anyone here treated for delayed sleep phase syndrome?

After another argument about my night owl tendencies with my partner, I'm taking his suggestion to see whether there are other people out there to connect with who also have delayed sleep phase syndrome. Since it's not as popular a problem as OSA, I haven't found any forums for it and this is the best place I can think of.

A couple of you may know this has been an issue for me, discussed here now and then briefly. Short story, I've always been a very late night owl. I thought the cpap would help, it hasn't. I thought the thyroid meeds would help, and they haven't. In reality both have contributed to better quality sleep of shorter (normal) duration, but the late bedtimes haven't really resolved.

I had an appointment with a sleep clinic but due to insurance problems I now need to restart the whole procedure at another lab, so that means another two months for an appointment, several months to get the diagnosis, follow up etc, easily another 6 months can go by.

Problems are that (a) recently lost job, very likely due to DSPS, and now I don't have a reason to get up very early so the marital harmony is getting worse - my late bedtimes are annoying my partner because he thinks I like to go to bed late or something else?, and is worried what will happen when I start working again. (b) I have researched the diagnosis and treatment of DSPS and while it seems straightforward I haven't been successful as implementing the treatment on my own. No matter what I do, I cannot shift my schedule back. Even when working, my bedtime was the same as it is now, I just got up earlier and was therefore chronically sleep deprived.

Soooo my question is, has anyone actually been successfully treated for DSPS? Is there any other magic bullet besides melatonin, bright light in the morning, evening sunglasses, and maybe some psychoanalysis mumbo jumbo?

My sleep hygiene itself seems to be quite ok, no caffeine in the afternoon or evening, same time to bed, awake without an alarm clock, etc, I'm just offset with the rest of society by 4 or 5 hours!

I'm getting really annoyed by this whole thing, not so much because I am currently bothered by it, but because my partner's nightly nagging is getting unbearable (mind you I had already heard about how undisciplined I was regarding sleep for YEARS by parents, aunts and uncles,....), and also because I too am worried about the near future when I have to work a normal job again.

I guess I feel alone and like a nutcase. I had complained to my original sleep lab about this three years ago and they just told me the typical sleep hygiene stuff. I can't even get people to _believe_ me let alone _help_ me. This latest clinic I went to would have helped but because of the idiotic insurance issue that too is now not an option. I'm just hoping this other clinic knows a thing or two about these circadian rhythm issues.

Thanks for letting me vent. And if anyone knows anyone that's been treated for this, let me know!

HI echo!
Sorry to hear you are still having this problem.

I know you have been trying everything..

I am also a night owl, but my schedule seems to run in a cycle. I was managing to get to sleep by ten pm, and now Im back
at the early morning sleep cycle. I have tried everything too. I have been this way since I was a child, Im beginning to think its
just the way I was put together, you too?
I know you want to be able to change your schedule for work.. Its hard to figure this out when you have tried all the very latest sleep
hygiene tricks and tips.

Does your late night sleep time come and go or is it absolutely constant? Mine seems to change several times a year, almost with the seasons,
or weather..

who - been there done that. As I said sleep hygiene is not the issue. I am not ADHD either.
And this article merely encourages the fallacy that it's in all the head, that you stay up because you want to. Perhaps for some, but that's not the only issue here. DSPS is real and there has been a ton published about it. It's not merely a psychological issue.
At least they got it right at the end - seek medical consultation.... which is exactly what I'm trying to do.

Then . . .

"Exposure to morning light causes a phase advance (shift to an earlier time), whereas melatonin administration in the morning causes a phase delay (shift to a later time). Conversely, evening light exposure causes a phase delay, whereas afternoon/evening melatonin administration causes a phase advance. Combining bright light exposure and melatonin can be a more powerful realigner of misaligned rhythms than either one alone. . . . However, this is true only if the dosing occurs at the proper times—but those times are different for each agent."



http://www.psychiatrictimes.com/display ... 68/1508187

hi Elena! good to hear from you again

Mine is definitely cyclical... worse in the winter, reaching a peak (or trough, depending on your point of view!) in February, and getting better as the days get longer and sunnier. It fits with the theory that DSPS people need things like the bright light therapy in the morning, because the winter sun isn't strong enough to trigger the circadian rhythm reset. I forget which article I read that it in. On the other hand, I also read that the problem can be due to all these artificial bright lights which stimulate the eye and therefore delay the sleep phase cycle. However since for me it's worse in the winter, I'd go with the theory that it's under-sensitivity to light that's the cause. Admittedly it's worse when there are stressors, but it's always been there, and according to my mother since the age of 1 . my $0.02!

Well, I will just bet you have something they havent thought of a name for yet!

so, I totally understand, and I know how frustrated you are trying to "fix" it..

It would make sense that this does happen in cycles..


I always thought that maybe some of us have thinner eyelids than others, so we are ultra sensitive to light..

Thanks who. I found a nice article written by some Norwegian doctors if I remember correctly, discussing the DSPS protocol they used. Bright light in the morning preceded 12 hours by melatonin administration the night before, and then wake up one hour earlier each day and use the bright light and continued melanin 12 hours prior to wakeup time. I found that 30 min of light wasn't enough, so I went to 45 or 60, together with the melatonin....I managed to shift back to a 2am sleep time but got stuck there. Prior to that I was at 4 or 5 am, sometimes later. When I was working 1.30am was typical, but not earlier. That's *sleeping time*, not *bed time* as I could easily lie awake for hours if I went to bed earlier.

So this is what I meant when I said I haven't been successful at implementing the treatment on my own.

I have this problem too, Echo (welcome back, BTW!). My understanding is that it's fairly genetically/innately determined, and difficult to change. I do take .75mg of melatonin at 6pm. I tried light therapy, but I think I'll start trying it again. It has to be immediately upon waking, for 45-60 minutes. Computers and other bright lights in the evening is a major no-no. I thought about getting those sunglasses because I don't know if I could give up computers at night. If you have trouble falling asleep, you have the usual insomnia options besides good sleep hygiene, such as medication or sleep restriction therapy. I can't bring myself to do restriction. I was doing reasonably well on Ambien in that I could fall asleep if I took it, but I always felt like crap when I woke up (but that could be the untreated SDB). As much EDS as I'd have, I still felt relatively better with 8 hours of sleep that ended at 10am than 8 hours of sleep that ended at 6am. I wish the rest of the world would get on my schedule!

OK, so I'm already taking melatonin at 6pm. Per the article that Who cited:

Similarly, when it comes to light exposure, subtle shifts in dosing schedule can make a big difference clinically. For example, some years ago, a medical student who heard me lecture decided to treat his own delayed sleep phase syndrome. He typically went to bed between 1 and 4 am and slept as late as noon. As treatment, he woke himself up at 6 am and exposed himself to bright light. But his sleep times did not advance as theory would predict; instead, they were actually delayed a bit further. This was probably because his light PRC was so severely delayed in the first place that bright light at 6 am was stimulating its delay zone.

I advised him to get the bright light exposure at his usual wake time and to shift his wake time (and sunlight exposure) 15 minutes earlier every other day until he awoke consistently at 6 am.

I think I'm stimulating my delay zone right now. I really should stop with the computer at night or at least buy the sunglasses. I guess I could try bright light at 6am (shoot me now, just the words "6am" makes me want to vomit...), and if that doesn't work, I'll do the schtick where I use light when I wake up and shift it earlier by 15 minutes a day. I think I'll start day after tomorrow.

I think DSPS has been mentioned in my files, but I've never gone beyond sleep hygiene and sleep restriction and OTC meds in addressing it. I remember there being discussion on here once about a subspecialty of sleep that deals with this mostly thru behavioral therapy. I actually is "in our head" as that's where the chemicals and hormones that affect sleep are housed, just not in our imagination. I think the causes of DSPS can vary, so what works for one may not for another. For me it took sleep restriction. At least I know I can, I just don't like to because my sleep is very short and I prefer to get it closer to morning. My doc explained that the quality of our sleep is better if we get it during the time the hormones favor it. I read that what and when we eat can be a part of resetting our circadian rhythm, and should be combined with controlled light exposure. I can't say I've always been like this. Seems reasonable to me though that some people are just wired this way. I know someone who sleeps opposite times of her hubby and they've just accepted that as how their life is. She's always worked late shift, he's worked days. Hey, if we could just all move a few time zones west we'd be on a "normal" schedule.

I was diagnosed with DSPS in 2001 (at the same time I was dx'd with apnea). I've tried light box therapy and melatonin, and it didn't work so well for me. Every few months I find that my cycle shifts a bit and what helps to get me back on track is a week of chronotherapy (going to bed 3 hours later than the night before for a week until I'm on a more "normal" schedule, then going to sleep on the new "normal" schedule). I also managed it by working late and was lucky to have found an employer who offered odd shifts in my specialty.

My son was plagued with a similar problem that started about when he hit puberty (typical starting time, I've read). He originally had non-24-hour sleep/wake syndrome, also known by this ridiculous name...hypernychthemeral syndrome. It's where your internal clock is on a more than 24-hour clock, usually 25 or 26 hours, which pushes you around the clock as far as when you can go to sleep. (One night you can go to sleep at midnight, the next night 1, the next 2 or 3 a.m., and so on around the clock. This is part of the reason we home schooled his senior year of high school. He would go to bed at a "normal" time and lay awake for hours. If he went to bed when he was sleepy, he'd go right to sleep. And that could be at noon or 3 p.m.!

One thing that is recommended for this is the methylcobalamin version of Vitamin B12. Some small research has shown it can be helpful, but it didn't help him. He tried the bright light boxes, too. They didn't help. Sleeping pills in his early teen years wound him up. Once he was 18, I took him to my sleep doc (most didn't want to see him before 18 or prescribe medication before 18 either). Through him my son tried Ambien (didn't work and he had hallucinations); Rozerem and a few others that didn't work. Then he tried 3 milligrams of melatonin and that did it! The sleep doc said he could go up to 6 milligrams, but he never had to go that high. We hadn't tried that before because of his age.

My son is starting his senior year of college in the fall and the sleep issue has settled way down now. He says he takes the melatonin now two or three times a week on nights before having to get up for an early class. Other nights it's more like DSPS, but at least he's not "going around the clock" anymore with when he can get to sleep. Very often when the sleep cycle sleep problem starts at puberty is subsides in the early 20's. I was praying his would do that.

I have a ton of research I did on this way back when, but don't have it close at hand right now. The Talk About Sleep forum has a board on this. That section is not extremely active, but I did get some good info at the time. http://www.talkaboutsleep.com/message-b ... m.php?f=16.

breakfast wrote:I was diagnosed with DSPS in 2001 (at the same time I was dx'd with apnea). I've tried light box therapy and melatonin, and it didn't work so well for me. Every few months I find that my cycle shifts a bit and what helps to get me back on track is a week of chronotherapy (going to bed 3 hours later than the night before for a week until I'm on a more "normal" schedule, then going to sleep on the new "normal" schedule). I also managed it by working late and was lucky to have found an employer who offered odd shifts in my specialty.

breakfast, when you went to bed 3 hours later than the night before, did you also get up 3 hours later? That seems like a very rapid shift... I'm surprised it's not slower.

I have heard that low doses of melatonin, taken approximately 6 hours before you typically get tired, work best for resetting circadian rhythms. I know lots of people take higher doses of melatonin, closer to bed, for it's sedative effects, but I just don't understand how this doesn't screw up the circadian rhythms (we do this as well with my son--we give him 1mg of melatonin 30-60 minutes before he needs to go to bed, to offset the insomnia caused by his stimulant medications). But as I said, I was told to take .5-1mg of melatonin at 6pm. Clearly that alone is insufficient. Also, this forum tends to make me stay up later than I should, and I'm sure the computer use at night is bad for me. I will have to get more disciplined.

Wow, thanks guys, thank you all for your replies! there is tons of good info here!! I need to digest it all a bit first and (unbelievably) try to go to bed early tonight, so a reply will be in order tomorrow. till then my fellow "insomniacs".....

SleepingUgly wrote:

breakfast wrote:I was diagnosed with DSPS in 2001 (at the same time I was dx'd with apnea). I've tried light box therapy and melatonin, and it didn't work so well for me. Every few months I find that my cycle shifts a bit and what helps to get me back on track is a week of chronotherapy (going to bed 3 hours later than the night before for a week until I'm on a more "normal" schedule, then going to sleep on the new "normal" schedule). I also managed it by working late and was lucky to have found an employer who offered odd shifts in my specialty.

breakfast, when you went to bed 3 hours later than the night before, did you also get up 3 hours later? That seems like a very rapid shift... I'm surprised it's not slower.

I have heard that low doses of melatonin, taken approximately 6 hours before you typically get tired, work best for resetting circadian rhythms. I know lots of people take higher doses of melatonin, closer to bed, for it's sedative effects, but I just don't understand how this doesn't screw up the circadian rhythms (we do this as well with my son--we give him 1mg of melatonin 30-60 minutes before he needs to go to bed, to offset the insomnia caused by his stimulant medications). But as I said, I was told to take .5-1mg of melatonin at 6pm. Clearly that alone is insufficient. Also, this forum tends to make me stay up later than I should, and I'm sure the computer use at night is bad for me. I will have to get more disciplined.

Sorry SleepingUgly, I left that part out. I did end up waking up 3 hours later. The rapid shift seemed odd to me as well, but doc explained that by changing your sleep schedule by three hours every night, you're basically trying to shock your circadian rhythm into complying with your new sleep schedule. The key to making chronotherapy work is, after that first week, adhering to an extremely strict sleep/wake cycle. A few minutes deviation can throw the whole thing off.