From the Guidelines
To minimize the risk of relapse in Delayed Sleep Phase Syndrome (DSPS) and promote long-term success, implement a flexible approach combining morning bright light exposure, melatonin supplementation, and consistent sleep hygiene practices, as supported by the most recent study from 2022 1. This approach is based on the understanding that light therapy, particularly morning bright light exposure, can help advance the circadian phase, while melatonin supplementation can help regulate sleep-wake cycles.
- Start with morning bright light exposure (10,000 lux) for 30-45 minutes immediately after waking, which can help phase advance the circadian rhythm, as shown in studies examining the influence of supplementing morning light therapy with adjunctive interventions 1.
- Take melatonin (0.5-3mg) 5-7 hours before your desired bedtime, as its timing is more important than dose for circadian effects, and it can have direct soporific effects, particularly at higher doses 1.
- Gradually shift your sleep schedule by 15-30 minutes earlier every few days until reaching your target bedtime, allowing your body to adjust to the new sleep-wake cycle.
- Even during disruptions, maintain morning light exposure and evening melatonin timing relative to your sleep schedule, to prevent circadian drift and relapse.
- Create a wind-down routine including reduced blue light exposure 2-3 hours before bed using blue-blocking glasses or screen filters, as short-wavelength light exposure can suppress melatonin secretion and delay circadian phase 1.
- Prioritize consistent wake times even after disruptions rather than strict bedtimes, as this can help regulate the circadian rhythm and improve sleep quality. This flexible approach, combining light therapy, melatonin supplementation, and consistent sleep hygiene practices, can help minimize the risk of relapse in DSPS and promote long-term success, as it targets the circadian rhythm and accommodates unavoidable disruptions, as supported by the most recent and highest quality study from 2022 1.
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, several strategies can be employed:
- Gradual advancement of rise time, which has been shown to produce a phase advance during treatment, irrespective of treatment condition 2
- Long-term treatment with bright light and melatonin, which can help maintain an advanced sleep phase 2
- Melatonin administration, which has been found to be a simple and easy treatment option with a sleep-promoting and entraining action when taken in the evening 3
- Chronotherapy, which involves systematically delaying sleep time to realign the circadian rhythm with the desired sleep schedule 4, 5
- Behavioral strategies, such as morning bright light exposure and exogenous melatonin administration, which can help phase change the delayed sleep circadian rhythm 4
Factors Influencing Relapse
Several factors can influence the likelihood of relapse in DSPS, including:
- The length of the circadian rhythm period, with longer periods potentially making it more difficult to phase advance to a more conventional sleep time 6
- The timing of sleep and wakefulness, with later sleep onset and wake times potentially increasing the risk of relapse 3
- The effectiveness of treatment, with some treatments, such as melatonin administration, potentially having a higher risk of relapse after treatment is stopped 3
Promoting Long-Term Success
To promote long-term success in DSPS treatment, it is essential to:
- Continue treatment for an extended period, such as three months, to maintain the advanced sleep phase 2
- Monitor sleep patterns and adjust treatment as needed to prevent relapse 2, 3
- Combine multiple treatment approaches, such as bright light therapy, melatonin administration, and chronotherapy, to achieve optimal results 2, 4, 5