From the Guidelines
To reduce the risk of relapse in Delayed Sleep Phase Syndrome (DSPS) and improve long-term treatment outcomes without using chronotherapy, maintaining a consistent sleep-wake schedule and using strategic light exposure, such as morning light therapy with a 10,000 lux light box, are crucial interventions. According to the American Academy of Sleep Medicine clinical practice guideline 1, interventions for CRSWDs can be broadly categorized into prescribed timing of sleep-wake and/or physical activity/exercise, strategic receipt and/or avoidance of light, use of medications and/or supplements to phase shift and/or to promote sleep or wakefulness, and alternate interventions that exert effects by altering bodily functions to impact sleep/wake behaviors. Some key strategies to reduce the risk of relapse in DSPS include:
- Maintaining a consistent sleep-wake schedule every day, including weekends, as the foundation of treatment
- Using light therapy, such as a 10,000 lux light box for 30-60 minutes immediately upon waking each morning, to reset the circadian rhythm
- Limiting light exposure in the evening by wearing blue-light blocking glasses 2-3 hours before bedtime and avoiding screens or using night mode
- Considering melatonin supplementation, typically at a low dose of 0.5-3mg, 1-2 hours before the desired bedtime
- Establishing a relaxing bedtime routine that signals to the body it's time to sleep
- Engaging in regular exercise, preferably in the morning or early afternoon, to help regulate sleep patterns
- Avoiding caffeine after noon and limiting alcohol, as both disrupt sleep quality These approaches work by reinforcing the natural circadian rhythm through consistent environmental cues, helping the body maintain proper melatonin and cortisol cycles that regulate sleep-wake patterns, as discussed in the clinical practice guideline 1.
From the Research
Strategies to Reduce Relapse Risk in DSPS
To reduce the risk of relapse in Delayed Sleep Phase Syndrome (DSPS) and improve long-term treatment outcomes without using chronotherapy, several strategies can be employed:
- Gradual advancement of rise times: This approach has been shown to produce positive effects on subjective sleepiness, fatigue, and cognitive performance during short-term treatment of patients with DSPS 2, 3.
- Bright light therapy: Combined with melatonin treatment, bright light therapy can improve subjective daytime sleepiness, fatigue, and cognitive function in the long term 2, 3.
- Melatonin administration: Melatonin has a sleep-promoting and entraining action when taken in the evening, and its administration can be a relatively simple and easy treatment option for DSPS patients 4.
- Behavioral strategies: Therapies to phase change the delayed sleep circadian rhythm, such as morning bright light exposure and exogenous melatonin administration, can be effective in managing DSPS 5.
Long-term Treatment Outcomes
Long-term treatment with bright light and melatonin can allow maintenance of the advanced sleep phase, whereas termination of treatment can cause relapse into delayed sleep times 3. Additionally, melatonin treatment has been shown to be helpful in improving sleep patterns in DSPS patients, although relapse can occur within 1 year of the end of treatment 4.
Treatment Approaches
Various treatment approaches can be used to manage DSPS, including: