If you struggle to get your teenager to bed at a reasonable hour and fight to get them out of bed in the morning, you may be dealing with delayed sleep phase syndrome (DSPS). This relatively common condition can be accentuated during adolescence when the pressures of school schedule restraints conflict with changes in the body’s circadian rhythm.
The Circadian Rhythm and Adolescence
As children get older and enter the teenage years, the timing of their desire to sleep changes. Many teens develop delays in desired sleep onset and offset, resulting in a shift to later bedtimes and sleep periods. As such, it is not uncommon for teenagers to stay up past 11 p.m. and to want to sleep in until 9 or 10 a.m. (or even later).
This occurs because of a shift in their circadian rhythms. The circadian rhythm is the synchronization of the body’s functions to the natural light-dark cycle. It helps to coordinate our periods of sleep to the nighttime. When this becomes delayed, it may result in DSPS.
What Causes DSPS in Teens?
Teens who experience DSPS will often begin having difficulties with the onset of puberty. There may be underlying genetic factors involved that affect the suprachiasmatic nucleus, which is in part of the brain called the hypothalamus. It is thought that between 5% and 10% of teens have DSPS.
Symptoms of DSPS in Teenagers
It is important to recognize the symptoms that may suggest DSPS. Some of these symptoms that a teenager may experience include:
- Feeling at their best in the evening
- Difficulty falling asleep (called insomnia)
- Excessive daytime sleepiness
- Chronic school tardiness
- Avoiding school
Other Conditions Resembling DSPS
Overlap occurs in the symptoms of DSPS and other medical and psychiatric conditions. As the treatments will differ, it is necessary to recognize the distinctions. Many teens simply do not get the sleep that they need and may benefit from tips to improve teen sleep. Some have an underlying sleep disorder that is contributing to their difficulties, such as insomnia, restless legs syndrome, or even sleep apnea. In addition, psychiatric illnesses, such as anxiety and depression, may masquerade as a sleep disorder.
Diagnosis and Treatment of DSPS in Teens
Aside from answering a few questions, it can be helpful to do some basic investigative testing. One option is to look at the patterns of sleep and wakefulness with actigraphy. This small device records movement, and with the information collected, a doctor can determine whether DSPS is likely to be present. As a complement to this, the use of a sleep-wake diary may be useful in accounting for the patterns over several weeks.
Depending on the particular symptoms associated with the sleep disturbance, additional testing may be indicated. The treatment will depend on the cause, but teens with DSPS may respond to behavioral therapy, phototherapy with a light box, and even medications such as melatonin.
As there can be significant consequences from DSPS, including disruption of school performance and activities, it is important to get affected teenagers the help that they need.
Durmer, JS et al. "Pediatric Sleep Medicine." Continuum Neurol. 2007;13(3):182-184.