In general, it is best to maintain a regular bedtime, and wake up time, even on the weekends, to ensure you remain in sync with the environment. In your situation, however, we recommend a short nap of 30 minutes during the day: this restricted duration is restorative, yet produces minimal grogginess (“sleep inertia”) when you wake up. Set your cellphone timer to alert you to get up, and don’t nap once evening approaches. If you do feel groggy after the nap, you could drink a caffeinated beverage immediately upon awakening.
It depends on the individual. Six hours is around the short extreme, and nine hours is around the long extreme. Most people fall somewhere in the middle. How can you tell what’s right for you? One clue is whether you feel work or family pressures are preventing you from going to bed, or staying in bed, when you’re sleepy. The best measure, though, is if you feel alert throughout the day, stay in a reasonably good mood, and don’t oversleep on days off. If you don’t do all three of these things, you should test whether a longer sleep interval — daily throughout the week — does the trick. On the other end, some people allow themselves to sleep longer than they need, and they pay for this with low mood and fatigue during the day. They often say to themselves, “If I could only sleep longer, I would have more energy the next day.” That may be a reasonable intuition, but it is a mistake. Longer sleep than necessary can feed depression and a sense of exhaustion.
It’s relatively difficult to answer such a question without knowing the patient, for example, the temperamental characteristics of the patient. It sounds as if he might be a morning type, which occurs frequently in toddlerhood, especially in children born preterm. I would suggest avoiding later diurnal naps, and trying to consolidate the nap, for example, between 1 and 2 pm. The parents can enrich the diet with nutrients rich in tryptophan, which is useful for sleep continuity.
At this moment I would not consider pharmacological treatment because we speak about a chronotype which can vary with age, and no diurnal consequences are reported about possible sleep restriction.
Eleven hours of sleep a day could be sufficient, following recently published recommendations from American Academy of Sleep Medicine (AASM) and the National Sleep Foundation.
Your target of achieving 7.5 hours of sleep is excellent, and in line with most studies that suggest we should obtain 7-9 hours of sleep per night. It is always better to allow additional time to fall asleep. Thus, you should go to bed at 8:50 PM. If you fall asleep faster (before 40 minutes), you will obtain a little more sleep, which will be beneficial.
You’re right: it is quite possible that you are using the light box too early, for too long a duration, at too high an intensity—or combinations of these dosing factors. Let’s assume you are taking a 30-minute treatment session at 545am, while having woken up prematurely at 4am. As a first step, see whether delaying light therapy to 615am resolves the problem, fully or partially. You may have to play with session timing to get it right. You may also need to reduce session duration from 30 to 20 minutes, for example. The AutoMEQ gives a starting point for finding the precise session time to serve your need best—and that time may vary at different times of year. If the sun is rising at 5am in the summer, for example, you may need to reduce the light dose because natural dawn illumination is doing the trick for you. In the fall, if you start waking up later, you would resume treatment. This guideline applies whether or not you experience SAD.
Sleep need varies widely among individuals. A sign that you’re not getting enough is when you find yourself sleeping longer hours on days off compared with work days. Your goal should be to sleep the same hours all week long on a schedule that allows you to feel alert and energetic during the day. Statistically, it has been suggested that people who chronically sleep very long OR very short hours (for example, 10 hours or 5 hours) may have shorter life expectancy: but that’s just statistics, and doesn’t apply in every case. Some people sleep longer when they become depressed (or they become depressed when they sleep longer — we’re not sure!). In such cases, morning light therapy with earlier awakening can do the trick. Such people are often amazed that they do better with less sleep, and their impression that “if I could only sleep longer, I’d have more energy for day ahead” is proved wrong. As for alcohol, it may help knock you out, but the resulting sleep has poor physiological restorative quality and often leads to multiple awakenings during the night. Don’t do it!
You give lots of information about this difficult situation– ot enough to give a definitive answer, but plenty on which to speculate. First, you are not alone with this problem, which is typical of the delayed sleep phase disorder-in extremis– coupled with a fight to get to sleep on a normal nighttime schedule. As you say, the problem can be life-long, and it can get worse over time. In DSPD, sleeping pills don’t work because they don’t adjust the internal clock earlier, and several common sleep hygiene principles (for example, sleeping at night in a dark room) are irrelevant. One major question is whether, if you allowed yourself to sleep in a dark room during the day, you would have normal sleep duration. That’s an experiment–probably not a solution, assuming you are obligated to function during the day. Light therapy might provide a solution, but it will not work if you simply start doing it in the early morning (which, to you, is really early night).
A general strategy would be to: (a) find out when you awaken in the afternoon after you allow yourself to sleep during the day for several days; (b) begin light therapy at that hour; (c) gradually schedule light therapy (and wake-up) earlier over several weeks; (d) see if you become sleepy and can fall asleep gradually earlier at some point in this process. If it works, you can aim for wake-up when you are now falling asleep, which will need to be maintained by a daily schedule of morning light therapy. It may facilitate the transition to take a low dose of melatonin (1-3 mg) 12 hours before you use the lights–which means gradually, as you move the lights earlier. It may also be worth considering with your doctor the use of a new melatonin-like prescription drug, Rozerem, if you don’t find the melatonin helpful. Finally, keep room lights as low as possible and avoid work, physical activity, caffeine and heavy meals for at least five hours before you sleep. Obviously, you will not be able to keep a normal daytime work schedule during the transition period, so you will need a vacation or leave of absence of up to a month. We make all these suggestions on the assumption that you have DSPD; if the strategy works, you will validate the assumption. It would be best to proceed under monitoring and guidance of a sleep medicine specialist
Yes, the advanced sleep phase syndrome is opposite to the more prevalent delayed sleep phase syndrome. This may be caused by inappropriate light exposure, a genetic predisposition for a fast internal circadian clock, or both. You indicate that before your repeated light exposure at the “wrong time of day” you did not experience the problem, so the cause appears to be environmental. Yet, it seems that the problem did not resolve after you eliminated the problematic lighting exposure. We would need to know much more about your abnormal sleep, and also your work schedule, in order to make a specific recommendation (which is beyond the scope of this forum).
However, we can offer some general hints. Using bright light therapy just before your daytime sleep episode (say, noontime), followed by restricted light exposure (strong wrap-around sunglasses) for the rest of the day after you wake up, should begin to move your internal clock later. As this happens, you can delay the light exposure accordingly, until you are going to sleep in the late evening (say, 10 p.m.). You can expedite the process by taking a low dose of melatonin (say, 3 mg) when you wake up in late afternoon or early evening. Be careful never to use melatonin when exposed to bright outdoor or indoor light. Caveat: If you are getting significant sleep at night, beyond your daytime sleep, the solution would require clinical consultation with a sleep clinician.
It won’t work immediately to wake up at your target time. You need to start using the lights about 15-30 minutes before your normal (late) wake-up time, which will start to move your internal clock earlier. Every few days, you can advance your wake-up/light time by 15-30 minutes, depending on how early you can wake up easily. Over a period of time–which might last two weeks, for example–you will be able to approach your target (early) wake-up time. This cannot be done abruptly! If you have difficulty even with the small adjustments earlier, try low-dose melatonin (0.3 to 1.0 mg) 12 hours before your current wake-up time. As you move wake-up and lights earlier, also move the melatonin earlier.
This is a great, insightful contribution to our forum. Some thoughts in response: If you are finding it difficult to wake up on schedule, it’s a sign of that you have gained only partial effect. We want it to become easy to wake up at the target time. You might achieve this by increasing your light dose with higher lux (but please, not above 10,000 lux) or longer session duration. If the session gets as long as an hour, take a brief break in the middle for some stretching. Second idea: Short of using a dawn simulator, attach your bed lamp to an electronic appliance timer set for 15 minutes before wake-up, and then proceed to the bright light session. If you find the bedside light disturbing, stop using it. Third idea: Take a low-dose melatonin capsule (not more than 1 mg) in the evening 12 hours before the scheduled light session. This should reinforce the phase-shifting effect of morning light without making you sleepy immediately. Thus, you’ll go to sleep about four hours after taking the melatonin if you are an eight-hour sleeper. If the melatonin disturbs your sleep, stop using it. You are correct: once you slip later, you should not resume the lights at the target time, but rather edge earlier over several days from when you are waking up. Finally, during the four hours before bedtime, keep your room lights low-–just comfortable enough for reading, socializing and watching TV–and avoid exercise and stimulating work activities that can contribute to difficult sleep onset.