Sleep Phase Chronotherapy

Circadian Rhythm Sleep Disorder - a family of sleep disorders affecting, among other things, the timing of sleep. People with circadian rhythm sleep disorders are unable to sleep and wake at the times required for normal work, school, and social needs. They are generally able to get enough sleep if allowed to sleep and wake at the times dictated by their body clocks.

Anonymous Commenter: Circadian Rhythm disorders are a research interest of mine. Almost everyone's internal, natural circadian rhythms are slightly over 24 hours. These rhythms are kept in check by bright light every morning coming in through a person's eyes. This turns off a person's melatonin production (the sleep signal). She is likely not receiving this signal {commenter was under the mistaken impression that Kitty was blind}. A more effective treatment would be for her to take .3 mg of Melatonin every day at 6PM. This very small dose would signal her body that nighttime was coming. This would keep her regular and in phase with the world.

Most of the people I know with bipolar disorder have chronic issues with insomnia. It is probably also an issue with PTSD and the hyper-vigilance that goes with that. Bear often had bouts of horrible flashbacks or night terrors that caused his whole body to react as though he were reliving the trauma (which he probably was). Understandably he fought sleep and while most sleep meds didn't work, the one that helped (also an anti-psychotic) he usually refused to take.

Kitty and I both have the sub-type -
Delayed sleep phase disorder (DSPD), aka delayed sleep phase syndrome (DSPS), characterized by a much later than normal timing of sleep onset and offset and a period of peak alertness in the middle of the night. Like babies who get night and day mixed up!

When Kitty did a sleep study in April, we realized that sleep medicines just don't work for her (including Melatonin, Ambien, Lunesta, Seroquel...), and were told that the only treatment left was Sleep Phase Chronotherapy (SPC), which progressively advances sleep time by 1–2 hours per week until you've gone all the way around the clock to your preferred bedtime. The idea is that it's almost impossible to make yourself get sleepy and go to sleep early, but it is possible to stay up a little later every night until you move your bedtime all the way around the clock to the right time.

The doctor told us that few people attempt this treatment, because it's so disruptive to real life (how many people can miss 3 to 8 weeks of work?) and of the few of his patients that do attempt it, a substantial portion fail.  Even worse, if something happens to disrupt the process then Kitty's sleep schedule could end up even more horribly distorted.  At the time, we decided that all of Kitty's compliance issues would make this treatment impossible.

When nothing else worked, we did attempt Sleep Chronotherapy. I'm not sure how we ended up deciding that it could be done in 1 week, maybe we were so tired that we misunderstood the doctor. There was also a major issue caused by Kitty's refusal to miss any scheduled work hours (it was summer, but she had a part-time evening job at a local entertainment center).

Kitty and I did it together - for many reasons (including the fact that I probably needed it too), but primarily because Kitty doesn't have the ability to do it on her own. If you're going to try this, I highly recommend having a partner to help both of you stay awake.

I wrote out a schedule of sleep and awake times for the entire week (again, this should have taken a couple of months!). This is important! When your sleep schedule is off, you'd be amazed at how complicated and confusing it all gets trying to remember what time to set the alarm for and when not to make appointments.

If I had to do it again, which I WON'T!, here's some things I would do differently.

1. Figure out a meal schedule.  I think I lost 2lbs because I never remembered to eat, and I'm guessing Kitty gained quite a bit, because she ate continuously (she tends to turn to food when she's upset and/or bored).
2. Have planned activities, especially with other people involved (since Kitty and I are both extroverts). For times when others are asleep or busy, try doing something active, like taking a walk.
3. Extend the time to make the transition (6 to 8 weeks?). It takes a full month for your body to accept a new circadian rhythm. 
4. On the first night, be sure your new bedtime is at least an hour (preferably 2) after the latest time you tend to fall asleep.  We've both stayed up until 4am many times before.  I didn't schedule it this way, because we had something to do at 1pm, and I wanted to give us a full 8 hours plus some time to wake up and get ready for an appointment. Kitty wasn't able to fall asleep until 5am.
5. Avoid driving (or operating heavy machinery) and making life altering decisions. 
6. You might want to avoid deep conversations with people you care about - you will regret a lot of things you say when you're sleep deprived and cranky.
7. Remember sleep deprivation is a common means of torture and brain washing.

Honestly chronotherapy did not help either of us. We were both back to having chronic insomnia within weeks. If you attempt it, please do so under the supervision of a doctor and take significantly longer than a week to make the transition.

Update:
Now, many, many years later, we are ready to try this again, and by "we" I mean Kitty, who is now 22. Hopefully by doing it right this time (advancing at 2 hour intervals a week over a period of 2 months), Kitty will be successful, but I'm not holding my breath. I'll keep you posted here. Remind me if I forget!