Circadian Interventions as Adjunctive Therapies to Cognitive-Behavioral Therapy for Insomnia

Abstract

The circadian system plays a key role in the sleep-wake cycle. A mismatch between the behavioral timing of sleep and the circadian timing of sleepiness/alertness can contribute to insomnia. Patients who report primarily difficulty falling asleep or early morning awakenings may benefit from circadian interventions administered adjunctively to cognitive-behavioral therapy for insomnia. Specific circadian interventions that clinicians may consider include bright light therapy, scheduled dim light, blue-blocking glasses, and melatonin. Implementation of these interventions differs depending on the patient's insomnia subtype. Further, careful attention must be paid to the timing of these interventions to ensure they are administered correctly.

Keywords: Circadian; Circadian rhythms; Cognitive-behavioral therapy for insomnia; Insomnia; Insomnia treatment.

Fig. 1.

Summary of timing of circadian interventions relative to the sleep period by insomnia subtype = bright light therapy; dim light or blue-blocking glasses; melatonin 0.5 mg.

Fig. 2.

Phase response curves to light and melatonin. (From Emens JS, Burgess HJ. Effect of light and melatonin and other melatonin receptor agonists on human circadian physiology. Sleep Med Clin 2015;10(4):435–453; with permission.)