Delayed Sleep Phase Syndrome

People with delayed sleep phase syndrome are unable to adjust to socially established sleep-wake schedules. Due to the lack of information and understanding of this disorder, they are often labeled as lazy or lazy by the people around them.

The sleep-wake pattern follows a circadian rhythm, that is, it fluctuates regularly every 24 hours. This oscillation is determined by an internal biological clock that is helped by certain external synchronizers.

Social elements, such as the hours of work or meals, serve to more precisely adjust the hours of sleep and wakefulness. However, the most powerful external synchronizer is the light-dark cycle.

The problem arises when there is a mismatch between the body’s own circadian system and the requirements of the environment. In the case of delayed sleep phase syndrome, the person’s usual nighttime sleep period is behind the conventional schedule.

Individuals who suffer from it feel the need to go to bed and get up (chronically) at least two hours later than the rest. This lag is more common in adolescence; however, the prevalence in adults is significant.

When daily obligations force a person to follow a common schedule, they will suffer from chronic sleep deprivation : they are unable to fall asleep at the desired time. All this translates into drowsiness and fatigue during the day that will affect the school and work performance of those who suffer from this disorder.

During holidays or vacation periods, in which you can freely choose and delay your sleep schedules, it becomes adequate both in quantity and quality. Insomnia and difficulty getting up disappear and the person enjoys a good night’s rest.

Differential characteristics of delayed sleep phase syndrome

Some of the most common features in delayed sleep phase syndrome would be:

• The person can maintain proper sleep hygiene and is still unable to sleep at the desired time.
• There are no personal or work situations, anxious or depressive symptoms that cause the person to not be able to fall asleep.
• Once they have fallen asleep, those who suffer from this syndrome have no difficulty in staying asleep. This is continuous and there are no awakenings typical of maintenance insomnia. 
• Due to lack of sleep, drowsiness and decreased alertness occur during the first half of the day. This situation improves as the maximum waking point approaches , which for these people is around sunset. 
• Being able to choose their preferred hours, the person falls asleep without difficulty and wakes up rested.

Treatment of delayed sleep phase syndrome

Behavioral interventions

The first step is constituted by certain interventions in the habitual behavior of the individual. This has to try to maintain the best possible hygiene of the dream. Take care of the environment in which you sleep, the consumption of stimulant substances or the type of activities you do before sleeping.

In this sense, it is especially important that the person acquire fixed times for going to bed and getting up. It is essential to follow them every day without changing them on holidays or vacations. In addition, this habit must be maintained even when the person has achieved his goal, to avoid relapses.

Phototherapy

Decreasing exposure to light in the evening and increasing it in the morning can help advance the biological clock. For this it is important to use dim light during the last hours of the day, as well as to dispense with the use of screens.

On the other hand, it is convenient to sleep with the blinds raised so that there is a greater exposure to sunlight in the minutes that follow after waking up.

Melatonin

The administration of melatonin (1-5mg) a few hours before going to sleep helps to advance the wake-sleep cycle. In combination with phototherapy, its effectiveness increases.

Chronotherapy

This procedure consists of gradually delaying bedtime and getting up. The person goes to bed later each day until they fit in with their desired sleep schedule. From there, the challenge is to maintain it.

The main difficulty is that several days of modification of the sleep schedule are needed to achieve the fit, something that can interfere with work or school responsibilities. In any case, we are talking about an alteration against which we have strategies so that it does not become a disabling limitation on a day-to-day basis.