By Judith Canlas, ND
Dragon’s Medical Bulletin Nov-Dec 2023
Delayed sleep phase syndrome (DSPS) is the most common circadian rhythm disorder pattern where the person’s bedtime is delayed by two or more hours past the socially acceptable norm.
The exact cause of DSPS is not known, but it is proposed that there may be a genetic component involved wherein there is a higher incidence seen in those with a family history of it. It is also linked in those with psychological disorders such as depression, anxiety, attention deficit hyperactivity disorder and obsessive-compulsive disorder. Poor sleeping habits can also exacerbate it, such as being exposed to too much light in the evening and lack of light exposure in the daytime.
However, DSPS is not the same as being a “night owl”. A night owl often chooses to stay up late at night and can sleep in the next morning. But when they need to, they are able to revert back to a normal sleeping pattern. Whereas with DSPS, even if they desire to sleep early or are tired, they have a greater difficulty to adjust their sleeping pattern.
BM is a 33-year old female that presented with DSPS. She was prescribed zopiclone by her medical doctor to help with sleep. If she takes the zopiclone at 10pm, she is able to fall asleep by 1-2am and can sleep through the night until morning. Without the medication, she would sleep at 5am and wake up at 1pm. She wanted to find a natural alternative to help with the sleep and get off the prescription medication as it made her feel groggy the next morning. She has tried melatonin in the past but she didn’t feel like it helped her much to fall asleep.
Her sleep has been an issue ever since she was a teenager, wherein she would miss classes and sleep in the next morning but she had originally blamed it on laziness and being young. She didn’t recognize it as abnormal until her delayed sleep pattern persisted into adulthood.
I saw her over the course of 7 months as follows:
On her initial visit, she had recent blood work from her medical doctor that showed low optimal levels of ferritin at 19 ug/L. Her complete blood count, thyroid, urinalysis, blood glucose, lipid panel, liver enzymes and kidney function tests were all within normal limits.
I started her on an iron supplement (36mg daily) that also had other nutrients in it too such as active folate, B12, and Vitamin C. I also had her start on an adrenal supplement that had adrenal glandular tissue and nutrients such as Vitamin C, zinc and B vitamins, to take in the morning, and a cortisol manager in the evening containing Ashwagandha, Magnolia and Epimedium extract and phosphatidylserine.
She returned about 6 weeks later and reported not much change in sleep, but her energy was better since taking the adrenal supplement in the morning. She reported still not being able to sleep until 5am if she didn’t take zopiclone; and sleeping at 1am if she did take zopiclone.
This time, I recommend she add in Resolaxin, an herbal supplement that has Chamomile, Lemon balm, Wild jujube, Passionflower extract, L-theanine, magnesium and vitamin B6. I had her increase the cortisol manager to 2 tablets at night. And I encouraged her to try adding in a melatonin 5mg tablet in the evening even if she didn’t necessarily notice a difference with taking it before in the past.
She returned 3 months later reporting that her sleep was much better. She was able to stop taking the zopiclone and would fall asleep at 2am now; whereas it would take her until 5am to fall asleep without taking it in the past. She had finished off the Resolaxin and her sleep remained good even without it. She continued taking 2 tablets of the cortisol manager, 5mg melatonin, iron supplement, and 1 capsule of the adrenal supplement in the morning. She has also been using a “wake up” lamp that would slowly get brighter in the morning, and she opens the windows to let the sunlight in as soon she wakes up in the morning.
This time, I recommended she take Vitamin D3 4000 IU daily. Continue to expose herself to natural sunlight first thing in the morning on waking. I encouraged her to try to decrease her melatonin dosage to 2.5mg (half a tablet) instead of the full 5mg tablet to see if her sleep will continue to be better even at a lower dosage.
She returned 2 months later reporting that she is happier with her sleeping pattern. She is able to fall asleep at 1am and would start to feel sleepy at midnight whereas in the past she would still be awake at 4am and not feel sleepy. She wakes up at around 8-9am and does not feel groggy in the morning. She continued to take the adrenal supplement in the morning and cortisol manager at night with the melatonin. She did report feeling sleepier when she takes the melatonin versus when she didn’t take it and was able to successfully decrease the dosage to 2.5mg.
I suggested moving forward that she try to wean off the cortisol manager to only 1 tablet in the evening and then eventually only take it as needed as opposed to taking it nightly. I encouraged her to continue to wean down her melatonin dosage, such as half a tablet of a 3mg tablet, and see if the sleep continues to still be better at a lower dosage. I lowered her iron supplement to every other day as opposed to daily, and asked her to retest her iron levels in the near future to make sure her ferritin is in good range.
Delayed sleep phase syndrome is conventionally treated with melatonin and light exposure therapy. But in BM’s case, it is interesting to note that she didn’t notice as big of an improvement with taking melatonin on its own but rather in combination with adrenal support. Therefore, supporting the adrenals may be an important component in those with DSPS.
BIO: Judith Canlas, ND
Dr. Judith Canlas, ND, received her Doctor of Naturopathic Medicine from the Boucher Institute of Naturopathic Medicine. She practices at Aurora Integrative Medical Clinic in Burnaby, BC and enjoys a general family practice with a special interest in women’s health, gastrointestinal conditions, and pain management. She holds additional certifications in Prolotherapy, Intravenous Vitamin Therapy, Acupuncture, and Bowen Therapy.