DSPD: A Sleep Disorder Common to Plugged-In Teenage “Night Owls”

by Harish Rao, MD, MBBS

All of us have an “internal clock” or circadian rhythm that regulates our sleep and wake cycles. For most of us, our internal clock is more or less in synch with the natural day/night cycle, which is why we sleep at night and are awake during the day. But for some people, that “internal clock” is shifted late. The problem usually presents as trouble falling asleep at night and trouble waking up in the morning, especially for school or work. These people are often called night owls or, worse, lazy.

Sound like any teenagers you know? The disorder is common among adolescents, although it can occur at any age. One study reported a prevalence of 1 in 1,000 people, but it is several times higher in adolescents. Sometimes called night-owl disorder, the actual name of the problem is delayed sleep phase disorder, or DSPD.

This shift in the internal clock most often occurs when a person’s weekday and weekend wake-up times differ by more than 1 or 2 hours, and may be aggravated by daytime naps and caffeine. In many individuals, DSPD is a genuine neurological disorder with a probable genetic basis. These individuals live in a state of sustained jet lag. They are often thought of as lazy or irresponsible, as it is difficult for others to understand that the abnormal sleep hours are out of the sufferer’s control.

Among teenagers and young adults, PSPD is often a “social malady,” the result of chronic late-night exposure to electronic and social media compounded by peer pressure to be connected at all hours. But biological changes during adolescence can also contribute to the problem. Many sleep experts have been calling for delayed school start times for adolescents to address this concern.

Many people try to cope with DSPD by forcing themselves to keep a normal schedule (ie, waking earlier than desired by the internal clock), leading to sleepiness/grogginess on waking as well as a chronic sleep deficit. This sleep deficit manifests as fatigue, depression, and inability to focus at work or school. DSPD symptoms are frequently misdiagnosed as insomnia, chronic fatigue syndrome, or attention deficit disorder.

To address the problem, wake-up time must be controlled to help re-set the internal clock. Sleep charts and actigraphy (watch-like devices with motion sensors that can monitor rest/activity cycles) are extremely useful in tracking an individual’s sleep schedules. Use of low-dose melatonin at night and well-timed exposure to light in the morning (either daylight or a light box) corrects the problem in many individuals. A light box (with light intensity of 10,000 lux) is useful during times when daylight is scarce, such as during the winter in many parts of the world.

Sleep phase chronotherapy is used in more difficult cases with close monitoring by a sleep physician. During chronotherapy an attempt is made to move bedtime and rising time later and later each day, around the clock, until the person is sleeping on a normal schedule.

Good “sleep hygiene” is then required to maintain an appropriate sleep/wake cycle:

• Wake up at the same time every day to readjust internal clock.

• In the morning be up, active, and exposed to bright light, and eat breakfast. Being active sends the brain a strong message that it is morning, and will help your body clock adjust.

• Have a calm bedtime routine, such as reading with a dim light for 15 minutes before turning out the light. Turn off music before falling asleep.

• Avoid bright lights and TV, computer, cell phone, or other screens for 1 to 2 hours before bedtime. Keep all screens outside of the bedroom.

• Avoid caffeine after 12:00 pm (coffee, tea, chocolate milk, cola, energy drinks).

• Avoid daytime naps.

Important tip for parents of night-owl adolescents:

• Do not let your child’s weekday and weekend wake-up time differ by more than 1 or 2 hours.

• If your child’s sleep schedule is off during vacation, you can correct the schedule by bringing wake time forward by 30 minutes every 2 or 3 days.

And be sure to see a sleep physician if you are a “night owl” and are struggling to correct your sleep schedule.

Learn more about healthy sleep habits and sleep disorders, and explore our collection of useful links and resources at onebreath.org. OneBreath is an initiative of The CHEST Foundation, the philanthropic arm of the American College of Chest Physicians.

Photo: Bruce Rogovin, Photolibrary

Harish Rao, MD, MBBS, is a Fellow at the Center for Pediatric Sleep Disorders at Boston Children’s Hospital. He sees four to five patients with DSPD each week.

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