Can DSPS Ever Really Be "Cured"?

by Brooke
(San Francisco, CA)

My question is, can someone with DSPS (delayed sleep phase syndrome) ever really change their schedule successfully?

I’m 38 years old, and have been a night owl since at least my high school days. I’ve typically gone to bed around 2am and awakened for work or school around 7am, and then slept long hours on the weekends to make up for the lost sleep. During a period of unemployment in 2001, I eventually went to bed around 7am and woke around 3-4pm.

I was recently unemployed for 16 months, and went to a sleep schedule of 2-3am to 10-11am. I was blissfully well-rested – I felt like a million bucks every day!! It was a true gift to feel so rested. Then 5 weeks ago I started a new job, and have been trying to adjust my sleep schedule to roughly 10:30pm-6:45am.

I have very little trouble falling asleep, I think thanks to melatonin (3mg nightly). However, I typically wake up throughout the night from about 3am onwards, and don’t feel rested during the day.
I’ve been doing a sleep hygiene protocol for about 4.5 weeks. I use a light box in the morning (GoLite blue LED), I have bright lights in my office during the day, I don’t drink caffeine or alcohol, I get a modest amount of exercise daily (walking 1-2 miles a day, with hills), I start winding down at night around 9:30, I minimize my computer time at night (and use f.Lux to warm the color temperature of the screen), I don’t have a TV in the bedroom, the bedroom is dark and cool, etc. etc. I maintain my sleep schedule on weekends.

But except for about 4 nights when I managed to get about 7 hours of uninterrupted sleep I still can’t sleep through the night.

On various DSPS community boards, there are lots of miserable people who seem to think they can never really change their schedule. I’m terrified they’re right. So, does it just take a long time to adjust someone’s sleep schedule and I need more time? Or am I screwed?

Thank you for your help!!

Kevin's Answer

Hey Brooke,

Thanks so much for laying out your situation--you clearly have a pretty strong understanding already of DSPS and the treatments that are typically used to counteract it.

Let me just start by responding directly to your initial question: Can someone with DSPS change their schedule successfully? The answer is a definite yes.

In terms of the relationship between your biological clock and the outside environment, a delayed sleep phase is essentially like jet lag, right? Except without the vacation ;)

Your circadian rhythm is shifted so that your body is releasing hormones that keep you alert at night and hormones that make you tired during the daytime, similar to what happens for the first week or two when you fly halfway around the world and your body's rhythm does not match up in the traditional way with that of the sun and moon.

Interestingly enough, Mark Rosekind, who sits on the Advisory Board for this website (update 11/2010: Dr. Rosekind was recently elected to the National Transportation Safety Board & had to leave the board for governmental reasons), specializes in adjusting biological clocks when it is imperative to do so, like when an Olympic athlete is going to compete overseas or when a team of astronauts are preparing for a middle-of-the-night launch.

I remember him recently sharing stories with us of when he worked with Apollo Ohno to adjust his biological clock right before an international meet so he was at peak alertness, rather than wanting to be in bed, at the time he needed to compete.

He's also worked as director of the NASA Fatigue Countermeasures Program, and I recall him telling us about a specific mission where he had a group of astronauts getting ready to launch into space in the middle of the night. And of course, as tragic events have shown us in the past, the launch is a period of time when the entire team needs to be fully alert and prepared to make sure everything goes smoothly and is accounted for.

So essentially, he needed to turn night into day for these guys. From what I recall, the main thing they did involved having the astronauts gradually spend their nights in a room that was decked out with extremely bright light, and in a matter of time their circadian rhythms were shifted enough for them to feel fully alert during the launch.

The fact that both of these examples were successful and organizations like NASA are using their resources to shift biological clocks (NASA has also conducted a series of studies on the subject), shows that it is indeed possible to shift the biological clock, and therefore to swing DSPS back to a traditional sleep/wake schedule. (update 11/2010: my original comment here really doesn't do justice to the difficulties someone suffering from a circadian disorder faces. See Andrew's great comment below for more.)

But these of course are both really extreme examples involving the help of a professional. How does this translate to you and others on an individual level?

Dr. Rosekind's website has a lot of great information (you can get the NASA studies on there, as well as see the different products and services they offer) about how to shift one's biological clock and achieve optimal alertness. You can visit it at Alertness-Solutions.com.

You're also very right to have put the word "cured" in quotation marks, for delayed sleep phase syndrome is really only a disorder when it is truly disruptive and getting in the way of someone's life. For example, your period of unemployment where you were falling asleep at 7am and waking up a few hours into the afternoon--clearly a delayed sleep phase, but maybe this was a perfectly fine schedule for you at the time. Maybe your nights were your most alert, productive time (socially, personally, what have you), and when you woke up in the afternoon you felt completely rested and ready to go again.

There have been many a mad genius who has produced his or her most inspired work, I'm sure, in the wee hours of the morning ;)

And in this case DSPS is can hardly really be considered a disorder. But when you then landed your job, and now have to wake up before 7 in the morning (the time you were once going to bed!), having a shifted sleep schedule is not conducive at all to obtaining enough sleep.

So, of course, the question then becomes how can you shift your biological clock back to a place where you can go to bed, sleep through the night, and wake up for your job with enough rest to keep you fully alert throughout the whole day?

As evidenced by the Olympic athlete and NASA examples above, it's clearly possible. There's evidence that some individuals with chronic DSPS have greater difficulty shifting their circadian rhythms, but even in light of this there is still so much to be said about the effects of environment and behavior.

Strategic bright light treatment, as you say, is regarded as the most effective treatment. But it takes a minimum of a 10,000 lux light treatment to show much of an effect at all. I'm pretty sure the Philips goLite that you use is right at that minimum, so it could be possible that your body requires a higher lux. Also, are you making sure to look at the light at an angle, out of your periphery? Because that too is another necessity for effectiveness.

I know I haven't laid out too many specifics for you, but I hope these stories have at least shined a little more light on your perspective of DSPS. If you have any follow up questions or comments, please share them with the "post comments" link below!

Warmly,
Kevin