Delayed Sleep Phase Disorder (DSPD) is a phenomenon in which the internal circadian clock is set to a time relatively late compared to desired sleep timing. DSPD is characterized by difficulty both going to sleep at a desired bed time and waking up in the morning. DSPD is very common in adolescents as they have both biological and social changes that cause a delay (latening) of circadian timing. This results in an abnormally late bedtime. The delay in sleep timing, by itself, is not problematic. When wake time is fixed, however, as it is for most adolescents attending school, DSPD results in a curtailment of sleep that is associated with a variety of negative consequences including depression, substance abuse, fatigue, poor academic or work performance, poor socialization, increased risk-taking behavior, and an increased risk for the development of diabetes and obesity. The loss of sleep in adolescence is pervasive and often debilitating for both the teen and the family. Bright light "phototherapy" is often prescribed for treatment of DSPD. This treatment consists of 2-3 hours of bright light administered every day prior to desired wake time to advance the timing of the circadian clock to an earlier hour. This means that an adolescent who needs to wake up at 7AM for school would need instead to wake up at 4 or 5AM and sit in front of bright lights for 2-3 hours every day, a difficult if not impossible set of instructions to follow. Recent data from our laboratory has shown that a sequence of brief, millisecond flashes of light can change the timing of the circadian clock. Furthermore, these flashes of light can change circadian timing while the subject is asleep. That is, the flashes can be administered during sleep and the light will penetrate closed eyelids. When light is administered in such a manner, it does not disturb sleep.
We aim to examine the novel hypothesis that a sequence of bright light flashes administered during sleep to adolescents with DSPD can change the timing of the circadian clock such that it will be set to an earlier hour and enable an earlier bedtime. We hypothesize that this will improve the symptoms of DSPD as well as improve overall mood and behavior. In order to examine these hypotheses, adolescents enrolled full-time in high school will be recruited to take part in a one-month, at-home study. During every night of this month, participants will be exposed to a sequence of flashes while they sleep. The quality of their sleep, as well as measurements of mood from both the adolescent's and the parent's perspectives, will be captured before, during, and at the end of the protocol. Results from this experiment could fundamentally change the manner in which DSPD is treated, significantly improving sleep in adolescents and simultaneously improving mood, academic performance, and family life. Results from this study will also be useful in understanding how light administration during sleep could be useful in the treatment of other circadian-based disorders, such as jet lag, shift work sleep disorder, and Advance Sleep Phase Disorder.

Public Health Relevance

Delayed Sleep Phase Disorder is an intrinsic, biological disruption characterized by being unable to go to sleep early enough and sleeping insufficient amounts;it is pervasive in teens. In addition to daytime fatigue, this loss of sleep is associated with negative behavioral (increased risk taking, depression, agitation, and hyperactivity), cognitive (poor academic performance), medical (increased obesity), and social (increased truancy, increased family tensions, difficulties with socialization) consequences. This project intends to examine a novel therapy for this disorder, one that would require minimal effort and cost to enact and could redefine how this disorder is treated.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Exploratory/Developmental Grants (R21)
Project #
5R21HD073095-02
Application #
8641407
Study Section
Cardiovascular and Sleep Epidemiology (CASE)
Program Officer
Haverkos, Lynne
Project Start
2013-04-01
Project End
2015-03-31
Budget Start
2014-04-01
Budget End
2015-03-31
Support Year
2
Fiscal Year
2014
Total Cost
$228,906
Indirect Cost
$83,106
Name
Stanford University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
009214214
City
Stanford
State
CA
Country
United States
Zip Code
94305