Delayed Sleep Phase Disorder

Delayed Sleep Phase Disorder (DSPD) is commonly found in teenagers and young adults.  Sleep onset is delayed by 3–6 hours compared with conventional times (10–11 pm) due to the demands of school, sports, and social media. Once sleep is attained, it is normal in length and quality but is delayed, resulting in social and often psychological difficulties.  Some people suffer from DSPD due to alternative rhythms of melatonin secretion and the core body temperature (typically lowest in the early am) which manage the normal sleep cycle. This cycle of delayed melatonin secretion often starts in early adolescence and fades by early adulthood, but it can last a lifetime.
 
Adolescents require an average of 9 hours of sleep. This is rarely achieved, with most students cumulatively sleep-deprived as school weekdays progress.  When forced out of bed at conventional wake-up times, adolescents with DSPD continually experience a short sleep duration and feel permanently jetlagged. Teens may complain of taking “hours” to get to sleep and being extremely difficult to wake in the morning for school or work.
 
Melatonin
In the treatment of DSPD, melatonin should be given 4 hours before the current sleep onset time and move it back 1 hour every week until you have reached the desired sleep onset time. Use a small dose (0.5 mg) of synthetic melatonin (avoid “natural” melatonin derived from cow/pig brains.)  A sleepy effect may occur in the very early evening, so avoid driving after taking the melatonin.
 
Bright light therapy
Bright light therapy works well as an adjunct to melatonin for DPSD. If natural exposure to dawn sunlight is not available, bright artificial light can be substituted to maintain a normal circadian phase.
Look for a light box emitting 10,000 lux. Use the light box for a 30 min session each morning, as soon as possible after wake up.  Position the box at eye level, about 2 feet from the eyes, and at an angle (at 10 or 2 o’clock).  Once the sleep phase has been successfully shifted, you may want to continue with 15 min light sessions right after waking to help maintain the new sleep schedule.
This is a great tool that combines bright light therapy with an alarm clock (not quite as effective as light therapy with eyes open, but helpful nonetheless):
Wake-up Light with Sunrise Simulation by Phillips
 
Limit use of technology in the bedroom, particularly in the hour before desired sleep time
The alerting effect of media is strongest with blue-green light. Watching television, texting and using a computer or electronic tablet device are associated with delayed sleep onset and poorer sleep quality.  Set electronics to shift to “evening mode” (or use a program like F.lux) if they must be used in the 1-2 hours prior to bedtime.
 
Establish regular sleep patterns
Adolescents tend to sleep longer on weekends to compensate for sleep deprivation incurred over the week. If a catch-up sleep of 1–2 hours is required, it is better for this to occur on a Saturday morning. Sunday morning get-up time needs to be at the mid-point between Saturday sleep in time and the necessary Monday morning get-up time.
 
Avoid caffeine and energy-dense foods before desired sleep time
Caffeine is a stimulant. Energy-dense foods, such as those high in sugar content, stimulate the digestive and endocrine system, producing an alerting effect.
 
Avoid exercise too close to sleep time
In general, regular exercise is a good way to promote sleep and good health. However, evening exercise can delay sleep in young, and prolonged aerobic exercise even a few hours earlier can maintain high body temperature, increasing alertness and interfering with evening “wind down”.
 
Patients with significant sleep phase shifts (falling asleep more than 3 hours later than desired bedtime) may need more detailed treatment plans managed by a sleep therapist/physician.