Delayed Sleep-Wake Phase Disorder in Teens

Also called: Delayed Sleep Phase Syndrome

What Is Delayed Sleep-Wake Phase Disorder?

As they enter their teen years, many kids have trouble falling asleep at their usual bedtime. But sometimes a teen can’t fall asleep or wake up at the desired times and has trouble functioning during the day. When this happens for at least 3 months, it’s called delayed sleep-wake phase disorder (DSWPD). Delayed sleep-wake phase disorder is one of the most common sleep problems in teens.

DSWPD can cause sleep deprivation (not getting enough sleep), which can lead to problems with focusing, mood swings, and low energy.

What Causes Delayed Sleep-Wake Phase Disorder?

The cause of DSWPD isn’t clear, but several things can play a role:

• The sleep-wake cycle (circadian rhythm) tends to shift later during puberty. This means the brain releases melatonin (a hormone that tells the body to get ready for sleep) later in the evening than it would for a younger child or older adult. That’s why teens often don’t feel sleepy at the same time in the evening as kids or adults: Their “body clock” isn’t ready for sleep. In teens with DSWPD, this shift becomes a problem.
• DSWPD can run in families, meaning it could be genetic. A teen may be more likely to develop DSWPD if a parent had it.
• Teens have a strong need to stay connected to their friends. Often, though, they’re so busy with homework and after-school activities that they can’t do this until the evening. Given the choice between going to bed or staying up late to chat and hang out with friends, many teens choose staying up late.
• Bright lights or blue light from smartphones or tablets in the evening. These can affect a person’s body clock. Many teens use these devices every evening, but doing so long after the sun goes down can keep them awake past their ideal bedtime. Likewise, not being exposed to bright light early in the morning (when the sun comes up) can also affect a person’s body clock.

Other things that can raise the risk of having DSWPD include working night shifts, traveling across time zones, and having too much caffeine.

What Are the Signs & Symptoms of Delayed Sleep-Wake Phase Disorder?

The main symptom of DSWPD is having a hard time falling asleep and waking up when needed, such as for a school or work schedule. Other signs to look for are daytime sleepiness, trouble focusing or paying attention, and feeling depressed or cranky.

It’s normal to have these symptoms every so often during puberty. But because most high schools begin earlier in the morning than the natural waking time for many teens, most teens need to wake up earlier than their body clock wants to. Many teens can often “catch up” on sleep when needed, but those who have these symptoms for more than 3 months may have DSWPD.

How Is Delayed Sleep-Wake Phase Disorder Diagnosed?

There’s no medical test for DSWPD, but having your teen keep a sleep journal can help the doctor figure out whether there’s a problem with the sleep-wake cycle. This means writing down sleep and wake times as well as energy levels (feeling sleepy or awake) in the morning and evening every day for at least a week. It’s also important to track sleep schedules on weekends and holidays when your teen may be able to sleep longer and wake up later.

In some cases, the doctor may ask your teen to wear a wrist device (called an actigraph) that can record times when the body is at rest and times when it’s active. This can help confirm what your teen wrote in the sleep journal.

How Is Delayed Sleep-Wake Phase Disorder Treated?

Your teen’s doctor may recommend strategies that can help, such as:

• Improving sleep hygiene. This is an important first step in treating DSWPD.
  
• Shifting the body clock to an earlier sleep-wake schedule. This can help when DSWPD symptoms are mild. To do it, move your teen’s bedtime earlier by about 15–30 minutes each night for up to a week or two until your teen reaches the target bedtime.
• Taking melatonin supplements. These can help your teen feel ready for sleep earlier in the evening. But talk to the doctor first to find out whether they're suitable for your teen and how much they should take. Melatonin supplements aren’t regulated, so ask the doctor which brands are trustworthy.
• Light therapy. Exposure to bright lights in the morning can block the release of melatonin and wake up the brain. Your teen also should avoid bright lights in the evening, especially blue light from electronic devices.
• Chronotherapy, which can help in more severe cases. This involves moving the bedtime later by about 2–3 hours each night for up to a week or two until the target bedtime is reached. For this to work, your teen will need to be able to sleep during the day for a week or two, so it’s best to do it during long vacations or breaks from school.

How Can I Help My Child With Delayed Sleep-Wake Phase Disorder?

To help your teen manage DSWPD:

• Talk to your teen about practicing good sleep hygiene, such as keeping the bedroom cool, dark, and quiet. Start small, with one or two changes that your teen can manage, and celebrate small wins.
• Talk to your teen’s teachers or school guidance counselor to find out whether your teen can avoid having early morning classes.
• If possible, have your teen change activities scheduled for later in the day to an earlier time. Having more free time in the afternoon and evening can let your teen do homework and talk to friends without having to stay up late.

What Else Should I Know?

While there’s no cure for DSWPD, many teens will grow out of it as they get older. By the time they reach young adulthood, their sleep-wake cycles often shift earlier.

In the meantime, you can help by following these tips and making sure your teen goes to all regular doctor’s visits.