Delayed Sleep Phase Disorder is a subtype of the DSM-5 category of Circadian Rhythm Sleep-Wake Disorders (for an overview of this category, see THIS PAGE.)
Laypersons call them “night owls.” DSM-5 calls the condition “Circadian Rhythm Sleep-Wake Disorder, Delayed Sleep Phase type.” But, that’s a mouthful, so I will continue to call it Delayed Sleep Phase Disorder.
In addition to DSM-5, a very important classification system for sleep disorders is the International Classification of Sleep Disorders, 3rd edition (American Academy of Sleep Medicine, 2014). It uses the name “Delayed Sleep-Wake Phase Disorder.”
What is Delayed Sleep Phase Disorder?
In Delayed Sleep Phase Disorder, the sleep phase is shifted so that the person’s natural tendency is to go to bed late and to wake up late.
The key thing to remember is that if the person is allowed to go to sleep whenever s/he wants and to wake up whenever s/he wants (for example, on vacations) then there is no problem! The person has no difficulty falling asleep, sleeps for enough time, and follows a 24-hour sleep-wake cycle.
But, because the person has to wake up in the morning to go to school or to work, two problems can occur:
1. Difficulty falling asleep
The person may try to go to sleep earlier than their natural bedtime. So, not surprisingly, s/he has difficulty falling asleep. Because of this, many patients with Delayed Sleep Phase Disorder are misdiagnosed as having insomnia. About 10% of patients with chronic insomnia (Magee et al., 2016) or who go to a sleep clinic with complaints of recurrent insomnia (American Academy of Sleep Medicine, 2014) are believed to have Delayed Sleep Phase Disorder
2. Difficulty waking up
The person goes to bed late but has to get up earlier than natural to go to school or work. Not surprisingly, the person finds it difficult to wake up–hitting snooze repeatedly, sleeping through multiple alarms, and so on.
The American Academy of Sleep Medicine guideline adds that the problems with going to sleep and waking up are present both on days when the person has to go to school/ work the next morning and on days when the person is off the next day.
Because of these problems, these persons are typically in a state of chronic sleep deprivation.
Next, please read the following article on this website:
American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed (2014). Darien, IL.
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 Oct 15;11(10):1199-236. PubMed PMID: 26414986; PubMed Central PMCID: PMC4582061.
Danielsson K, Jansson-Fröjmark M, Broman JE, Markström A. Cognitive Behavioral Therapy as an Adjunct Treatment to Light Therapy for Delayed Sleep Phase Disorder in Young Adults: A Randomized Controlled Feasibility Study. Behav Sleep Med. 2016;14(2):212-32. PubMed PMID: 26244417.
Figueiro MG. Delayed sleep phase disorder: clinical perspective with a focus on light therapy. Nat Sci Sleep. 2016 Apr 6;8:91-106. PubMed PMID: 27110143; PubMed Central PMCID: PMC4830627.
Gradisar M, Crowley SJ. Delayed sleep phase disorder in youth. Curr Opin Psychiatry. 2013 Nov;26(6):580-5. PubMed PMID: 24060912; PubMed Central PMCID: PMC4142652.
Magee M, Marbas EM, Wright KP Jr, Rajaratnam SM, Broussard JL. Diagnosis, Cause, and Treatment Approaches for Delayed Sleep-Wake Phase Disorder. Sleep Med Clin. 2016 Sep;11(3):389-401. Review. PubMed PMID: 27542884.
Morgenthaler TI, Lee-Chiong T, Alessi C, Friedman L, Aurora RN, Boehlecke B, Brown T, Chesson AL Jr, Kapur V, Maganti R, Owens J, Pancer J, Swick TJ, Zak R; Standards of Practice Committee of the American Academy of Sleep Medicine. Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. An American Academy of Sleep Medicine report. Sleep. 2007 Nov;30(11):1445-59. Review. Erratum in: Sleep. 2008 Jul 1;31(7): table of contents. PubMed PMID: 18041479; PubMed Central PMCID: PMC2082098.
Nesbitt AD, Dijk DJ. Out of synch with society: an update on delayed sleep phase disorder. Curr Opin Pulm Med. 2014 Nov;20(6):581-7. Review. PubMed PMID: 25160887.
Revell VL, Burgess HJ, Gazda CJ, Smith MR, Fogg LF, Eastman CI. Advancing
human circadian rhythms with afternoon melatonin and morning intermittent bright light. J Clin Endocrinol Metab. 2006 Jan;91(1):54-9. PubMed PMID: 16263827; PubMed Central PMCID: PMC3841985.
Richardson CE, Gradisar M, Short MA, Lang C. Can exercise regulate the circadian system of adolescents? Novel implications for the treatment of delayed sleep-wake phase disorder. Sleep Med Rev. 2016 Jul 11. pii:S1087-0792(16)30062-4. Review. PubMed PMID: 27546185.
Sack RL, Auckley D, Auger RR, Carskadon MA, Wright KP Jr, Vitiello MV, Zhdanova IV; American Academy of Sleep Medicine. Circadian rhythm sleep disorders: part II, advanced sleep phase disorder, delayed sleep phase disorder, free-running disorder, and irregular sleep-wake rhythm. An American Academy of Sleep Medicine review. Sleep. 2007 Nov;30(11):1484-501. Review. PubMed PMID: 18041481; PubMed Central PMCID: PMC2082099.
Snitselaar MA, Smits MG, van der Heijden KB, Spijker J. Sleep and Circadian Rhythmicity in Adult ADHD and the Effect of Stimulants. J Atten Disord. 2017 Jan;21(1):14-26. Review. PubMed PMID: 23509113.
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