What strategies can minimize the risk of relapse in Delayed Sleep Phase Syndrome (DSPS) and promote long-term success without relying on chronotherapy or strict schedules, despite unavoidable disruptions?

From the Guidelines

To minimize the risk of relapse in Delayed Sleep Phase Syndrome (DSPS) and promote long-term success without relying on chronotherapy or strict schedules, despite unavoidable disruptions, prioritize a combination of wearable, short-wavelength light therapy and cognitive-behavioral therapy (CBT). This approach is supported by recent studies, such as 1, which demonstrate that wearable, short-wavelength light therapy can effectively phase advance the melatonin circadian rhythm in young adults and improve sleep outcomes in adolescents with DSPS. Key strategies include:

• Using wearable, short-wavelength light therapy, such as glasses-like or visor-like devices, which provide light therapy while the user remains mobile to engage in other activities, as shown in 1.
• Implementing CBT, which provides additional structure and motivational enhancement to light therapy, and has been shown to produce more robust effects on sleep timing and measures of sleep disturbance in adolescents relative to waitlist-control and CBT alone, as demonstrated in 1.
• Maintaining a consistent sleep-wake schedule when possible, and prioritizing morning light exposure immediately upon waking during unavoidable disruptions.
• Making lifestyle adjustments, such as reducing blue light exposure 2-3 hours before bed, keeping the bedroom cool, and exercising regularly but not within 2-3 hours of bedtime, to help reinforce the circadian rhythm. By combining these strategies, individuals with DSPS can better manage their condition and reduce the risk of relapse, even in the face of disruptions to their routine.

From the FDA Drug Label

The effectiveness of tasimelteon in the treatment of Non-24-Hour Sleep-Wake Disorder (Non-24) was established in two randomized double-masked, placebo-controlled, multicenter, parallel-group studies (Studies 1 and 2) in totally blind patients with Non-24 In study 1, 84 patients with Non-24 (median age 54 years) were randomized to receive tasimelteon 20 mg or placebo, one hour prior to bedtime, at the same time every night for up to 6 months.

The FDA drug label does not answer the question.

From the Research

Strategies to Minimize Relapse in DSPS

To minimize the risk of relapse in Delayed Sleep Phase Syndrome (DSPS) and promote long-term success without relying on chronotherapy or strict schedules, several strategies can be employed:

• Gradual advancement of rise times: This approach has been shown to be effective in improving subjective daytime sleepiness, fatigue, and cognitive function in patients with DSPD 2.
• Melatonin treatment: Combined with behavioral sleep-wake scheduling, melatonin treatment has been found to improve sleep initiation, sleep efficiency, and reduce sleep-related impairments in patients with DSWPD 3.
• Bright light exposure: Morning bright light exposure has been suggested as a therapy to phase change the delayed sleep circadian rhythm in DSPD patients 4.
• Behavioral strategies: Behavioral sleep-wake scheduling and other non-pharmacological interventions can help patients with DSPD to establish a consistent sleep-wake cycle and improve sleep quality.

Avoiding Relapse Despite Disruptions

To avoid relapse despite unavoidable disruptions, patients with DSPS can:

• Establish a consistent sleep-wake schedule: Sticking to a regular sleep-wake schedule, even on weekends or days off, can help regulate the body's internal clock and reduce the risk of relapse.
• Use light therapy: Exposure to bright light in the morning can help regulate the circadian rhythm and improve alertness.
• Avoid stimulating activities before bedtime: Avoiding stimulating activities such as watching TV, using electronic devices, or engaging in intense conversations before bedtime can help improve sleep quality and reduce the risk of relapse.
• Get regular exercise: Regular physical activity can help improve sleep quality and reduce the risk of relapse, but it should be avoided within a few hours of bedtime.

Considerations for Long-Term Success

For long-term success, patients with DSPS should:

• Work with a healthcare professional: Collaborating with a healthcare professional can help patients develop a personalized treatment plan and provide ongoing support and guidance.
• Monitor progress: Regularly monitoring sleep patterns, sleep quality, and other relevant factors can help identify potential issues and prevent relapse.
• Be patient: Overcoming DSPS can take time, and patients should be patient and persistent in their efforts to establish a consistent sleep-wake cycle and improve sleep quality 2, 3, 4.