Miya Pearson
Advanced Sleep Phase Syndrome (ASPD) is a disorder where the timing of sleep and peak alertness are advanced by several hours compared to the standard societal clock. This results in individuals with ASPD having difficulty staying awake unless they go to bed very early and wake up very early, unable to fall back asleep. While ASPD does not affect daytime activities, it can cause issues with social activities and relationships. Treatment for ASPD focuses on delaying the circadian timing to align with the desired sleep and wake schedules. Bright light exposure in the evenings has been shown to be effective, and while CBT-I (Cognitive Behavioral Therapy for Insomnia) is often used to treat insomnia, it is not clear if it is effective for ASPD. CBT-I involves exploring the connection between thoughts, feelings, behaviours, and sleep, and typically consists of 6-8 sessions. While it has been shown to be effective in treating insomnia, with improvements in sleep latency and duration, it is typically used in conjunction with other therapies, such as bright light therapy.
| Characteristics | Values |
|---|---|
| Treatment Type | Evidence-based approach without drugs |
| Effectiveness | More effective in the long run than sleeping pills |
| Effectiveness | 70% to 80% of patients with primary insomnia experience improvements |
| Effectiveness | Improvement in insomnia symptoms from digital CBT-I is similar to face-to-face approaches |
| Treatment Focus | Restructuring the thoughts, feelings, and behaviors that are contributing to insomnia |
| Techniques | Sleep restriction |
| Techniques | Stimulus control |
| Techniques | Relaxation training |
| Techniques | Cognitive therapy |
| Techniques | Learning about positive sleep habits |
| Patient Type | Patients with insomnia issues |
| Patient Type | Patients with comorbid sleep disorders |
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What You'll Learn
CBT-I for insomnia
Cognitive Behavioral Therapy for Insomnia (CBT-I) is a multi-component, evidence-based treatment for insomnia that is delivered over the course of six to eight sessions. It is considered a first-line treatment for chronic insomnia and is more effective in the long run than sleeping pills. CBT-I focuses on exploring the connection between thoughts, feelings, and behaviors that contribute to the symptoms of insomnia. During treatment, a trained CBT-I provider helps identify thoughts, feelings, and behaviors that are contributing to insomnia. Thoughts and feelings about sleep are examined and tested to see if they are accurate, while behaviors are examined to determine if they promote sleep. A provider will then clarify or reframe misconceptions and challenges in a way that is more conducive to restful sleep.
CBT-I techniques are tailored to the individual and include sleep restriction, stimulus control, and cognitive therapy. Sleep restriction consolidates sleep by initially reducing the time in bed to match the actual sleep time. Stimulus control strengthens the association between bed and sleep. Cognitive therapy works to change the patient's maladaptive cognitions in relation to sleep. For example, prior experiences of insomnia may lead to worry about falling asleep and spending excessive time in bed to try to force sleep. This can make falling asleep more challenging and create a frustrating, nightly cycle that is difficult to break.
CBT-I can also include educating clients about the importance of good sleep hygiene, which involves increasing practices that encourage and support sleep while decreasing or eliminating those that discourage sleep. Some topics that may be covered are the effects of diet, exercise, and sleeping environment on falling and staying asleep. CBT-I can also include relaxation training, such as guided or self-hypnosis, and meditation, which has been shown to reduce stress, anxiety, and increase relaxation.
DSPS, or Delayed Sleep Phase Syndrome, may develop in early childhood but most commonly emerges or worsens during adolescence. It is a disorder in which a person's sleep is delayed by two hours or more beyond what is considered an acceptable or conventional bedtime. It is worth noting that sleep schedules can normalize in early adulthood. CBT-I can be used to address the insomnia issues that are frequently presented by patients with DSPS.
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Bright light therapy
For advanced sleep phase syndrome, bright light therapy is recommended in the evening. Morning light therapy is recommended for those with DSPS, and it has also been used with sleep-disturbed adolescents with a history of substance abuse. Bright light therapy may be beneficial for blind people and those experiencing jet lag.
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Evening de-arousal
Additionally, evening de-arousal techniques involve avoiding caffeine, physical exercise, and electronic media use close to bedtime. Electronic media use, in particular, has been associated with delayed bedtimes and longer sleep latency in adolescents. By limiting these arousing activities in the evening, individuals can reduce nighttime arousal and promote a more relaxed state conducive to sleep.
The implementation of evening de-arousal techniques as part of CBT has shown improvements in sleep patterns, including reduced sleep latency, earlier sleep onset, and improved rise times. These techniques assist in advancing the circadian rhythm, reducing the discrepancy between endogenous sleep timing and societal expectations. Overall, evening de-arousal plays a vital role in helping individuals with advanced sleep phase syndrome achieve a more synchronised and socially acceptable sleep schedule.
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Sleep hygiene
Advanced Sleep Phase Syndrome (ASPS) is a disorder in which the timing of sleep and the peak period of alertness are advanced by several hours. This is caused by genetic mutations, which can be hereditary, or may occur randomly when cells are dividing. Those with ASPS generally have difficulty staying awake unless they go to bed very early, and wake up very early, unable to fall back asleep.
Maintain a Consistent Sleep Schedule: This is a critical component of sleep hygiene for ASPS. It involves going to bed and waking up at the same time each day, including weekends. Maintaining a consistent sleep schedule helps to regulate the body's internal clock and promote a healthy sleep-wake cycle.
Gradually Adjust Your Bedtime: If you need to change your sleep schedule, it is essential to make gradual adjustments. Aim to shift your bedtime by 15-20 minutes each day until you reach your desired bedtime. This gradual approach gives your body time to adjust to the new sleep schedule.
Bright Light Therapy: Bright light exposure in the evening, before your desired bedtime, can help delay your body clock. The light should be brighter than normal indoor lighting and can be obtained from specialised light boxes or portable devices. This therapy should be timed appropriately, as consistent early morning bright light exposure may contribute to the early phase of alertness associated with ASPS.
Melatonin Intake: Melatonin, the sleep hormone, plays a crucial role in regulating the body clock. Taking a 2mg slow-release melatonin tablet close to your desired bedtime can help reset your body clock. Alternatively, a smaller dose (0.5mg) can be taken halfway through your sleep period.
Sleep Restriction and Stimulus Control: These CBT-I techniques involve initially reducing time in bed to match actual sleep time and strengthening the association between the bed and sleep. This may include practices such as avoiding naps, only staying in bed when sleepy, and getting out of bed if unable to fall asleep within a certain time frame.
Cognitive Therapy: This aspect of CBT-I focuses on changing maladaptive thoughts and beliefs about sleep. It helps individuals manage expectations, address negative thoughts, and develop healthier sleep habits.
While these sleep hygiene practices can be beneficial, it is important to consult a healthcare professional or sleep specialist for personalised advice and to rule out other sleep disorders.
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Sleep education
During CBT-I, a trained therapist guides individuals to explore the intricate link between their thoughts, emotions, and behaviors and how they influence their sleep patterns. By identifying and addressing any misconceptions or unhelpful beliefs about sleep, therapists can reframe them to foster more restful sleep. This process often takes 6 to 8 sessions, but the duration may vary depending on individual needs.
For adolescents and teenagers, CBT-I is often combined with bright light therapy (BLT) to address delayed sleep phase disorder (DSPD). This combination therapy includes sleep education, teaching them about circadian rhythms and how to advance them through light exposure. Adolescents are instructed to start with 30 minutes of natural light upon waking up, gradually increasing to 2 hours. This method helps to advance their sleep timing, leading to earlier sleep onset and wake-up times.
The effectiveness of CBT-I is evident, with improvements seen in reduced sleep latency, increased sleep duration, and less frequent waking during sleep. Up to 70-80% of patients with primary insomnia experience these benefits, and the results tend to be long-lasting. Notably, digital CBT-I has proven to be an effective treatment for insomnia across all age groups, including children, adolescents, and adults.
While CBT-I is a powerful tool for combating insomnia, it may not always yield immediate results. It requires time and dedication to learn and apply the skills taught during therapy. Additionally, it is important to recognize that insomnia often co-occurs with other conditions, such as mental health disorders or sleep disorders like circadian rhythm disorders. In such cases, a comprehensive sleep assessment is necessary, and further referrals to sleep specialists may be required to address the comorbid conditions alongside CBT-I.
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Frequently asked questions
Advanced Sleep Phase Syndrome (ASPS) is a disorder in which the timing of sleep and the peak period of alertness are advanced several hours earlier than the societal norm. People with ASPS generally have difficulty staying awake unless they go to bed very early and wake up very early, unable to fall back asleep.
CBT-I, or Cognitive Behavioral Therapy for Insomnia, focuses on exploring the connection between thoughts, feelings, behaviours, and sleep. During treatment, a trained CBT-I provider helps identify thoughts, feelings, and behaviours that contribute to insomnia symptoms. These are then examined and addressed through cognitive, behavioural, and educational components to promote better sleep.
CBT-I can help individuals with ASPS improve their sleep patterns and duration. It can reduce the time it takes to fall asleep, increase total sleep time, and decrease the number of wake-ups during sleep. CBT-I can also address associated issues such as insomnia and help maintain a regular sleep schedule.
CBT-I is recommended for individuals with ASPS who have chronic sleep issues and multiple contributing factors. It is effective for treating insomnia in children, adolescents, and adults. However, it may not be suitable for those with other sleep disorders, as treating insomnia alone will not address comorbid sleep disorders.
Yes, bright light therapy is often used in conjunction with CBT-I for ASPS. Exposure to bright light in the evenings, typically for about 2 hours from 7 to 9 pm, can help delay the circadian timing to the desired sleep and wake schedule.
