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Delayed sleep-wake phase disorder, or DSWPD, is a sleep condition that is especially common in children and adolescents. It is also sometimes referred to as delayed sleep phase syndrome or DSPS. If you have trouble falling asleep and waking up at normal times, you may be dealing with delayed sleep-wake phase disorder.
Read on to learn more about delayed sleep-wake phase disorder, its symptoms, diagnosing DSWPD, and how you can treat it.
Delayed sleep phase syndrome can be described as a sleep disorder that causes someone's sleep to be delayed by two hours or more. This delay is two hours or more than the conventional times for bedtime or the scheduled bedtime you create for yourself based on your lifestyle. When you're consistently having trouble falling asleep and waking up at the right time, then delayed sleep-wake phase disorder could be the culprit.
Children who have this disorder may go to bed late on school nights, feel groggy when they wake up, and sleep in for a long time on weekends. An adult with the disorder may try to go to bed at a decent hour to be ready for work in the morning, but find themselves tossing and turning for hours before they can fall asleep, causing them to feel sleepy and fatigued at work the next day. People with delayed sleep-wake phase disorder may find that they’re more alert during the evening hours and at night.
Delayed sleep phase syndrome is one of several circadian rhythm sleep disorders that affect the timing of sleep. The American Academy of Sleep Medicine recognizes that circadian rhythm disorders significantly impact sleep-wake cycles and daily functioning. These circadian disorders occur when your body's internal clock doesn't align with environmental time cues or social expectations.
Delayed sleep-wake phase disorder will have several symptoms that you may notice and that may help you diagnose the cause of your sleep difficulties. These symptoms include:
Trouble falling asleep and waking up at your scheduled sleep time: This is the most common symptom of the disorder. You try to go to sleep at a scheduled time and you're unable to, and you have trouble waking up when you want to. When you try to wake up, you'll likely feel groggy and you won't feel as refreshed since you didn't get to bed at the time that would have let you get the hours of sleep you needed.
Excessive sleepiness: Since you're not getting enough sleep, you may feel sleepy and groggy during the day. This can also make it more difficult to focus at work or school. Research shows that excessive sleepiness affects up to 10% of people with chronic insomnia.
Mood problems: When you don't get enough sleep, you may become irritable during the day. You may also increase your risk for mood disorders like depression and anxiety. Studies indicate that excessive sleepiness and mood disruptions significantly impact daily life functioning.
Feeling the need for caffeine: As a result of your lack of sleep, you may feel more dependent on stimulants like caffeine.
No sleep problems otherwise: One symptom that helps to differentiate delayed sleep-wake phase syndrome from other sleep disorders is the fact that all of the other symptoms resolve when a sleep schedule isn't necessary (e.g., if you're on vacation and you can easily fall asleep, stay asleep, and feel rested). Typically, the pressure of a necessary sleep schedule will cause a delay in the sleep-wake cycle, bringing on delayed sleep phase syndrome.
The cause of delayed sleep phase syndrome is not completely clear. It is, however, a relatively common sleep disorder for children and adolescents. Research demonstrates that the disorder may be caused by the internal clock shifting after puberty, however, this may just be one potential cause. As mentioned, this disorder is most commonly seen in adolescents and children. In rare cases, it can be seen with young adults and adults. With that being said, if you're an adult, it's likely that a different sleep disorder is the cause of your sleep difficulties.
Several environmental factors can contribute to delayed sleep phase disorder:
Understanding these factors can help in developing effective management strategies. For those struggling with timing issues, our comprehensive guide on 5 tips to improve sleep patterns naturally provides additional support.
Understanding the risk factors can help identify who might be more susceptible to developing this sleep phase disorder:
Age: Children and adolescents are most commonly affected, with the condition often persisting into adulthood. Night owls may be particularly vulnerable during teenage years when natural circadian rhythm changes occur.
Genetics: Family history plays a significant role, with research indicating that delayed sleep phase syndrome tends to run in families, potentially linked to specific genes like hPer3 and CRY1.
Associated Conditions: The disorder shows strong associations with ADHD, with studies revealing that a high proportion of people with ADHD also have delayed sleep phase syndrome.
Delayed sleep phase syndrome can have several effects on your health. When you're not getting enough sleep, you can feel fatigued and have difficulties at work or school. Good quality sleep contributes to both our physical and mental health. It's essential to get enough sleep so you are able to function normally in your daily life and so that you don't increase your risk for adverse health effects. Some of the consequences of lack of sleep include:
It can also increase your risk for various health conditions. Good sleep is essential at any age.
When dealing with delayed sleep phase syndrome, it's important to address these health impacts comprehensively. For strategies on feeling more rested, explore our guide on how to wake up feeling refreshed and relaxed and learn about why you might not feel rested after sleep.
Delayed sleep-wake phase disorder is typically diagnosed by telling a doctor your symptoms. Keeping a sleep diary of your sleep habits can also help determine the nature of your sleep disorder. A sleep log documenting the timing of sleep patterns over several weeks provides valuable information for a sleep specialist to make an accurate diagnosis.
The American Academy of Sleep Medicine recommends comprehensive evaluation including sleep history and potential sleep studies. On occasion, a sleep study may be recommended to find out if any other sleep disorders, such as sleep apnea, could be the cause of your sleep problems.
As with many sleep disorders, delayed sleep-wake phase disorder is very treatable. Often, it can be treated by making lifestyle changes to promote better sleep. There are a few different treatments that may be recommended as part of a comprehensive treatment plan to treat delayed sleep phase syndrome.
Good sleep hygiene involves creating a comfortable sleep environment and forming healthy sleep habits. Good sleep hygiene can help those with delayed sleep-wake phase syndrome maintain a normal sleep schedule and fall asleep at the right time. Let's look at some good sleep hygiene habits to form:
The sleep environment: Make sure the environment you're sleeping in promotes sleep. This means that the room is dark, cool, and quiet. The bedding and mattress should also be comfortable.
Sleep habits: There are several good sleep habits that those with delayed sleep-wake phase disorder should form. These habits include:
For comprehensive guidance on establishing healthy routines, explore our 10 tips to improve your sleep and learn about improving sleep hygiene.
When you're treating delayed sleep-wake phase disorder, you'll need to shift your bedtime to get your internal clock on track. This involves either shifting your internal clock forward or shifting it back.
Shifting your clock forward: This method shifts your bedtime gradually until you start falling asleep at the time you want to. If you want to fall asleep at 9 p.m., start by going to sleep at 11 p.m. and then move your bedtime forward 15 minutes each night.
Shifting your clock back: This method makes your bedtime later, shifting it one hour or more each night until you have the bedtime you want. This method involves a later bedtime each night.
Once a sleep schedule is determined, it's important to stick to it as strictly as possible. The temptation to sleep in or stay up late on weekends and other days off can make this difficult, but prioritizing sleep is essential when you're trying to treat a sleep disorder. Once you're able to maintain your sleep schedule for an extended period, you'll be able to fall asleep and wake up at the right time much more consistently without feeling groggy or drowsy.
For additional support in maintaining consistent sleep patterns, explore our resources on sleep coaching and discover 11 ways to sleep better for comprehensive sleep improvement strategies.
Light therapy is a method that some people find helpful when dealing with delayed sleep-wake phase disorder. This exposes you to bright light to help your body adjust its circadian rhythm and get you back on track. Research shows that bright light exposure in the first one or two hours of the morning advances your circadian rhythm.
Light exposure should be carefully timed - getting bright light in the morning helps advance sleep onset to an earlier time, while avoiding light at night prevents further delays. If possible, it's also a good idea to get a lot of natural light during the day. Your circadian rhythm is largely determined by light exposure, so getting outside during the day can definitely help to get your sleep on track. Bright light therapy typically involves exposure to bright light for 30-60 minutes in the morning.
For additional strategies on optimizing your circadian rhythm, read our guide on how to boost circadian rhythm and learn about using technology in the bedroom to minimize disruptive light exposure.
As a last resort, some people may try a melatonin supplement or other sleep supplements. Studies show that melatonin administration 5-6 hours before desired sleep onset can help advance the timing of sleep. The problem with these is that the side effects like grogginess may be worse than the side effects you're already dealing with from your delayed sleep-wake phase disorder. A sleep specialist should supervise any melatonin treatment to ensure proper timing and dosage.
For more information about melatonin options, read about melatonin vs prescription sleep aids and explore natural alternatives to sleep medication.
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The primary symptoms include difficulty falling asleep before 2 AM, extreme difficulty waking up in the morning, excessive sleepiness during the day (especially in the morning), feeling most alert in the evening and night hours, and normal sleep quality when allowed to follow your natural delayed schedule. People with this condition often describe feeling like "night owls" but experience significant impairment in daily functioning when forced to maintain conventional times for sleep and wake.
Several factors can worsen delayed sleep phase syndrome symptoms: irregular sleep schedules, exposure to bright light in the evening hours, insufficient light exposure in the morning, consuming caffeine late in the day, using electronic devices close to bedtime, maintaining poor sleep hygiene, stress and anxiety, and frequent changes to sleep timing (such as sleeping in on weekends). Environmental factors like inconsistent daily routines and lifestyle choices significantly impact the severity of symptoms.
Key risk factors include age (most common in adolescents and young adults), family history (genetic predisposition with 40-50% having affected relatives), associated psychiatric conditions like ADHD and obsessive-compulsive disorder, certain genetic mutations affecting circadian rhythm genes, being naturally inclined toward evening preferences ("night owl" tendencies), and experiencing major life transitions or stress. Research indicates that delayed sleep phase syndrome has a strong familial component, suggesting genetic factors play a significant role in its development.
Dr. Shiyan Ooi
Dr. Shiyan Ooi is a medical doctor with over a decade of experience treating patients with chronic conditions. She graduated from the University of Manchester with a Bachelor of Medicine and Surgery (MBChB UK) and spent several years working at the National Health Service (NHS) in the United Kingdom, several Singapore government hospitals, and private functional medicine hospitals. Dr. Ooi specializes in root cause analysis, addressing hormonal, gut health, and lifestyle factors to treat chronic conditions. Drawing from her own experiences, she is dedicated to empowering others to optimize their health. She loves traveling, exploring nature, and spending quality time with family and friends.
