This Sleep Disorder Is a Legit Medical Diagnosis for Being an Extreme Night Owl
Delayed sleep-wake phase disorder pushes your bedtime by two or more hours, no matter how early you go to bed. Should you adjust or lean into your natural sleep schedule?
Do you struggle to fall asleep at night, even though you go to bed at a *decent* hour? Does getting out of bed early in the morning literally feel impossible?
If you answered "yes," then you might chalk it up to being a night owl, but these are actually common signs of delayed sleep-wake phase disorder (DSWPD)—also known as delayed sleep phase syndrome—a circadian rhythm disorder in which a person's sleep is delayed by two or more hours beyond the conventional bedtime.
"DSWPD occurs when sleep onset and final awakening are delayed with respect to the desired clock time," explains Eve Van Cauter, Ph.D., chair of Sleep Number's scientific advisory board, and professor in the department of medicine at the University of Chicago. "Typically, the affected individual falls asleep and awakens two or more hours beyond the socially acceptable or conventional bedtime," she says.
Is Being a Night Owl the Same Thing as DSWPD?
So does being a night owl mean you have a sleep disorder? Not necessarily.
Real talk: Not everyone is born a morning person. In fact, there are a variety of chronotypes, which refers to a person's biological clock and genetic propensity to sleep during a 24-hour period. Evening chronotypes, or night owls, are people who function better at night and sleep in until late morning or early afternoon, while morning chronotypes are up and at it in the early a.m. Some schools of sleep believe that people with DSWPD are on the extreme evening end of the chronotype spectrum.
"DSWPD is controversial because it's the purest form of a manifestation of an extreme trait; just like there are extremes in height, DSWPD is a night owl (or evening chronotype) extreme," says Robert Auger, M.D., sleep medicine specialist and consultant at the Mayo Clinic Center for Sleep Medicine in Rochester, Minnesota. "It becomes a disorder when your schedule isn't compatible with the time you're able to fall asleep at night. So if you're routinely falling asleep at 2 a.m. and you're supposed to be at work at 8:30 a.m., then you aren't getting enough sleep." (Related: The Actual Definition of a Good Night's Sleep)
However, DSWPD and being a night owl isn't the same thing, says Michelle Drerup, Psy.D., a sleep psychologist, and director of behavioral sleep medicine at the Cleveland Clinic Sleep Disorders Clinic in Cleveland, Ohio.
Here's the difference: People with DSWPD aren't easily able to adjust their internal clocks. For example, "if you're a night owl, you might purposely stay up to do work or socialize. You'll also wake up later than usual. But when it's time to follow a normal routine, someone with night owl tendencies would be able to adjust their sleep schedule with consistent earlier bedtimes and wake times," explains Drerup. On the other hand, when someone has DSWPD, their internal clock delays sleep even if they're tired and don't try to stay up late, says Drerup. (Related: How I Made the Transition from Night Owl to Super Early Morning Person)
Keep in mind that it's normal to occasionally go to bed and wake up an hour later than normal, and it usually won't cause a major issue with your sleep. "Most people experience these subtle shifts, especially when adjusting to daylight savings time," says Van Cauter. "We're also more likely to drift toward later bedtimes during summer as a result of longer days with natural light that shift the biological clock," she says. But if your sleep is delayed two to four hours past your usual bedtime, then it could be a sign of DSWPD or another sleep disorder.
How Do You Know If You Have DSWPD?
Dr. Auger says that DSWPD is usually comorbid with insomnia because people with the disorder have trouble falling asleep at the desired time. Even if they have lights out by 10 p.m., people with DSWPD have internal clocks that prevent them from actually snoozing. As a result, they may find it really challenging to wake up at a certain time early in the morning and experience excessive daytime sleepiness. People with DSWPD might also have depression-like symptoms, like an inability to focus and be productive during the day, says Drerup. (Related: Are You Actually Tired—Or Just Lazy?)
However, if people with DSWPD are able to dictate their own sleep/wake schedule, they should be able to sleep well and have no issues getting the recommended seven to nine hours of sleep per night. "When they're able to sleep on their preferred schedule, people with DSWPD often stay up late until they get tired and then sleep until they awaken late in the morning or early afternoon," says Drerup. "In this case, they tend to have good sleep quality and have no complaints of difficulty falling asleep or feeling poorly during the day," she says.
What Causes DSWPD?
Although the exact cause of DSWPD isn't known, Drerup says that circadian rhythm disorders like DSWPD most likely occur when your internal clock that regulates sleep and wakefulness is weakened or doesn't align with your desired sleep period. "There are many things that weaken your sleep drive and can alter your internal clock. These can include an irregular work or sleep schedule, low activity levels, anxiety, and light exposure, such as too much light exposure close to bedtime," says Drerup. "A lack of morning sunlight exposure and overexposure to bright evening sunlight are likely to lead to a shift in the circadian rhythm towards a delayed sleep phase," she says. That's why it's so important to get morning sunlight after you first wake up; it signals to your body that it's time to start the day.
Genetics plays a role, too: "DSWPD tends to run in families—approximately 40 percent of people with DSWPD may have inherited this trait from their parents," says Drerup. According to a 2017 study in Cell, which looked at 70 people from six different families, a mutation in a gene called CRY1 was common among those with DSWPD. The CRY1 (cryptochrome circadian regulator 1) gene is responsible for—you guessed it—regulating the circadian clock. It's also an important gene for regulating other physiological functions, such as metabolism, body temperature, blood pressure, and cardiovascular function. Moreover, there are differences in other circadian clock genes for night owls and people with DSWPD, too, says Dr. Auger. For example, a 2003 study in Sleep found that certain variants of the Per3 gene were found more frequently in people with DSWPD, suggesting that it's a genetic marker for the disorder.
Van Cauter also notes that the tendency to develop DSWPD could be the result of a lack of social cues that help synchronize your internal clock, like the "shelter in place" conditions that are going on in the midst of the coronavirus pandemic. "Many people are experiencing changes in their routines. An online survey of over 2,000 adults conducted in 2020 by Sleep Number found that sleep routines have changed for 56 percent of respondents since the beginning of the epidemic, and of those, 57 percent are sleeping less," says Van Cauter. (Related: How and Why the Coronavirus Pandemic Is Affecting Your Sleep)
Why Is DSWPD Common in Teens and Young Adults?
DSWPD can develop at any age, but it most commonly affects teenagers and young adults due to changes during puberty. "Estimates suggest that approximately 15 percent of adolescents and adults have DSWPD," Drerup says. "During adolescence, the body's 24-hour sleep cycle becomes longer, which requires later sleep and wake times," she explains.
A 2013 study of more than 10,000 teenagers between 16 and 18 years old in BMC Public Health found that 3.7 percent of the girls had DSWPD and 2.7 percent of the boys. The study also revealed that more than half of the adolescents with DSWPD had insomnia. "That's why many high schools have started to delay their start times to 8:30 a.m. or later so students can get enough sleep," says Dr. Auger. In 2014, the American Academy of Pediatrics recommended that middle and high schools start at 8:30 a.m. or later because the delayed release of melatonin (the hormone that makes you sleepy) in adolescents has made it more difficult for them to fall asleep at an earlier bedtime.
As for adults? If you have DSWPD as a teen, it can extend into your early 20s, but generally dissipates and goes away when you hit your 30s, says Dr. Auger.
It's rare to develop DSWPD later in life, especially if you never had symptoms of it in your teens. "It is very uncommon for adults to develop DSWPD at a late stage of life, although living under conditions of evening light exposure and scarce exposure to morning light may progressively delay the circadian clock and develop a late chronotype," says Van Cauter.
Drerup says another potential trigger for DSWPD in adulthood is working overnight shifts or having a chronic illness that affects your sleep schedule. "It is certainly something you can live with for your entire life; however, everyone's internal clock shifts earlier with age," she says.
What Are the Health Risks of DSWPD?
Evening chronotypes and people with DSWPD tend to have higher rates of mental health disorders, says Drerup. "However, it is unclear if there is a genetic link between delayed sleep phase and mental health, or if the stressors of DSWPD negatively impact mental health," says Alicia Roth, Ph.D., a post-doctoral fellow in behavioral sleep medicine who works with Drerup at the Cleveland Clinic. Evening chronotypes are associated with depression, seasonal affective disorder, substance abuse, anxiety disorder, and bipolar disorder, according to a 2018 review in Current Sleep Medicine Reports. A 2012 study in Sleep Medicine showed that in evening chronotypes and people with DSWPD, 40 percent of the participants had a history of depression. Moreover, another study in BMC Psychiatry found that among depressed young adults, 18 percent reported DSWPD.
"Research has also demonstrated a greater risk for obesity in evening chronotypes with eating habits playing a significant role (e.g., larger dinner, poorer diet quality, and more calories consumed in the evening)," says Roth. Moreover, epidemiologic studies have found an association between skipping breakfast and late evening eating with increased risk of obesity, diabetes, and heart disease, says Van Cauter.
How to Treat DSWPD and Get Enough Sleep
Because of social norms, people with DSWPD aren't able to follow their preferred sleep timing and might not be getting enough sleep. If you have a lifestyle that allows you to lean into your delayed circadian rhythm, then you should adjust your schedule so that you're able to meet your sleep needs—even if that means operating on a slightly different schedule from the rest of the world.
"There are certainly people who can keep a delayed circadian rhythm because of the flexibility of their jobs or family, and many with DSWPD do choose careers based on their sleep schedule," says Roth. But for most people, this isn't an option, so Roth recommends working with a sleep specialist to help advance your sleep schedule.
"In behavioral sleep medicine, we offer a treatment called cognitive-behavioral therapy (CBT) for DSWPD. CBT for DSWPD includes developing a specific sleep schedule that gradually moves bed and wake times earlier," says Roth. CBT works to address certain behaviors and environmental factors that influence your sleep, like your diet, what you do for a living, and the type of hours you work. "This disorder can affect school and job performance, as well as social lives, and the way you feel about yourself, like being called lazy for your preferred sleep schedule," she says.
Here are some ways night owls and people with DSWPD (and, really, anyone) can adapt to an earlier sleep schedule and improve their daytime productivity.
- Stick to your sleep schedule seven days a week. So if you wake up at 7 a.m. Monday through Friday, aim to do the same during the weekend. "Sleeping in on the weekends may feel amazing, but it may impact your ability to fall asleep Sunday night and feel alert on Monday," says Roth. Dr. Auger advises not to wake up more than an hour and a half later than your usual wake time during the week. "People that sleep in a lot during the weekends develop what's called social jetlag. They become very delayed by Sunday and experience pronounced insomnia, which starts this vicious cycle," he says. This is especially important if the quarantine is affecting your sleep, too. Van Cauter says that when delayed sleep phase is less than two hours, re-instating social cues and keeping a regular sleep-wake schedule may be enough to re-entrain your body to the desired sleep schedule. "In the case of 'shelter at home' conditions, to avoid developing DSWPD, you need to keep normal sleeping habits by setting up your sleep-wake cycle, staying disciplined and keeping to your schedule," says Van Cauter. "Plan the day and be careful not to let the evening drag on until wee hours. Seek bright light exposure in the morning and avoid it in the evening."
- Get sunlight when you first wake up. Open up your curtains and go for a quick walk around the block to awaken your senses. Natural light suppresses melatonin, which is the hormone that regulates your sleep-wake cycle. "Avoiding light in the evening so melatonin can increase is important too, and yes, this includes tablets, smartphones, and TVs," says Roth. (Psst..there's no harm in trying blue light glasses.)
- Bring light into your office. Dr. Auger says changing your work setup so it allows more light into the room can help you feel less sleepy. Place your desk closer to a window, use translucent curtains or decorate a wall with a mirror to reflect more light into the room. Dr. Auger says that you can also talk to your doctor about light box therapy.
- Keep naps short. Dr. Auger recommends napping for only 30 minutes or shorter. Napping longer than that can affect your sleep at night.
- Talk to your doctor about melatonin. Your physician or sleep specialist may also prescribe melatonin. They will determine the dosage and timing of the medication. "Appropriately timed and dosed melatonin can help you fall asleep. It's a chronobiotic to help advance your sleep schedule," Dr. Auger says. Van Cauter says you usually take melatonin one hour before your desired bedtime.
- Follow a workout routine. "Physical activity is an important component from our daily routines that reduces levels of anxiety, which can have a tremendous impact on how we sleep," says Van Cauter. Fitting in some exercise in the afternoon or after work can give you natural energy if you're feeling sleepy—just avoid working out too close to your bedtime. "Exercise also increases sleep drive, which increases the chance of feeling sleepy earlier," says Roth.
- Create a relaxing nighttime routine in the early evening. Stop the emails and Instagram scrolling, and do something that will help you unwind, like journaling, meditating, reading a book (FYI, not one that will trigger anxiety)—basically anything that involves little mental focus and physical energy. "In other words, don't give your body an excuse to want to stay up later," says Roth. (Related: This Bedtime Routine Uses Yoga for Sleep So You Can Have a More Restful Night)
Very interesting article. I'm 70+ years old, and I have problems falling asleep and staying asleep. I go to bed about 2 a.m., watch TV for about an hour; I fall asleep between 3 and 4 a.m., and wake up around 5 or 6 a.m. to go to the bathroom. After that, I can't fall back to sleep until about 8 or 9 a.m.; then I can sleep until 10: 30 a.m. or as late as 1:30 p.m.Read More