Circadian Rhythm Disorders: How We Treat

How are circadian rhythm sleep disorders treated?

Children's Hospital Colorado

Treatment of circadian rhythm disorders starts by finding out a child's natural sleep patterns, then using sleep hygiene techniques or bright light therapy to help reset those patterns to be closer to desired wake and sleep times.

Sleep logs should be kept for at least two weeks to establish a child's natural sleep patterns. Sleep logs show providers the child's natural wake-up time and approximately how many hours of sleep the child needs. Ideally, these logs are collected during a vacation when kids and teens can sleep according to their own internal clocks. Otherwise, providers estimate natural wake-up time by looking at weekend sleep patterns.

In a clinic visit with the patient and parents, the desired wake-up time is decided. Since light is the body's biological "time keeper" the most reasonable approach to correct a child's circadian rhythm is with light therapy. Light therapy can range from exposure to natural sunlight to using a prescription light-box. Light therapy treatment plans are developed to shift patients' sleep times and wake times to match the family's goals. This plan is individualized for each patient, based on the patient's current sleep cycle and family situation.

Once the desired wake-up time is reached, it is important to maintain constant bedtime and wake up times. Even on weekends, teens should wake up within two hours of their weekday schedule, meaning no sleeping in on weekends. Naps should be avoided. Patients and parents need to be motivated for therapy to be successful. Sometimes, it helps to see a sleep psychologist.

Before starting medicine, over the counter remedies or bright light therapy, patients and parents should consult a provider at the Children's Hospital Colorado Sleep Center because certain conditions, such as bipolar disorder, may be worsened if not properly treated. Using bright light therapy inappropriately can make a delayed sleep phase disorder worse.

It is important not to miss other causes of daytime sleepiness or sleep disruptions, such as snoring and obstructive sleep apnea, movement disorders, narcolepsy and many others.

Patients should also follow these recommendations to improve their sleep hygiene:

  • Remain active and expose yourself to bright light during the day.
  • In children who are school age or older, napping during the day should be avoided because naps "steal" from nighttime sleep.
  • Regular exercise in the late afternoon or early evening can promote sleep, but avoid strenuous activity just prior to bed.
  • Quiet activities prior to sleep allow one to relax. This includes reading (with the light behind you, not shining directly into your face) and listening to soft music or relaxation tapes.
  • Avoid bright lights in the evening, especially 1 to 2 hours before bed. This includes television, computers, video games and cell phones.
  • Keep the bedroom environment comfortable, quiet and dark with a cool temperature and comfortable bed.
  • Beds are only for sleeping and not for other daily activities, like TV or homework.
  • Only stay in bed for as long as you are sleeping.
  • Turn the clock away from you.
  • Ignore intrusive ideas and thoughts. Write them down to give yourself or your child permission to forget them until the next day.
  • Caffeine stays active in the body for about 10 hours, so avoid caffeine after lunchtime (or altogether).
  • Everyone should be aware that nicotine and alcohol make sleep restless.

Why choose Children's Hospital Colorado for your child's circadian rhythm disorder?

The Sleep Clinic at Children's Colorado is made up of a team of providers that includes sleep physicians who specialize in pediatric pulmonology and pediatric ENT, a sleep-specialized psychologist, two sleep-specialized nurse practitioners and a sleep-specialized respiratory therapist.

We see children who have been referred from all over the Rocky Mountain region for evaluation of any and all sleep concerns. We will develop an individualized plan of diagnosing and treating your child's sleep issues with you. Our providers are actively involved in pediatric sleep research and train doctors to become pediatric sleep medicine specialists.