How is delayed sleep phase syndrome (DSPS) treated?

Treatment for DSPS involves the following:

  • Good sleep habits. Children and adolescents with DSPS need to do everything they can to develop and maintain good sleep habits and a steady sleep schedule. Habits should include going to bed and waking up at the same times on weekends as on weekdays; avoiding caffeinated products (eg, coffees, teas, colas, some non-cola pops, energy drinks, chocolates, and some medications [Excedrin®]); avoiding other stimulants and products that can disrupt sleep (eg, alcohol, sleeping pills, nicotine); maintaining a cool, quiet and comfortable bedroom; and avoiding activities before bedtime that are stimulating (eg, computer games and television).
  • Shifting the bedtime schedule. Treatment for DSPS 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 p.m. on the following night and so on. This is facilitated by concomitantly moving the wake time to allow this transition to occur with more control. These methods are best individualized with the help of a sleep specialist.
  • Delaying the internal clock (“Chronotherapy”). This method moves the bedtime sequentially 1-3 hours or more 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. Again, this is best done with advice from a sleep specialist.
  • 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 clock under control but does not "cure" the tendency for delayed sleep phase. Once the desired bedtime/wake time 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 adhering to the schedule can there be some flexibility allowed on special occasions. However, efforts should be made to wake up close to the prescribed wake time to keep the rhythm going, regardless of when the adolescent goes to sleep.
  • 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 and the correct method of use.
  • Avoidance of light at night. Any screen time with a back light (hand held devices, computers, TV etc.) can theoretically delay the sleep rhythm and make it harder to go to sleep. These should be avoided in the few hours prior to bed time, especially when trying to shift the rhythm.
  • Medications. Melatonin or other natural sleep-inducing drugs are another option that may be tried with the help of a sleep specialist.