From the Guidelines
Cognitive Behavioral Therapy (CBT) for Delayed Sleep Phase Disorder (DSPD) should be administered using a multicomponent approach, combining cognitive therapy strategies with education about sleep regulation, stimulus control instructions, and sleep restriction therapy, as outlined in the American Academy of Sleep Medicine systematic review and meta-analysis 1. To address unhelpful beliefs about sleep timing and consequences of sleep schedule changes, the therapy should include:
- Cognitive restructuring to identify and modify negative thoughts about sleep timing
- Behavioral interventions, such as:
- Gradual sleep schedule adjustments (typically 15-30 minutes earlier every few days)
- Consistent sleep-wake times (even on weekends)
- Bright light therapy in the morning and avoiding bright light in the evening
- Sleep education to promote realistic expectations about sleep schedule changes and create helpful coping strategies for managing daytime fatigue during the adjustment period The treatment typically involves 4-8 weekly sessions of 45-60 minutes each, with homework assignments between sessions, as described in the American Academy of Sleep Medicine clinical practice guideline 1. Key components of CBT for DSPD include:
- Stimulus control instructions to extinguish the association between the bed/bedroom and wakefulness and establish a consistent wake-time
- Sleep restriction therapy to enhance sleep drive and consolidate sleep by limiting time in bed equal to the patient’s sleep duration
- Relaxation training to reduce somatic tension and cognitive arousal that may perpetuate sleep problems
- Sleep hygiene education to promote lifestyle and environmental factors that support sleep By addressing both the cognitive and behavioral aspects of sleep, CBT for DSPD can create sustainable changes in sleep patterns over time, improving morbidity, mortality, and quality of life for patients with this condition 1.
From the Research
Cognitive Behavioral Therapy (CBT) for Delayed Sleep Phase Disorder (DSPD)
- CBT is used in conjunction with other treatments such as bright light therapy to address DSPD 2
- The goal of CBT is to identify and change unhelpful beliefs and behaviors that contribute to the delayed sleep phase 2, 3
- CBT may include techniques such as cognitive restructuring and sleep education to target associated insomnia and sleep hygiene 2
Administration Methods for CBT in DSPD
- CBT can be administered in individual sessions, with or without bright light therapy 2
- The number of sessions can vary, but one study used 6 individual sessions 2
- CBT can be combined with other treatments such as melatonin administration and behavioral sleep-wake scheduling 4
Addressing Unhelpful Beliefs about Sleep Timing
- CBT can help individuals identify and challenge negative thoughts and beliefs about sleep timing 2, 3
- This can include addressing concerns about the consequences of sleep schedule changes, such as impact on school or work performance 2, 3
Consequences of Sleep Schedule Changes
- Changes to sleep schedules can have significant consequences, including impact on school or work performance, mental health, and overall quality of life 5, 3
- CBT can help individuals develop strategies to manage these consequences and adjust to new sleep schedules 2, 3