Delayed Sleep-Phase Disorder

Delayed sleep-phase disorder (DSPD) can range from mild to severe and affects not only an individual's sleep but also daytime functioning. A comprehensive assessment is necessary to reliably estimate the degree of circadian-phase delay and thus determine the most effective treatment (morning bright light or chronotherapy). For phase advancing the circadian rhythms and sleep-wake cycle, the recommendation is a schedule of incremental advances of wake-up time and morning bright light as well as low-dose early-evening melatonin administration. It is also important to treat any psychophysiological insomnia with cognitive/behavior therapy. For the more extremely delayed DSPD individual, chronotherapy involving delays of scheduled sleep periods in increments of 2 hours is recommended. Following either type of therapy, maintenance of consistent wake times, exposure to morning light, changes in lifestyle, and improvement of attitudes about morning times are also recommended to help prevent relapse.