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Section 9
Delayed Sleep Phase Disorder Treatment

Question 9 | Test | Table of Contents

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In the last section, we discussed circadian rhythms.  In addition to how circadian rhythms work, we will also discuss realigning circadian rhythms and altering circadian rhythms with light.  

In this section, we will discuss delayed sleep phase syndrome. Delayed sleep phase syndrome is a different type of circadian rhythm maladjustment.  In Jeff’s case, delayed sleep phase syndrome became a somewhat urgent matter. Jeff was a school teacher who scheduled a session with me in late August.

Jeff explained that he was a night owl throughout the summer and had therefore fallen into an atypical sleep pattern. By the time Jeff had scheduled his first session, he was going to bed as late as 4 or 5 a.m.  Jeff stated, "I’m starting to panic.  I’m sure you know that within two weeks I have to conform to the normal class schedule and be in the classroom by nine."  Before Jeff contacted me, he had tried to get to sleep earlier each night, but his circadian rhythms were aligned on a 4 a.m. to noon schedule.

3-Step Intervention for Phase Delay

♦ Step 1: Initial Phase Delay
First, let’s discuss step one- initial phase delay. During Jeff’s first session, I stated, "If you can implement phase delay, the treatment may only take one week.  However, phase delay may require a temporary upset in your schedule. Are you able to spare a week to get your circadian rhythms back on track?" Jeff said that he did.

Therefore, I continued to explain, "When you go to bed tonight, don’t go at 4 a.m.  Instead, go to bed three hours later, at 7 a.m." Jeff stated, "I’ve been trying to go to bed earlier each night. But instead you want me to go to bed later?"  How would you have responded to Jeff?  I continued by explaining step two.

♦ Step 2: Subsequent Phase Delays
I stated to Jeff, "Tomorrow night, if you go to bed yet another three hours later, you’ll go to bed at 10 a.m."  Jeff stated, "What?!?  And sleep all day?"  I responded, "Yes.  That’s why you must interrupt your schedule for an entire week.  Each night you go to bed three hours later than the previous night.  You might find that the three hours of phase delay adds to your ability to fall asleep each night." 

If your client cannot devote this amount of time to treatment, you might consider referring back to the techniques in section 7.  However, in Jeff’s case phase delay could be worked into his schedule.  Therefore, Jeff agreed to continue the therapy.  Is it possible for your client to devote a week to phase delay?

♦ Step 3: Maintaining the Rhythm
In addition to initial phase delay and subsequent phase delays, step three is maintaining the rhythm.  After a week implementing phase delay each night Jeff’s circadian rhythms were on a schedule more conducive to his class schedule.  At the following session, I stated to Jeff, "Now you simply need to maintain your new circadian rhythm." 

Jeff asked, "How do I do that?"  How might you have responded to Jeff? I reviewed techniques from other sections on this course with Jeff.  These techniques can be found in your Reproducible Client Worksheets and include mental imagery and relaxation techniques. Would you agree that by letting Jeff choose from a number of techniques he could find the one that works for him? At a later session, Jeff stated, "It was helpful to have a number of different ways to get to sleep.I just chose the one I liked and it seemed to work better than the other ones." 

Would you consider using phase delay to treat a client with delayed sleep phase syndrome? 

I find this technique useful when it is applicable due to the relative ease clients experience going to bed later as opposed to going to bed earlier. It was of course, necessary to for Jeff to stay with the new schedule once established and avoid his tendency to stay up late.

How might your client deal with avoiding late nights?

In this section, we discussed delayed sleep phase syndrome. Delayed sleep phase syndrome is a different type of circadian rhythm maladjustment. Our discussion focused on treating delayed sleep phase syndrome through a three step intervention called phase delay. The three steps to phase delay are initial phase delays, subsequent phase delays, and maintaining the rhythm.

In the next section, we will discuss treating narcolepsy.  We will discuss methods for decreasing narcoleptic occurrences, tips for those who live with a narcoleptic, and sleep inertia.
Reviewed 2023

Peer-Reviewed Journal Article References:
Carr, M., Konkoly, K., Mallett, R., Edwards, C., Appel, K., & Blagrove, M. (2020). Combining presleep cognitive training and REM-sleep stimulation in a laboratory morning nap for lucid dream induction. Psychology of Consciousness: Theory, Research, and Practice. Advance online publication.

Richardson, C., Micic, G., Cain, N., Bartel, K., Maddock, B., & Gradisar, M. (2019). Cognitive “insomnia” processes in delayed sleep–wake phase disorder: Do they exist and are they responsive to chronobiological treatment? Journal of Consulting and Clinical Psychology, 87(1), 16–32.

Selby, E. A. (2013). Chronic sleep disturbances and borderline personality disorder symptoms. Journal of Consulting and Clinical Psychology, 81(5), 941–947.

Walters, E. M., Jenkins, M. M., Nappi, C. M., Clark, J., Lies, J., Norman, S. B., & Drummond, S. P. A. (2020). The impact of prolonged exposure on sleep and enhancing treatment outcomes with evidence-based sleep interventions: A pilot study. Psychological Trauma: Theory, Research, Practice, and Policy, 12(2), 175–185.

QUESTION 9
What are the three steps to phase delay as a method to adjust circadian rhythms? To select and enter your answer go to Test.

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