing withactigraphy(small monitors) needed.
Delayed Sleep Phase Syndrome Treatment
Delayed sleep phase syndrome can be treated. There areeffective waysto keep the timing of sleep in a normal phase. It may require a little extra effort, but consider the following potentially helpful interventions.
Consistency
There is good evidence that night owls can maintain a socially acceptable sleep timing. This requires consistency, especially in regard to the wake time. Get up at the same time every day, including weekends. Do not sleep in.
Go to bed feeling sleepy, even if this initially requires a delay in the preferred bedtime. This will make it easier to fall asleep faster, relieve the pressure to sleep, and reinforce the sleep quality.
Morning Sunlight
It is especially important to reset the timing of sleep withmorning sunlight. This is most effective immediately upon awakening. Try to go outside for 15 to 30 minutes upon awakening. Wake with an alarm, throw on clothes, and immediately get outside. Take a walk. Read the newspaper in the garden. Check social media while facing the sunrise.
The light should hit the eyes, but don’t stare directly into the sun. Even on a cloudy or rainy day, try to stick to the routine. In winter months, alight boxmay be necessary for phototherapy. The effects may take up to one month to become evident.
Light therapies also are used in clinical settings to treat DSPS.
Avoid Light at Night
Artificialscreen lightshould be minimized at night, especially in the hours preceding bedtime. It may shift the timing of sleep to occur later, causing insomnia and morning sleepiness. Devices may be switched to night mode, cutting out the blue light that can shift sleep timing.
Blue blocker sunglasses (with an amber tint) or screen covers may be employed. Or, simply shut down the electronics in the two hours before bedtime. Thebuffer zonebefore the goal bedtime should be spent relaxing.
Melatonin
Though melatonin is an over-the-counter product, be sure to speak with your heatlhcare provider to be safe before implementing any supplements in your routine.
Cognitive Behavioral Therapy for Insomnia (CBTI)
CBTIis an effective treatment that helps to improve the patterns of sleep and a person’s relationship to it. Sleep consolidation, stimulus control, mindfulness, and relaxation techniques may be integrated into a program. It may be guided with help from a psychologist, class, online course, or book.
Chronotherapy
Rarely, it may be necessary to adjust the timing of sleep incrementally in a structured environment withchronotherapy. It is difficult to carry out at home and may require inpatient care, in order to carefully control sleep times and monitor therapy outcomes.
Prescription Medications
Sleeping pillsand stimulant medication to enhance alertness have a limited role in this condition. Generally, they will be weakly effective. As a result, they may be overused and even abused.
The risk of overdose in night owls, especially when these medications are used in combination with alcohol, is high. Instead of masking symptoms with a drug, the underlying timing of the circadian rhythm should be corrected.
Social Awareness
Summary
Delayed sleep phase syndrome (DSPS) occurs in people whose circadian rhythm is set to a sleep-wake cycle that keeps them falling asleep and waking up later than most people. The causes aren’t always known, but DSPS is common in people diagnosed with ADHD. Genetic factors also affect sleep and circadian rhythm.
DSPS can lead to sleep deprivation, which can have serious impacts on health and well-being. If you are struggling with delayed sleep phase syndrome, consider seeking the guidance of a board-certified sleep specialist.
How to Keep a Sleep Log
13 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Stanford Medicine.Delayed Sleep Phase Syndrome.van Andel E, Bijlenga D, Vogel SWN, Beekman ATF, Kooij JJS.Cardiovascular risk in adults with Delayed Sleep Phase Syndrome (DSPS) and Attention-Deficit/Hyperactivity Disorder (ADHD).Chronobiol Int. 2023 Dec 2;40(12):1566-1573. doi: 10.1080/07420528.2023.2287058.Auger RR, Burgess HJ, Emens JS, Deriy LV, Thomas SM, Sharkey KM.Clinical practice guideline for the treatment of intrinsic circadian rhythm sleep-wake disorders: Advanced sleep-wake phase disorder (ASWPD), delayed sleep-wake phase disorder (DSWPD), non-24-hour sleep-wake rhythm disorder (N24SWD), and irregular sleep-wake rhythm disorder (ISWRD). An update for 2015: An American Academy of Sleep Medicine Clinical Practice Guideline.J Clin Sleep Med. 2015;11(10):1199-236. doi:10.5664/jcsm.5100Watson NF, Martin JL, Wise MS, et al.Delaying middle school and high school start times promotes student health and performance: An American Academy of Sleep Medicine position statement.J Clin Sleep Med. 2017;13(4):623-625. doi:10.5664/jcsm.6558Oh CM, Kim HY, Na HK, Cho KH, Chu MK.The effect of anxiety and depression on sleep quality of individuals with high risk for insomnia: a population-based study.Front Neurol. 2019;10:849. doi:10.3389/fneur.2019.00849Bron TI, Bijlenga D, Kooij JJ, Vogel SW, Wynchank D, Beekman AT, Penninx BW.Attention-deficit hyperactivity disorder symptoms add risk to circadian rhythm sleep problems in depression and anxiety.J Affect Disord. 2016 Aug;200:74-81. doi: 10.1016/j.jad.2016.04.022.Knutson KL, von Schantz M.Associations between chronotype, morbidity and mortality in the UK Biobank cohort.Chronobiol Int. 2018;35(8):1045-1053. doi:10.1080/07420528.2018.1454458Waters F, Chiu V, Atkinson A, Blom JD.Severe sleep deprivation causes hallucinations and a gradual progression toward psychosis with increasing time awake.Front Psychiatry. 2018;9:303. doi:10.3389/fpsyt.2018.00303Patke A, Murphy PJ, Onat OE, et al.Mutation of the Human Circadian Clock Gene CRY1 in Familial Delayed Sleep Phase Disorder.Cell. 2017;169(2):203-215.e13. doi:10.1016/j.cell.2017.03.027Braun R, Kath WL, Iwanaszko M, et al.Universal method for robust detection of circadian state from gene expression.Proc Natl Acad Sci USA. 2018;115(39):E9247-E9256. doi:10.1073/pnas.1800314115Wittenbrink N, Ananthasubramaniam B, Münch M, et al.High-accuracy determination of internal circadian time from a single blood sample.J Clin Invest. 2018;128(9):3826-3839. doi:10.1172/JCI120874Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD.Management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians.Ann Intern Med. 2016;165(2):125-33. doi:10.7326/M15-2175Magee M, Marbas EM, Wright KP, Rajaratnam SM, Broussard JL.Diagnosis, Cause, and Treatment Approaches for Delayed Sleep-Wake Phase Disorder.Sleep Med Clin. 2016;11(3):389-401. doi:10.1016/j.jsmc.2016.05.004
13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Stanford Medicine.Delayed Sleep Phase Syndrome.van Andel E, Bijlenga D, Vogel SWN, Beekman ATF, Kooij JJS.Cardiovascular risk in adults with Delayed Sleep Phase Syndrome (DSPS) and Attention-Deficit/Hyperactivity Disorder (ADHD).Chronobiol Int. 2023 Dec 2;40(12):1566-1573. doi: 10.1080/07420528.2023.2287058.Auger RR, Burgess HJ, Emens JS, Deriy LV, Thomas SM, Sharkey KM.Clinical practice guideline for the treatment of intrinsic circadian rhythm sleep-wake disorders: Advanced sleep-wake phase disorder (ASWPD), delayed sleep-wake phase disorder (DSWPD), non-24-hour sleep-wake rhythm disorder (N24SWD), and irregular sleep-wake rhythm disorder (ISWRD). An update for 2015: An American Academy of Sleep Medicine Clinical Practice Guideline.J Clin Sleep Med. 2015;11(10):1199-236. doi:10.5664/jcsm.5100Watson NF, Martin JL, Wise MS, et al.Delaying middle school and high school start times promotes student health and performance: An American Academy of Sleep Medicine position statement.J Clin Sleep Med. 2017;13(4):623-625. doi:10.5664/jcsm.6558Oh CM, Kim HY, Na HK, Cho KH, Chu MK.The effect of anxiety and depression on sleep quality of individuals with high risk for insomnia: a population-based study.Front Neurol. 2019;10:849. doi:10.3389/fneur.2019.00849Bron TI, Bijlenga D, Kooij JJ, Vogel SW, Wynchank D, Beekman AT, Penninx BW.Attention-deficit hyperactivity disorder symptoms add risk to circadian rhythm sleep problems in depression and anxiety.J Affect Disord. 2016 Aug;200:74-81. doi: 10.1016/j.jad.2016.04.022.Knutson KL, von Schantz M.Associations between chronotype, morbidity and mortality in the UK Biobank cohort.Chronobiol Int. 2018;35(8):1045-1053. doi:10.1080/07420528.2018.1454458Waters F, Chiu V, Atkinson A, Blom JD.Severe sleep deprivation causes hallucinations and a gradual progression toward psychosis with increasing time awake.Front Psychiatry. 2018;9:303. doi:10.3389/fpsyt.2018.00303Patke A, Murphy PJ, Onat OE, et al.Mutation of the Human Circadian Clock Gene CRY1 in Familial Delayed Sleep Phase Disorder.Cell. 2017;169(2):203-215.e13. doi:10.1016/j.cell.2017.03.027Braun R, Kath WL, Iwanaszko M, et al.Universal method for robust detection of circadian state from gene expression.Proc Natl Acad Sci USA. 2018;115(39):E9247-E9256. doi:10.1073/pnas.1800314115Wittenbrink N, Ananthasubramaniam B, Münch M, et al.High-accuracy determination of internal circadian time from a single blood sample.J Clin Invest. 2018;128(9):3826-3839. doi:10.1172/JCI120874Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD.Management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians.Ann Intern Med. 2016;165(2):125-33. doi:10.7326/M15-2175Magee M, Marbas EM, Wright KP, Rajaratnam SM, Broussard JL.Diagnosis, Cause, and Treatment Approaches for Delayed Sleep-Wake Phase Disorder.Sleep Med Clin. 2016;11(3):389-401. doi:10.1016/j.jsmc.2016.05.004
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Stanford Medicine.Delayed Sleep Phase Syndrome.van Andel E, Bijlenga D, Vogel SWN, Beekman ATF, Kooij JJS.Cardiovascular risk in adults with Delayed Sleep Phase Syndrome (DSPS) and Attention-Deficit/Hyperactivity Disorder (ADHD).Chronobiol Int. 2023 Dec 2;40(12):1566-1573. doi: 10.1080/07420528.2023.2287058.Auger RR, Burgess HJ, Emens JS, Deriy LV, Thomas SM, Sharkey KM.Clinical practice guideline for the treatment of intrinsic circadian rhythm sleep-wake disorders: Advanced sleep-wake phase disorder (ASWPD), delayed sleep-wake phase disorder (DSWPD), non-24-hour sleep-wake rhythm disorder (N24SWD), and irregular sleep-wake rhythm disorder (ISWRD). An update for 2015: An American Academy of Sleep Medicine Clinical Practice Guideline.J Clin Sleep Med. 2015;11(10):1199-236. doi:10.5664/jcsm.5100Watson NF, Martin JL, Wise MS, et al.Delaying middle school and high school start times promotes student health and performance: An American Academy of Sleep Medicine position statement.J Clin Sleep Med. 2017;13(4):623-625. doi:10.5664/jcsm.6558Oh CM, Kim HY, Na HK, Cho KH, Chu MK.The effect of anxiety and depression on sleep quality of individuals with high risk for insomnia: a population-based study.Front Neurol. 2019;10:849. doi:10.3389/fneur.2019.00849Bron TI, Bijlenga D, Kooij JJ, Vogel SW, Wynchank D, Beekman AT, Penninx BW.Attention-deficit hyperactivity disorder symptoms add risk to circadian rhythm sleep problems in depression and anxiety.J Affect Disord. 2016 Aug;200:74-81. doi: 10.1016/j.jad.2016.04.022.Knutson KL, von Schantz M.Associations between chronotype, morbidity and mortality in the UK Biobank cohort.Chronobiol Int. 2018;35(8):1045-1053. doi:10.1080/07420528.2018.1454458Waters F, Chiu V, Atkinson A, Blom JD.Severe sleep deprivation causes hallucinations and a gradual progression toward psychosis with increasing time awake.Front Psychiatry. 2018;9:303. doi:10.3389/fpsyt.2018.00303Patke A, Murphy PJ, Onat OE, et al.Mutation of the Human Circadian Clock Gene CRY1 in Familial Delayed Sleep Phase Disorder.Cell. 2017;169(2):203-215.e13. doi:10.1016/j.cell.2017.03.027Braun R, Kath WL, Iwanaszko M, et al.Universal method for robust detection of circadian state from gene expression.Proc Natl Acad Sci USA. 2018;115(39):E9247-E9256. doi:10.1073/pnas.1800314115Wittenbrink N, Ananthasubramaniam B, Münch M, et al.High-accuracy determination of internal circadian time from a single blood sample.J Clin Invest. 2018;128(9):3826-3839. doi:10.1172/JCI120874Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD.Management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians.Ann Intern Med. 2016;165(2):125-33. doi:10.7326/M15-2175Magee M, Marbas EM, Wright KP, Rajaratnam SM, Broussard JL.Diagnosis, Cause, and Treatment Approaches for Delayed Sleep-Wake Phase Disorder.Sleep Med Clin. 2016;11(3):389-401. doi:10.1016/j.jsmc.2016.05.004
Stanford Medicine.Delayed Sleep Phase Syndrome.
van Andel E, Bijlenga D, Vogel SWN, Beekman ATF, Kooij JJS.Cardiovascular risk in adults with Delayed Sleep Phase Syndrome (DSPS) and Attention-Deficit/Hyperactivity Disorder (ADHD).Chronobiol Int. 2023 Dec 2;40(12):1566-1573. doi: 10.1080/07420528.2023.2287058.
Auger RR, Burgess HJ, Emens JS, Deriy LV, Thomas SM, Sharkey KM.Clinical practice guideline for the treatment of intrinsic circadian rhythm sleep-wake disorders: Advanced sleep-wake phase disorder (ASWPD), delayed sleep-wake phase disorder (DSWPD), non-24-hour sleep-wake rhythm disorder (N24SWD), and irregular sleep-wake rhythm disorder (ISWRD). An update for 2015: An American Academy of Sleep Medicine Clinical Practice Guideline.J Clin Sleep Med. 2015;11(10):1199-236. doi:10.5664/jcsm.5100
Watson NF, Martin JL, Wise MS, et al.Delaying middle school and high school start times promotes student health and performance: An American Academy of Sleep Medicine position statement.J Clin Sleep Med. 2017;13(4):623-625. doi:10.5664/jcsm.6558
Oh CM, Kim HY, Na HK, Cho KH, Chu MK.The effect of anxiety and depression on sleep quality of individuals with high risk for insomnia: a population-based study.Front Neurol. 2019;10:849. doi:10.3389/fneur.2019.00849
Bron TI, Bijlenga D, Kooij JJ, Vogel SW, Wynchank D, Beekman AT, Penninx BW.Attention-deficit hyperactivity disorder symptoms add risk to circadian rhythm sleep problems in depression and anxiety.J Affect Disord. 2016 Aug;200:74-81. doi: 10.1016/j.jad.2016.04.022.
Knutson KL, von Schantz M.Associations between chronotype, morbidity and mortality in the UK Biobank cohort.Chronobiol Int. 2018;35(8):1045-1053. doi:10.1080/07420528.2018.1454458
Waters F, Chiu V, Atkinson A, Blom JD.Severe sleep deprivation causes hallucinations and a gradual progression toward psychosis with increasing time awake.Front Psychiatry. 2018;9:303. doi:10.3389/fpsyt.2018.00303
Patke A, Murphy PJ, Onat OE, et al.Mutation of the Human Circadian Clock Gene CRY1 in Familial Delayed Sleep Phase Disorder.Cell. 2017;169(2):203-215.e13. doi:10.1016/j.cell.2017.03.027
Braun R, Kath WL, Iwanaszko M, et al.Universal method for robust detection of circadian state from gene expression.Proc Natl Acad Sci USA. 2018;115(39):E9247-E9256. doi:10.1073/pnas.1800314115
Wittenbrink N, Ananthasubramaniam B, Münch M, et al.High-accuracy determination of internal circadian time from a single blood sample.J Clin Invest. 2018;128(9):3826-3839. doi:10.1172/JCI120874
Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD.Management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians.Ann Intern Med. 2016;165(2):125-33. doi:10.7326/M15-2175
Magee M, Marbas EM, Wright KP, Rajaratnam SM, Broussard JL.Diagnosis, Cause, and Treatment Approaches for Delayed Sleep-Wake Phase Disorder.Sleep Med Clin. 2016;11(3):389-401. doi:10.1016/j.jsmc.2016.05.004
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