Delayed sleep phase syndrome + its symptoms, causes, diagnosis and treatment

We often use the term “night owl” to describe someone who stays up late or even early in the morning. But what makes a person (especially a teenager) naturally inclined to stay up late? In this article from Dr. Salam’s department of psychology and diseases, we examine the causes, symptoms, diagnosis, tests and treatment of delayed sleep phase syndrome. We also help you consider the consequences of insomnia and sleep deprivation and do what you can to control the situation.

Delayed sleep syndrome

Anyone who sleeps later than other people’s average bedtime may be considered a night owl. However, those who suffer from delayed sleep phase syndrome are likely to have a different behavior and style. If the natural desire to fall asleep is delayed by at least a few hours compared to a normal person (starting to sleep from 1 am to 3 am), the person with delayed sleep phase syndrome is likely to be. In some cases, this sleep delay may be even more severe and the person does not sleep until sunrise.

There is no desire to wake up with at least a few hours in a person with delayed sleep phase syndrome. He falls asleep as the sun approaches and may not wake up until the afternoon or later.

How does delayed sleep phase syndrome happen?

It is estimated that 10% of the population can be considered as having sleep phase delay syndrome. This may be more common among teenagers, as they are sensitive to slight delays in their sleep time, but can endure and tolerate it. Retired people also experience these conditions.

Symptoms of delayed sleep phase syndrome

People with delayed sleep phase syndrome will generally experience two things:

  • insomnia
  • Drowsiness

Why do these seemingly contradictory symptoms occur in the same person at the same time? The answer is that it is a matter of time.


If nocturnal people go to bed earlier than their natural desire to sleep, they will experience significant insomnia. Going to bed after 10pm may lead to hours of tossing and turning. It can trigger anxiety, frustration, and anger—emotions that cause insomnia.

When you stay up late on weekends or during vacations, you fall asleep more easily. When sleep is delayed, it can be normal and uninterrupted, regardless of how late your bedtime is.

Morning sleep:

In the early hours of the morning, it is difficult to wake up a person who has been awake until morning. (Many parents have experienced the futile attempt to wake up their teenagers). Morning sleep can be deep. Depending on the time of awakening, it is similar to waking up a normal sleeper in the middle of the night.

Waking up is very difficult for people with delayed sleep phase syndrome. Their sleepiness decreases in the middle of the day. When night falls, the nocturnal person feels very alert and wants to be awake, so the cycle repeats itself.

Delayed sleep phase syndrome

Social pressure and sleep disorders in people with delayed sleep phase syndrome

Unfortunately, these people are usually not in tune with their bodies and cannot listen to their bodies when they sleep and wake up. If they always sleep at 2 am and wake up at 10 am, there will be no problem. They fall asleep easily without insomnia and wake up without conflict. Unfortunately, other societal pressures such as parents, spouses, bosses, school systems, etc. can be destructive and distracting.

This fatigue created after insomnia can lead to academic and professional performance disorders. If someone does not fall asleep normally until 2 am, but has to wake up at 6 am to go to work on time, it will lead to lack of sleep and insomnia. Unfortunately, 4 hours of sleep is not enough to meet a person’s basic sleep needs. This can have profound effects on a person’s health and living conditions. Pay attention to some symptoms related to insomnia:

  • Drowsiness
  • tiredness
  • Difficulty concentrating
  • Memory problems
  • Posterior and behavioral changes (depression, anxiety or anger)
  • Errors or accidents
  • Physical pain
  • delirium
  • paranoia

There is evidence that severe sleep deprivation can be fatal. This is most likely due to the chronic effects it produces.

Causes of delayed sleep phase syndrome

It appears that there is a genetic basis for the development of sleep phase delay syndrome. Some cases are scientifically investigated. For example, a mutation in the human chromosome 1 gene changes the human circadian clock and delays it by up to 2 hours compared to normal people.

As researchers investigate the condition further, they have found that “clock genes” play a role in the development of the syndrome. About 40% of people with delayed sleep phase syndrome have shown that family history has an effect on this issue.

Beyond genetics, there are environmental factors that may worsen the condition. Most importantly, light has powerful effects on the timing of the circadian system and may induce sleep delays. However, it may be used to modify the condition.

Delayed sleep phase syndrome

Circadian and sleep system

Sleep depends on two processes:

  • amount of sleep
  • 24/7 alarm system

If you are in a closed environment like a cave, the 24-hour clock will be genetically determined. It is controlled by the suprachiasmatic nucleus, which is a region of cells in the hypothalamus of the brain, and is strongly influenced by light.

Every cell and organ in the body follows the circadian pattern. For most people, this internal clock is programmed to run a little longer, perhaps once every 24 hours. In the cave, without exposure to light, an isolated person falls asleep naturally and wakes up 30 minutes later, and this time changes every day.

Within a week, sleep time will increase by 3 hours. Within a month, 14 hours will increase so that a person can sleep naturally during the day and stay awake at night naturally. This shift is reset during the circadian system by the early morning sunlight.

Exposure to natural light in the early hours of the morning sends a signal to the brain to wake up, making it easier to wake up. It also changes the bedtime a little and makes it easier to fall asleep. This will help your desire to sleep at a natural time and when it is dark during the night, without which there will be significant problems with your health and sleep.

Diagnosis of delayed sleep phase syndrome

With proper training, it becomes relatively easy to recognize the symptoms of delayed sleep phase syndrome. It can become a lifelong problem, starting in puberty and continuing for decades. But how is it diagnosed?

Fortunately, there is no specific test to reach a suitable and needed diagnosis. A thorough and complete medical history review by a licensed physician can usually identify the condition. In some cases, a person’s sleep reports over several weeks may help with identification.

Rarely, special tests are needed. In research settings, measuring melatonin levels can help identify circadian timing. Especially low light “melatonin” (DLMO) which is measured through blood or saliva can create this pattern.

Unfortunately, frequent sampling requires a controlled laboratory environment. This is practically not done in clinical cases. Recently, a blood test called TimeSignature has been discovered, but it is not widely available and is not commonly performed.

Treatment of delayed sleep phase syndrome

If the condition is genetically determined and lifelong, it may seem like a life sentence. Fortunately, this is not the case for delayed sleep phase syndrome. There are effective ways to maintain normal sleep time. It may take a little more effort, but take and implement potentially beneficial actions.

Delayed sleep phase syndrome


There is good evidence that night owls have acceptable sleep times. This requires consistency, especially when it comes to waking up. Wake up every day, including weekends. Sleep well and don’t stay up late.

Go to bed until you feel sleepy, even if you need to wait a little while to fall asleep. This will help you fall asleep more easily, reduce sleep pressure and increase your sleep quality.

Morning sunlight and its effect on delayed sleep phase syndrome

It is important to coordinate your sleep time with sunlight. This is much more effective for waking up. Try to wake up for 15 to 30 minutes. Wake up to the alarm on your mobile phone, put on your clothes and go out immediately. take a walk Read a newspaper in the park and check social media to see the sun rise.

Light hurts the eyes, so don’t look directly at the sun. Even on a cloudy or rainy day, try to follow your routine and go to bed on time and wake up on time. During the winter months, phototherapy may require a light box and the effects may take up to a month to become apparent.

Prevention of delayed sleep phase syndrome by staying away from light at night

Artificial screen light at night, especially in the hours before bedtime, should be minimized. These disorders may change sleep time and cause insomnia or morning sleepiness. Existing devices, such as mobile phones, etc., may be switched to night mode and cut off blue light, which can alter and disrupt sleep timing.

Blue blocking sunglasses (with an amber tint) or screen covers can be used. Or, two hours before bedtime, turn off electronic devices completely and put them away from you.

Delayed sleep phase syndrome

Melatonin and its effect on delayed sleep phase syndrome

Melatonin is a hormone produced by the pineal gland in the brain. This hormone can be an external signal for the circadian system, which is effective among the blind. If taken up to six hours before bedtime, it may help people fall asleep earlier.

However, its effects may be somewhat weak and definitely affected by the effects of light. Although melatonin is available without a doctor’s prescription, you should talk to your doctor before adding any supplements to your routine.

Cognitive behavioral treatment of insomnia and delayed sleep phase syndrome

CBTI is an effective treatment that helps improve sleep patterns and a person’s relationship with it. Sleep integration, stimulus control, mindfulness, and relaxation techniques may be integrated and taught in one program. This book may guide your class or lesson with the help of a psychologist.


It is rarely possible to gradually adjust sleep time in a chronotherapy setting. This is difficult to do at home and may require hospitalization. In the following days, the sleep duration may be delayed by about one to two hours until the optimal sleep time is achieved. Unfortunately, timed lighting can complicate the results, so strict adherence to planning will be required.

Prescription drugs

Sleeping pills and stimulants to increase alertness have a limited and small role for this condition. Generally, they will be weakly effective. As a result, they may be abused.

The risk of overusing these drugs is high for night owls, especially when used in combination with alcohol. Instead of covering the symptoms of insomnia with drugs, we need the basic timing of the circadian rhythm and this timing should be corrected.

Delayed sleep phase syndrome

Social awareness of delayed sleep phase syndrome

Education and social literacy can help parents to understand what their teenager is experiencing and know that laziness or struggle is not their main problem. High schools should instill this natural timing among their students by changing school times and school start times, increasing academic performance, reducing tardiness and truancy, and even reducing teenage car accidents.

Although this may not be a critical issue, it is worth bringing up at parent-teacher conferences.

Final point

Sleep deprivation can have serious effects on human health. If you are diagnosed with delayed sleep phase syndrome, consider seeking the guidance of a good, skilled practitioner. Start with a simple tip:

Go to bed until you feel sleepy (even if this feeling comes to you later, but be sure to lie down until you feel sleepy), and wake up in the morning with sunlight. If you need more help, ask your doctor or specialist for help and guidance.

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