From the Guidelines
To reduce the risk of relapse in Delayed Sleep Phase Disorder (DSPD), maintaining a consistent sleep-wake schedule every day, including weekends, is crucial, as irregular schedules can quickly undo progress. This approach is supported by the American Academy of Sleep Medicine clinical practice guideline for the treatment of intrinsic circadian rhythm sleep-wake disorders, which emphasizes the importance of consistent sleep-wake timing 1. Some key strategies to achieve this include:
- Using a 10,000 lux light box for 30-60 minutes immediately upon waking to help regulate the circadian rhythm, as suggested by recent studies on electric lighting and adolescent sleep outcomes 1
- Avoiding bright light in the evening, especially blue light from screens, by using blue-blocking glasses or apps after sunset if necessary, as this can suppress melatonin secretion and delay sleep onset 1
- Melatonin supplementation can help shift the circadian rhythm when taken 5-7 hours before the current sleep onset time at doses of 0.5-3mg; once the schedule normalizes, it can be gradually reduced and eventually discontinued, as indicated by studies on melatonin's phase-shifting effects 1
- Practicing good sleep hygiene, such as avoiding caffeine after noon, exercising regularly but not within 3 hours of bedtime, keeping the bedroom cool (65-68°F), dark, and quiet, and establishing a relaxing pre-sleep routine, is also essential for reinforcing the body's natural circadian rhythm 1
- Chronotherapy medications like tasimelteon (Hetlioz) or ramelteon (Rozerem) may be prescribed for persistent cases, as they can help regulate the circadian rhythm and improve sleep quality 1 These approaches work by reinforcing the body's natural circadian rhythm, which controls sleep-wake cycles through the interaction of light exposure, melatonin production, and core body temperature fluctuations, ultimately reducing the risk of relapse in DSPD.
From the Research
Strategies to Reduce Relapse Risk in CRSD, Specifically DSPS
The following strategies can help reduce the risk of relapse in Circadian Rhythm Sleep Disorder (CRSD), specifically Delayed Sleep Phase Syndrome (DSPS):
- Morning bright light exposure: This therapy can help phase change the delayed sleep circadian rhythm 2
- Exogenous melatonin administration: Evening melatonin administration as a sole treatment appears promising, and can be combined with cognitive-behavior therapy and morning bright light 3, 4
- Chronotherapy: A behavioral technique in which sleep time is systematically delayed, can be used to treat DSPS 5
- Behavioral sleep-wake scheduling: Combining melatonin treatment with behavioral sleep-wake scheduling can improve sleep initiation and reduce sleep-related impairments 4
- Developing an evening routine: Minimizing arousal-increasing activities in the evening can help individuals with DSPS 6
- Gradually shifting sleep-wake times: Shifting sleep-wake times toward more functional ones can help individuals with DSPS 6
- Appropriate light exposure during the day: Exposure to natural light or bright light therapy during the day can help regulate the circadian rhythm 6
- Cognitive-behavior therapy: Combining cognitive-behavior therapy with morning bright light and melatonin administration can help treat DSPS 3