National Sleep Foundation

Chapter 5: Circadian Rhythm Sleep Disorders

Treatment

What is the Treatment for Delayed Sleep Phase Disorder (DSPD)?

The use of morning bright light therapy and evening exogenous melatonin administration can be effective to advance sleep onset. The 1999 AASM guidelines for the use of light therapy in DSPD recommend 2,000 to 2,500 lux from 6:00 AM to 9:00 AM, and optionally wearing goggles from 4:00 PM to dusk.1 A recent randomized placebo-controlled trial of patients with severe DSPD (white light; 2,700 lux; 26 days, light on 4-hours prior to rising) further supports the safety and efficacy of bright light therapy.2 However, there is still a need for large randomized, placebo-controlled studies to determine the optimal intensity, duration, and overall efficacy of bright light therapy.

Randomized controlled trials have demonstrated the efficacy of melatonin to advance the timing of sleep and circadian phase3 and reduce sleep latency4 in patients with delayed sleep phase disorder. Behavioral approaches such as scheduled wake times and blocking out evening light with wrap-around sunglasses have also been suggested.5-7

References

  1. Chesson AL Jr, Littner M, Davila D, et al. Practice parameters for the use of light therapy in the treatment of sleep disorders. Sleep. 1999;22:641-660.
  2. Cole R, Smith J, Alcala Y, Elliott J, Kripke D. Bright-light mask treatment of delayed sleep phase syndrome. J Biol Rhythms. 2002;17:89-101.
  3. Mundey K, Benloucif S, Harsanyi K, Dubocovich ML, Zee PC. Phase-dependent treatment of delayed sleep phase syndrome with melatonin. Sleep. 2005;28:1271-1278.
  4. Kayumov L, Brown G, Jindal R, Buttoo K, Shapiro CM. A randomized, double-blind, placebo-controlled crossover study of the effect of exogenous melatonin on delayed sleep phase syndrome. Psychosom Med. 2001;63:40-48.
  5. Mundey K, Benloucif S, Harsanyi K, Dubocovich ML, Zee PC. Phase-dependent treatment of delayed sleep phase syndrome with melatonin. Sleep. 2005;28:1271-1278.
  6. Kayumov L, Brown G, Jindal R, Buttoo K, Shapiro CM. A randomized, double-blind, placebo-controlled crossover study of the effect of exogenous melatonin on delayed sleep phase syndrome. Psychosom Med. 2001;63:40-48.
  7. Eastman CI, Stewart KT, Mahoney MP, Liu L, Fogg LF. Dark goggles and bright light improve circadian rhythm adaptation to night-shift work. Sleep. 1994;17:535-543.