Treatment recommendations included (1) strict sleep hygiene
with a regular wake time 7 days a week at 8 AM. On awakening
she would be engaged in a vigorous physical activity with
priority given to exposure to outdoor morning light. A letter was
written to the school advocating for a later school start time
based on her "biologically driven sleep rhythm." (2) In the
evening she should have limited contact with bright lights and
natural sunlight. The television would be moved out of her
bedroom. (3) If after 2 weeks of regular 8 AM waking she
continues to be unable to fall asleep by midnight, a sedative
hypnotic was to be prescribed.
Danielle was disciplined about her sleep hygiene. The following
year her school attendance improved dramatically. She
uses a sedative hypnotic rarely when she cannot fall asleep
before i I PM