From the Guidelines
Cognitive Behavioral Therapy (CBT) for Delayed Sleep Phase Disorder (DSPD) should be administered using a multicomponent approach, incorporating cognitive restructuring, stimulus control, sleep restriction, and sleep hygiene education, as well as bright light therapy and chronotherapy, as supported by the most recent and highest quality study 1.
Key Components of CBT for DSPD
- Cognitive restructuring to challenge unhelpful thoughts about sleep
- Stimulus control to associate the bed with sleep
- Sleep restriction to consolidate sleep efficiency
- Sleep hygiene education to promote healthy sleep habits
Administration Methods
- Begin with a comprehensive sleep assessment to identify specific patterns and beliefs
- Use thought records to identify and challenge negative sleep beliefs
- Gradually advance bedtime by 15-30 minutes every few days
- Establish consistent wake times regardless of sleep quality
- Implement proper sleep hygiene practices, such as limiting screen time before bed and creating a comfortable sleep environment
Additional Therapies
- Bright light therapy using 10,000 lux light boxes for 30-45 minutes upon waking
- Chronotherapy to gradually reset the circadian rhythm
- Consider using wearable, short-wavelength light therapy devices for increased mobility and adherence
Treatment Duration and Format
- Treatment typically requires 6-8 weekly sessions of 45-60 minutes each, with homework assignments between sessions
- Consider using a motivational framework to increase adherence to advancing rise time schedule
- School-based sleep education programs may provide wider treatment dissemination with limited provider involvement, but may require supplemental interventions to bolster treatment effects.
From the Research
Species of Cognitive Behavioral Therapy (CBT) for Delayed Sleep Phase Disorder (DSPD)
- Cognitive Behavioral Therapy (CBT) is used as an adjunct treatment to light therapy for DSPD in young adults 2
- CBT is used to address unhelpful beliefs about sleep timing and consequences of sleep schedule changes, although specific details on the species of CBT used are not provided in the studies
Administration Methods for CBT in DSPD
- CBT is administered over a period of four weeks, following two weeks of light therapy 2
- The administration of CBT is not specified in terms of frequency or duration of sessions
Addressing Unhelpful Beliefs about Sleep Timing
- Unhelpful beliefs about sleep timing are addressed through CBT, although the specific techniques used are not described in the studies 2, 3
- Evening melatonin administration is used as a sole treatment or in combination with CBT to address delayed sleep phase 4, 3
Consequences of Sleep Schedule Changes
- Sleep schedule changes can have significant consequences, including daytime sleepiness, anxiety, and depression symptoms 5, 3
- CBT and morning bright light therapy are used to treat the delayed circadian rhythm and associated sleep-onset insomnia, which can help mitigate these consequences 2, 3
Treatment Approaches for DSPD
- Treatment approaches for DSPD include therapies to phase change the delayed sleep circadian rhythm, such as morning bright light exposure, exogenous melatonin administration, and chronotherapy, as well as behavioral strategies 5
- CBT is used as an adjunct treatment to light therapy, and has been shown to decrease anxiety and depression scores in young adults with DSPD 2