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People with delayed or advanced sleep phase

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People with delayed or advanced sleep phase can benefit. For example, someone who cannot go to sleep before 3 or 4 am, and then cannot get up until noon, would benefit from immediately going outside on waking for about an hour. After a few days, it should be easier to go to sleep earlier and get up at 10am.

Then the person could get up at 9 am and go outside for an hour, continuing to do this, one hour earlier every few days until the desired waking time is achieved.

Similarly, someone who becomes sleepy too early in the evening could go outside (in the summer) for an hour, so that they could then stay up for longer and sleep later in the morning.

This bright light exposure changes the setting of the internal clock, but not the speed at which it is running: it still runs either too fast or too slow. Therefore this exposure needs to be repeated almost daily.

At any time you are sleepy but don't want to be, go outside for about an hour. Of course, this may not be feasible in the winter, but perhaps sitting in a sunny window might help.

Some sort of exposure to natural daylight is helpful. If there is no strong daylight (in the middle of winter), phototherapy using artificial light boxes is a good alternative.

A study in France last year suggested that "any disease or dysfunction where a misalignment of sleep-wake and circadian rhythms may be suspected" can be treated with phototherapy (which was originally developed for Seasonal Affective Disorder) (9).

As with SAD, dawn can be simulated using artificial lights, and this can effectively be used to adjust waking times.

Note that in a small minority of people, excessive bright light can make them "hyper" or almost manic. If you can't afford a light box, you can make one using four or five shop lights, each with two four-foot fluorescent tubes. Either hang them from the ceiling or make an easel-type frame. The centre of the lights should be no more than one foot from your eyes.

White tablecloth and white walls will raise the effectiveness.

The light therapy can best be used to "nudge" the sleep-wake rhythm from what you typically experience to what you would prefer. If you sleep from 4 am. to noon, bright light would first be given at noon for a few days, then at 11 am, then 10 am etc. Too rapid a jump would be likely to be counterproductive.

Suggested reading:

No More Sleepless Nights. Hauri and Linde, John Wiley & Sons, 1996.
Counting Sheep: the Science and Pleasures of Sleep and Dreams.  Paul Martin, Harper Collins 2002.

1.  Moul DE, Nofzinger EA, Pilkonis PA, Houck PR, Miewald JM, Buysse DJ. Symptom reports in severe chronic insomnia. Sleep 2002 Aug 1;25(5):553-63.
2. Bixler EO, Vgontzas AN, Lin HM, Vela-Bueno A, Kales A. J Psychosom Res 2002 Jul;53(1):589-92 Insomnia in central Pennsylvania
3. Lamberg L. JAMA. 2000 Nov 1;284(17):2173-5.Sleep disorders, often unrecognized, complicate many physical illnesses.
4. McCracken LM, Iverson GL. Pain Res Manag 2002 Summer;7(2):75-9 Disrupted sleep patterns and daily functioning in patients with chronic pain.
5. Kumar S, Bhatia M, Behari M. Mov Disord 2002 Jul;17(4):775-81 Sleep disorders in Parkinson's disease.

6. Ferini-Strambi L, Filippi M, Martinelli V, Oldani A, Rovaris M, Zucconi M, Comi G, Smirne S. J Neurol Sci 1994 Sep;125(2):194-7 Nocturnal sleep study in multiple sclerosis: correlations with clinical and brain magnetic resonance imaging findings.
7. Donker GA, Foets M, Spreeuwenberg P, van der Steen J. Ned Tijdschr Geneeskd 1996 Jul 13;140(28):1459-63 [Multiple sclerosis in family practice]
8. Han SY, Yoon JW, Jo SK, Shin JH, Shin C, Lee JB, Cha DR, Cho WY, Pyo HJ, Kim HK, Lee KB, Kim H, Kim KW, Kim YS, Lee JH, Park SE, Kim CS, Wea KS, Oh KS, Chung TS, Suh SY Nephron. 2002 Sep;92(1):127-32.. Insomnia in diabetic hemodialysis patients. prevalence and risk factors by a multicenter study
9. Poirrier R. Rev Neurol (Paris) 2001 Nov; 157 (11 Pt 2): S140-4 [Photoperiod phototherapy and wakefulness-sleep rhythm disorders.]
Dr. Sarah Smith (nee Andreae-Jones) MB BS
September 2002