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Why is my daughter unable to get up early in the morning?

Q: My 21 years old daughter is a medical student and has a habit of sleeping late due to which is unable to get up early for the last 2.5 years. She does not attend classes and has been debarred from taking university exams twice due to low attendance, though she has cleared first set of exams with the supplementary exams. But she has again been debarred for the second exams. No amount of counselling helps. She is now isolated due to this habit and has almost no friends. She feels very depressed and comes home at least once a month. How can we help her? Please advise.

A:From your description it seems like she may be having delayed sleep phase syndrome (DSPS). It is a condition where the individuals' sleep cycle is pushed in to later part of the night. In a healthy adult the sleep cycle is set for 10-11 PM till 6-7 AM. However, in individuals who develop DSPS they are able to fall asleep later in the night like 2-4 AM and can sleep for 7-8 hours from there on. These individuals have difficulty waking up early in the morning since their natural wake-up time is set later part of the day. Even if they try to go to bed early they cannot fall asleep. If they force themselves to wake up early they may end up tired and sleepy the following day. DSPS seem to start in teen years and becomes of concern when the individual had to wake up early for school or work.

Often individuals with DSPS have associated depression / mood disorders, which could be secondary to an underlying sleep disorder; however, it may be difficult to tease out the relationship.

It is likely that your daughter may have DSPS, however, one needs to rule out other conditions, which may be making it difficult for her to wake-up early in the morning. She may need to see a sleep specialist and possibly a psychiatrist as well to get a comprehensive assessment. A psychiatrist who also specialized in sleep medicine may be the best option, however, it may be difficult to find one.

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