Delayed sleep phase disorder: clinical perspective with a focus on light therapy

Mariana G Figueiro, Mariana G Figueiro

Abstract

Delayed sleep phase disorder (DSPD) is common among adolescents and further increases their susceptibility to chronic sleep restriction and associated detrimental outcomes, including increased risk of depression, drug and alcohol use, behavioral problems, and poor scholastic performance. DSPD is characterized by sleep onset that occurs significantly later than desired bedtimes and societal norms. Individuals with DSPD exhibit long sleep latencies when attempting to sleep at conventional bedtimes. Circadian sleep disorders such as DSPD can occur when there is misalignment between sleep timing and societal norms. This review discusses studies using light therapy to advance the timing of sleep in adolescents and college students, in particular on those suffering from DSPD. A discussion on how to increase effectiveness of light therapy in the field will also be provided.

Keywords: adolescents; circadian; light; melatonin; sleep; sleep phase disorder.

Figures

Figure 1
Figure 1
Model for eyelid transmittance proposed by Bierman et al. Figure adapted from Bierman A, Figueiro MG, Rea MS. Measuring and predicting eyelid spectral transmittance. J Biomed Optics. 2011;16(6):067011. Copyright 2011 Society of Photo Optical Instrumentation Engineers. One print or electronic copy may be made for personal use only. Systematic electronic or print reproduction and distribution, duplication of any material in this paper for a fee or for commercial purposes, or modification of the content of the paper are prohibited. http://dx.doi.org/10.1117/1.3593151.
Figure 2
Figure 2
Flashing blue light mask used by older adults living at home. Notes: Flashing light was delivered through closed eyelids during sleep. The blue light mask shown here contains two blue LED arrays (λmax =480 nm, FWHM =24 nm), one for each eyelid. In the study, the light-stimulus condition was a train of blue or red light pulses: 2-second duration light pulses spaced apart 30 seconds, for no more than 3 hours, delivered before predicted minimum core body temperature. Photo courtesy of Lighting Research Center, Rensselaer Polytechnic Institute. Abbreviations: LED, light emitting diode; FWHM, full width at half maximum.
Figure 3
Figure 3
Correlation between DLMO and the predicted phase changes calculated from the Daysimeter data and the modified Kronauer model. Notes: (A) Measured changes in dim light melatonin onset (DLMO) from baseline to postintervention are plotted on the ordinate and circadian stimulus (CS)-oscillator model predictions based on actual measured light exposures during the intervention are plotted on the abscissa. (B) Measured changes in DLMO from baseline to postintervention are plotted on the ordinate and CS-oscillator model predictions based solely on the treatment light exposures (ie, not using light exposures measured throughout the day by the Daysimeter) are plotted on the abscissa. The ideal fit was determined using the least square method, where the difference between the measured DLMO and the predicted DLMO was calculated.

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