• Sleep · Dec 2011

    Randomized Controlled Trial

    A randomized controlled trial of cognitive-behavior therapy plus bright light therapy for adolescent delayed sleep phase disorder.

    • Michael Gradisar, Hayley Dohnt, Greg Gardner, Sarah Paine, Karina Starkey, Annemarie Menne, Amy Slater, Helen Wright, Jennifer L Hudson, Edward Weaver, and Sophie Trenowden.
    • Child & Adolescent Sleep Clinic, School of Psychology, Flinders University, Adelaide, SA, Australia. michael.gradisar@flinders.edu.au
    • Sleep. 2011 Dec 1;34(12):1671-80.

    ObjectiveTo evaluate cognitive-behavior therapy plus bright light therapy (CBT plus BLT) for adolescents diagnosed with delayed sleep phase disorder (DSPD).DesignRandomized controlled trial of CBT plus BLT vs. waitlist (WL) control with comparisons at pre- and post-treatment. There was 6-month follow-up for the CBT plus BLT group only.SettingFlinders University Child & Adolescent Sleep Clinic, Adelaide, South Australia.Patients49 adolescents (mean age 14.6 ± 1.0 y, 53% males) diagnosed with DSPD; mean chronicity 4 y 8 months; 16% not attending school. Eighteen percent of adolescents dropped out of the study (CBT plus BLT: N = 23 vs. WL: N = 17).InterventionsCBT plus BLT consisted of 6 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.Measurements And ResultsDSPD diagnosis was performed via a clinical interview and 7-day sleep diary. Measurements at each time-point included online sleep diaries and scales measuring sleepiness, fatigue, and depression symptoms. Compared to WL, moderate-to-large improvements (d = 0.65-1.24) were found at post-treatment for CBT plus BLT adolescents, including reduced sleep latency, earlier sleep onset and rise times, total sleep time (school nights), wake after sleep onset, sleepiness, and fatigue. At 6-month follow-up (N = 15), small-to-large improvements (d = 0.24-1.53) continued for CBT plus BLT adolescents, with effects found for all measures. Significantly fewer adolescents receiving CBT plus BLT met DPSD criteria at post-treatment (WL = 82% vs. CBT plus BLT = 13%, P < 0.0001), yet 13% still met DSPD criteria at the 6-month follow-up.ConclusionsCBT plus BLT for adolescent DSPD is effective for improving multiple sleep and daytime impairments in the immediate and long-term. Studies evaluating the treatment effectiveness of each treatment component are needed.Clinical Trial InformationAustralia-New Zealand Trials Registry Number: ACTRN12610001041044.

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