From the Guidelines
To minimize the risk of relapse in Delayed Sleep Phase Syndrome (DSPS) and promote long-term success, maintain consistent sleep hygiene practices, use a combination of timed light exposure, melatonin supplementation, and behavioral strategies, as supported by the most recent evidence from 2022 1. When disruptions occur, take 0.5-3mg of melatonin 2-3 hours before your target bedtime, use bright light therapy (10,000 lux) for 30 minutes upon waking, and gradually shift your sleep schedule by 15-30 minutes earlier each day until returning to your desired schedule. Establish a consistent sleep routine with fixed wake times even on weekends, limit evening screen exposure, and create a dark, cool sleeping environment. During unavoidable disruptions like travel or shift work, use strategic napping (20-30 minutes) to manage sleepiness without interfering with nighttime sleep. These approaches work by resetting your circadian rhythm through the combined effects of melatonin, which signals sleep onset, and morning light exposure, which suppresses melatonin production and promotes wakefulness. Consistency is crucial as the circadian system responds best to regular timing cues, helping maintain phase alignment even when occasional disruptions occur.
Some key strategies to minimize relapse risk include:
- Increasing exposure to bright light during the day, as recommended by general sleep hygiene measures 1
- Regular exercise in the morning and/or afternoon
- Avoiding exposure to bright light during the night
- Avoiding heavy meals or drinking within 3 hours of bed
- Avoiding alcohol, caffeine, nicotine too close to bedtime
- Enhancing sleep environment (dark, quiet room, comfortable temperature)
- Setting aside worry time
- Avoiding looking at the clock
It's essential to note that while these strategies can help minimize the risk of relapse, individual results may vary, and it's crucial to consult with a healthcare professional for personalized advice. The evidence from 2022 1 provides the most up-to-date guidance on managing DSPS, and its recommendations should be prioritized in clinical practice.
From the Research
Strategies to Minimize Relapse Risk in DSPS
To minimize the risk of relapse in Delayed Sleep Phase Syndrome (DSPS) and promote long-term success without chronotherapy, several strategies can be employed:
- Gradual advancement of rise time, as seen in the study by 2, can help advance the sleep phase and maintain it in the long term when combined with bright light and melatonin treatment.
- Behavioral strategies, such as maintaining a consistent sleep schedule and creating a sleep-conducive environment, can also be beneficial in managing DSPS, as discussed in 3.
- Morning bright light exposure and exogenous melatonin administration can help phase-change the delayed sleep circadian rhythm, as mentioned in 3 and 4.
- Regulation of the lighting environment, methylcobalamin, and/or melatonin treatment can be effective in treating DSPS, as shown in the study by 5.
- Attention to non-photic and extrinsic factors, including healthy sleep parameters, is also important to enable better sleep and mood outcomes in adolescents with DSPS, as highlighted in 4.
Long-Term Treatment and Relapse Prevention
For long-term treatment and relapse prevention:
- Melatonin administration can be a relatively simple and easy treatment option, as discussed in 6.
- However, the study by 6 also found that 91.5% of patients reported a relapse to their pretreatment sleeping patterns within 1 year of the end of treatment, highlighting the need for ongoing treatment and management strategies.
- The study by 2 found that long-term treatment with bright light and melatonin (three months) allowed maintenance of the advanced sleep phase, suggesting that ongoing treatment can be effective in preventing relapse.
- A step-by-step procedure of combined treatments, as proposed in 5, may be necessary to effectively manage DSPS and prevent relapse.