National Sleep Foundation

Chapter 5: Circadian Rhythm Sleep Disorders

Treatment

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

Treatment is designed to align the individual’s circadian rhythm, with the desired sleep-wake cycle

The use of morning bright light therapy and evening melatonin administration can be effective to advance sleep onset.

A recent randomized placebo-controlled trial of patients with severe DSPD supports the safety and efficacy of bright light therapy (white light; 2,700 lux; 26 days, light on 4 hours prior to rising) further.19 There is still a need for large randomized, placebo-controlled studies to determine the bright light therapy’s optimal intensity and duration, as well as its overall efficacy.

Randomized controlled trials have demonstrated melatonin’s efficacy to advance the timing of sleep and circadian phase20 and reduce sleep latency21 in patients with DSPD (i.e., taken five or six hours before desired sleep time).

Behavioral approaches, such as firmly adhering to scheduled wake times and blocking out late afternoon and evening light (i.e., by using wrap-around sunglasses) have also been suggested.22 23 24

References

19. Rosenthal NE, Joseph-Vanderpool JR, Levendosky AA, Johnston SH, Allen R, Kelly KA, Souetre E, Schultz PM, Starz KE, Phase-shifting effects of bright morning light as treatment for delayed sleep phase syndrome, Sleep1990 Aug;13(4):354-61.

20. 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. 

21. 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.
22. 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
23. 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. 24. 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.