What is delayed sleep-wake phase disorder (DSWPD)?

Delayed sleep-wake phase disorder (DSWPD) is a disorder in which a person's sleep is delayed by two or more hours beyond the socially acceptable or conventional bedtime. This delay in falling asleep causes difficulty in waking up at the desired time. As an example, rather than falling asleep at 10:00 pm and waking at 6:30 am, an adolescent with DSWPD will fall asleep well after midnight and have great difficulty getting up in time for school.

Most children and adolescents with DSWPD describe themselves as "night owls" and say they function best or are most alert during the evening or night hours. If they were to keep a sleep log it would show short sleep periods during the school/work week (with few or no awakenings during the night) and lengthy sleep-ins (late morning to mid afternoon wake up times) on the weekend.

What causes delayed sleep-wake phase disorder (DSWPD)?

The exact cause of this disorder is not completely known. However, approximately 7% to 16% of adolescents have DSWPD. Thus, it is a common disorder. Scientists think DSWPD may be an exaggerated reaction to the normal shift in the internal clock that is seen in many adolescents after puberty. It is important to understand that this is not a deliberate behavior. DSWPD most commonly occurs during adolescence, but cases have been reported during childhood; it is rare for it to begin after early adulthood.

What are the signs and symptoms of delayed sleep-wake phase disorder (DSWPD)?

Symptoms of DSWPD include:

  • Inability to fall asleep at the desired time. This usually presents as insomnia complaints. It may be heightened by the social pressures teenagers feel to stay up late (homework, internet or cell phone use).
  • Inability to wake up at the desired time and excessive daytime sleepiness. Usually this is the most common complaint because it is more readily evident than the nighttime insomnia. Because of the delay in falling asleep and yet still needing to get up at the required time for work or school, children or adolescents with DSWPD often experience excessive daytime sleepiness as a result of not getting enough sleep, at least on weekdays.
  • Generally no sleep problems if allowed to maintain their desired sleep/wake schedule. If uncomplicated by other sleep disorders, children and adolescents with DSWPD sleep well through the night with few or no awakenings once they fall asleep. They simply suffer from a shift in their internal clock or sleep-wake cycle. Children and adolescents with DSWPD often sleep well during vacations or school breaks when there is no pressure to wake at a certain time. Sleep maintenance is not an issue.
  • Depression and behavior problems. Children and adolescents with DSWPD may experience depression and other psychiatric problems including behavioral problems as a result of daytime drowsiness and missing school. Daytime drowsiness can also lead to lowered academic performance from missed school days or tardiness and inattention. Dependency on caffeine, sedatives or alcohol may also be seen.

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