How is delayed sleep-wake phase disorder (DSWPD) treated?

Treatment for DSWPD involves the following:

  • Good sleep habits. Children and adolescents with DSWPD need to do everything they can to develop and maintain good sleep habits and a consistent sleep schedule. Habits should include going to bed and waking up at the same times including on weekends and vacations; avoiding caffeinated products (coffees, teas, colas, some non-cola pops, energy drinks, chocolates, and some medications [Excedrin®]); avoiding other stimulants and products that can disrupt sleep (alcohol, sleeping pills, nicotine); maintaining a cool, quiet and comfortable bedroom; and avoiding activities before bedtime that are stimulating (computer games, smart phone, television use).
  • Shifting the bedtime schedule. Treatment for DSWPD can involve one of two methods: advancing or delaying the internal clock.
    • Advancing the internal clock. This method simply moves the bedtime a bit earlier on each successive night until the desired bedtime is reached. For example, setting the bedtime at midnight on one night, 11:45 p.m. on the next night, 11:30 on the following night and so on.
    • Delaying the internal clock. This method moves the bedtime sequentially 1 to 3 or more hours later on successive nights until the desired bedtime is reached. This requires several days free from social activities and may be best attempted during a long school break or vacation period. The thinking behind this strategy is that it is much easier for the body to adjust to a later bedtime than an earlier one.
  • Staying motivated to stick with the schedule. It is especially important not to lose sight of the goals during holidays and weekends. Adhering to strict bed and wake times keeps the body’s internal clock under control but does not "cure" the tendency toward a delayed sleep-wake phase. Once the desired bedtime is reached, your child or adolescent must stay motivated and stick with going to bed at the desired bedtime on a nightly basis in order to reset the internal clock. Only after several months of sticking to the schedule can there be some flexibility allowed on special occasions.
  • Bright light therapy. Some physicians recommend bright light therapy, which requires the purchase of special light box. Exposing your child to bright light for approximately half an hour in the morning helps to reset the body’s internal clock. Reduced exposure to bright light in the evening also helps. Your sleep doctor will be able to suggest commercially available light boxes.
  • Medications. Melatonin or other natural sleep-inducing drugs are another option some physicians may try.

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