What is the optimal treatment for delayed sleep phase syndrome (DSPS), a circadian rhythm disorder?

From the Guidelines

The best way to treat delayed sleep phase circadian rhythm disorder is through a combination of light therapy, chronotherapy, and melatonin supplementation. Morning bright light therapy using a 10,000 lux light box for 30-60 minutes immediately upon waking helps reset the circadian rhythm 1. This should be paired with evening melatonin supplementation (0.5-5mg) taken 5-7 hours before the desired bedtime, not immediately before trying to sleep. Chronotherapy involves gradually shifting sleep times by delaying bedtime by 2-3 hours each day until reaching the desired schedule. Maintaining strict sleep hygiene is essential, including consistent sleep-wake times (even on weekends), avoiding screens 1-2 hours before bed, keeping the bedroom dark and cool, and eliminating caffeine after noon. These approaches work by resetting the body's internal clock, which in people with delayed sleep phase disorder is shifted later than typical. Light therapy suppresses melatonin in the morning, while supplemental melatonin helps signal sleep onset earlier in the evening, gradually shifting the body's natural sleep timing to a more conventional schedule.

Some key points to consider when implementing this treatment plan include:

• The importance of consistent sleep-wake times, even on weekends, to help regulate the body's internal clock 1
• The use of light therapy to suppress melatonin in the morning and help reset the circadian rhythm 1
• The role of melatonin supplementation in signaling sleep onset earlier in the evening and helping to shift the body's natural sleep timing to a more conventional schedule 1
• The potential benefits of combining light therapy with cognitive-behavioral therapy (CBT) to improve sleep outcomes and increase motivation to change sleep habits 1

Overall, a comprehensive treatment plan that incorporates light therapy, chronotherapy, and melatonin supplementation, along with good sleep hygiene practices, can help individuals with delayed sleep phase circadian rhythm disorder reset their internal clock and improve their sleep quality.

From the Research

Treatment Approaches for Delayed Sleep Phase Circadian Rhythm Disorder

• The treatment of delayed sleep phase disorder involves therapies to phase change the delayed sleep circadian rhythm, such as morning bright light exposure, exogenous melatonin administration, and chronotherapy, as well as some behavioral strategies 2.
• A gradual advancement of rise times seems to produce positive effects on subjective sleepiness, fatigue, and cognitive performance during short-term treatment of patients with DSPD 3.
• The combined bright light and melatonin treatment improved subjective daytime sleepiness, fatigue, and cognitive function in patients with DSPD 3.
• Treatment of DSWPD involves the use of scheduled melatonin, scheduled sleep-wake times, and bright light therapy 4.
• Melatonin, taken in the evening, advances sleep and circadian phase in patients with DSPS, and the effectiveness of melatonin is phase-dependent, with earlier administration times being more effective 5.
• Appropriately-timed exposure to bright light can reset the timing of sleep and wake to the desired times, and improve sleep quality and daytime alertness 6.

Key Considerations

• The timing of melatonin administration is crucial, with earlier times being more effective in advancing the circadian phase 5.
• The efficacy of bright light therapy is dependent on the time-of-day of the circadian cycle that the light is administered 6.
• A combination of bright light therapy and melatonin administration may be more effective than either treatment alone 3.
• Behavioral strategies, such as gradual advancement of rise times, can also be effective in improving subjective sleepiness, fatigue, and cognitive performance 3.