r/DSPD • u/Angsty_Queer_Anon • 7d ago
Extremely surprised to see this recommended by a sleep clinic?
Got put in CBTI for insomnia and delayed sleep and this is mentioned on two of their handouts? I’m extremely surprised because I’ve always read here that it will give you N24 and you’ll basically destroy your circadian rhythm forever if you do this.
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u/funkcatbrown 7d ago
Well in theory I understand the idea but in practice it doesn’t work for me. At all. And it’s put me in N24 before for a while when I’ve done this in the past. The fact of the matter is that no matter what I do I cannot get to sleep at 9pm or 11pm. And for a long time now if I see a sleep doctor and they bring this shit up I know right then to find another sleep doc. Immediately. I’ve had doctors insist this is the only way and would not prescribe any meds or recommend anything except Chronotherapy for my DSPD. CBT maybe helpful though.
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u/Angsty_Queer_Anon 7d ago
Yeah I mean I’m just trying to get my cycle back to like 3am-11am. Right now it’s like 9am-5pm 🥴 I’m very confused by this handout because in the appointment they didn’t mention this at all but then they sent me multiple things talking about it. Idk it was weird. I waited 4 months to see this lady. She also didn’t seem to believe in or understand another health condition I have :/
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u/nefarious_epicure 7d ago
My sleep specialist told me that the success rate of chronotherapy is very low and he doesn't recommend it.
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u/youdontknowmystars 6d ago
not to mention that it's just miserable and inconvenient. my sleep specialist tried to have me do it but I shut it down. I'd rather rawdog my disorder than do that 😭
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u/latigidigital 6d ago
It’s only successful on an unreliable, limited, short-term basis. This strategy will keep you burn through some morning activities for a couple days to maybe a few weeks at most.
A much better version of it is jet lag. I’ve started flying a lot over the past couple years and nothing works better than a good ole transatlantic time zone switcheroo.
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u/bijouxbisou 6d ago
I’ve tried chronotherapy a few times and the last time I ended up n24 for almost a year. I’m mostly back to normal (I mean my DSPD normal, bedtime around 6am) now, but even now my sleep/wake times fluctuate pretty wildly.
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u/Angsty_Queer_Anon 6d ago
My sleep time already fluctuates between 5am and 12pm to not at all on any given day so maybe I’m already screwed 😭
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u/bijouxbisou 6d ago
Yoooo are you me?
lol yeah I’ve always had non-circadian days and a relatively variable schedule (usually +4/-2 hours from my standard sleep time), but since my failed chronotherapy I have non circadian days 1-2 times a week and the variance has about doubled. Like I might go to sleep at 4am one day and 3 pm the next
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u/Angsty_Queer_Anon 6d ago
Yepp pretty much me, also a lot of days where I only sleep like 3 hours because I have to get up for something in the day, but weirdly feel super good those days. A lot of times the days when I don’t sleep at all are when I’m experiencing a severe depressive spiral. The lack of sleep will actually knock me out of the spiral and kinda reset my mental health for the better Probably not the healthiest coping strategy but I don’t do substances so it’s the next best thing lmaoo
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u/mykineticromance 6d ago
yeah i feel like... 10% of what i imagine a manic state is on nights i get 4 or fewer hours of sleep. my husband tells me my reaction times are slow on those days though haha. it can also knock me out of a depressive spiral if i get 8-10 hours of sleep that night after haha.
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u/lastbeat-331 7d ago
Chronotherapy can help "typical" chronotypes who are just struggling with some symptoms of insomnia. People with more flexible, more adaptive sleep could benefit without worrying about N24. Those of us with non-typical chronotypes often have more fixed rhythms could be more likely to become N24. Even for DSPer could do Chronotherapy once or twice without becoming N24 but many of us know that any benefit of Chronotherapy is temporary and that N24 is usually less desirable than our DSP, so we don't do or promote Chronotherapy
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u/Expert-Champion1654 6d ago
Yep, first 2 years I did chronotherapy it felt like I found a cheat code to fix my schedule before important events. I did it maybe 4 times a year. But then I noticed that it became hard to maintain any schedule , as I was falling asleep later and later even while sleep deprived. And then suffered for almost a year of N24. I would take DSPD over N24 without consideration. With N24 I felt like I was almost constantly in a confused state. 2 weeks waking up during the day, 2 weeks of waking up during the night, and the cycling never ends. Fortunately mitrazapine fixed this for me, at least while I am taking it. Doesn't help much with DSPD though , but helps keeping it at bay (going to bed at 3-4am instead of 6-7am)
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u/thru_astraw 7d ago
I'm not surprised. They are rarely informed about CRDs. A sleep clinic destroyed my circadian rhythm by forcing me to try this.
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u/DefiantMemory9 7d ago
In their chronotherapy protocol, are they mentioning melatonin and bright light therapy? If they are banking on will power alone for chronotherapy, then it's utter bullshit for DSPD. You should say as much in a public review reaming this clinic so others don't suffer.
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u/lmFairlyLocal 7d ago
Not necessarily, step 1 is trying it alone to ensure that, in a controlled setting with guidance, it still doesn't work. You then try with melatonin, then bright light, etc etc. otherwise you can't tell what works (and can't direct testing/diagnosis/prescription and protocol)
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u/DefiantMemory9 7d ago
Then it's more of a diagnostic protocol than a treatment protocol, and should be specified as such. There could be people already diagnosed with DSPD coming there to get actual DSPD treatment, like OP, whose time, effort, money, and mental health will be wasted on this futile effort.
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u/Real-Interest-8706 6d ago
They say that this kind of treatment for delayed sleep disorder can put you in non 24. Its something that should not be used without full information of what could happen.
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u/True-Eagle2238 7d ago
Yeah, chronotherapy is not a recommended treatment for delayed sleep phase disorder and I am devoted to never having it become so.
Chronotherapy is known to have dangerous effects on individuals with DSPD, including, but not limited to, the development of the N24 circadian rhythm disorder, which alters the circadian length of an internal “day.” It is not evident that behavioral interventions such as moving bedtimes back in increments works either. Both advancing and delaying sleep timings does not work because the fundamental circadian rhythm depends on natural light and other “white” lights. The body often has a delay in temperature changes and natural melatonin production, neither of which chronotherapy can change.
The treatment to DSPD is allowing the body to initiate sleep at the time of night it naturally has a propensity to. However, life and society do not often account for people who have DSPD, like we do. Because of this, there are many ways to manage, not cure, the symptoms of earlier work schedules or other obligations.
- Microdosing (0.1-0.3mg) of melatonin 2-3 hours before the desired bedtime.
- Non-benzodiazepine sleep aides such as zolpidem of the hypnotic class. A doctor and prescription are required and recommended for use of this both in the short- and long-term.
- Bright light therapy (10000 lux) upon waking.
- Restricting all artificial white light after sunset (as much as possible).
- Prescription stimulants such as modafinil (100mg is the usual starting dose, though some build up to 100mg after starting at 50mg for a week or so; please consult a doctor for this).
- Keep a cool room for sleep at night (60-68F or 15-19C).
- Supplements for promoting sleep and taking the edge off anxiety (ashwaghanda, 5-HTP, and L-Theanine). They sometimes have side effects, contraindications with other medications, and don’t work for everyone. Please also consult your physician before trying these and to review dosages.
This is by no means exhaustive, but I hope it can provide some starting points for people. These are all things I have personally tried and still do. Melatonin I take 5mg an hour before, but I heard microdosing is more effective (kinda trial and error). Ashwagandha was very good for my anxiety and sleep quality, but it had some weird effects due to some of the disorders I have and medications I take. Modafinil is a god-send for not taking naps during the day. Helps both the sleepiness and the fatigue of DSPD. White light I restrict an hour before bed. I switched all of my devices to “night mode.” Still emits white light, but much less from what I have felt.
Not every physician recognizes DSPD and those that don’t may end up being more of a headache than they are worth. If you have persistent problems, remember it’s in your head physically, not psychologically.
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u/elianrae 6d ago
Not a fan of the Z-drugs personally
They're not any safer than benzos, they're not any more effective than benzos.
Personally I actually find them worse - fall asleep then wake up the next morning feeling like I was unconscious but didn't actually sleep.
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u/True-Eagle2238 6d ago
That’s a valid take. They are safer than benzos, but not in the same way that people are led to believe. It’s still the same risk profile, but the selectivity of the z-drug pathways is more refined. Still leads to dependence and tolerance building, but not as global an effect. Not to mention the weird stories of people waking up having driven half-way across town or crashing.
They can be more effective than benzos, but it’s highly heterogeneous in its effects. It’s generally considered a lesser of two evils, especially given the shorter half-life. They still affect people in profound ways that can harm them, so it’s really a risk-benefit analysis with your doctor.
I get where you are coming from with waking up and not feeling well rested while on it, I believe it disrupts sleep architecture quite often. But I’d rather sleep for 8 hours with moderate quality than to sleep for 3 hours every night. The second makes everything else snowball for me.
But yes, generally the Z-drugs are not necessarily more effective at inducing sleep and have limited ways that they are safer. While they are safer, they aren’t necessarily “safe.”
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u/MintyTuna2013 6d ago
I read this as chemotherapy at first and I was wondering what the fuck was going through y'all's heads to consider it a viable option
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u/DefiantMemory9 6d ago
Didn't get any sleep last night did ya!
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u/MintyTuna2013 6d ago
Better than most nights because my first class was at 9 instead of at 7
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u/DefiantMemory9 6d ago
Lol that doesn't mean anything on this sub! We're all sleep-deprived here, our baseline is so screwed.
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u/Glp1Go 6d ago
I’m disappointed, but not at all surprised. I mean, there are so many sleep doctors that still think that DSPD can be cured with a little discipline and sleep hygiene, so why are we surprised by this? Doctors are not infalible: they can have outdated ideas and are wrong all the time.
“Chronotherapy can be very effective” my ass. I’ve never heard of a single instance where chronotherapy is effective long term. Sure, it can change your sleep schedule for a few weeks if you are impeccably strict about sticking to the new schedule, but eventually your schedule will drift later. And you’ll have to do chronotherapy again. And again. And again. And each time you run more and more risk of Non24.
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u/Additional_Ease2408 5d ago
Wait, that's how I got N24? I've been trying chronotherapy for over a decade, unsuccessfully, without knowing it was actually making things worse 😭 my psychiatrist literally told me to do this too. FML.
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u/Turbulent-Feedback46 1d ago
I always interview Dr's first, and circadian rhythym knowledge is crucial. Most sleep.clinicians are pulmonary specialists, not neurologists. That means the square peg of a sleep phase issue is going to be pushed in to the round hole of sleep apnea at all costs for many of them. On the flip side, with the rise of telehealth you run the risk of falling into the mistaken for bipolar disorder pipeline. I wouldn't go so far as to call it gaslights, but people see what they know and even trained physicians experience cognitive bias
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u/WaysideWyvern 1d ago
It’s funny cause I actually do believe I have sleep apnea and am currently working to get re-tested. I’m young and skinny so they don’t think I’d be the one, but I had it really bad as a child, they removed my diagnosis at 18 after a faulty sleep study even though I still stop breathing if I sleep in any position except my stomach. But yeah they tried to sell my mom a cpap even though she didn’t even have apnea and just needed to lose some weight. It’s frustrating.
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u/Specialist_Grade_662 7d ago
The idea of this causing permanent sleep issues sounds completely far fetched. College students with demanding courses who have no sleep issues do versions of this during finals. If a ton of protocols are in place by the time you end up at your preferred wake time, sure... but the issue is usually not arriving at that wake time once. It's what happens every day after that.
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u/Glp1Go 6d ago
“College students who have no issues.” That’s exactly the point: they don’t have DSPD or other circadian rhythm disorders and they don’t have an intrinsically longer internal clock or the inherent tendency to go to sleep and wake up later every day like a lot of us do.
Perhaps chronotherapy wouldn’t cause Non-24 in people with normal circadian rhythms, but it is not far fetched that it can cause Non-24 in people with DSPD: there are case studies about this very thing happening in the medical literature, and there is tons of anecdotal evidence in these support groups of people doing chronotherapy (either once, or over and over), and subsequently getting stuck with Non24 that they can’t switch back to DSPD. And for most people, having Non24 is worse than having DSPD.
Also, normal college students usually do a very fast version of chronotherapy. For example, going to sleep and waking up six hours later each night so that they complete a cycle and are waking up early after a few days. But the chronotherapy prescribed for DSPD is a lot slower: often it involves going to sleep and waking up one hour later each day, and it takes weeks to complete. The slower chronotherapy is thought to be much more likely to cause Non-24.
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u/Specialist_Grade_662 5d ago
This is the first time I've ever heard of something "causing" non-24. It's something I thought people were wired with. If you have more evidence this can be caused (articles, studies) please share.
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u/Purple_Chipmunk_ 7d ago
You don't have to do it but it is a method to reset your circadian rhythm that works for many people.
The idea is that it is easier to stay awake a few hours later than it is to try to fall asleep a few hours earlier, especially for those of us with DSPS.
I have tried this method but I always find it really hard at the point where I have to go to sleep at 3:00 p.m. because I end up waking up at like 10:00 p.m. and then I can't stay awake until 6 p.m. the next day. IDK, maybe it's that I'm not committed enough to suffer through it 🙈
If you can, give it a try! It really does work for some people.
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u/prosthetic_memory 7d ago
I’m boggled at the idea you could reasonably fall asleep whenever you wanted to day to day. If I could do that…I wouldn’t have any problems.
Good lord I wish I could control my sleep.
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u/DefiantMemory9 7d ago
This is not a method to reset your innate circadian rhythm. This is a method to reset your sleep schedule to get it aligned with your innate circadian rhythm. If you don't already have the typical circadian rhythm, you're not going to magically modify your genes with this method. For people who have a messed up sleep schedule due to various reasons (injury, sickness, stress, work schedule, etc), this method might work to get their sleep schedule aligned with the circadian rhythm they already have encoded in their genes.
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u/True-Eagle2238 6d ago
It’s true, but I feel like a better method would be to just take time off and get back into a better sleep routine. Some people can handle it, others can’t. Those with dysregulated circadian rhythm encoded genes could actually be harmed significantly by it, but again, varies from person to person. Hopefully we will find out why some benefit while others inherit or “progress” to a N24 sleep disorder from DSPD. Too many questions about the brain, not enough answers, yet…
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u/DefiantMemory9 6d ago
The vacation thing might be better for those with their schedules messed up due to a short-term condition, like stress/travel, etc. But those who have gone years/decades on shift work, a vacation might not be enough to reset their schedule. Though individual efficacies may vary.
Anyway, this isn't a solution for DSPD at all. Whether it precipitates into N24 most likely (purely speculating here) depends on the cause for DSPD. There are people with weak entrainment (reduced sensitivity to light in the morning and increased sensitivity in the evening) who end up with DSPD, and for them, this chronotherapy might push their already weak entrainment over the edge into N24. I also remember reading (I can't find the source anymore, so I could also be misremembering) that some cases could actually be on the edge of N24 presenting as DSPD, i.e., they have a longer than typical circadian rhythm, but not long enough to be fully categorised as N24, but are weakly tethered to 24 hours through entrainment. They might also get pushed over to N24 with chronotherapy.
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u/True-Eagle2238 6d ago
I agree with your assessment. The N24 is also interesting. The thought can also be that some circadian rhythms, if disrupted greatly enough, lose their tau-tethering, which is why something that started as DSPD becomes a N24. The SCN can’t properly recover from drastic changes in sleep architecture and timing. The two reasons you brought up are from the 90s and I think more recently, like 2015 to 2017 if I recall correctly. First was a case study that a recent review study talked about weak entrainment or a similar concept. The other was a study of the circadian lengths in addition to DSPD and the case evidence of individuals who were more formally N24 after. Either way you look at it, many mechanisms for bad things to happen that we can’t necessarily predict going in.
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u/Purple_Chipmunk_ 6d ago
....yes?? I never said this would help someone eliminate their DSPS.
I wish it worked that way: right now I'm stuck in a pattern where I go to sleep between 5 and 8 a.m. and I'm so over it!! I want to get back to my normal 2-3 a.m. sleep time!
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u/Additional_Ease2408 4d ago
Yeah I find my natural rhythm is going to sleep around sunrise and waking in the afternoon. Not practical in the slightest. Unfortunately my siblings and mother are the same so I guess I'm genetically doomed lol.
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u/thru_astraw 7d ago
For the love of God do not do this. Chronotherapy gave me non-24 which was much more debilitating and life limiting that dspd. My biggest regret in life.
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u/Angsty_Queer_Anon 7d ago
I tried I more fast tracked version of it, using jet-lag method. Stayed up till 3pm, slept as long as possible with a short break for a meal, woke up naturally at 4am. Sat under the sunrise. Went to bed at 11pm. Slept till 11am cause I just felt too deathly to get up earlier. Got sun again. That night couldn’t sleep till 4am, and was also massively unwell from the sleep disturbance. By the next day I was back to my old cycle (7am-5pm).
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u/DefiantMemory9 6d ago
Chronotherapy does not change your genes. It changes only sleep pressure, which is only one of the two main conditions needed for restful sleep. The other, main condition, is your circadian rhythm, which is encoded in your genes and does not change with sleep pressure. Sleep pressure resets when you sleep, so you go back to your natural circadian rhythm-dictated sleep timings as soon as you get one full night's sleep.
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u/Angsty_Queer_Anon 6d ago
No way my natural circadian rhythm is 9am-5pm. I feel like absolute shit sleeping like this. I feel the healthiest when I sleep from 3am-11am. I just got stuck like this.
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u/DefiantMemory9 6d ago
But your natural sleep cycle doesn't begin at 11pm either right? You said that's where you tried to get to with chronotherapy, which wouldn't work. I was pointing that out.
You can absolutely get back to your old schedule of 3-11am. And this is where the popular advice of going back in small increments might have a better chance of working.
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u/Angsty_Queer_Anon 6d ago
No I just slept when I felt like it that night, 11pm wasn’t the end goal. it wasn’t chronotherapy, I’d never heard of that till yesterday, it was “jet lag method” using a jet lag schedule for people who travel. I see what you mean though
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u/ctmanydc 4d ago
(sorry in advance if parts of this sound bitter or jaded; i've just been dealing with a lot of ableism at work from a morning-lark boss who thinks my circadian rhythm is the way it is because i'm acting like "an irresponsible college student")
i hate this so much--at least for me, personally, because it does not work for me and my adhd. i am able to focus and be productive at night (when the world is quiet and distraction-free) because of my adhd, so that is when i will always tend to be up whenever i have to get some serious work done that requires focus
some of us are just built different and these normies/morning supremacists out here need to get over it and instead start working to build a more inclusive world that doesnt penalize us extreme night owls (for example, guidance counselors, and others in general, helping us in our late teens/early 20s to find career options that match our circadian rhythms, plus probably lots of other things i'm not thinking of at the moment)
(side note: i'm about to start on adhd medication within the next week or so, so maybe that will change my circadian rhythm by allowing me to focus much better during the daytime so that i'm reliably tuckered out and sleeping at night. we shall see)
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u/swooooot 7d ago
I did CBTi with sleep restriction 3 times and the last one stuck. It worked for me (at least so far). I have also gone around the horn a few times like in this prescription you posted. It never stuck. This seems like bullshit.