Delayed sleep wake phase disorder (DSWPD) is a circadian rhythm sleep disorder characterized by a mismatch between a person’s internal biological clock (or circadian rhythm) and societal norms. As a result of attempting to sleep out of sync with the internal biological clock, individuals with DSWPD report a significantly prolonged sleep onset, difficulties waking in the morning, suboptimal sleep duration, and excessive daytime sleepiness. If the preferred schedule is allowed (eg, the individual goes to bed late and sleeps late into the morning), sleep duration and maintenance are normal.
Onset of DSWPD often occurs during adolescence as a result of behavioral and physiological factors. Prevalence estimates of DSWPD in adolescents vary; however, ranges from 3.3% to 16% have been reported.1-3
Assessment of DSWPD
Presenting symptoms of DSWPD often mimic those of other sleep disorders, including insomnia or hypersomnia. Polysomnography is not indicated unless symptoms of other sleep disorders are present. Suggested strategies for assessment of DSWPD are provided in Table 1.
Assessment of sleep patterns including bedtime routines, bedtimes, sleep-onset latency, wake times, and sleep environment are critical to an effective differential diagnosis. Differentiating the features from insomnia entails understanding the adolescent’s schedule during school compared with weekends or holidays. Individuals with DSWPD often report normal sleep-onset latency and sleep duration on weekends, holidays, or school vacations when they are allowed to sleep on their preferred schedule. In contrast, those with insomnia will report lengthy sleep-onset latency regardless of the time they go to bed. In addition, those with insomnia may report difficulties with sleep maintenance—a feature not as characteristic of DSWPD.
Sleep hygiene is also an important area of assessment. Adolescents with DSWPD may develop compensatory behaviors to manage frustrations related to lengthy sleep-onset latency. Such behaviors often function to alleviate frustration at sleep onset (eg, phone use) or compensate for daytime sleepiness (eg, napping). However, restriction of the sleep-inhibiting behaviors as a stand-alone treatment rarely helps decrease sleep-onset latency in DSWPD.
Dr. Dore-Stites is Clinical Assistant Professor of Pediatrics and Communicable Diseases, Michigan Medicine, University of Michigan, Ann Arbor, MI; Dr. Conroy is Clinical Associate Professor of Psychiatry and Clinical Director of the Behavioral Sleep Medicine Program, Michigan Medicine, University of Michigan Hospital, Ann Arbor.
The authors report no conflicts of interest concerning the subject matter of this article.
1. Sivertsen B, Pallesen S, Stormark K, et al. Delayed sleep phase syndrome in adolescents: prevalence and correlates in a large population based study. BMC Public Health. 2013;13:1163.
2. Saxvig I, Pallesen S, Wilhelmsen-Langeland A, et al. Prevalence and correlates of delayed sleep phase in high school students. Sleep Med. 2012;13:193-199.
3. Bartlett D, Biggs S, Armstrong S. Circadian rhythm disorders among adolescents: assessment and treatment options. Med J Aust. 2013;199:16-20.
4. Auger RR, Burgess HJ, Emens JS, et al. Clinical practice guideline for the treatment of intrinsic circadian rhythm sleep-wake disorders: advanced sleep-wake phase disorder (ASWPD), delayed sleep-wake phase disorder (DSWPD), non-24 hour sleep-wake rhythm disorder (N24SWD), and irregular sleep-W. J Clin Sleep Med. 2015;11:1199-1236.