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Up at 4 a.m.:Case Study of Chronotherapy for Delayed Sleep Phase Syndrome (Disorder)

Updated on May 27, 2013

I have Delayed Sleep Phase Disorder.  DSPS, or phase lag syndrome, is a circadian rhythm disorder.  DSPS is relatively rare, often misdiagnosed and difficult to treat. 


A Brief Explanation of DSPS


Circadian refers to the 24-hr wake/sleep cycle.  Your circadian rhythm doesn’t just regulate sleep patterns it also regulates the body’s core temperature, endocrine (gland and hormone) function, airway function, and kidney (renal) function. A person with DSPS has an internal clock that is out of synchronization with his or her external environment.

Simply put for the majority of human beings, as the day turns to night, their internal clock signals changes in the body and brain that signal sleep. For the person with DSPS, it’s quite the opposite.

Help for DSPS

There is no cure for DSPS and it does not respond to insomnia medications. Some people have gotten relief with the sleep medication, Rozerum. (You know the commercial with astronaut, beaver and Abraham Lincoln? “Your Dreams Miss You.")

Others respond well to taking over the counter melatonin.

Nothing has worked for me. In desperation, I tried Chronotherapy.


Chronotherapy Explained

Chronotherapy involves progressively going to bed and waking up three hours later for six consecutive nights. For example, my natural rhythm is fall asleep at 3 a.m. and wake up at 10 a.m. Therefore my sleep schedule for the week would look like this:

Day 1 - Go to bed at 6 a.m. and wake up at 1 p.m.

Day 2 – Go to bed at 8 a.m. and wake up at 4 p.m.

Day 3 –Go to bed at 11 a.m. and wake up at 7 p.m.

Day 4 – Go to bed at 2 p.m. and wake up at 10 p.m.

Day 5 – Go to bed at 5 p.m. and wake up at 1 a.m.

Day 6- Go to bed at 8 p.m. and wake up at 4 a.m.

Day 7- Go to bed 11 p.m. and wake up a 7 a.m.

This basically forces you into a “normal” sleep rhythm, however it doesn’t work for all people with DSPS and it often has to be repeated.



My Chronotherapy Experience

Because I work a “9 to 5 “job the first thing I had to do was get permission from my boss to work “weird” hours.

Day 1 –Monday

I stayed up until 6 a.m. on Monday and then went to sleep at 6 a.m. Although I told everyone in my house to NOT DISTURB me between 6 a.m. - 1p.m. I was woken up at 9, 10, and 11. I suggest if you can afford it, go somewhere quiet and alone for a week. A cabin in the woods, or a fancy hotel on the beach would be my first choice. Despite, those issues, I did wake up at 1 p.m. and felt relatively refreshed. I showered, dressed, ran some errands, did some sewing, and made dinner. I spent 5:30-9p.m.with my husband. At 9:30 p.m. I went to work. Made coffee and had a semi-productive night. I found out that night a friend’s daughter had died, so I spent time informing mutual friends and crying. I think it affected the experiment in that it helped keep me up until my next bedtime, 8 a.m. Tuesday.

Day 2 –Tuesday

It was a little hard staying awake until 8 a.m. I gave up at work at 5:30 a.m. and started my drive home. There were some scary moments on the drive. I HIGHLY recommend if possible you take leave from work before starting chronotherapy. I got home at 6 a.m. Hubby was getting ready for work. I watched the old Batman TV show and ate an English muffin. I took a shower and was able to make it to 7:30 a.m. I figured it would take me 2-30 minutes to fall asleep. I feel asleep instantly. I woke up at 2 p.m. – My daughter called she needed a ride. After that, I went over to a friend’s house and worked on a logo design for him.

At 7:30 p.m. I went home and had dinner with my husband and I went to work at 10 p.m. And I stayed until 6 a.m. when I went home. I had plenty of work to keep me awake and occupied. Again the ride home was a little difficult.

I struggled to stay awake until 11 a.m. when I could go to sleep again.

Day Three- Wednesday

By day three, I felt like it was working because I was falling asleep and staying asleep at the appointed hours. Everyone else seemed annoyed that I was not available at their convenience. Too bad. They weren’t the ones who hadn’t slept in 20 years! People were still calling me and waking me up. AAARGH!

This time I went to work at midnight and stayed until 1p.m. Thursday. I had reached that adrenalin high you get when you stay awake way to long. I got home and literally passed out at 2 p.m. I was supposed to get up at 10 p.m. but I woke up at 8:30. Things got really rough!

Day 4 – Thursday.

I had to stay awake from 8:30 p.m. Thursday until 5 p.m. Friday. I was too tired and sleep deprived to do anything constructive or useful so I just watched TV. I did OK until about 2 a.m. and then I really struggled to stay awake. (My normal sleep cycle is 3 a.m. - 10 a.m.) I made it to 3 a.m. I watched a movie about Ernie Pyle. Apparently I drifted off near the end, because all of a sudden something else was on. I got up washed my face and walked around. I was so exhausted I got back on the couch and started watching that movie. I drifted off again. Woke up to a new movie. I actually watched that entire one. By then it was 7:30 a.m. and time to get ready for work. I guess all the drifting off revived me, because I felt pretty good as I drove to work. By the time I got there I was super tired and needed coffee. I couldn’t wait for lunch time.

I had also started having a lot of joint paint and neck and back stiffness and I was real cranky! I just wanted everyone to leave me alone. All I thought about was sleeping.

Day 5 – Friday

I went home at 3:30 p.m. Showered and went to bed at 5 p.m. I had a hard time falling asleep and I woke up a lot. I also woke up hungry. I got up at 1 a.m. My husband tried to be supportive and stay up with me. I tried watching movies. Again once I hit the 3 a.m. wall (because this is when my brain really wants to shut down) I struggled to stay awake. I was so tired, in so much joint pain that I didn’t even care anymore.

Day 6- Saturday

By now it was Saturday and we were moving into day six. I got up and made biscuits and eggs for me and my husband. The struggle got harder. I told him if he saw me fall asleep to talk to me and make we up. This seemed to drag on for hours. I at some point I fell asleep and he didn’t wake me up. I woke up at 11:30 a.m. We picked up my daughter, had lunch, the rest of it is kind of a blur. I remember being constantly tired. We moved some stuff to a friend’s new apartment. I was supposed to go to sleep at 8 p.m. but I was hungry and had gotten a second wind. I ended up going to bed at 9 p.m. and I had a hard time falling asleep. Once I did I tossed and turned. I set my alarm to wake me up at 4 a.m. I didn’t fall asleep until 2 a.m.

Day 7- Sunday.

I woke up at 11 a.m. I was supposed to get up at 7 a.m. Sunday night I did go to bed, like a normal person at 11 p.m. I was unable to fall asleep, but I did not turn on the TV or get on the computer. I think I fell asleep between 1 and 2 a.m. and woke up at 8 a.m. I was still able to make it to work a little after 9 a.m.

The Conclusion

Overall, I have to say it was very painful and did not fix my circadian rhythm. It could be because I messed it up on Friday-Sunday. I don’t know if I will try again. Also, I go to school via the internet and can only work on my assignments at night. By the time I get home from work, cook, spend time with my family, etc. it’s 9 or 10 p.m. before I get started and 12-2 a.m. when I finish.

On Monday I went to bed a 12 a.m. Tuesday, I was cleaning and getting ready for out of town guests so I was up till 1 a.m. Wednesday, either it was sheer exhaustion or the two beers I drank but I was in bed by 10:15 p.m. and asleep by 10:45. Thursday, I was up till 1:30 a.m. doing homework. At least I am falling asleep before 3 a.m.

Next, I am going to try Blue Light Therapy. I’ll let you know how it goes.


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