CBT-I for patients with phase disorders or insomnia with circadian misalignment

Abstract Circadian factors are recognized contributors to insomnia symptoms, whether in the context of full-blown circadian rhythm sleep-wake disorders or subthreshold circadian misalignment. While cognitive-behavioral therapy for insomnia (CBT-I) and brief behavioral treatment of insomnia (BBT-I) consider circadian factors, neither fully leverages available assessment options and chronotherapeutic approaches. In this chapter, we draw on the published literature and anecdotal experience in our clinic to offer suggestions on how to enhance CBT-I (or BBT-I) to identify, characterize, and treat individuals with both insomnia and full-blown circadian rhythm sleep-wake disorders or subthreshold circadian misalignment.