Le syndrome de retard de phase : une expérience personnelle de prise en charge associant lumière et mélatonine

The Delayed Sleep-wake Phase Disorder (DSPD) is common in sleep clinics. Physiopathology remains little known today but it would be mainly accounted for by a significantly prolonged circadian period length. The resulting insomnia would be self-perpetuated by behavioral and cognitive factors. The concomitant use of bright light/exogenous melatonin administration represents the treatment of choice, but it must be scheduled at appropriate timing in order to optimize its efficacy. Therefore, the adequate markers of circadian phase (“Dim Light Melatonin Onset” and temperature minimum) should be determined before initiating the treatment, but such measurements are never realized in clinical practice. To address this difficulty and considering the absence of detailed guidelines from learned societies, we provide an updated review on DSPD and we propose a protocol based upon the estimation of circadian markers.