Sleepy Teenagers: Delayed Sleep Phase Syndrome

As sleep specialists, we see this in our clinic often — a teenager is difficult to rouse in the morning, drags through most of the day, and yet, despite the evident exhaustion, has a great deal of difficulty falling asleep until hours after midnight. It is likely that he or she has delayed sleep phase syndrome (DSPS).

What is delayed sleep phase syndrome?

Delayed sleep phase syndrome is a circadian rhythm disorder — a condition which shifts the normal sleeping pattern beyond what is considered normal. Teens with DSPS often do not fall asleep until hours after midnight and, when allowed, sleep in until well after noon (typically on the weekends). Their quality of sleep is otherwise normal.

About 9-10% of teenagers develop this problem. DSPS often develops over the summer months when kids tend to sleep in. It seems to be worse lately due to the pandemic, as online school may allow for a later start. Thus, DSPS becomes problematic only when a child must show up to school or work on time and just cannot.

How can I start sleeping at an earlier time?

Nightly routine

Developing good habits before bedtime, called sleep hygiene, helps signal your body when it is time to rest and prepares you for a good night’s sleep. For example, having a consistent nightly routine of showering, changing into pajamas, brushing teeth, and then going to bed.

Controlling light

The role of light is important in the development of this disorder since light “pushes sleep”. The later the lights are on, the later the body clock will signal for alertness. So, keeping lights on or viewing screens late at night will tend to push our natural body clock later and later as well. To facilitate good sleep and avoid DSPS, it is important to wrap up the use of screens an hour before bedtime.

Waking on schedule

For many teenagers, simply being forced to get up early when in-person school starts again will reset their body clock. After a tough week or so, they will be falling asleep and waking up at an appropriate time. But if parents are unsuccessful at helping them recover their sleep patterns, it may be helpful to consult with a sleep specialist.

Are there any treatments available?

Bright light therapy

In the clinic, we often use light therapy to move the sleep pattern to an earlier and more acceptable time. This can involve bright light applied just a bit earlier than the usual time of awakening to gradually push the sleep pattern to an earlier time.

Chronotherapy

For more severe DSPS, we may use chronotherapy to reset your body clock by going to bed 2-3 hours later every day or two, until arriving at the “right” bedtime. This is harder to do as it will affect the entire family’s schedule.

Underlying concerns

Finally, I often present a teenager with a riddle in clinic; “Three frogs sat on a log and one decided to jump off. How many are left?” The answer is three, for he only decided to do it, but did not actually act on his decision. Finding out why a teen may be unable to take action can require help, as they might be struggling with anxiety or depression, or lack structure in their life. Our goal is to identify what helps them move forward and what holds them back, and provide them with the tools to take action.

Photo: hackNY Spring 2011 Student Hackathon by @matylda, hackNy.org