Chronotherapy for treatment of severe sleep phase delay in an adolescent girl

Aims: Healthy, adequate sleep is integral to the process of growth and development during adolescence. At puberty, maturational changes in the underlying homeostatic and circadian sleep regulatory mechanisms influence the sleep-wake patterns of adolescents. These changes interact with psychosocial factors, such as increasing academic demands, hours spent in paid employment, electronic media use, and social opportunities, and constrict the time available for adolescents to sleep. As a result many adolescents have a delayed sleep phase, which makes falling asleep difficult and getting up for school even more difficult. This paper reports a severe case of delayed sleep phase disorder (DSPD) in an adolescent girl that was confounded by anxiety and school attendance issues. Methods: A chronotherapeutic approach was taken using natural light exposure at specific time points and a forward moving sleep restriction schedule, advancing bedtime three hours every night, over one week. Results: The sleep schedule was reprogrammed from a pre intervention mean sleep onset of 02.00h to a mean sleep onset of 22:30h. Secondary anxiety was alleviated and the sleep schedules were maintained 2 months later. Discussion: This forward moving chronotherapeutic schedule was, successful in achieving a stabilised sleep p/wake pattern and a reduction of anxiety. This was achieved with simple sleep restriction and natural light exposure. Whilst compliance can be difficult for this intervention, this case suggests that it is a promising treatment for severe delayed sleep phase in adolescents.