Everyone is familiar with the difference between morning and evening people. One person is fresh and fruity ready to start when the alarm goes off early in the morning, the other is just a little slower but gets going after a few cups of coffee or a good breakfast. But there are also extreme variants on both sides. People with Advanced Sleep Phase Syndrome (ASPS) are wide awake at 3 a.m. and exhausted by 8 p.m. Those with Delayed Sleep Phase Syndrome (DSPS) sometimes only fall asleep in the morning and wake up early. woke up again in the afternoon. Both extremes cause significant inconveniences, but DSPS has the greatest impact on daily life. Functioning well during office hours is not always easy for people with DSPS.

How can DSPS be recognized?

DSPS is sometimes compared to permanent jet lag. By far the most important characteristic is a sleep/wake rhythm that is structurally shifted towards the night, which cannot be achieved or can only be achieved with extreme difficulty. Many people who are later diagnosed with DSPS have already extensively tried home remedies and counting sheep, and sleeping pills often have little effect. Related to this are a number of symptoms, some of which mainly occur when someone with DSPS tries to function during ‘normal’ times (such as in an office job), such as:

• Severe problems getting up.
• Need a lot of time to get going in the morning.
• Caffeine addiction.
• Inertia.
• Concentration problems and sometimes making sloppy things.
• Bad mood in the morning.
• Dejected feeling.
• Be most productive and have the most energy in the second half of the evening.
• Problems falling asleep when you go to bed at a ‘normal’ time.
• A dreamy, drowsy feeling the day after you have had a good night’s sleep.
• No problems sleeping if you can keep to your own times.

The latter is especially important, because it distinguishes DSPS from ‘classic’ insomnia or sleep problems caused by, for example, sleep apnea. The precise symptoms may also vary slightly from person to person.

Frustration

For many people, living with DSPS can be quite frustrating, especially if it has not been diagnosed, has been diagnosed incompletely or incorrectly. A lot is often done to keep in line with the rest of society. Alcohol, drug and medication abuse is sometimes seen, and there are even general practitioners who reject the existence of DSPS. Furthermore, it also regularly occurs in combination with depression, which is often a consequence of sleep problems and the associated misunderstanding. It sometimes happens that someone with DSPS is labeled lazy, maladjusted, unruly and antisocial, and he or she may face (punishment) measures and even dismissal at school or work due to lateness or sleepiness. Explaining what is going on often leads to well-intentioned advice and tips that have often been tried by the person in question, or sermons about adjustment and discipline. This can make someone feel powerless, which sometimes leads to a downward spiral.

What can be done about it?

The problem with DSPS is that there are many possible ways to reduce the impact, but it is impossible to say whether these ways will help every person. DSPS is difficult to treat and is often present for life. A genetic background for DSPS has also recently been found: when the gene defect is present, treatment will only become more difficult.

Melatonin

In many people with DSPS, the production of melatonin in the body starts later than normal, which also causes drowsiness to occur later. Taking melatonin tablets can hasten the onset of drowsiness, provided the pills in question are taken about five hours before the desired bedtime. The solution for some, but there are also others for whom swallowing has no effect at all. In many cases, the tablets must be taken for several months before the effect is noticeable. The melatonin tablets sold at the drugstore are not strong enough for this, a prescription from your GP or sleep doctor is required for the correct ones. These tablets are not reimbursed by insurance.

Light therapy

With light therapy, the dose of light that the body of the person with DSPS perceives through the eyes is regulated. This requires a light therapy lamp that is not reimbursed by insurance. When he or she gets up in the morning, he or she sits down for about half an hour. The amount of light in the evening should also be reduced: no bright light, no television and no computer use about two hours before the desired bedtime (and if the latter is absolutely necessary: use light filters). With this method it is also impossible to say how well it will work, the time saved in the evening differs per person.

Chronotherapy

In chronotherapy, the sleep and wake times of the person with DSPS are moved up a small amount (typically half an hour) every day until they arrive at the desired time. This is not going forward, but rather backwards . This takes about a month, after which these times must be adhered to extremely rigorously: missing bedtime due to a party, appointment or other reason can mean that the chronotherapy can be restarted. Furthermore, during chronotherapy there will be a period when he or she is literally awake at night and asleep during the day, so this requires taking time off from school or work for an extended period of time. In addition, there are indications that chronotherapy is risky: there are some known cases in which DSPS has developed into non-24-hour sleep-wake syndrome, which is an even more serious sleep disorder.

Adjustments in life

Many people with DSPS choose to adapt their lives accordingly. They often work evenings, including in the catering industry, the transport sector, security or healthcare. Others choose freelance work such as writing, or start self-employment. This gives them the flexibility to work when they are at the peak of activity according to their own biological clock. Often this alone is enough to eliminate almost all DSPS-related complaints.Although there are quite a few options to deal with this sleep disorder, DSPS remains something that can get in the way. Children have to go to school in the morning, employees who have been allowed to adjust their working hours often still have to attend a meeting occasionally in the morning and if something needs to be done in the house, the professional often reports very early. In fact, it is nothing more than an evening-oriented biorhythm in a morning-oriented society, and finding the balance between the two is an enormous challenge.