From the Guidelines
To decrease the risk of relapse in Delayed Sleep Phase Syndrome (DSPS) without relying on chronotherapy or strict schedules, focus on consistent behavioral interventions, such as cognitive-behavioral therapy for insomnia (CBT-I) and stimulus control instructions. These approaches work by addressing the underlying psychological and behavioral factors that contribute to DSPS, and can be used in conjunction with other strategies to improve long-term success. According to the American Academy of Sleep Medicine systematic review and meta-analysis 1, CBT-I is a multicomponent treatment that combines cognitive therapy strategies with education about sleep regulation, stimulus control instructions, and sleep restriction therapy, and has been shown to be effective in improving sleep outcomes in adults with chronic insomnia disorder. Additionally, stimulus control instructions, which involve establishing a consistent wake-time and using the bed/bedroom only for sleep and sex, can help to extinguish the association between the bed/bedroom and wakefulness, and establish a consistent sleep schedule 1. During unavoidable disruptions, prioritize maintaining a consistent sleep schedule and wake-time, and consider using relaxation techniques, such as progressive muscle relaxation or mindfulness, to help manage stress and anxiety that may exacerbate DSPS symptoms. It is also important to note that while melatonin supplementation may be beneficial in some cases, the evidence for its use in DSPS is limited, and it should be used under the guidance of a healthcare professional 2, 3, 4. Overall, a comprehensive approach that incorporates behavioral interventions, such as CBT-I and stimulus control instructions, and addresses the underlying psychological and behavioral factors that contribute to DSPS, is likely to be the most effective strategy for decreasing the risk of relapse and improving long-term success. Some key points to consider include:
- Establishing a consistent sleep schedule and wake-time
- Using the bed/bedroom only for sleep and sex
- Avoiding stimulating activities before bedtime
- Engaging in relaxation techniques, such as progressive muscle relaxation or mindfulness, to manage stress and anxiety
- Considering melatonin supplementation under the guidance of a healthcare professional
- Prioritizing maintaining a consistent sleep schedule and wake-time during unavoidable disruptions.
From the Research
Strategies to Decrease Relapse Risk in DSPS
To decrease the risk of relapse in Delayed Sleep Phase Syndrome (DSPS) and improve long-term success without chronotherapy, despite unavoidable disruptions to strict schedules, several strategies can be employed:
- Melatonin treatment: Melatonin administration 1 hour prior to the desired bedtime, combined with behavioral sleep-wake scheduling, has been shown to improve sleep initiation and reduce sleep-related impairments in DSPS patients 5.
- Gradual advancement of rise time: Gradually advancing rise times, alongside timed bright light and melatonin administration, can produce a phase advance and improve sleep timing 6.
- Appropriate light exposure: Exposure to bright light during the day can help regulate the circadian rhythm and improve sleep timing 6, 7.
- Evening routine: Developing an evening routine that minimizes arousal-increasing activities can help improve sleep quality and reduce the risk of relapse 7.
- Behavioral sleep-wake scheduling: Implementing a consistent sleep-wake schedule and establishing a relaxing bedtime routine can help regulate the circadian rhythm and improve sleep timing 5, 7.
Factors Contributing to Relapse
Several factors can contribute to relapse in DSPS patients, including:
- Circadian rhythm period length: A longer than normal circadian rhythm period length (tau) can make it difficult for DSPS patients to phase advance and maintain a conventional sleep schedule 8.
- Disruptions to strict schedules: Unavoidable disruptions to strict schedules can lead to relapse in DSPS patients, highlighting the need for flexible and adaptable treatment strategies.
- Lack of long-term treatment: Termination of treatment can cause relapse into delayed sleep times, emphasizing the importance of long-term treatment and maintenance strategies 6.