If you have (or suspect you have ADHD) and are struggling to fall asleep at a "normal" hour, wake up feeling groggy, or find yourself alert and restless late at night, you might be dealing with something called Delayed Phase Sleep Syndrome, or DSPS.  It's not just insomnia or anxiety—it’s a circadian rhythm sleep disorder that often goes misunderstood and misdiagnosed.

We'll explore how DSPS differs from the more commonly discussed "revenge bedtime procrastination," which is the habit of staying up late to reclaim a bit of personal time after a busy day. 

I will also delve into effective treatments like light therapy and melatonin, and discuss how understanding your sleep patterns can be a game changer for those balancing ADHD and entrepreneurship.

So, if sleep's been your nemesis, this episode will help you learn how you can finally get the rest you deserve.

Understanding DSPS:

Unlike insomnia or general sleep problems, DSPS aligns your internal clock much later. It’s not a result of poor sleep hygiene or bad habits,  it’s an actual condition in both ICD and DSM diagnostic manuals.

Revenge Bedtime Procrastination vs. DSPS:

Revenge bedtime procrastination involves deliberately delaying sleep for fun or relaxation, when one feels their day is too packed with responsibilities and too little time for some self indulgence like scrolling social media or bingeing a Netflix series.

DSPS is about a genuine inability to fall asleep at typical times. Both are common among those with ADHD and are often confused with each other. 

Treatment for DSPS:

Gradual exposure to bright light in the morning and reducing light exposure before bedtime can help recalibrate your internal clock. Click here for a list of light therapy products recommended by the Yale School of Medicine Dept of Psychiatry

Sleep specialists often suggest a 3 mg dose of melatonin taken around 9 PM to help initiate sleep. Click here for the Medical News Today article on treatment options. Click here for blue light blocking (orange) glasses. 

Fun Fact 🧠✨

Morning exposure to natural daylight—even on a cloudy day—has a more beneficial effect on aligning your circadian rhythm than indoor lights.

Past episode of ADHD-ish on the topic of ADHD & sleep:

• Episode #202_ Morgan Adams on The Impact of Sleep on Women’s Wellness 
• Episode # 28_ Sleep Your Way to Success with Yishan Xu, PhD 

What did you think of this episode?  What topic do you want me to dig into next?  

DM me here on LinkedIn - Send me an email - Leave me a voice message 

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© 2024 ADHD-ish Podcast. Intro music by Ishan Dincer / Melody Loops  / All rights reserved. Outro music by Vladimir /  Bobi Music / All rights reserved. 

Problems with sleep are so common among those with ADHD, and there are quite a few of them. Difficulty falling asleep at a reasonable hour, being able to stay asleep as long as you want, getting enough rest, waking up when you'd like to, feeling rested and refreshed when you get up, and managing daytime sleepiness are just a few. Now sleep difficulties are not part of the diagnostic criteria, but I think they should be. However, they are one of the most disruptive effects of ADHD on the brain affecting everything from work performance to intimate relationships. Something I see quite often among clients, family, and friends who have ADHD is something not well understood, and it's called delayed sleep phase syndrome.

I'm gonna refer to it through most of this episode as DSPS for short. It is characterized by great difficulty falling asleep and waking up at the conventional times, let's say, between 9 and 11 PM falling asleep and waking up between 6 and 8. It is considered to be a circadian rhythm sleep disorder affecting the body's internal clock. So individuals who have DSPS are able to fall asleep and wake up just as easily as everyone else, but 2 or more hours later than most people.

Now, according to the American Academy of Sleep Medicine, lots of people who have this feel completely alert and energized during normal sleeping hours. Everyone else is tired and falling asleep, and then they will stay up very late engaging in activities and continuing to get artificial light exposure, which further affects their circadian rhythm. In the most severe cases, they're not even going to feel sleepy until the early hours of the morning. So individuals with DSPS, can force themselves to go to bed at socially conventional times only to lie awake in the dark for hours, tossing, turning, wishing, and waiting they could just freaking fall asleep.

They are alert and restless, but it's not anxiety or the racing thoughts that come with an ADHD mind that just can't shut off. A lot of treating clinicians don't understand this and will end up diagnosing these individuals with anxiety, depression, insomnia, and giving them medication for these things that doesn't really help. Delayed sleep phase syndrome is related to ADHD. In fact, a growing number of people with ADHD, especially women, are recognizing that they have ADHD after attempting to get treatment for their sleep disturbance for years.

Many of them have been diagnosed incorrectly with insomnia, generalized anxiety, depression, and put on sleeping pills or anti-anxiety or anti-depressant medication, which only partially helped. And I feel so bad for these people because I personally think sleep is the number one thing we need to regulate in order to have stable mood, stable energy, stable functioning. Even if we don't have ADHD, but especially if we do. Now if you spend any time on TikTok, I spend way too much time there. You've probably also heard if you follow any of the TikTok creators, who talk about ADHD, many of them are talking about something called revenge bedtime procrastination. And I hear a lot of people confusing this with delayed sleep phase syndrome. They are not the same.

Revenge bedtime procrastination is not a clinical diagnosis. However, delayed sleep phase syndrome is. As a matter of fact, delayed sleep phase syndrome is listed under circadian rhythm sleep wake disorders in both the ICD and DSM. Revenge bedtime procrastination is not. It's also not part of the diagnostic criteria for ADHD. Now what difference does it make? Well, I'll tell you what. Having jacked up sleep cycles totally messes with your executive functioning, your mood, and sometimes even your ability to sustain your business or manage a romantic relationship. It is in our best interest to figure out when we have a sleep disorder, what kind it is that we're experiencing so that we can take advantage of the right strategies and solutions that actually help.

Okay, okay, okay. Getting off the soapbox, public service announcement over. Back to revenge bedtime procrastination. I can understand why so many people get them confused, but revenge bedtime procrastination, and key in on the word revenge. It is the deliberate delay of going to bed in order to do other mildly pleasurable activities, like typically scrolling through social media, maybe online shopping, maybe streaming a Netflix series, or just some other mildly, stimulating and somewhat rewarding dopamine boosting activity that keeps the brain alert. The reason why it's referred to as revenge bedtime procrastination is because people who have ADHD who tend to do this feel cheated when they go to bed and all they feel like they've been able to do that day is work.

A lot of us who are self employed, who haven't figured out how to streamline our business and are putting in way too much time for the money, and then maybe also have household, pet, child, or partner responsibilities. Like, I really understand why going to bed after basically just taking care of anybody else and everybody else all day long without getting any me time or fun time. I completely understand why people wanna stay up late to squeeze a little bit of fun, a little bit of entertainment, excitement, pleasure, relaxation out of their day before calling it quits. I've also had many clients tell me they spend their whole day being responsible, running their business, leading a team, caring for their family, managing a household.

And the only way they feel like they are doing something just for them is staying up late and doing something that honestly I mean, nobody's really making their life better by spending an hour on TikTok when they should be sleeping. But it feels like at least I'm doing a little something for me. I get it, I totally get it. And, because all behavior is habit forming, revenge, bedtime, procrastination very quickly becomes chronic. Now, folks with ADHD have challenges regulating their emotions and regulating their dopamine.

So it's pretty easy to assume that if you stay up late, obviously it's revenge bedtime, procrastination, right? This knee jerk response overlooks the very real possibility that what's actually going on is delayed sleep face syndrome. And I'm pretty passionate about this because I think people with ADHD are all too quick to shame, blame, judge and hate on themselves. Always jumping to the conclusion that they're sabotaging themselves. When you've gone to see a provider and they've diagnosed you with generalized anxiety or depression or insomnia and put you on sleeping medication and you're still staying up late, it would be very understandable that you'd come to the conclusion that it's revenge bedtime procrastination. But if it's actually delayed sleep phase syndrome, you need treatment, not willpower.

Further complicating matters, and why I feel strongly enough about this that I'm devoting an entire episode to it, is because nearly all of us with ADHD have difficulties with organization and time management. And that can also mean not getting to bed on time because we're still running around trying to take care of things that could have gotten taken care of earlier in the day, but didn't. So it's very confusing why so many of us are up too late, don't get enough sleep, don't feel rested, struggle to stay alert during the day. It's like a compounded situation. But if you do have DSPS, you need to know, because none of the other strategies that work for other things are going to work for this because it's actually a clinical condition.

Now, how do you know? How do you figure it out? Is it revenge bedtime procrastination? Are you just ridiculously disorganized and not in control of your time? Or is it DSPS? Well, I believe it starts with a combination of two things that I talk about all the time. Radical self acceptance, which making it safe to be honest with ourselves, because we take self hate, shame and blame off the table. So we can take an honest look at ourselves, and that look can be one of mindful awareness. And remember, mindfulness simply means open to what is, curious about why it is, and not judgmental about any of it.

When we can look at ourselves with radical self acceptance and mindful awareness, we will know it's revenge bedtime procrastination, when we know we could fall asleep at the so called normal time, the typical time, the socially conventional time, but we resist it. We might even feel sleepy when we're engaging in our late night activities, whether it's scrolling, shopping, whatever. But, once the stimuli that's keeping you awake is removed, you probably would fall asleep pretty quickly. If it's DSPS on the other hand, you are really not going to be able to fall asleep at the socially conventional time, even under the most controlled sleep conditions.

Like, I'm talking blackout curtains, you know, white noise, pink noise, brown noise machine, like sleep mask, ear plugs, like all the things, you know, withdrawing light sources. You're still not gonna be able to fall asleep because it's a clinical condition. It is a circadian rhythm difference. Now there can be an overlap, you can absolutely have DSPS and revenge bedtime procrastination and be totally disorganized and not manage your time in the evening. It could be all of the above. But when you remove all of the things that you can control for, and under the best of conditions, you simply cannot fall asleep, you probably have DSPS.

Now, insomnia is probably the diagnosis that most people have while they're trying to figure out what's really going on and later finding out it's delayed sleep phase syndrome. Insomnia means you're either gonna have trouble falling asleep, but once you're out, you're out, pretty much. Or secondary insomnia is you don't have trouble falling asleep. You fall asleep okay, and then you wake up. And maybe you fall back asleep and you wake up and you fall back asleep and you wake up. That's secondary insomnia.

Falling asleep actually comes easily for people who have delayed sleep phase syndrome, when it is aligned with their internal clock. So if they go to bed at 1 am, because that's when their body, mind, and brain tell them they're actually tired, they fall asleep just great, or 3 am even. It's just that it's several hours later than what's considered normal. Also, staying asleep is not an issue for people with DSPS, but it frequently is for people with insomnia. So when you practice radical self acceptance and mindful awareness, you can actually go down these checklists and see, oh, I thought it was this, but maybe it's that.

Now, if you're wondering if there's a connection between delayed sleep phase disorder and night shift work, you get to go to the head of the class. There have actually been numerous studies that examine the connection between night shift workers and DSPS, indicating that night shift workers are at a much higher likelihood of having this. So much so that, emergency room personnel who see these people for accidents, related to being asleep when they're, when they're awake, when they're supposed to be asleep, they refer to it as shift work sleep disorder. It's not a clinical term, but it's what you'll often see in a medical chart. Now, personally, I would like to see a lot more studies done examining the role of genetics in terms of susceptibility to developing DSPS, as well as like a chicken or egg study.

Do people develop this difficulty, you know, subsequent to doing shift work or do they go into shift work because they're awake at that time anyway? I think there's so much we still don't understand about circadian rhythms, the brain and mental health. No matter what nighttime looks like, the result for those with delayed sleep phase syndrome is often that they have what's called a short sleep window. So they have obligations like running a business, getting the kids off to school in the morning, but they went to bed when they got tired, which maybe was 1 am or 3 am.

So waking up is really hard because they're sleep deprived. And many of these people are gonna have to force themselves to wake up with multiple alarms or even being physically shaken or pulled out of bed by a partner or an older child. Now, once they're awake, these people I call hard to arouse individuals, they're absolutely sleep deprived. Their brain is still honestly half asleep and they usually feel like absolute shit, like they have a hangover. There are people who drag themselves through the day, through the work week, usually supported with lots of caffeine and other stimulants. Red Bull, Doctor Pepper, ones I hear a lot about.

Some people get up and take a cold shower. Some people have to drive, to the office with the windows down when it's raining or snowing to try to finish waking themselves up. And what they miss out on is quality time with everyone, friends, family, their team, their clients. Because people who are not well rested are generally very irritable, and their brains are not firing on all pistons.

I am always, saddened when I have a new client who tells me they've been treated for insomnia and they were put on a sleep hygiene routine and it didn't really help. And they just came to the conclusion that there was nothing that could help them and so they just live with it. While I do think that sleep hygiene I'm a big fan of bedtime routines, morning routines, because I think the more things we can create routines around, the less willpower we need, the more they become what I call no brainers. We just train our brain to these habits so we don't have to choose them every day.

But people who are not able to sleep in the socially conventional times often miss out on a lot of things because they're either slogging through the day, sleep deprived, and then trying to catch up on, sleep on weekends, holidays, vacation times. So they're missing out on quality time with friends and family. They're still not going to be well rested because you can't ever really catch up on time. So if this sounds like you or someone you care about, there are 2 things that actually work. Melatonin and light therapy, I'm gonna talk about light therapy first.

So light therapy for delayed sleep face syndrome and you've also heard me refer to it as disorder, both terms are used. Involves increasing the brain's exposure to bright light after waking up for at least 30 minutes and then reducing light exposure as much as possible before bed, while also shifting little by little by little, wake up and sleep times. Now this is considered an intervention. I think there are people that have learned how to do it on their own. If they're very committed and very disciplined, most people will have better results if they're working with a sleep specialist. If that's at all something that, is available to you and you have access to that and the resources for it. It's probably easier to get a really good result if you're working with someone.

But, basically, we need and this is true for everyone, by the way. Every human would benefit from this. Every human with ADHD would benefit from this. But for people with delayed sleep phase syndrome, it's an absolute necessity. Having exposure to unfiltered daylight for at least 30 minutes within a couple of hours of waking up. And I didn't know this for quite some time, but even on an overcast day, natural daylight has a better effect than indoor lighting. Some people use, light boxes. There's all kinds of light exposure devices, wearable LED visors, things like this. Some people swear by them and other people say they cause headaches.

So I think it's a trial and error situation. But going for a morning walk outdoors to get exposure to natural daylight, and the walking isn't bad for you either, is actually going to be better for the vast majority of people than any device they might buy. So how does this work? If you would normally fall asleep at 3 am, your light exposure should not happen until after 9 in the morning. Because if you wake up before 9 am, whether you mean to or not, you should not expose yourself to light just yet.

Now, if you gotta be outside before 9 in the morning, this is gonna sound kind of weird, but it would be a good idea to wear sunglasses and a hat to try to avoid direct sunlight when you are going through this recalibration. To augment light therapy, and avoid light exposure before and during sleep, to prevent melatonin suppression. We wanna dim the lights, avoid looking at screens for 2 hours before bedtime, I get a lot of pushback on this. Because so many of us are in a habit of watching something on a screen with our partner or kids by ourself as a way of relaxing in the evening.

But if you have this sleep phase disorder, you are functioning with half your brain tied behind your back, and it is definitely detrimental to your mental health and your executive functioning. So what is ideal is to avoid screens for 2 hours before bedtime so that your natural melatonin production can be facilitated. If it's not feasible, then you wanna install a blue light filter on the device or wear the orange glasses. I'll link to a couple of options for that. People also wear sleep masks. They install blackout curtains to make their room as dark as possible.

The jury's kind of out on all these things, there are people who swear by each of them, all of them. And other people have said, I've tried them all. And the only thing that works for me is this one thing. So there's unfortunately gonna be a little bit of trial and error. But the light therapy on its own is not gonna be effective without this. You also have to calibrate your sleep cycle. What seems to work the best for the majority of people is 15 minutes a day. So going to bed 15 minutes earlier, waking up 15 minutes earlier, and then doing it if you can do it every day, shift it by 15 minutes every day.

I've worked with people who could only shift it every 2 or 3 days so it could take weeks. It could take months to shift. But I think your mood, energy, and motivation, and how groggy and irritable you are during the day will show you whether you're going too fast or whether you can speed it up. The other treatment is melatonin. Now I have taken melatonin, it didn't do shit for me at any dosage. But I also know people who say 3 milligrams of melatonin at 9 o'clock at night, and it's perfection.

The standard treatment is, while you're calibrating, you wanna take 3 milligram dose of melatonin at about 9 pm. And as you're shifting your sleep cycle earlier and earlier and earlier, you may be able to reduce that down to a lower maintenance dose of 1 or 2 milligrams. I've known people that need to stay on 3 pretty much long term and others some people have been able to, get rid of the melatonin altogether after a few months. Everybody is different. Now, because this podcast is for business owners, I wanna end with this. You know, a lot of people end up being self employed who have this condition and don't even know it.

I've had people tell me the reason why they started their own business, especially one where they don't have to manage a team and they can work from home, is because they cannot conform to the norm when it comes to sleep and when they were expected to be in the office, just couldn't do it. And before I understood about, delayed sleep phase syndrome, I just thought, well, I guess they didn't really want the job that much. Now I feel bad that I once thought that because I've known and worked with enough people who genuinely have this.

This is not a matter of a weak character or not giving a shit. This is a legitimate medical condition. And most, most clinicians don't know it, most therapists don't know about it. So some people become self employed because they got they kept getting fired from jobs that required them to be in the office at 8 or 9 am. And so they created the job that they couldn't get fired from. And maybe they start at noon or maybe they don't even start till 3 in the afternoon.

A delayed sleep cycle when we don't get enough sleep because we're trying to force ourselves to conform to someone else's preferences, is absolutely going to lead to significant impairment and probably some kind of accident, because our brain is just not all there. Some people even have a completely reversed sleep cycle where they sleep all day and stay awake all night. But it is well known that this tends to come with a lot of functional impairments and additional mental health problems, including depression. So if your natural sleep cycle isn't too far out of alignment with the conventional norms, let's say you, you think you should go to bed at 10, but you just can't do it until 1, but 1 o'clock s terrific and you wake up at 9 and you're good to go.

Now, clearly if you have young children or your business model requires you to conform to a more conventional time schedule, you might not have the ability to shape your business and your life to your unique circadian rhythms. But it's worth at least considering the possibility of working with what comes naturally to you before committing to try to change it. I hope that's given you something to think about. And if this is you, I encourage you do some additional research. I'm gonna link to some resources in the show notes and see if you can't get an official sleep study or assessment and start working on calibrating with light and melatonin.

There's so many things we miss out on when the rest of the world is going on without us, that it's probably for most people well worth the effort to make these adjustments. And if this is you, I wish you all the best of luck with it. And please let me know if this content was valuable to you. Share it with someone who needs to hear it. And if you would like to hear more episodes like this, you can DM me. You can leave a review or you can send me an email. I make sure you have links to do all of that in the show notes.