What are the species of and administration methods for Cognitive Behavioral Therapy (CBT) for Delayed Sleep Phase Disorder (DSPD), including unhelpful beliefs about sleep timing and consequences of sleep schedule changes, and helpful coping mechanisms for managing daytime fatigue?

From the Guidelines

Cognitive Behavioral Therapy (CBT) for Delayed Sleep Phase Disorder (DSPD) should focus on addressing unhelpful beliefs about sleep timing, developing effective coping strategies, and implementing behavioral interventions, including gradual sleep schedule adjustments and strategic light exposure, as suggested by the American Academy of Sleep Medicine clinical practice guideline 1.

Overview of CBT for DSPD

To administer CBT for DSPD, begin with a comprehensive sleep assessment, then implement a structured program that includes sleep education, cognitive restructuring, and behavioral interventions. The therapy should address unhelpful beliefs such as "I'm naturally a night owl and can't change," "I'll never be able to function in the morning," or "Changing my sleep schedule will make me feel worse."

Key Components of CBT for DSPD

• Sleep education: educating patients about sleep physiology, the importance of a consistent sleep schedule, and the consequences of sleep schedule changes
• Cognitive restructuring: challenging negative thoughts and replacing them with more balanced perspectives
• Behavioral interventions:
  • Gradual sleep schedule adjustments (typically advancing bedtime by 15-30 minutes every few days)
  • Strict sleep hygiene practices
  • Strategic light exposure (morning bright light and evening light restriction)

Coping Mechanisms for Daytime Fatigue

CBT for DSPD also includes developing helpful coping strategies for managing daytime fatigue, such as:

• Scheduled short naps (under 30 minutes)
• Appropriate caffeine use
• Activity scheduling to maximize alertness

Administration of CBT for DSPD

Treatment usually requires 6-8 weekly sessions, with homework assignments between sessions to practice new sleep habits. This approach works by resetting the circadian rhythm through both psychological and behavioral mechanisms, gradually shifting the body's internal clock to align with conventional sleep-wake times, as supported by the clinical practice guideline 1.

From the Research

Cognitive Behavioral Therapy (CBT) for Delayed Sleep Phase Disorder (DSPD)

• CBT is used as an adjunct treatment to light therapy (LT) for DSPD in young adults, with a randomized controlled feasibility study showing no significant group differences in primary endpoints, but decreased anxiety and depression scores in the LT+CBT group compared to LT+NT 2
• A randomized controlled trial of CBT plus bright light therapy (BLT) for adolescents diagnosed with DSPD showed moderate-to-large improvements in sleep latency, sleep onset and rise times, total sleep time, wake after sleep onset, sleepiness, and fatigue 3
• CBT plus BLT was found to be effective for improving multiple sleep and daytime impairments in the immediate and long-term, with significantly fewer adolescents meeting DSPD criteria at post-treatment and 6-month follow-up 3

Administration Methods for CBT in DSPD

• CBT can be administered in individual sessions, including morning bright light therapy to advance adolescents' circadian rhythms, and cognitive restructuring and sleep education to target associated insomnia and sleep hygiene 3
• A combination of CBT and morning bright light therapy is suggested as a promising treatment for DSPD, with evening melatonin administration as a sole treatment also appearing promising 4

Unhelpful Beliefs about Sleep Timing and Consequences of Sleep Schedule Changes

• Patients with DSPD often have problems initiating sleep if they go to bed at a conventional time, and they often have problems waking at desired times, leading to severe sleepiness during morning hours 5
• A delayed circadian rhythm, insensitivity to clock-resetting morning light, and heightened cognitive activity are contributing factors to DSPD, with significant impact on school/work performance and mental health 4

Helpful Coping Mechanisms for Managing Daytime Fatigue

• Gradually advancing rise times seems to produce positive effects on subjective sleepiness, fatigue, and cognitive performance during short-term treatment of patients with DSPD 5
• Bright light and melatonin treatment can improve subjective daytime sleepiness, fatigue, and cognitive function in patients with DSPD, with long-term treatment increasing some of the positive effects seen after short-term treatment 5, 6