Uppsala University Hospital,Sweden
Agneta Markstrom is since 2009 working as an Associate Professor and Senior Consultant at the Centre of Sleep and Breathing at Uppsala University Hospital, Sweden. She works full time taking care of diagnostics in persons with insomnia, parasomnia, circadian rhythm disorders, hypersomnia, narcolepsy and people with sleep breathing disorders. She works as a Consultant at the Department of Women’s and Children’s Health at Karolinska Institutet in Stockholm, Sweden and is a national expert in initiating CPAP and home mechanical ventilation in children. Her research interests lay in the fi elds of sleep particularly in the treatment of insomnia, circadian rhythm disorders, concrete delayed sleep phase disorder and sleep breathing disorder.
Delayed sleep phase disorder (DSPD) is common among young people and is characterized by a mismatch between the desired timing of sleep and the ability to fall asleep and remain asleep. Th e underlying cause of this could be related to biological or behavioral reasons. Individuals with DSPS have problems in falling asleep and consequently struggle with waking up in the morning. Sleep diffi culties, excessive sleepiness leads to poor performance and they acquire diffi culty with school and employment. Th is may result in adverse medical, psychological and social consequences. Light is the most eff ective environmental cue for circadian entrainment and light therapy (LT) has been shown eff ective for treatment of DSPS. Unfortunately, compliance is a concern and also the high amount of relapse. Cognitive behavioural therapy (CBT) might contribute as an adjunct therapy in DSPS. A randomized controlled short and long term trial with DSPS individuals aged 16 to 26 years was performed. Subjects received LT for 2 weeks and thereaft er one group received CBT for 4 weeks while the other group received no further treatment at all. LT advanced sleep onset 1 hour 50 min and sleep off set 2 hour 20 min during the second week of LT for all participants and this was maintained at a 6 months follow-up. Insomnia sleepiness score (ISI) was the primary outcome measure for sleep diffi culties and there was a signifi cant decrease in ISI over time. Anxiety and depression scores decreased signifi cantly more in the group that has received CBT and subjects in this group were able to retain the eff ect of LT better compared to the group that only received LT. It was concluded that CBT given aft er LT can maintain the eff ect of LT better and can decrease sleep diffi culties beyond those improvements observed with light therapy alone.