How are circadian rhythm sleep disorders treated?
Treatment options for circadian rhythm sleep disorders vary based on the type of disorder and the degree to which it affects your quality of life. Your healthcare provider will develop a personalized treatment plan, which improves your chance of success. Most treatment plans require a combination of approaches.
Treatment options include:
Lifestyle and behavior therapy: This approach encourages changes to improve sleep and to develop good sleep habits. Good sleep habits include maintaining regular sleep-wake times (even on weekends and vacations); avoiding naps (exception: shift workers); developing a regular routine of exercise (avoid high-intensity exercise within one hour of bedtime); and avoiding alcohol, caffeine, nicotine, and stimulating activities within several hours of bedtime.
Bright light therapy: Bright light therapy is used to advance or delay sleep. The timing of this treatment is critical and requires guidance from a sleep specialist. Bright light therapy works by resetting the circadian clock to be more in sync with the earth’s cycle of light and dark. A high intensity light (2,000 to 9,500 lux) is required and the duration and timing of exposure varies from one to two hours.
Exposure to bright light in the morning may help you if you have a delayed sleep disorder. You should also decrease your exposure to light in the evening and during the night by reducing indoor lighting and avoiding bright TV and computer screens. Exposure to bright light in the evening may help if you have advanced sleep disorder.
Medications: Medications such as melatonin (available over-the-counter), wake-promoting agents (such as modafinil [Provigil®]) or caffeine, and short-term sleep aids may be used to adjust and maintain the sleep-wake cycle to the desired schedule. Tasimelteon (Hetlioz®) is approved to treat non-24-hour sleep-wake disorder.
Chronotherapy: This therapy approach uses progressive advancement or delay (three hours every two days) of sleep time depending on the type and the severity of the disorder. This type of therapy requires a firm commitment by you and your partner, as it can take weeks to successfully shift the sleep-wake cycle. Once the desired schedule is achieved, you have to keep this regular sleep-wake schedule.