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Author: Ron Cridland, MD
In this disorder, bedtime and wake time are significantly later than average. If you try to go to sleep earlier, you have a hard time falling asleep. If you go to bed later, you can fall asleep much quicker. If allowed to sleep in and wake up spontaneously, you can get a normal number of hours of sleep. If you can do this on a regular basis, you tend to feel fairly rested. The problem is that you are often sleep deprived because you must get up earlier than your biological clock would like.
Diagnosis
The diagnosis of Delayed Sleep Phase Syndrome is based on a fairly consistent history of a significant delay in the usual bedtime and wake time. When allowed to sleep on this schedule there is improved sleep quality and quantity.
Management
If you are able to successfully live a lifestyle that allows you to sleep on your delayed schedule and get enough sleep to feel rested, then you do not necessarily have to change anything. However, if you are having trouble falling asleep or getting enough sleep to feel rested, then you will need to advance your biological clock. For more information about changing the biological clock, go to the section on Light Therapy.
If your biological clock is only delayed 3 or 4 hours, the quickest way to return things to normal might be just to get up at the required time and make sure you get 30 – 45 minutes of bright light each morning. Do not immediately try to go to bed earlier yet. Go to bed at your usual later time when you are typically able to fall asleep. As your biological clock advances you should be able to fall asleep 30 to 60 minutes earlier each night until you are getting enough sleep to feel rested. Initially you will be sleep deprived. That extra sleepiness will make it easier for you to fall asleep at night and overcome the insomnia.
A gentler way to change your biological clock is to determine what is the earliest time you can be reasonably successful at getting up. Get up with an alarm and get 30 – 45 minutes of bright light (preferably outside) starting within 30 minutes of rising. Go to bed no earlier than 8 hours before your rise time assuming you are sleeping 8 hours. After one to three days of success at falling asleep within 30 minutes of bedtime, you can advance the alarm 30 minutes. Then that night you can go to bed 30 minutes earlier. Do not try to go to bed earlier first. Your biological clock needs the earlier light in the morning first to advance your clock. You then advance the morning alarm 30 minutes followed by advancing the bedtime 30 minutes every 1 – 3 days until you are sleeping in the right “time zone”. Maintain that time zone by not allowing yourself to sleep in later than one hour on days off. Use morning bright light on awakening as needed to reset your biological clock which reinforces the ability to feel sleepy by bedtime.
To assist you in improving your sleep quality and quantity you should also review the page on Sleep Hygiene. For a more detailed program, you can register for the Online Insomnia Management Program.
