People who cannot sleep early ,Delayed sleep phase syndrome

Professional skylarks are people with a morning chronotype and owls with an evening chronotype. Many people are somewhere in the middle, it is neither a typical owl nor a typical lark. In this article, you will read about the extreme form of the evening chronotype, or the delayed sleep phase syndrome.

What is the delayed sleep phase syndrome?

In short, it is a disagreement between the internal, biological rhythm of sleep and wakefulness and the rhythm imposed by social norms . The natural hours of falling asleep for such people are 2-4 hours at night, and getting up 10-14 hours, which is why they are unsuitable for typical working hours or school education. Probably everyone who suffers from this has repeatedly heard the advice “go to bed earlier, then you will sleep.” The problem, however, is that having a delayed sleep phase is simply impossible to go to sleep early.

The diagnostic criteria for delayed sleep phase syndrome according to the International Classification of Sleep Disorders (ICSD) are: 
1. The shift of the sleep phase in relation to the expected hours, causing a chronic or recurrent inability to fall asleep at the expected time and awakening at the expected socially acceptable time. 
2. In the absence of requirements to fall asleep and get up at certain times, sleep is of good quality and of adequate length, but in shifted hours. 
3. Slight or no problems with maintaining sleep when the patient is already asleep. 
4. Very little or no ability to shift the sleep phase to earlier hours, by forcing to sleep at conventional hours.
5. Falling asleep at late hours, usually after 2 am for at least two weeks in a row. 
6. Occasional deviations from the cycle (eg waking throughout the day, night and part of the next day), followed by a sleep lasting 12-18 hours. 
7. Symptoms do not meet the criteria for any other sleep disorders and cause problems with falling asleep or excessive sleepiness. 
8. If laboratory methods are used for the diagnosis (eg polysomnograph), they also show a phase delay. The lowest body temperature occurs in the second half of sleep.

What distinguishes the delayed sleep phase from insomnia and other sleep disorders is the fact that people with this disorder, if they can live in harmony with their natural rhythm, have no problems. If they are going to sleep at “their own time”, eg 3 am and can sleep eg at 11 am, they get sleepy during the day, do not wake up at night and have no problems falling asleep. However, they have big problems, if they have such a rhythm, they have to go to work at 8 am. The delayed sleep phase syndrome is sometimes called “social jet lag”. The biological clock of such people is shifted daily compared to the typical hours imposed by social norms. People with this disorder are not able to fall asleep at the right time, because even if they feel drowsy, they will not fall asleep earlier than their natural time to sleep. From my own experience I know that you can be after a sleepless night, no longer suitable for learning, work, reading or anything else, go to bed very sleepy at 22 and for 4 hours to swing from side to side until natural comes hour to sleep. The problem stems from the fact that in people with delayed sleep syndrome, sleep deprivation does not reset the daily clock, as it is in normal people, so they can not change it.

Most people with delayed sleep syndrome fall asleep at fixed hours, but it happens that this syndrome is transformed into so-called a freely running rhythm, also known as a set of non-24-hour sleep-wake rhythms. The natural day of such people extends beyond 24 hours and as a result, they fall asleep every day and get up later. It is suggested that delayed sleep phase syndrome results from reduced sensitivity to morning light and increased sensitivity to evening light. Perhaps this very sensitivity to the evening light does not let you fall asleep to such people and for this reason, some rhythm develops freely.

How often does a delayed sleep phase syndrome occur?

Among adults, it is about 0.15%. It is much more common in adolescents, among whom according to some data it is even 7%. The syndrome usually develops in early childhood or adolescence. In people with whom he developed in adolescence, he often passes into early adulthood. However, if it does not pass to this period, you can be prepared for it that it will not pass.

How to treat delayed sleep phase syndrome?

Treatment of delayed sleep syndrome is difficult and often only partially successful, eg someone who usually gets up at 12hours, thanks to treatment may be able to get up at 10 or 10:30hours.

Methods that help some people are:

1. Light therapy  – Exposure with a suitable lamp for 30-90 minutes during the spontaneous waking time of the patient or shortly before. It does not help some at all, it helps some people but they have to use radiation every day, some people may use it less often after some time. This method is often recommended in combination with melatonin intake. 
2. Darkness therapy  – Limiting the light in the evening. It may help to wear a pair of hours before going to sleep with sunglasses or amber-colored glasses. Amber glass blocks blue light, and melanopsin – a protein contained in photosensitive retinal ganglion cells is sensitive mainly to the blue component of visible light. 
3. Chronotherapy – Behavioral therapy. It’s about changing behavior so that you can switch to more appropriate hours. It is impossible to move backward, but you can go to sleep later than usual. Specialists advise to go to sleep every day two or more hours later, and when it comes to the right time, you have to stop and sleep every day at this hour, no longer allowing yourself further delays. It can also be done at one time, ie one night not to sleep at all, and then go to sleep 90 minutes earlier than usual. Then, for a week, you should go to sleep at the new time, and then one more time avoid one night and lie down even earlier. And so until you reach the right hours of sleep. Then you just have to look after the old rhythm. Apparently, such therapy helps some.
4. Melatonin  – This is the hormone responsible for regulating circadian rhythms. It is recommended for regulating the sleep and waking rhythm of people working on shifts, traveling with a change of time zone and the blind. There is nothing in the leaflet about the delayed sleep phase syndrome, but there are studies indicating that it can help. And my own experience also indicates it 🙂 It is available without a prescription, sold in 1 mg, 3 mg, and 5 mg tablets. I do not know what doses doctors recommend, but effectiveness is probably dependent on individual predispositions, so it’s probably best to try it. Of course, side effects can occur. Wikipedia writes about sleep disturbances, nightmares, daytime sleepiness and depression. The leaflet also says that breasts can grow, but only men;)Read more about melatonin uses and dosage

The most effective method, of course, is to stop fighting your natural biological rhythm and adapt your life duties to it.

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