Have you always been someone who wakes up late?
You find yourself most creative and most productive in the late hours of night, even though you
know you need to wake up early the next day for school or work.
So your alarm goes off in the morning and you drag yourself to get out of bed feeling
like your one sneeze away from death.
And then when the weekend comes along, you find yourself catching up on all that lost
sleep and you wake up late in the afternoon as your mum, dad, friends, cat and dog look
at you disapprovingly.
No matter how hard you try or how many sleep hygiene hacks you read, you still find yourself
reverting back to your old ways when there's no push from school or work.
If this sounds like you, chances are you have something called Delayed sleep phase syndrome,
or DSPS.
From early age, we're taught that waking up early is a sign of success and hard work.
But it's simply not true.
I'm a medical doctor and I'm making this video to debunk the myth that waking up late makes
you lazy.
So what is DSPS?
Everyone has their own biological clock, that controls the processes within the body with
a 24-hour rhythm.
This biological clock, also known as the circadian rhythm, controls daily variations in body
temperature, alertness and hormone secretion.
Melatonin is one of the hormones that follows this 24-hour cycle.
Melatonin produced by the pineal gland in the brain and is the hormone that makes us
feel sleepy and tired at night.
When our eyes are exposed to sunlight during daytime, it suppresses melatonin secretion
and makes us feel more alert.
And at night time, the reduction the light intensity we experience, stimulates melatonin
secretion and makes us feel sleepy.
Delayed sleep–wake phase syndrome occurs when our circadian rhythm is out of tune with
what society considers "normal".
The reason for this is not 100% clear but it's most likely due to your genetic makeup
making you more sensitive to light than usual.
Meaning sunlight or even the artificial lights in your house or light coming from computer
screens or phones, will suppress melatonin in your brain more than the average person.
This is supported by a study that exposed a DSPS group and a control group with a bright
light.
They stated that "The results suggest hypersensitivity to nighttime light exposure in patients with
this syndrome." and they suggest that "evening light restriction is important for preventing
patients with DSPS from developing a sleep phase delay."
Also the fact that DSPS runs in families indicates that there is a genetic basis to this condition.
And some studies have even isolated genes responsible for it.
So how can you diagnose DSPS?
For you to be diagnosed with DSPS you have to fit certain criteria.
Firstly, there must be a chronic inability to wake up and sleep at a socially acceptable
times.
Secondly, when you're not required to maintain a strict sleep schedule, you sleep pretty
normally.
That is, you fall asleep relatively quickly at approximately the same time every night.
Also, you sleep for a normal length of time and you feel rested the next day.
Thirdly, you don't find yourself waking up in the middle of the night frequently.
And, lastly, you can't pin it down to any other medical conditions or substance use,
meaning it's a diagnosis of exclusion.
DSPS is frequently misdiagnosed as insomnia, however it's important to make the distinction
because the treatment for the two conditions are completely different.
Insomnia is a more serious medical condition that requires input from a doctor because
it has implications for your physical and mental wellbeing.
The key differentiating factor is that insomniacs have one of three features: one, they struggle
to fall asleep at any time of day; two, they wake up early before a full night's rest and
struggle to get back to sleep; or, three, they wake up frequently throughout the night.
Finally, insomniacs feel sleepy and tired throughout the day.
Anyway, if you see a sleep doctor for your DSPS and they're unsure about the diagnosis,
they might get you to do a sleepy diary or a formal test like actigraphy.
Actigraphy involves wearing a wristwatch with built-in accelerometer that measures your
movements through the night similar to how Fitbits or Apple watches measure your sleep
these days.
Some of these actigraphy units will measure things like your body temperature to better
estimate your circadian rhythm.
In some cases, doctors may use polysomnography to rule out more severe sleep disorders like
sleep apnea or narcolepsy.
In polysomnography, you sleep at a dedicated facility with sensors all over your head and
body to measure things like brain, muscle and heart activity to get a better picture
of what your sleep cycles look like.
So how do you treat DSPS?
Obviously, society is not going to change and adapt to our sleep cycles anytime soon,
so we as night owls have to come up with strategies to try and move our circadian rhythms a bit
earlier.
The obvious starting point is to develop good sleep hygiene practices.
That is going to sleep and waking up at regular times, not using technology before bed, avoiding
caffeine and naps late in the day, avoiding meals close to bedtime.
But I know that 90% of you are probably thinking "been there, done that" and sleep hygiene
practices don't work.
Well here are some additional strategies that you can try.
The first strategy is light therapy.
This involves exposing yourself to a bright light in the morning either with a lamp or
wearable LED device.
The light is used just before wakening or just as your wake up for anywhere between
30 to 90 minutes.
This simulates the midday sunlight and strongly suppresses your melatonin secretion so that
hopefully your circadian rhythm gets pulled back by a few hours.
A simpler but perhaps less effective alternative is to just to open up the blinds and use what
sunlight you do have and turn on all the lights in your room.
A related strategy is to minimise blue light exposure at night time by using blue light
filters on your computer screens or your phone, because it's thought that the blue light is
what suppresses the melatonin.
Sleep restriction is another really effective strategy.
That means going to sleep at your normal late sleeping time and then waking up early so
your slightly sleep deprived.
Eventually, if you do this for a few days, your body will start to crave sleeping earlier
and this will hopefully correct your sleeping cycle.
And then it's important to maintain that sleep cycle throughout the weekends and throughout
the holidays otherwise all your work will be undone.
There's also a number of medications that can be used to treat DSPS with the safest
and most common one being melatonin tablets.
However, there are a lot of risks you need to consider and procedures that you need to
follow, so make sure you talk to your doctor before trying this.
The whole aim with these strategies is to gently move your circadian rhythms back by
a few minutes every night.
It's only after weeks, months or even years of consistency that you'll notice a big difference.
Because remember, you're fighting against your own genes.
There are also some associated conditions that you should be aware of.
About half of people with DSPS will also have depression.
It's not clear whether DSPS causes depression or if depression causes DSPS but it's important
to consider if you have any symptoms of depression yourself.
That is, low mood, loss of feeling pleasure, loss of energy or motivation, feelings of
guilt or worthlessness, diminished concentration, weight changes, agitation or suicidal thoughts.
If you have any of these symptoms, it's worth seeing a doctor about it because treating
the depression may also solve the DSPS.
Also, DSPS has been shown to be associated with low vitamin D levels, obesity and ADHD
so treating those first might help with your sleep.
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for me, just leave a comment below.
Thank you.