From the Guidelines
Treating delayed sleep phase disorder (DSPD) permanently requires a comprehensive approach combining light therapy, melatonin supplementation, and consistent sleep habits, as recommended by the American Academy of Sleep Medicine clinical practice guideline 1, 2. To achieve the most effective results, the following steps can be taken:
- Use a 10,000 lux light therapy box for 30-60 minutes immediately upon waking each morning to suppress melatonin production and signal wakefulness 1.
- Take 0.5-5mg of melatonin 5-7 hours before the desired bedtime, as the timing is more important than the dose, and the melatonin PRC is approximately 180 degrees out of phase with the light PRC 1.
- Gradually shift the sleep schedule earlier by 15-30 minutes every few days until reaching the target bedtime.
- Maintain strict sleep-wake times even on weekends, avoid screens 1-2 hours before bed, and ensure the bedroom is dark, cool (65-68°F), and comfortable.
- Regular morning exercise and avoiding caffeine after noon can further support this regimen. These interventions work by resetting the circadian rhythm, and while complete "cure" isn't always possible, most people can achieve significant and lasting improvement by consistently applying these techniques for at least 2-3 months and then maintaining the healthy sleep habits indefinitely 1, 2. Key considerations for the treatment of DSPD include:
- The strategic use of light and melatonin to phase shift circadian timing, with light timed in the evening and before the core body temperature minimum leading to phase delays, and light timed after the core body temperature minimum in the morning leading to phase advances 1.
- The importance of consistent sleep habits and a regular sleep schedule to maintain the desired sleep-wake cycle.
- The potential benefits of additional interventions, such as wakefulness-promoting medications or somatic interventions, although these may not be necessary for all individuals with DSPD 1.
From the Research
Treatment Approaches for Delayed Sleep Phase Syndrome (DSPS)
- The most common treatment approaches for DSPS are based on the administration of bright light and/or exogenous melatonin with or without adjunct behavioral instructions 3, 4, 5.
- Morning bright light exposure, exogenous melatonin administration, and chronotherapy are also used as therapies to phase change the delayed sleep circadian rhythm 4.
- Developing an evening routine that minimizes arousal-increasing activities and gradually shifting sleep-wake times toward more functional ones are additional treatment strategies 5.
Efficacy of Melatonin in Treating DSPS
- Melatonin, taken in the evening, advances sleep and circadian phase in patients with DSPS 6.
- The administration of melatonin (0.3 or 3.0 mg) advances the circadian phase of endogenous melatonin, with earlier times of administration being more effective 6.
Light Therapy for DSPS
- Light therapy is a common treatment for delayed sleep-wake phase disorder (DSWPD), with morning light therapy being the most frequently used approach 7.
- While some studies have reported substantial clinical and laboratory advances in the sleep phase using light therapy, the benefits may not persist in the long term 7.