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People with DSPD fall asleep at more or less the same time every night, and sleep comes quite rapidly if the person goes to bed near the time they usually fall asleep. Young children with DSPD resist going to bed before they are sleepy, but the bedtime struggles disappear if they are allowed to stay up until the time they usually fall asleep.
A circadian rhythm is an entrainable, endogenous, biological activity that has a period of roughly twenty-four hours. This internal time-keeping mechanism is centralized in the suprachiasmatic nucleus (SCN) of humans, and allows for the internal physiological mechanisms underlying sleep and alertness to become synchronized to external environmental cues, like the light-dark cycle. [4]
Sleep-phase disruption is also common among adolescents, whose school schedules are often incompatible with their natural circadian rhythm. Effective treatment begins with careful diagnosis using sleep diaries and perhaps sleep studies. Modifications in sleep hygiene may resolve the problem, but medical treatment is often warranted. [34]
Here is an example of how chronotherapy could work over a week's course of treatment, with the patient going to sleep 3 hours later every day until the desired sleep and wake time is reached. [1] Day 1: sleep 3:00 am to 11:00 am; Day 2: sleep 6:00 am to 2:00 pm; Day 3: sleep 9:00 am to 5:00 pm; Day 4: sleep 12:00 pm to 8:00 pm; Day 5: sleep 3: ...
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Insomnia cannot be blamed for all the deficits the patient is experiencing in their daytime life (not all problems will go away once the patient is able to sleep); this is important to know, because it takes some of the unrealistic expectations off sleep. It is not helpful to try to sleep – trying harder will only keep the patient more awake.