From the Guidelines
To minimize the risk of relapse in Delayed Sleep Phase Disorder (DSPD) and promote long-term success without chronotherapy, despite unavoidable disruptions to strict schedules, prioritize consistent light management and healthy sleep habits, including strategically timed melatonin and light therapy, as endorsed by recent guidelines 1. When establishing a routine, consider the importance of cumulative light exposure history, as increased daytime light exposure is associated with increased evening melatonin production and advanced circadian phase 1. Key strategies include:
- Using bright light therapy (10,000 lux) for 30-45 minutes immediately after waking to reset the circadian rhythm
- Wearing blue-light blocking glasses 2-3 hours before bedtime to reduce evening light exposure
- Taking melatonin supplementation 5-7 hours before the desired bedtime at doses of 0.5-3mg, as supported by guidelines 1
- Prioritizing morning light exposure at the regular wake time, even after a late night, and avoiding sleeping in more than 1-2 hours on weekends
- Gradually adjusting the schedule by 15-30 minutes daily in the desired direction for travel or shift work, rather than making abrupt changes
- Maintaining sleep-promoting habits like regular exercise (but not within 3 hours of bedtime), avoiding caffeine after noon, limiting alcohol, and creating a cool, dark sleeping environment These approaches work by reinforcing the body's natural circadian signals through light exposure patterns and melatonin timing, which helps maintain phase alignment even when perfect adherence to schedules isn't possible, as suggested by recent research on the effects of light exposure on circadian outcomes 1.
From the Research
Strategies to Minimize Relapse in DSPD
To minimize the risk of relapse in Delayed Sleep Phase Disorder (DSPD) and promote long-term success without chronotherapy, despite unavoidable disruptions to strict schedules, 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 DSPD 2, 3.
- Combined bright light and melatonin treatment: This treatment has been found to improve subjective daytime sleepiness, fatigue, and cognitive function in patients with DSPD, and can help maintain an advanced sleep phase over time 2, 3.
- Behavioural sleep-wake scheduling: This approach, combined with melatonin treatment, has been shown to be efficacious for improving objective and subjective measures of sleep disturbances and sleep-related impairments in DSPD patients with delayed circadian phase relative to desired bedtime 4.
- Melatonin treatment: Melatonin has been found to be effective in improving sleep initiation in clinically diagnosed DSWPD patients with a delayed endogenous melatonin rhythm relative to patient-desired bedtime 4.
Maintaining Treatment Effects
To maintain the positive effects of treatment over time, it is essential to continue treatment with bright light and melatonin, as termination of treatment can cause relapse into delayed sleep times 3. Additionally, a vigorous and continued application of chronobiological and behavioural therapies may be necessary to entrain DSPD patients to their desired earlier sleep times 5.
Avoiding Relapse
Relapse can be avoided by maintaining a consistent sleep schedule, even on weekends or during vacations, and by avoiding exposure to bright light in the evening, which can delay the sleep phase 2, 3. Furthermore, establishing a relaxing bedtime routine and creating a sleep-conducive environment can also help minimize the risk of relapse 4.