Sleep struggles don’t discriminate; they can affect everyone
A routine question on my checklist during any well visit is how a child is sleeping. Sleep struggles don’t discriminate; they can affect everyone, whether it’s a baby adjusting to a new schedule, a toddler starting to resist bedtime, or a teenager who stays up way too late. Implementing a routine with consistency and patience can tackle most of these issues. What if nothing you try is working? If all “sleep hygiene” avenues have been exhausted, it may be time to consider delayed sleep phase disorder or delayed sleep-wake phase syndrome (DSWPS) diagnosis.
DSWPS is characterized by a significant delay in the regular sleep-wake cycle, where individuals struggle to fall asleep and wake up at “normal” times, and are ready to fall asleep and wake up significantly later than most people. This disorder affects the timing of various biological rhythms, including sleep, alertness, core body temperature, and hormonal cycle. This diagnosis isn’t made lightly and usually requires some data like a sleep diary or an extensive sleep history. The distinguishing features of DSWPS is that an individual will only begin to feel tired very late at night and will find it very difficult to wake up early in the morning, and that even being sleep deprived will not help them fall asleep earlier. Whenever given the opportunity (such as on weekends, when they don’t have regular responsibilities), they will go to sleep late and wake up late.
The first line treatment — early entrainment — isn’t easy, but can be extremely effective. It involves moving the child’s weekend or “natural” wake-up time earlier and earlier. This may take a few weeks. As a result of this waking up earlier, the child’s circadian rhythm will naturally begin to shift earlier. This strategy aims to move the child’s natural “time zone” to one that more aligns with what the family schedule requires. For more extreme cases, it may be easier to advance the sleep phase forward. This involves progressively delaying sleep and wake times by delaying bedtime a little bit every day. This process continues through the following day until it loops back around to the next evening and ends at the desired bedtime.
Another approach is timed light exposure. The idea is that bright light can reset the circadian rhythm. This may be done either through light therapy boxes or outdoor light, ideally for a few hours between seven and nine a.m. Avoiding light exposure during the evening, especially from electronic devices, is critical for this to be successful.
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