Session | Contents | Homework (use of strategies) |
---|---|---|
1 | Introduction to treatment, information about CBT and CBT-i models of treatment. Introduction to the use of organizing-strategies. Discussing treatment goals. | Fill out a sleep diary every day. Use calendar, to-do list, distractibility reduction skills, set treatment goals. |
2 | Problem-solving and behavioral experiments if neededa. Psychoeducation about sleep, sleep myths, sleep and ADHD, and effects of ADHD medication on sleep. Role of relaxation and use of relaxation techniques. | If needed, discuss ADHD-medication timing with prescribing psychiatrist. Stabilizing sleep medication. Practicing relaxation techniques to be used both during daytime and in bed. |
3 | Setting the circadian rhythm. Approximating the circadian nadir of each patient and setting the appropriate “light schedule”. b | Use light and darkness systematically, according to the light schedule developed in session. |
4 | Regularizing sleep schedule and adjusting other activities accordingly, to help set circadian rhythm and use sleep pressure to improve sleep, use of a morning-routine to get up in time. Develop each patient’s individual sleep schedule.b | Follow the sleep schedule developed in session (after the first week, sleep compression is applied if sleep efficiency is low), use a morning routine to get up in the morning. |
5 | In the evening: activity level, routines and management of pre-sleep worry. Identifying individual needs and planning how to work with them. | Gradually-less arousing activities 1,5–2 h before bedtime, “worry time” if needed, use a simple evening routine. |
6 | Follow up on treatment progress and goals. Stimulus control and sleep hygiene. Identifying individual sleep hygiene needs and planning how to work with it. | Getting out of bed when unable to sleep for 20 min. Follow individual plan for sleep hygiene practices. |
7 | Daytime activity, variability and pacing. Identifying individual needs and planning the work. Non sleep-disturbing ways to handle fatigue. | Physical activity. Increase variability of activity level, use non sleep-disturbing ways to handle fatigue. |
8 | Cognitive activity and sleep. Cognitive restructuring. | Identify and manage sleep disturbing thoughts. |
9 | Acceptance and mindfulness. Summarize the treatment, choose a strategy to apply during the last week. | Work with the chosen strategy, and try acceptance and mindfulness strategies. |
10 | Evaluation of treatment goals. Relapse prevention. Create an individual Sleep Plan based on strategies from the treatment. | Follow the Sleep Plan, including relapse prevention. |