Assessment and treatment of Delayed Sleep Phase Disorder in adolescents: Recent innovations and cautions

DSPD is the most common condition with which adolescents present to sleep clinics. Recent innovations in phase-advancing the delayed circadian rhythm include: (1) commercial availability of home assessment of DLMO with sequential salivary melatonin assays, which allows for specific timing of evening melatonin administration based on markers of circadian biology; and (2) brightlight therapy with short-wavelength (green) LED glasses. There is also good evidence to support the use of broad-spectrum white light, as well as sunlight, to phase-advance adolescents sleep timing. The authors encourage clinicians to be cautious of long-acting melatonin preparations because they may inadvertently worsen the phase delay, and to be wary of chronotherapy because of the limited available evidence. Finally, although more evidence is needed to support its use, motivational interviewing may be a useful technique to supplement the aforementioned treatment strategies.