Treating Circadian Rhythm Disorders

Behavior therapy

Health-care providers aim to change certain behaviors to provide successful treatment of circadian rhythm sleep disorders. Patients should, for example, maintain regular sleep-wake times (even on weekends and vacations), avoid naps, exercise regularly, and avoid caffeine, nicotine and other stimulating behaviors and substances several hours before bedtime.

If you have delayed sleep phase disorder, meaning you get sleepy only in the early morning hours and sleep until the afternoon, you should avoid bright light in the evening. You should also keep the lights dim at home at night and avoid TV and computer screens.
If you experience advanced sleep phase disorder, meaning you are sleepy in the very early evening and wake up fully rested in the wee hours, increase your light exposure in the evening. Keep the lights on or, if it’s light outside, spend time outdoors when sleepiness sets in.

Bright light therapy

Also known as phototherapy, bright light therapy is used to advance or delay the time to go to sleep. A high-intensity light is used, and treatment is provided by a sleep specialist. To help readjust the body clock for delayed sleep phase disorder, patients are exposed to a bright light for 30 to 45 minutes in the morning.

It takes up to two weeks for the treatment to be effective. You may also need to use the light therapy in an ongoing manner to maintain the new schedule. If you have advanced sleep phase disorder, bright light is used in the early evening to tell the body to stay awake for a few more hours. In both cases, repeating the treatment may be needed on occasion to maintain the new sleep schedule.

Chronotherapy

Chronotherapy literally means time therapy. Bedtime is advanced or delayed by one to two hours per day, depending on the disorder being treated. It may take weeks to shift to the new sleeping and waking schedule. Once the new schedule is achieved, patients must make a firm commitment to the therapy for treatment to be successful.

Medications

When other therapies don’t work, your doctor may prescribe medication or drugs to help you adjust and maintain the desired sleep/wake cycle. Drugs can promote wakefulness, and short-term sleep aids can help get you to sleep. To help with jet lag, the hormone melatonin is especially effective and is available over the counter.

Considerations

Anyone with circadian rhythm sleep disorders severe enough to disturb normal daytime activities should consider discussing treatment options with a sleep specialist.

Effectiveness

Treatment for advanced phase sleep disorder, delayed sleep phase disorder, and shift work sleep disorder are often very successful. But ongoing success requires a firm commitment to maintain the sleep times established through therapy. Repeated sessions of light therapy are often required, too.

Jet lag is a temporary circadian rhythm sleep disorder and usually clears up in a few days after adjusting to the new time zone.

Risks

Light therapy should only be conducted under the supervision of a sleep medicine specialist. As with all medications, prescription drugs and over-the-counter remedies carry risks.

It’s important to follow prescription regimens exactly and to let your physician and sleep medicine team know if you are taking any over-the-counter medications to treat yourself.

Risks from not receiving treatment

Advanced sleep phase disorder, delayed sleep phase disorder and shift work sleep disorder often place stress on relationships at work, home and school. Failing to address sleep-wake cycle disruptions will likely continue to create unnecessary strain in these areas of your life. Treatments are effective and can make a big difference in a matter of a few days.

Urgency

Unaddressed circadian rhythm disorders may adversely impact school, work, family and social interactions. If sleep-wake cycle disruptions are affecting your life, it’s important to talk with a sleep medicine specialist.