- Diseases, Disorders & Conditions
Living with Delayed Sleep Phase Disorder Syndrome or The Case of Why I Can’t Sleep
Ever experience jet-lag? How about insomnia? Yeah. Ok. Now imagine living your entire life like that. For people, like me, with Delayed Sleep Phase Syndrome being unable to sleep at night and being tired all day is our reality. DSPS, or phase lag syndrome, is a circadian rhythm disorder. DSPS is relatively rare, often misdiagnosed and difficult to treat.
What is a Circadian Rhythm?
Circadian refers to the 24-hr wake/sleep cycle. Your circadian rhythm doesn’t just regulate sleep patterns it also regulates the body’s core temperature, body temperature regulation, endocrine (gland and hormone) function, airway function, and kidney (renal) function. A person with DSPS has an internal clock that is out of synchronization with his or her external environment.
Simply put for the majority of human beings, as the day turns to night, their internal clock signals changes in the body and brain that signal sleep. For the person with DSPS, it’s quite the opposite.
Symptoms of DSPS
1. The inability to fall asleep before early morning, typically 12-3 a.m.
2. Insomnia medications are ineffective.
3. Difficulty waking before 7 a.m.
4. A history of difficulty sleeping.
Some people who suffer from DSPS have difficulty keeping a job, and performing well in morning classes. Some people with DSPS in desperation turn to alcohol or drug abuse to cope. Those with DSPS often feel guilty or that others think they are lazy. Like other sufferer of DSPS if I am allowed to fall asleep and wake based on my own circadian rhythm I would fall asleep easily between 3 and 4 a.m. and wake around 10 or 11 a.m. refreshed. Since I live in a 9-5 world, this doesn’t happen very often.
Some people simple adopt a life style and careers that are more compatible to DSPS such as bartenders, night watchmen, night shift nurses and any other jobs that offer 3-11 p.m. or 11 p.m. - 7 a.m. type of work shifts.
- Causes for DSPS - Delayed Sleep Phase Syndrome - Sleep Channel
Delayed sleep phase syndrome is characterized predominantly by the inability to fall asleep before early morning (i.e., 12 midnight to 3 a.m.. The precise medical cause of DSPS is unknown. Circadian rhythms, which regulate the internal biological clo
A True Night Owl
I was literally born this way. Some people develop DSPS in early childhood. About seven percent of adolescents develop DSPS. Usually people who develop DSPS in adolescence or early adulthood eventually “grow out of it.” Those who are born this way, or develop it in early childhood, are affected by it their entire lives.
My mother remembers hearing me playing in my crib as a baby late at night and in the early morning. She would tell me stories about how as a toddler she would be barely able to stay awake trying to get me tired enough to go to sleep. I distinctly remember going to bed at my mother’s appointed bedtime for me and sneaking books into bed with me. I would crawl down to the end of my bed where the nightlight was and read. I counted sheep to the millions. I made up stories and sang songs quietly to myself. I played with my teddy bears, desperately waiting for sleep that would not come. I remember waking up exhausted for school in the morning. My grandmother once observed, “You are like a cockroach; you come alive at night.”
Diagnosing DSPS is difficult. I suffered in silence for years. As a young person DSPS worked for me, not against me. I could stay up all night and cram for exams in college and then sleep after them. In my youth I could push through the grogginess and function. I didn’t take early morning classes. I could take classes from mid-morning to night. Somehow I managed to function on three hours of sleep a night for five years in the Army. People praised my apparent need for little sleep. Little did they know I was suffering in silence.
The older I got the harder it became. Getting up on time got harder and harder. I was irritable all the time. I was late to work. I made my daughter late to school. At night I would have anxiety attacks because I was tired, couldn’t sleep and knew I had to be up early for work. I would fall asleep driving to work.
I went to my doctor who but me on Ambien. All that did was make me dizzy and even more tired in the morning. Then one day, quite by accident, I found and article about Morning Larks and Night Owls. It was such a relief. Reading it was a revelation. Finally, I understood what was wrong with me. On my follow up appointment with my doctor, I told him about the article and he agreed. Yes, it did seem as though I had DSPS. That was the good news. The bad news; there is no cure.
Most doctors familiar with DSPS recommend resetting your internal clock. My doctor suggested I take a hot shower before bed and go to be 15 minutes earlier every night until I could fall asleep before midnight. This technique was about as effective as serving soup with a fork for me.
Some experts recommend a combination of chronotherapy and bright light therapy. In bright light therapy DSPS patients are exposed to artificial light in the early morning and during the winter months to encourage sleep onset at night. The earlier the light therapy is applied to the patient, generally between 6 a.m.-8a.m. the more effective it is. Some patients have seen a 75% improvement in sleep. Additionally, those with DSPS need to avoid bright sunlight late in the day as this tends to delay sleep onset.
Chronotherapy involves progressively going to bed and waking up three hours later for six consecutive nights. I have tried chronotherapy. The effect only last a couple of weeks, sometimes a month or so, until some event or jus the passage of time will but me back into my "Normal" DSPS cycle. For example, my natural rhythm is fall asleep at 3 a.m. and wake up at 10 a.m. Therefore my sleep schedule for the week would look like this:
Day 1 - Go to bed at 6 a.m. and wake up at 1 p.m.
Day 2 – Go to bed at 8 a.m. and wake up at 4 p.m.
Day 3 –Go to bed at 11 a.m. and wake up at 7 p.m.
Day 4 – Go to bed at 2 p.m. and wake up at 10 p.m.
Day 5 – Go to bed at 5 p.m. and wake up at 1 a.m.
Day 6- Go to bed at 8 p.m. and wake up at 4 a.m.
Day 7- Go to bed 11 p.m. and wake up a 7 a.m.
This basically forces you into a “normal” sleep rhythm, however it doesn’t work for all people with DSPS and it often has to be repeated.
- DSPS Treatment - Delayed Sleep Phase Syndrome - Sleep Channel
All forms of treating DSPS are aimed at rephasing the patient's circadian rhythm and sleep pattern. Sleep therapy usually combines proper sleep hygiene practice and external stimulus therapy. Benzodiazepines are sometimes used to modify sleep-wake pa
Awake While the World Sleeps
Having DSPS can be somewhat lonely. You are awake when the rest of the world is asleep. Even as write this hub at 3 a.m., my family sleeps. Even the dogs in the bed with me are sound asleep. Since I cannot sleep I have found things to fill the long hours. I went back to college online. I often work on my assignments every night from 8 p.m. to around 11 p.m. to 12 a.m. depending on the assignment I figured since I was awake I might as well finally get that degree. I joined hubpages. I do laundry. Sometimes I sew, although, I tend to make more mistakes. I usually get up for work at around 7 a.m. My work schedule has been adjusted in order for me to come in as late as 9:30 a.m. and work until 6 p.m. I usually get about 4 – 5 hours of sleep on weeknights and on the weekend; my family lets me sleep as late as possible to “catch up” on my sleep, which you never really can. I figure, I will sleep when I am dead.