From a previous therapist: "No one should have trouble making a 10am appointment (her office was 1 hour away). If you can't get up early your depression is very severe and I won't treat you unless you go on meds." On the first appointment I made it clear I wasn't going on meds; I'd be on and off so many different meds (for depression only) at that point I just couldn't face more and dealing with the weird side-effects. I explained I was a 'night owl' and wanted afternoon appointments. I tried to explain the DSPS concept to her but she dismissed it. I stopped seeing her. However, I've had many therapists and doctors who don't understand the concept of DSPS. Had many conversations like this: 1. No, it's not a sleep hygiene issue; tried it, doesn't change. 2. It's not a 'habit'. I can force myself out of bed at 6am every day for 3 months but I'll never feel rested, I'll still have trouble falling asleep, there will be many days I'll try and function on 3 hours sleep and no, it's STILL not a sleep hygiene issue. 3. If I go to bed at 11pm it can take me hours to fall asleep; if I go to be at 6am I'm asleep within 15 mins., sleep about 8 hours, wake up without an alarm and feel quite rested. 4. Now, why don't YOU, Doctor, try changing YOUR natural sleep schedule and see how YOU feel.

From what I've read there does seem to be a correlation with ADHD and DSPS but so far I haven't found any studies that focus on the combination exclusively. There are articles that focus on circadian rhythm disorders in general and DSPS specifaclly. Treatment options for DSPS don't seem promising--the rigid sleep hygiene, various medications and light therapy at very specific times can help tremendously--unfortunately, the regimen must be strictly adhered to or you slip back into DSPS patterns.

I've also been fighting nocturnal tendencies for a long time. It compounds the frustrations of trying to create and manage some semblance of a normal life by limiting opportunities for jobs, recreation, friends. And I've had several people who envied my 'luxury' of sleeping late. Why don't they realize that I sleep the same amount they do, just different hours!

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Let me say I totally empathize with your syndrome. First of all, a therapist should never talk to someone the way that they did to you. I am just completing an undergraduate degree in human services and I pray that I never talk to a client in that manner.

What attracted me to your posting is the fact that my ADHD son (10 years old) goes to bed much later then his peers. Even if I send him to bed at a "normal" time he will not fall asleep until much much later. He appears to need a great deal of time to wind down and "typically" cannot fall asleep any earlier then 11:30 but, finds it easier to fall asleep after midnight.

I, too, even though I have now been conformed to the "other side" can sleep "normal' hours but, I typically do not become fully awake until late afternoon or early evening. In my 20's I always worked second shift or evening hours and found it very conducive to my sleep cycle. I did not know there were people that suffer from this syndrome. Most people have always viewed me as "lazy". Good luck and you are not lazy or weird.

kelbo

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Hi Katz, I truly feel your pain and wish there were more research on delayed sleep phase syndrome (dsps) with adhd. As a child I was always coined as a "night owl" and just "plain lazy" in the morning. I've always been plagued with delayed sleep and it has negatively affected most aspects of my life. I too have searched the web for ways to correct the problem and have found the same results as you did. I guess the real problem is that dsps is not really a "problem" it's just not society's standard of sleeping and waking. I look at it like adhd. It's not that my attention is deficit, it's just different then non-ADHDer's. But, to make life easier for people with dsps, I do wish there was something we could do to change our internal clocks and not have to be on such a stringent regiment that’s impossible to stick with. Let’s hope someone is reading these posts that have some answers…..anyone??? Thanks

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So that's what it is called! I have had this since I was a child. Now at least I know the name for it.

It may encourage you to know that there is research being done here in the UK at the moment on ADHD and sleep patterns, and I suspect this probably includes DSPS specifically.

A friend of mine took part in a study being done that hypothesised that people with ADHD have a peak sleep time that is different to most people. According to my friend, this study was designed to test the proposal that most people's peak sleep time is about 4am, but people with ADHD have a peak time that could be at, say 8pm, or 11am, which in turn can cause all kinds of problems. I think they are trying to find out whether ADHD causes the sleep variation, or vice versa.

The studies are being done at the Swansea University, in Wales, UK. I have found a couple of links referring to one of these studies. http://lib.bioinfo.pl/pmid:17948273 http://neurologicalcorrelates.com/wordpress/2007/10/22/daylight-savings-time-ends-november-4-unless-you-have-clock-gene-polymorphism-rs1801260/

Dr Johannes Thome is one of the people involved in these studies. That's all I know about them.

Some people with either ADHD, DSPS or both take Melatonin, a sleep hormone, to help them get to sleep. Melatonin is relatively safe and has little side effects, but as always, it is best to check with your doctor. Pilots often take it to help get combat jet lag.

As I understand it, in the US it is available in health food shops, but it in the UK you have to order it online, or get it prescribed by a doctor, as it is considered to be a medicine. It is legal to import it though. I get mine online from Puritan's Pride in the US.

I have tried Melatonin and it helped me get to sleep immediately. The first time I tried it, I was able to get to sleep at a normal time and wake up the next morning feeling fresh and awake, which rarely happens for me. I would like to try a 'slow-release' melatonin. Apparently, the normal melatonin is good for inducing sleep, the slow-release one is good for getting a consistent night's sleep.

I hope this helps.

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(... Sorry to double post this, but in the previous one I had a long link that seemed to mess up the readability of the post. Here it is again.) So that's what it is called! I have had this since I was a child. Now at least I know the name for it.

It may encourage you to know that there is research being done here in the UK at the moment on ADHD and sleep patterns, and I suspect this probably includes DSPS specifically.

A friend of mine took part in a study being done that hypothesised that people with ADHD have a peak sleep time that is different to most people. According to my friend, this study was designed to test the proposal that most people's peak sleep time is about 4am, but people with ADHD have a peak time that could be at, say 8pm, or 11am, which in turn can cause all kinds of problems. I think they are trying to find out whether ADHD causes the sleep variation, or vice versa.

The studies are being done at the Swansea University, in Wales, UK. I have found a link referring to one of these studies. http://lib.bioinfo.pl/pmid:17948273

Dr Johannes Thome is one of the people involved in these studies. That's all I know about them.

Some people with either ADHD, DSPS or both take Melatonin, a sleep hormone, to help them get to sleep. Melatonin is relatively safe and has little side effects, but as always, it is best to check with your doctor. Pilots often take it to help get combat jet lag.

As I understand it, in the US it is available in health food shops, but it in the UK you have to order it online, or get it prescribed by a doctor, as it is considered to be a medicine. It is legal to import it though. I get mine online from Puritan's Pride in the US.

I have tried Melatonin and it helped me get to sleep immediately. The first time I tried it, I was able to get to sleep at a normal time and wake up the next morning feeling fresh and awake, which rarely happens for me. I would like to try a 'slow-release' melatonin. Apparently, the normal melatonin is good for inducing sleep, the slow-release one is good for getting a consistent night's sleep.

I hope this helps.

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I am stunned that there is an actual name for this. My now teenage daughter has had this problem since she was born. Everyone I have taken her to has either made me feel crazy or that I wasn't being strict enough. I have come to feel over the years that she was just trying to be difficult. I have recently found a new neurologist who prescribed elavil for her headaches and meletonin for sleep but he did not mention a word about this disorder and pretty much blamed the concerta for the sleep problem. If anyone could tell me were I could research this more, I would deeply appreciate it.

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My son & I both can't cope with early hours--naturally go to sleep late & wake up late. I've been diagnosed for yesrs with ADD. He was screened & "flunked", but to me it's obvious he has ADD.

Sleeping late has negatively affected both our lives. Thanks for giving it a name.

Ted

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The concept of DSPS is still pretty new to me. I think it is relatively new to many professionals, and yet there are still many who have never heard of the disorder. I read that it is usually mistaken for and misdiagnosed as a psychological disorder. It is easy during adolescence for adults to dismiss the signs for laziness or, rebellion, or simply "just a phase". Being as DSPS affects only a small known percentage of our adult population and its symptoms can very often mimick other conditions, it also often goes unseen in adults as well.

I knew that something just didn't feel normal. I don't feel "mentall ill". I know I'm not sick. I don't have anxious thoughts that sustain me in insomniatic warfare. It's just that I'm... well, NOT tired at night. And then after I wake up, I'm SO tired. Before I read about DSPS, I would try and describe it to doctors by saying that it felt more like the hormones or biological rhythms in my body were just "off." I'd receive streams of advice from all directions from friends, family, professionals wanting to help: "All you have to do is..." etc, etc. Then they get frustrated when I decline each and every suggestion, but they don't understand - I've already TRIED that. I've tried sleeping meds, healthy diet, exercise, consistantly trying to put myself to bed early and wake up accordingly, keeping myself awake through the next day in attempts to restart my internal clock, alcohol, sleep hypnosis, and everything in between. I'm not depressed. I'm not stressed. But I'm BECOMING more depressed and stressed as I begin to see the manifestations of this struggle as I begin to embark on my adult life.

It has affected EVERYTHING, and no one really "GETS" it, even me until just recently. People think I'm lazy, and it's just not true. I am so ambitious in my mind, and I become so frustrated because it feels like my body just won't cooperate with me to function like I would give anything to. I just can't get up and go about my day like everyone else, and if I try to, I am pretty much useless, mentally and physically. I have taken more stimulants than you would ever imagine, all the while desperately trying to self-medicate myself just to get by.

But I know it's not even THAT simple. The specialists I've seen have all been more or less at a loss for what to make of it. They advise me within their own fields, but it just feels like it's more than just one area that factors into the equation. I told the last psychologist & psychiatrist I spoke with that I don't believe that this will be a simple diagnosis, but I didn't really know what else was was going on until I read about DSPS. I was thinking chronic fatigue, thyroid, blood sugar, stimulant abuse that had perhaps rendered me weak and immobile, and finally I started to believe that maybe I was just helpless or lazy. I just couldn't put my finger on it.

"Physicians often seek to exclude behavioral or lifestyle preferences, inadequate sleep hygiene, and psychophysiologic insomnia as causes for DSPS" (www.sleepdisorderchannel.com). Other exclusionary criteria are mental disorders, including none other than ADD. Yet the Wikipedia page on DSPS notes that stimulant meds are used to treat patients with both ADHD & DSPS. It seems to me that professionals are still trying to understand and define what is entailed in a true diagnosis of DSPS. One thing I have noticed throughout my psychology/premed education is that diagnosing many both psychological and physiological conditions begins by determining such exclusionary criteria so as to avoid misdiagnosis. But why are would ADD need to be ruled out when diagnosing DSPS?

It appears to me from my own experience, from the testimony of others, and from the research I have done personally in regards to a common dopamine deficit that undermines both disorders, that there is a clear link between the two. Does DSPS decrease cognitive functionality due to a lack of essential restoration during sleep, resulting in ADHD-like symptoms, or even causing/promoting the development of ADHD in those who may be already predisposed biologically? Does ADHD promote unhealthy sleep hygiene and habits that assist in perpetuating the severity of DSPS? I have also read that if you can correct the condition on your own, that you do not have a true diagnosis of DSPS, yet all known treatments for this condition can be performed ON YOUR OWN (with the exception of sleeping medication, which you can probably also get a prescription for on your own). They say that poor sleep hygiene further develops DSPS throughout time, so why are those same habits also considered to be exclusionary criteria in diagnosis?

After much research on my own (when the doctors and literature left me with still unanswered questions), I have come to tentatively believe that these two disorders, when observed comorbidly, are both manifestations of the same system. There are, of course, many things that can contribute to the evolution of either ADHD and DSPS of course. But one common factor appears to be the low levels of dopamine present in both. Dopamine is a hormone that, among many other functions, helps us to be motivated, focus and concentrate yet paradoxically also enables us to fall into a normal deep, full nights sleep. Another way to understand it is that it assists in the regulation of sleep/wake patterns. People with DSPS and ADHD have both been noted to show low levels of dopamine when tested. It is not so cut and dry, though, because hormone levels wax and wane throughout a 24-hour period. Perhaps it is possible that the inability to concentrate, in addition to being enhanced by a lack of productive sleep, can also be attributed to circadian rhythms administering low levels of dopamine during the daytime (which is also likely to be during the time when many patients were observed with this dopaminergic decrease). This would explain the decreased functionality in earlier times of the day. Please note that I am not a doctor, and this is all my own speculation based on a limited amount of exposure to information and literature that may or may not be entirely medically accurate. That is, though, what medical research is - the observating interactions, supplying theories, and testing those theories again and again until a strong enough link can be made. Even after all the research, I am still unable to determine any sufficient information beyond the common role of dopamine deficits that characterize both disorders.

I think that maybe the reason they try to rule out ADHD before they make a diagnosis for DSPS is because not necessarily all people who have ADHD have DSPS, and I would guess that not everyone with DSPS has ADHD, so it is logically necessary to discriminate between the two. But hormone levels in the body are so complex and individual that there may not be a clear distinction when these kinds of things seem to collide. The factors that contributed to the development of both ADHD and DSPS vary from individual to individual, so it is not feasible that we will better understand until we have examined our own physiology and history.

I am in no real position to solicit advice, but since all seem to be more or less in the dark, I CAN say what I am doing personally to cope with all of it. In determining the causes, this condition has two contributing branches - biological predisposition and habitual catalyzers. I separated the habitual factors and examined their potential influence on my symptoms. Understand that even without a chemical imbalance, these types of habits can promote an unhealthy sleeping routine. This link talks about sleep hygiene. (http://www.umm.edu/sleep/sleep_hyg.htm) Chronotherapy is also aimed at regulating and controlling consistency in times of sleep and awakeness through monitoring behaviors and habits that are considered to be good sleep hygiene.

At this point, however, I've exhausted all the tips for healthy sleeping without any success. I believe that, for any number of reasons and in any number of ways, the levels of dopamine in my body are not conducive to a normally functional sleep/wake pattern. So while equally as important, I don't believe that chronotherapy alone would suffice as a sole treatment in my case. This is why I began researching dopamine. Light therapy increases dopaminergic activity, so I am going to find out more on that. I also saw my psychiatrist and got him to prescribe me Adderall and Ambien. He didn't have any information for me about DSPS, and I don't know if this is the right or best medication for me to take, but it seems to be at this point and I guess I will be able to tell more in the next few weeks. I am going to see someone about a referral to a specialist who would be able to help me more on this matter. Hopefully I will have more information then.

Hope this may help someone. I know firsthand that understanding these issues can be very elusive to pursuit, and very frustrating as well. It's nice to know I'm not alone.

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Just found this site for the first time. Ran accross it while reasearching delayed sleep and ADHD. I work daily diagnosing children and adolescents who have a variety of MH pxs. A large percentage (about 80%) at this clinic have ADHD. My observations have lead me to the conclusion that delayed sleep phase is highly correlated with this problem. Among other things I am also a school psychologist,an adjunct psychology professor,a therapist,have ADHD and delayed sleep px. Despite many years of experience, my various professions, and background in school,clinical and forensic psychology etc I have rarely been belived by professionals in the medical,educational,or MH fields that I have a real problem. Almost everyone,especially in the MH field,has insisted that I am able to restructure my sleep patterns and either directly or by implication let me know I was lazy,willfull, or just stubborn.I have been given advice, even by a nationaly known sleep reasearcher,to use behavioral methods to deal with the issue.They do not work for more than a short time and are not worth the effort. My solution has been for live an uncomfortable schedule or,at times,have a private practice where I could set my own hours. When I had the practice I found many patients appreciated being able to get appointments at 8pm. Seems many of them had the problem too.As for a solution I haven't found one but it is comforting to knowthat some people are aware sleep delay is real and not a willful act.

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I have had trouble sleeping for most of my life. I definitely factored that into my career choice and work as a night nurse most of the time. However, I was diagnosed with bipolar disorder before my formal diagnosis of ADD and the mood stabilizer that I'm on (seroquel) would put an elephant to sleep. Still, I have no desire to take it until at least 2-3 am and if I take it early it doesn't always work. It just gives me the munchies. Still it's the best thing I've had so far.

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Really helpful to hear from folks will such similar experiences, and for the latest research. I am now of the opinion that attempting to regulate my sleep so that it conforms to 9 - 5 patterns is counter-productive. I don't feel refreshed after the 8 hrs normally timed sleep (between 11-12 - 7-8). I actually feel less refreshed than if I’ve had four hours sleep at a crazier time. If I have to do 9-5, I feel physically nauseous when I’m getting up and for an hour after: its like an all over dread which I thought was psychological. If I can push through it, I find that I am far less attentive through the day and very tired. When I’ve managed to maintain it, I usually slip within one week and get extremely disheartened and angry with myself. Nor have I ever found the ‘trigger’ that causes me that one morning to sleep through alarms.

EVERYONE, including my ADHD-specialist psychiatrist, has insisted that getting into a normal pattern will improve my life and others aspects of ADHD, but I have consistently found the exact opposite. The trouble it takes to do it has always been stressful for me and those around me, and has led to disappointment that I feel worse, not better (multiple alarms, enlisting help from parents, partners, flatmates etc). But I've not had the same sort of difficulty with learning to regulate other 'maladaptive' behaviours: I have restructured my lifestyle very successfully and am healthier, fitter, more organised, and more productive than I've ever been. (I was diagnosed with ADHD in the last 12 months). Getting up by 8am is the rub.

Recently I thought perhaps that I had DSPS and had been misdiagnosed with ADHD - but it makes much more sense to me that they are connected. Luckily I am in a line of work that is flexible enough to go with the flow a bit.

I would like to do the tests for DSDP though. Not keeping to 9-5 is meant to be very bad for long term health. But if one has DSDP, staying up and sleeping later is the natural and I assume healthier rhythm to follow.

Anything has to be better than the desperate things I've tried to enforce normal sleep/wake patterns, which have included 24hr - 36hr stints awake in an attempt to induce sleepiness at midnight (at times, I’ve done this on a weekly basis to get back into normal sync). Melatonin has been useful to get me off to sleep, but the mornings are still hellish: Melatonin at 10pm, sleep 11.30, will then have difficulty getting up earlier than 10am.

I think there is an issue with clinicians not understanding this. It gets turned back into a problem of will power, which re-inforces self flagalation and so is psychologically counter-productive. Also, the ADHD is much easier to manage when you’re rested and in a routine. Trying to enforce what feels like an unnatural sleep/wake cycle means I can’t get into a regular sleep pattern to help structure these daily routines.

Bring on more research!

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Sleep problems seem to be a big problem with us ADDers. I had a conversation with my sons pediatrician about sleep issues. It started out as a discussion about how late he could take his meds as he tends to stay awake late doing homework. and he was off his meds by then making it that much harder to focus on the work causing a vicious cycle. She told me something interesting: (paraphrase) some people need to be on the medicine at night because it allows there minds to focus on sleep rather that all of those thoughts racing through their head keeping them awake.

I'd be very interested in your experience and suggestions with dealing with your sleep issues.

I have posted a survey here http://addsherpa.com/2011/12/trouble-sleeping-your-not-alone/#respond and I would be grateful if you would let us know your experience and suggestions to get some sleep. Thanks

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