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  • Writer's picturePetra

Sleep and ADHD: Delayed Sleep Phase

Delayed sleep phase is a type of circadian rhythm sleep disorder in which an individual's sleep-wake cycle is shifted later in time, making it difficult for them to fall asleep and wake up at conventional times. People with delayed sleep phase tend to have a natural preference for staying up late at night and sleeping in late in the morning.

This condition typically starts in adolescence and may persist into adulthood, and can have a significant impact on an individual's daily routine and quality of life. People with delayed sleep phase may have difficulty waking up in the morning, leading to fatigue and difficulty concentrating during the day, which can affect academic or work performance. Additionally, they may have trouble falling asleep at a desirable time, leading to sleep deprivation and exacerbating the cycle.

Delayed sleep phase can be caused by a number of factors, including genetics, environmental factors (such as exposure to light at night), and lifestyle factors (such as irregular sleep patterns or shift work).

Delayed sleep phase is more common in people with ADHD. I have seen it in a number of my clients. For most people with a delayed sleep phase it slowly improves with ageing. With ADHD it may persist for longer than average. For some affected people they need to consider finding an occupation that aligns more closely with their sleep phase, rather than trying to force themselves into a 9 to 5 job.

Treatment of delayed sleep phase may need to start with a concerted change to sleep and wake times which is then "locked in" with ongoing maintenance behaviours. The change phase may include moving the sleep phase either forward or backwards until it maps more closely onto the desired sleep timing (this can take weeks if the gap is several hours). This can be done with a combination of having a strict waking time that changes each night (earlier or later depending on whether the sleep phase is rolled forwards in time or back), having a bedtime that changes over time in line with wake time, and careful use of light for waking hours and darkness for sleeping hours. Melatonin may also be a useful adjunct, but needs to be used differently than how it's usually prescribed in order to shift circadian rhythm. It is usually prescribed for its sedating effects. A person should talk to their prescriber about using it in the context of delayed sleep phase. The affected person may also be required to reduce time spent in bed to help associate bed with sleep rather than other possible activities.

Once the desired sleep and wake time are locked in, the following maintenance interventions will likely be required:

  1. Waking at the same time seven days a week, even after a late night (no more sleeping in as this allows the sleep phase to become delayed again)

  2. Having a set bedtime

  3. Continued use of light and dark exposure at set times of the day

  4. Continued use of behavioural strategies to associate bed with sleep

Melatonin may also be used if it was part of the initial treatment phase. If maintenance interventions are not continued, there is a high chance of the sleep phase reverting to its previous state. This can happen in a week or less.

As you can imagine, managing all this whilst also having ADHD and associated organisation difficulties can be a real challenge. It also makes sense to have a specific plan drawn up by a psychologist who knows quite a bit about sleep. There are a few of us around with a sleep interest.

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