xxxii. Chronotherapies for DSPS

3 March 2007 at 07:06 | Posted in Circadian rhythm | 10 Comments
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There are two forms of chronotherapy in use as treatments for DSPS. Since it is difficult or impossible to move sleep time to earlier in the night, an attempt can be made to sleep later than usual, by the one or the other system, until sleep and wake times are as desired.

(Note: The term “chronotherapy” can also refer to the optimization of schedules for administering medication. That is unrelated to its use here.)

1. The traditional method has been to stay up two or three hours later each night until one has gone ’round the clock. One might on subsequent days go to sleep at 6 a.m., 9 a.m., noon, 3 p.m., 6 p.m. and 9 p.m. It would then be wise to establish a bedtime of 9 p.m. for some days before easing toward the desired bedtime of 10 or 11 p.m.

This requires a week or more of strict self-discipline and a cooperative family. Maintaining the new bedtime requires very rigid discipline, and most people find that the effects may last from a few days to a couple of months at best, before the natural late night sleep time reasserts itself. There are people who routinely prepare for a daytime seminar or a holiday trip to the in-laws in this way.

IMPORTANT UPDATE:  See also post no. 55 about chronotherapy.

2. An article from Sleep Review, 2003, tells of a lesser known form. There we learn of a 16-year-old boy who had had DSPS for years. He slept nicely from 3 a.m. to noon but his mother had trouble getting him up for school and he dozed during breakfast, on the ride to school and during morning classes. The boy’s history and sleep log showed classic DSPS. He was active, not shy and not depressed.

“DSPS would not be problematic in a world without appointments and schedules. It becomes an issue when it results in conflict at school or work, or with family. Some adolescents are content with their DSPS and have no real desire to change. This perspective presents a serious barrier to therapy. Ultimately, it falls on patients to decide whether they are willing to make the effort and sacrifices required. We stress to families up front that DSPS can be alleviated in a motivated teenager, but therapy is “active” and not “passive.” It cannot be imposed on someone who is not willing to make substantial changes in lifestyle and habits.”

A modified chronotherapy was devised by M. J. Thorpy et al in 1988, apparently specifically for adolescents. It is called controlled sleep deprivation with phase advance, SDPA, and it is designed to be less disruptive to families and the school or work schedule while still taking advantage of the fact that most people find it easier to stay up late than to fall asleep early.

SDPA, step one: the patient sleeps regularly for a week on his natural schedule, in order to start treatment rested.

Step two: a night of total sleep deprivation followed by advancing bedtime by 90 minutes.

Step three: the new bedtime is observed for six days to consolidate the pattern.

Step four: the process of one night of total sleep deprivation followed by advancing the bedtime by 90 minutes is repeated. The process is continued every week until a target bedtime and wake-up time are attained.

Step five calls for maintaining the regular bedtime and rise-time once reached, to prevent relapse of DSPS. 

Conclusion
“Our patient responded to a trial of SDPA, though success required three attempts. Social events and failing to refrain from naps during the day interfered with the first trial. During the next attempt, he developed some performance anxiety around falling asleep even after being sleep deprived. He would lie in bed and worry about not being able to fall asleep. In this circumstance, we felt justified in adding a short course of zolpidem at bedtime for 1 week in combination with SDPA, and he successfully reset his schedule to a 10:30 pm bedtime and 7:00 am rise-time. The family enlisted help from his friends to reschedule their social activities, and this helped the therapy plan move ahead as well. 

 

“It is likely that we have not heard the last from our young man. DSPS patients have a high rate of recidivism, particularly when opportunities to fall off schedule (vacation, travel, college, final examinations, social events, and jobs) present themselves. It is our hope that we succeeded at least in giving our patient the tools he needed to correct his sleep troubles and that he will remember them and know what he needs to do the next time problems arise.” 

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This was an interesting approach. It mirrors somewhat my own tactic which I call my 36-hour trick. At times, almost once a week, I feel a need for a long sleep, 11-12 hours. This can only be attained by staying up one whole night and going to bed very early the next night. It does not, however, get me to bed earlier the following nights. It just allows me to feel rested and healthy for a few days. I have my doubts that the “new” chronotherapy (no. 2) would last any longer than the old, without the aid of melatonin and a light box.  

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Next:  xxxiii. Owls of the World, Unite!

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