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Symptoms of Delayed Sleep Phase Syndrome (DSPS)


Symptoms of Delayed Sleep Phase Syndrome (DSPS)


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Delayed Sleep Phase Syndrome (DSPS), also known as Delayed Sleep Phase Disorder (DSPD), is a circadian rhythm sleep disorder that affects an individual's internal body clock. People with DSPS have a natural inclination to fall asleep and wake up much later than what is considered typical or socially acceptable. 

Understanding Delayed Sleep Phase Syndrome

The sleep-wake cycle is regulated by circadian rhythms, which are normal, intrinsic biological processes that occur around once every 24 hours. These rhythms are driven by the body's biological clock and are influenced by external cues such as light and temperature. In individuals with DSPS, the circadian rhythm is delayed by two or more hours, leading to significant challenges in maintaining a conventional sleep schedule.

Symptoms of Delayed Sleep Phase Syndrome

  •  Difficulty Falling Asleep at Conventional Times:- One of the hallmark symptoms of DSPS is the inability to fall asleep at a socially acceptable time. While most people might feel sleepy around 10 PM or 11 PM, individuals with DSPS may not feel sleepy until much later, often between 2 AM and 6 AM. This delay in sleep onset is not due to insomnia or poor sleep hygiene but rather an intrinsic delay in the circadian rhythm.
  • Difficulty Waking Up in the Morning:- Due to the delayed sleep onset, waking up in the morning for school, work, or other commitments can be extremely challenging for those with DSPS. Even if they manage to fall asleep late, their bodies naturally want to sleep for a full 7-9 hours, leading to significant sleep deprivation if they are forced to wake up early.
  • Daytime Sleepiness and Fatigue:- The misalignment between the individual's internal clock and the external environment often results in insufficient sleep, causing excessive daytime sleepiness and fatigue. This can impact cognitive functions such as attention, memory, and decision-making, further affecting academic and occupational performance.
  •  Improved Alertness in the Evening:- Unlike people with general sleep deprivation, individuals with DSPS often feel more awake and alert in the evening and nighttime. This can make it difficult for them to unwind and prepare for sleep at a conventional bedtime.
  • Consistent Sleep Pattern on Free Days:- A key characteristic of DSPS is the consistency of the delayed sleep pattern when the individual is free to choose their own sleep schedule. On weekends or holidays, when external constraints like school or work are removed, they tend to revert to their natural sleep-wake cycle, going to bed and waking up much later.
  • Social and Occupational Impairment:- The inability to adhere to conventional sleep schedules can lead to significant social and occupational impairments. Individuals with DSPS may struggle with punctuality, attendance, and performance in school or work, leading to stress and potential conflicts. Social activities that require early morning participation can also be challenging.
  • Psychological Distress:- Chronic sleep deprivation and the inability to conform to societal norms regarding sleep can contribute to psychological distress, including anxiety and depression. The frustration of not being able to change their sleep pattern despite various efforts can also lead to feelings of helplessness and low self-esteem.
  • Sleep Inertia:- Sleep inertia, the grogginess and disorientation experienced upon waking, can be more pronounced in individuals with DSPS, especially if they are forced to wake up during their body's preferred sleep phase. This can make mornings particularly difficult and impact their ability to function effectively soon after waking.
  • Delayed Melatonin Release:- Melatonin, a hormone that regulates sleep-wake cycles, is typically released in response to darkness. In people with DSPS, melatonin release is delayed, aligning with their delayed sleep phase. This physiological delay contributes to their difficulty in falling asleep at an earlier time.
  • Lack of Awareness and Misdiagnosis:- Many individuals with DSPS may not be aware that their sleep difficulties are due to a circadian rhythm disorder. As a result, they might be misdiagnosed with insomnia or other sleep disorders. Proper diagnosis requires a comprehensive evaluation by a sleep specialist, often including sleep diaries and actigraphy

Causes of Delayed Sleep Phase Syndrome

  • Genetic Factors:- Research suggests that there is a genetic component to DSPS, as it often runs in families. Specific gene mutations that affect the biological clock and circadian rhythm regulation have been identified in some individuals with DSPS.
  • Environmental Factors:- Exposure to light, particularly blue light from screens and electronic devices, can exacerbate DSPS by further delaying the release of melatonin. Lack of morning sunlight exposure, which helps to reset the circadian clock, can also contribute to the disorder.
  • Behavioral Factors:- Irregular sleep schedules, such as those experienced by shift workers or individuals with irregular routines, can lead to or worsen DSPS. Staying up late for social or recreational activities can also reinforce the delayed sleep pattern.
  • Neurological Factors:- Some studies suggest that neurological differences, such as variations in brain structure or function, may play a role in the development of DSPS. Still, more research is required to fully understand these probable processes.
  • Diagnosis of Delayed Sleep Phase Syndrome
  • Clinical Evaluation:- A thorough clinical evaluation by a sleep specialist is essential for diagnosing DSPS. This includes a detailed sleep history, assessment of sleep habits, and evaluation of any underlying medical or psychological conditions.
  • Sleep Diary:- Patients may be asked to keep a sleep diary for at least one to two weeks, documenting their sleep and wake times, sleep quality, and any factors that might affect their sleep. This helps to identify patterns and confirm the delayed sleep phase.
  • Actigraphy:- Actigraphy involves wearing a wrist-worn device that tracks sleep-wake patterns over an extended period. This objective data complements the information obtained from the sleep diary and helps to confirm the diagnosis.
  • Polysomnography:- In some cases, an overnight sleep study, or polysomnography, may be conducted to rule out other sleep disorders such as sleep apnea or periodic limb movement disorder that could be contributing to sleep difficulties.
  • Treatment of Delayed Sleep Phase Syndrome
  • Light Therapy:- Bright light therapy, administered in the morning, is one of the most effective treatments for DSPS. Exposure to bright light upon waking helps to shift the circadian rhythm earlier, making it easier to fall asleep and wake up at desired times.
  • Chronotherapy:- Chronotherapy involves gradually shifting the sleep schedule earlier by 1-2 hours each day until the desired sleep-wake times are achieved. This approach requires strict adherence and can be challenging to implement.
  • Melatonin Supplementation:- Taking melatonin supplements in the evening can help to advance the sleep phase by signaling to the body that it is time to prepare for sleep. The timing and dosage of melatonin should be carefully managed under the guidance of a healthcare professional.

Cognitive Behavioral Therapy for Insomnia (CBT-I)

CBT-I can be beneficial for individuals with DSPS by addressing maladaptive sleep behaviors and thoughts. It covers methods including lack of sleep, cognitive restructuring, and sensory control.

  • Sleep Hygiene:- Maintaining good sleep hygiene is crucial for managing DSPS. This includes establishing a consistent sleep schedule, creating a conducive sleep environment, avoiding caffeine and heavy meals before bedtime, and limiting screen time in the evening.
  • Medications:- In some cases, medications such as sedative-hypnotics or wakefulness-promoting agents may be prescribed to manage symptoms. Use of these needs to be done carefully and under medical supervision.
  • Lifestyle Modifications:- Making lifestyle changes, such as incorporating regular physical activity, managing stress, and optimizing the sleep environment, can support the management of DSPS and improve overall sleep quality.
  • Impact of Delayed Sleep Phase Syndrome on Daily Life
  • Academic Performance:- Students with DSPS often struggle with early morning classes, leading to poor attendance, reduced participation, and lower academic performance. The inability to align with school schedules can also result in disciplinary issues and heightened stress.
  • Occupational Challenges:- For working adults, DSPS can lead to chronic lateness, absenteeism, and decreased productivity. The misalignment with standard work hours can also limit career opportunities and advancement.
  • Social Relationships:- The delayed sleep-wake pattern can interfere with social activities, making it difficult to maintain relationships and participate in events that occur in the morning or early afternoon. This can lead to social isolation and feelings of loneliness.
  • Mental Health:- The chronic sleep deprivation and social challenges associated with DSPS can contribute to mental health issues such as depression and anxiety. The frustration of living with a misunderstood and often stigmatized condition can exacerbate these feelings.
  • Physical Health:- Long-term sleep deprivation associated with DSPS can have negative effects on physical health, including an increased risk of cardiovascular disease, metabolic disorders, and weakened immune function.
  • Managing Delayed Sleep Phase Syndrome
  • Seeking Professional Help:- Consulting with a sleep specialist or a healthcare provider with expertise in circadian rhythm disorders is crucial for proper diagnosis and management of DSPS.
  • Educating Others:- Raising awareness about DSPS among family members, friends, and employers can help to foster understanding and support. Educating others about the condition can also reduce stigma and misconceptions.
  • Building a Support Network:- Connecting with others who have DSPS through support groups or online communities can provide valuable emotional support and practical advice.

Advocating for Accommodations

For students and employees, advocating for accommodations such as flexible schedules or remote work options can help to mitigate the impact of DSPS on daily life.

Counseling plays a vital role in managing Delayed Sleep Phase Syndrome (DSPS), especially for those facing stress or emotional challenges. Cognitive Behavioral Therapy for Insomnia (CBT-I) helps individuals improve sleep habits and address negative thoughts about their sleep. Counselors provide support with stress management, coping strategies, and guidance on lifestyle changes, helping individuals better manage the social and occupational impacts of DSPS. Through personalized care, counseling can significantly enhance sleep quality and overall well-being.

Conclusion

Delayed Sleep Phase Syndrome is a complex and often misunderstood circadian rhythm disorder that significantly impacts an individual's ability to maintain a conventional sleep schedule. The symptoms of DSPS, including difficulty falling asleep and waking up at desired times, daytime sleepiness, and psychological distress, can affect various aspects of daily life. Understanding the underlying causes, obtaining a proper diagnosis, and exploring treatment options such as light therapy, melatonin supplementation, and cognitive behavioral therapy can help manage the condition. Ongoing research and increased public awareness are essential for improving the lives of those affected by DSPS.

Psychowellness Center provides quality mental health services with experienced psychologists in Delhi NCR, Faridabad, Janakpuri, and Dwarka. 


 Contribution:- Dr. R K Suri  Clinical psychologist, and Ms. Nicole Fernandes Counselling psychologist lead in providing expert mental health care at TalktoAngel.


References

  • American Academy of Sleep Medicine. (2014). The International Classification of Sleep Disorders – Third Edition (ICSD-3).
  • Bootzin, R. R., & Perlis, M. L. (1992). Nonpharmacologic treatments of insomnia. Journal of Clinical Psychiatry, 53 Suppl, 37–41.
  • Dagan, Y., & Abadi, J. (2001). Sleep-wake schedule disorder disability: a lifelong untreatable pathology of circadian system? Chronobiology International, 18(6), 1019–1027.
  • Eastman, C. I., & Martin, S. K. (1999). How to use light and dark to produce circadian adaptation to night shift work. Annals of Medicine, 31(2), 87–98.
  • Lam, R. W., Levitan, R. D., & Levitan, C. (2000). Light therapy for seasonal affective disorder: A review of efficacy. Journal of Affective Disorders, 58(3), 229–239.
  • Monk, T. H., & Buysse, D. J. (2000). Exposure to morning light is associated with reduced subjective sleepiness. Behavioral Sleep Medicine, 1(1), 35–43.

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