Some insomnia sufferers who visit my website head straight for the posts on sleep restriction. So I decided to create a video trailer where I could talk about my own experience of sleep restriction: how off-putting the idea was at first, and the results I later achieved.

I posted the video on Facebook last week and got an interesting comment from a friend (who does not have insomnia himself). To him, the idea of restricting sleep time, and then increasing it bit by bit, did not sound counterintuitive at all. He compared it to the building of strength and dexterity that occurs with physical training, and the development of musical ability that occurs with daily practice on an instrument. The idea of improving sleep through the disciplined restriction of time in bed sounded perfectly reasonable to him.

There’s logic in what he says. Yet to those of us with insomnia, sleep restriction can sound daunting and downright scary. We know what it’s like to struggle with the daytime symptoms of insomnia: the fatigue, mood swings, and days when we can’t put two and two together or remember names. Why choose to subject ourselves to a treatment that involves slogging through a period when our symptoms may get worse?

Yet my own experience—and the experience of other insomniacs I went through group therapy with—suggests the bad days are numbered. By the second week we were already noticing improvements in our sleep and daytime stamina. Some of us found relief even sooner. Watch the video and see if you’re convinced.

As usual, I’d love to hear your comments.

Posted by Lois Maharg, The Savvy Insomniac

Lois Maharg has worked with language for many years. She taught ESL, coauthored two textbooks, and then became a reporter, writing about health, education, government, Latino affairs, and food. Her lifelong struggle with insomnia and interest in investigative reporting motivated her to write a book, The Savvy Insomniac: A Personal Journey through Science to Better Sleep. She now freelances as an editor and copy writer at On the Mark Editing.

192 Comments

  1. Hello Lois today makes my third week with srt. I’ve been noticing that I have been waking up at 5 am this whole entire time. I’ve been trying to fall asleep around 11 or 12 am but keep waking up around 3-5 am. My desire sleep schedule would be 11:20 pm to 6:20 am. Should I start staying awake until 1am and wake up at 6 am? My biggest fear is that my body will be accustom to only sleeping 1-6 for the rest of my life and I don’t want that. I also have a hard time falling asleep early on Friday and Saturdays. So should I continue to wake up at 6:20 on weekends too even though I sleep a bit later on weekends?

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  2. Hello John,

    It’s good that you’re doing something proactive to improve your sleep. SRT is helpful to many people with trouble sleeping, and chances are it’ll help you.

    You mention that now you’re on the 3rd week of therapy. But you didn’t mention whether you began by keeping a sleep diary for a week before starting to restrict your sleep. That first week, when you’re simply collecting and recording information about when and how long you actually sleep, is super important. From it, you establish exactly how much to restrict your time in bed.

    Here are 2 blog posts that may help out:
    https://thesavvyinsomniac.com/be-your-own-sleep-scientist
    https://thesavvyinsomniac.com/sleep-restriction-in-a-nutshell

    Once you figure out how many hours to begin with–let’s say you start with a sleep window of 5 hours (because that’s the amount of time you’re actually sleeping, at least as far as you can assess it yourself)–you choose one sleep schedule, which can be at the time of your choice. If you want to get up at 6, stay up till 1. If you want to get up at 5, stay up till midnight. And so forth.

    But once you’ve chosen your sleep schedule, you have to stick to it–all 7 days of the week. So the SRT protocol is quite demanding. You can’t sleep in on weekends, and you can’t go to bed earlier than your scheduled bedtime.

    Especially in people with insomnia, whose sleep systems are seemingly less flexible than those of normal sleepers, regular bed and wake times are absolutely crucial to developing sounder, consolidated sleep. Maintaining a strict wake-up time is the most important thing of all.

    Feel free to write in with other questions and comments. Good luck!

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  3. Okay will do. I will try my best to try and stay awake to 1 am and wake up at 6.( I would like 6:30) I think in these couple of weeks I’ve been either a sleeping to early at times and waking up around 8 last Saturday. My other question is after a week of 1-6, when will I be able to fall asleep from 11am-6am. By doing Srt this will make my sleep drive back to normal? This is a lot but I will do this.
    I will also print out the diary tommrow. I also need to stop forcing myself to sleep early when I not tired

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  4. Hi John,

    Sleep ability varies a lot from person to person, so I really can’t say when or if–by going through sleep restriction therapy–you’ll be able to sleep from 11 to 6, as you’d like. I myself started seeing improvements in my sleep in a matter of days. Other people wait a little longer for their sleep to stabilize.

    For many people, sleep restriction eventually brings about better sleep. Yet there are no guarantees as to how much more sleep SRT will enable people to get. Maybe a little, maybe more. What is true is that a substantial majority of the people who go through SRT say their sleep has improved in other ways: they fall asleep more quickly, wake up less in the middle of the night, have better overall sleep quality, and feel more rested in the morning. Gains like these can make a real difference in how you feel about your sleep.

    To maximize your chances of success with SRT, you need to be acquainted with the guidelines and follow them to the letter. I spell them out in detail in my book, The Savvy Insomniac, and in brief in the blog I referred to above (Sleep Restriction in a Nutshell–where I also reference other online resources). There are also other books available that teach SRT as part of cognitive-behavioral therapy for insomnia (CBT-I). Any of these books or online resources would make for worthwhile reading.

    Keeping a sleep diary for at least a week before beginning SRT is a very important step in the process. Now realizing that you skipped that step, I’d suggest starting over again. Go back to your normal sleep habits for a week and find out how much time you’re actually sleeping and how much time you’re spending in bed. Then you can settle on an appropriate sleep window and go from there. (And you adjust that sleep window from week to week based on information you record in your sleep diary from one week to the next.)

    It’s possible to go through sleep restriction on your own and get quite good results. I did. Other people do better under the guidance of a sleep therapist. You might consider this if you’re not getting the results you’d like on your own.

    Hope this helps.

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  5. Hi Lois,
    I came across your website and I wonder if you could give me an advice. I’ve lost my sleep about 5-6 months ago due to a lot of stress. I was put on seroquel for 3 months and I stopped it in beginning of September in hope that I could regain my natural sleep. Since that time I was sleeping 3 to 1 hrs a night unless I took some Ativan. Last Sunday I started SR – I did not sleep for a night, and after I tried going to bed at 12 pm until 6am. The thing is that I would get extremely drowsy around 10-11pm (and I unintentionally dosed off 1 night) but by 12 pm I am not sleepy. I was only able to get an hour of sleep for the last 3 nights and I wonder if SR could work for someone who is sleeping so little. I would appreciate any advice you may have. Thanks so much,
    Natasha

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  6. Hi Natasha,

    I’m sorry to hear you’re having such short nights. But it is likely that sleep restriction can help you out.

    When I went through group therapy for insomnia, sleep restriction was part of the program. Before starting the SR, one woman in my group was averaging 1 hour and 20 minutes of sleep a night. But of all of the people in the program, she was the one who benefited the most. She was sleeping a solid 5 1/2 hours by the end of the treatment. I hope that feels encouraging to you.

    It’s a good idea to acquaint yourself with all the guidelines before starting treatment, though. There’s quite a bit about SR on this blog, and I’ve written more extensively about it in chapter 8 of The Savvy Insomniac.

    Before you start treatment, you need to keep a sleep diary for a week to find out the average amount of sleep you’re getting each night (and also to figure out if there are things you’re doing that might affect your sleep). Only then do you start restricting your sleep.

    Normally, in Week 1 of restriction, you’d limit your time in bed to the average amount of time you’re actually sleeping. But in your case, if you’re really getting as little sleep as you think you are, most therapists would recommend starting the process at 5 hours a night. You choose a wake-up time (let’s say 6 a.m.) and then count backwards to find your bedtime (in this case it would be 1 a.m.). You have to stay awake and out of bed except from 1 to 6.

    As your sleep improves, you get to add 15 minutes to your time in bed each week until you find the sleep schedule that works best for you.

    Here are 3 blog posts that may help you get started:
    https://thesavvyinsomniac.com/be-your-own-sleep-scientist
    https://thesavvyinsomniac.com/sleep-restriction-in-a-nutshell
    https://thesavvyinsomniac.com/pre-sleep-activities-for-the-sleepless

    I’ll also be posting another blog about sleep restriction–which may clarify a few more things for you–this Monday. To make sure you get it, you could sign up for the newsletter or just check back in on Monday.

    I hope you stick with the process!

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  7. Hi Lois,
    I developed severe insomnia 4 months ago. And I am currently going through SRT on my own
    After getting the encourament from your articles.
    Before the SRT, I would always get recovery sleep on the 2nd or 3 rd nights after a bad night of sleep and get 5hrs of sleep.
    But now for the past 1 week since I Started SRT ,I am averaging only 2-3 hrs per night and I am not Getting the recovery sleep which I used to get. I was wondering is this something to be concerned about. I am worried that now I am not even getting the recovery sleep which at
    Least I used to get on 3 rd night. My SW is from 12 till 4:45 am. And Its been 6 days so far.
    I find SRT very tiring and I wonder how important is it to maintain exercise during this SRT period,
    Thank you so much for all of your helpful advices, I read them over and over again when I have
    Doubts and feel insecure.

    Thomas.

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  8. Hello Thomas,

    The variable sleep pattern you describe is one I can relate to well! On again, off again, etc. But of course you want your sleep to be more dependable, and I did, too.

    If you’ve followed the protocol closely–kept the sleep diary for a week before beginning treatment (and are continuing to keep it now), restricted your sleep the correct amount, and are staying out of bed except between 12 and 4:45–then you should start seeing some improvement in your sleep fairly soon.

    You aren’t sleeping a lot, so the pressure to sleep is building up steadily in your brain. There will come a point when you are so sleepy by midnight that you’ll simply be unable to stay awake. (And when that point comes, make sure to continue with the protocol, observing the designated bed and wake times, and increasing them week by week as your sleep becomes more stable and dependable.)

    Is it possible that you’re now more anxious about your sleep than you were before? That could explain why you’re getting only a few hours a night (rather than 5 hours every 3 nights).

    In any case, while you’re going through SRT, make sure to leave the bedroom if you find you can’t sleep. If you’re pretty sure you’re not going to sleep, go to another room and do some quiet activity until the urge to sleep returns. Doing this may eventually help you worry less about not falling asleep. And that could only help your sleep.

    It’s common to feel logy during the few couple weeks of SRT. I certainly did–at least during Week 1. At the same time, it’s a good idea to keep up with your daily routine as much as possible. This too assists with the build of sleep pressure. So you’re better off getting some exercise every day–even if you can’t exercise as much as you can when you’re feeling rested.

    Best of luck in continuing the process–chances are that persevering will result in better times ahead!

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  9. I’ve never been a great sleeper. I’d always had a night once a week or so where I did not sleep well. But I always sleep perfectly the next few nights – like 7 to 8 hours. My insomnia (if you could even call it that) was manageable. Starting a month ago, I had several bad nights in a row. It scared me. But after a few days, I would gain the confidence to sleep again and would go back to 7-8 hours for a week or week and a half. This last cycle has driven me over the edge. It started last Saturday night when I got 6 hours. No biggie, but I found myself worried that I was about to go through another week long sleepless cycle. I napped during the day when my two young kids were sleeping so felt fine by the end of Sunday. Sunday night I maybe got 4 hours. Monday night I laid a awake for hours and in total got 3 hours. Tuesday night I feel asleep quickly, but woke up soon after. Just two hours that night. Thursday night I took melatonin and feel asleep right away. I woke up 5 hours later at 1am and couldn’t fall back asleep. Friday night was a mess. I couldn’t get myself to sleep because I was so anxious about not sleeping. I tried melatonin, chamomile tea and Benadryl. I was up the whole night. Not a wink of sleep. I was a mess. Depressed. I even begged my hubby to take me to the hospital in hopes they’d give me a sedative to knock me out. I was going crazy. I was worried about my sanity, and I was concerned that if I went 2 days without sleep that I’d be suicidal. I went to my doctor’s walk in clinic and he prescribed me clonazepam (to calm me down since my heart was racing) and ambien. I took both and immediacy feel asleep around 8:30. I woke up around 12:30, read a bit and fell back asleep around 2am. I didnt wake up until 8am. I felt amazing! I had a wonderful day with my family. I was in a good mood. I wasn’t irritable. But the whole day I was anxious about not sleeping and had it on my mind non stop. I started dosing off around 9:45 while watching tv. Every time I start to dose off, my body would jolt me awake again. I took ambien around 10:30. I fell asleep close to 11 and stayed asleep until 12:30. Dosed off again around 1 and stayed asleep until 2:30. I am now wide awake on just 3 hours of sleep. I’m shaking from the anxiety. I fear that this is my life now. I’m calling a sleep specialist in my area tomorrow who specializes in cbt-I. I guess my biggest fear is that this won’t work. I’ve got two young kids who need me to be ok which I guess is playing into my anxiousness. My question – do you think I’m a good candidate for cbt-I? Do you think this will help? I’m hoping this is a quicker solution for me since I was sleeping 7 to 8 hours a night without any problem not too long ago.

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  10. Hi Nicole,

    Yes, I do think, based on what you’ve written, that CBT-I is going to be very helpful for you. The fact that you used to sleep 7-8 hours a night, with sleep on one night a week being not so good, suggests you’ll be able to return to that pattern with a little help and probably be able to do better.

    Recently your sleep got derailed, and then you started to worry about it. Once the worry starts, it’s harder to get sleep back on track. But CBT-I will help you to do it. It forces you to be very regular about the hours you spend in bed. That regularity will enable you to fall asleep much more quickly and stay asleep through the night.

    A couple quick pieces of advice about CBT-I: stick closely to the guidelines the sleep specialist provides, and don’t expect to see the transformation occur overnight. It may take anywhere from a few days to two weeks before you notice a solid improvement in your sleep. But it is definitely worth the wait!

    Best of luck with the process–you’re choosing the very best thing available to get your sleep back on track.

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  11. Hi Lois,

    Thank you so much for providing such helpful information here! Your website has given me more hope than I’ve had in years.

    I just started SRT almost a week ago, and I’m already seeing some improvement, though I do really struggle to make it to my bedtime. I’ve always been early to bed and early to rise, so I picked 5:30am as my wake time. But I just realized next week is Daylight Savings, which will bump my wake time to 4:30am, a time I’m not comfortable with. And knowing myself, once I’m into a wake up routine, I have a really tough time getting myself to sleep later. I’m not sure whether I should try to change it soon & quickly, before my routine gets firmly established, or whether I should wait until I have more sleep consolidation under my belt and then change it gradually, or perhaps something else. Do you have any recommendations on whether or how to adjust my wake time? I don’t want to risk losing the progress I’ve made, but I also dread the thought of firmly establishing a 4:30am wake time!

    Thanks in advance for your time, and any feedback you can offer!

    Mandy

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  12. Hi Mandy,

    I’m really glad you’re finding the website helpful. And congratulations on starting sleep restriction therapy! Chances are you’ll gain a lot from it.

    Yes, it can certainly be a struggle to remain awake and alert until bedtime. As I’ve mentioned before in some of my blogs and in my book, I had to resort to doing activities involving a bit of movement–playing the piano and walking around the house, for example. Otherwise I was prone to dropping off too early. Fortunately, as your sleep starts to solidify, you’ll be able to resume doing the pre-sleep activities that seem more natural to you.

    About the upcoming time change, on Nov. 2 we will lose an hour. So if you remained on the same 24-hour schedule, your new wake time would be 6:30 a.m. If you want to continue with 5:30 as your wake-up time, the challenge will be to adjust it from 6:30 to 5:30.

    For most people, losing an hour is more difficult than gaining an hour. And some people more readily adjust to small time changes than others. Since you’ve just started SRT, I would suggest adjusting to Daylight Savings gradually.

    For example, next week, when the time changes, get up at 6:30 for several days. Then set your wake time for 6:15 (while also advancing your bedtime by 15 minutes) and continue with that for several days. Then set your wake time at 6, then at 5:45, and finally 5:30 again.

    Do whatever feels best, but do it gradually.

    Good luck in stabilizing and improving your sleep. You’re on the right path.

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    1. Hi Lois,

      Thank you so much for your quick response. From everything I can find, it looks like we’re going to be gaining an hour on the 2nd. And although this is probably easier for most people, I find it harder because I’m so inclined to wake earlier than I want as it is.

      That being said, would you offer the same advice for moving a 4:30am wake time gradually to 5:30am (i.e. gradually moving bedtime & wake time both forward together by 15 minutes), and doing this before adding any 15 min increments to my total time in bed? I’d hate to delay adding sleep time if I’m at a high efficiency, but I’m also scared to get my body firmly established at a 4:30am wake time before moving it, especially since moving my wake time later has always been tough for me.

      Thanks again for your time and input – I really appreciate it!

      Mandy

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  13. Sorry, Mandy, I often get this “spring forward, fall back” thing mixed up! You’re right, on Nov. 2 we’ll be gaining, and not losing, an hour. My bad!

    All the same, I would go ahead and make the time shift gradually. Stick to the guidelines regarding your total time in bed. (If at the end of a week your sleep efficiency is at least 85 or 90 percent, give yourself 15 more minutes in bed the following week.)

    But when you’re trying to shift to a later wake-up time to accommodate the time change (15 minutes later, for example), also shift your bedtime that much later. (In other words, your total time in bed should remain the same.) Shifting in such small increments, and doing it slowly over the course of several days, seems like the best way to accomplish what you want to do.

    Also, exposure to a healthy dose of light in the evening–until 9 or 9:30, for example–might make it easier for you to remain awake until your chosen bedtime.

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    1. Hi Lois,

      Thank you so much for taking the time to help me! It’s a little daunting to work on both at the same time, but I think your feedback about doing it gradually is great. I’m going to try it & will keep my fingers crossed… Thanks so much!

      Mandy

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  14. Mandy,

    I’m glad to help. Keep us posted on how it goes!

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    1. Hi Lois,

      I hope you don’t mind me writing again so soon, but I’m getting overwhelmed and discouraged, and I was hoping you might be able to help. I’ve now been doing sleep restriction for one whole week, and up until two days ago my sleep efficiency was gradually increasing, and I was excited to soon add 15 minutes to my time in bed. But two days ago I moved my bedtime & wake time forward 10 minutes (as an initial step in preparation for the time change), and as I had feared, I woke up just as early (or earlier) than I had been, driving my sleep efficiency below 85%. I know if I keep my bedtime later I’ll eventually sleep later, but I fear it’ll take a week to accomplish this for every 10 minute adjustment, in which case it’ll be 6 weeks before I can add 15 minutes in bed, which sounds unbearable.

      Before I realized the time change was coming, I was feeling confident and hopeful about this therapy, because my sleep efficiency was improving. But now I’m anxious that this process will drag out longer than I can bear, and/or that it will fail altogether. And of course, all this angst is probably interfering further with my sleep.

      So I’m considering “ripping off the bandaid” and just moving my bedtime & wake time forward the whole hour, because I’d rather induce more extreme sleep deprivation in the short term if it will relieve my anxiety about the time change, and get me more quickly to a point where I can sustain 85% efficiency and start expanding my sleep window.

      Do you have any feedback on this, or perhaps words of encouragement? I feel like I need hope more than anything right now.

      Mandy

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  15. Hi Mandy,

    Feel free to write in as often as you like. These last couple of nights may have been shorter because of your concerns about the upcoming time change. If moving your bed and wake time later by an hour right now will relieve your anxiety, then that is what you should do.

    I think it’s probably the anxiety that’s making your nights shorter than you want them to be. Anything you can do to cut down on those feelings of stress will surely help out.

    A couple other thoughts here. If you wake up early and you know you won’t be able to get back to sleep, the best thing to do is to get out of bed and start your day. The thing to avoid is lying in bed and fretting about not being able to sleep.

    Getting up early one morning will result in a greater build-up of sleep drive that day. In turn, you’ll likely find that you fall asleep more quickly that night and are able to sleep longer the following morning. If it doesn’t happen this way right away, it will begin to happen soon.

    The other thing to keep in mind is that you should save your calculation about sleep efficiency until the end of the week. Calculating it every night could lead to worry–which is of course what you want to avoid.

    I’m certain that you’ll experience a turn-around very soon.

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    1. Hi Lois,

      Thank you so much for your response. I’m amazed by how generous you are with your time and insights, and I’m so grateful to have found your website.

      I think your suggestions are right on target. And I’m glad you mentioned the correct way to evaluate sleep efficiency, because I definitely had that wrong. The way you describe it sounds much more logical and less stressful.

      I’m feeling much more hopeful now, and definitely planning to forge ahead. Thanks again!

      Mandy

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  16. You’re certainly welcome for the suggestions, Mandy. I’m glad to help out when I can. And feel free to write in again if you want to. Good luck!

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  17. Hi Lois,
    I have written to you before.
    I am now into 3rd week and my sleep window is from 11pm till 4am.
    When i started I was averaging 3-4 hrs of total sleep per night. Now its
    Mostly 4 hrs per night .
    I have worked with a sleep psychologist before and we didnt try SR at that time.
    Last night I was happy because i slept total 5 hrs. With only one waking, and was
    Able to go to sleep right away. But tonight i am frustrated because I was so
    Worked up trying not to fall asleep before the allowed sleep time when
    I actually go to bed i am wide awake.and lost the built up sleep for the day.
    Only slept 2 hrs . I heard that even a small micro sleep can wipe out the sleep
    Pressure you accumulate for that day? Thank you for your guidance.it
    Means a lot to me.

    Thomas..

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  18. Hi Thomas,

    It sounds as though overall you’re making progress with SRT. What happened last night was disappointing, and I understand your feelings of frustration. But the immediate result of sleeping just 2 hours last night will be a great deal of pressure to sleep a full 5 hours tonight.

    Small micro sleeps will not interfere with the build-up of sleep pressure that has accumulated during the day. Usually you have to sleep about 30 minutes before you descend into deep sleep. Deep sleep is the way you pay off the sleep debt you incur while awake.

    But having to work yourself up to stay awake until your chosen bedtime could well make it harder to fall asleep. Something like this happened to me, too–I’ve written about it in chapter 8 of my book, The Savvy Insomniac. Trying so hard to stay awake can make you anxious, and anxiety tends to interfere with sleep.

    The way forward would be to think of very light tasks you could do in the hour leading up to bedtime that would involve a little bit of movement. Anything involving movement WILL keep you up, and you won’t have to expend so much effort to stay awake. You won’t feel as anxious, either, and that will set you up for a cleaner, quicker transition into sleep with the approach of 11 p.m.

    You may find this blog post helpful: https://thesavvyinsomniac.com/pre-sleep-activities-for-the-sleepless

    Feel free to write in again if need be. If you stay the course here, I think that eventually you’ll be happy with the results.

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  19. Hi Lois,

    I wanted to follow up with you and let you know that I threw in the towel about a week ago, and restarted taking Unisom at night. During the week leading up to Daylight Savings, my sleep gradually took a turn for the worse, gradually decreasing from almost 6 hours per night at the start of the week, down to 4 hours per night by the end of the week. On top of the mounting sleep deprivation, my cold developed into a full blown sinus infection. I felt sad and embarrassed about giving up, but I just couldn’t take it anymore, especially with all my responsibilities at work and with my kids.

    My husband has been encouraging me to try SRT again at some point, when I’m not sick and when it’s not Daylight Savings, since those things seemed to really throw me off. I have to admit that I’m scared to try again, though, because it was so hard and it ended in such a discouraging way. Have you worked with people before where their sleep started taking a steady turn for the worse during SRT? And are there people who have such intense and tenacious insomnia that even SRT can’t help, or can even make it worse?

    Mandy

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    1. Hi Mandy,

      I’m sorry sleep restriction didn’t help you improve your sleep. But you should not blame yourself or feel embarrassed about it. You’re juggling many responsibilities now, with a job and children. Plus you got sick.

      I’m not a doctor. But knowing a little bit about how important sleep is to recovering from an illness, I personally would not recommend that anyone who was sick go through sleep restriction. Why? Because in most cases, people experience mild sleep deprivation in the first week or two of SRT. When you’re healthy, this mild deprivation, while not pleasant, will not hurt you (at least, that is the consensus of the sleep therapists I have spoken to), especially since it generally primes you for better sleep ahead.

      But when you’re sick, shorting yourself on sleep is not a good idea.

      I would encourage you to try sleep restriction again when you’ve fully recovered from your cold. But, rather than trying to put yourself through the treatment again on your own, why don’t you try working with a sleep therapist? SRT is a key part of cognitive-behavioral therapy for insomnia (CBT-I). In addition to promoting behavioral changes, CBT-I helps people change their thinking, and reduce their anxieties, about sleep.

      It’s possible to work on these changes in attitude on your own. I address some of them in chapter 8 of my book, The Savvy Insomniac, and you may also find this blog post helpful: https://thesavvyinsomniac.com/ease-insomnia-by-changing-negative-thoughts

      But enlisting the help of a trained professional, who will challenge some of your ideas and assumptions about sleep and help reduce some of your anxieties, might be a better way to go.

      About 70 to 80 percent of the people who try CBT-I end up benefiting from it. Those are pretty good odds. Granted, your sleep will likely get worse before it gets better. (This, too, is something I grappled with during the treatment I went through, and I document this in chapter 8 of my book.) But if you can see your way to trying it again, the rewards may well be great.

      All best,
      Lois

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      1. Hi Lois,

        Thank you so much for the feedback, encouragement, and advice. As always, I am amazed with the care and time you put into your responses. You are so generous and helpful!

        Best,
        Mandy

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  20. Hi Lois,

    I have had on and off insomnia for two years now. I consulted a sleep therapist, who put me on “mild” SR of 7 hours, but it did not help. I am averaging 3-4 hours of solid sleep at the beginning of the night followed by tossing and turning with occasional fragmented sleep.

    I just came across your website and I am eager to try your program, however I am currently 5 months pregnant. I am otherwise healthy. Is this a good time to be forcing myself to stay awake? I would think so, considering the end goal is a more restorative sleep. Are there any modifications you would suggest I make to the program?

    Sylvie

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    1. Hi Sylvie,

      It’s good you’re taking the bull by the horns and trying to improve your sleep, and I’m sorry you haven’t succeeded yet.

      If you’re sleeping just 3-5 hours a night, it’s hard for me to see how restricting your time in bed to 7 hours would help to consolidate your sleep. The restriction would have to be greater for enough sleep drive to build up so the process could work. But your sleep therapist may be reluctant to advise restricting your hours in bed further because of your pregnancy.

      I haven’t seen studies that assess the advisability and effectiveness of CBT and SRT for insomnia during pregnancy. Two are under way right now–one at Stanford, and the other, at the University of Calgary. I’m guessing that investigators are conducting these studies because they suspect that cognitive and behavioral treatments will help pregnant women who are having trouble sleeping. But until I see the results, I wouldn’t feel comfortable offering advice.

      But . . . I’m sure that some clinicians HAVE administered SRT to clients who are pregnant. If the sleep therapist you saw isn’t willing to work with you any further on this, why don’t you try working with someone else? Other behavioral sleep specialists are listed here:
      Absm.org/BSMSpecialists.aspx
      Behavioralsleep.org/findspecialist.aspx

      Wish I had something more concrete to offer! Anyway, best of luck in finding help.

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      1. Hi Lois,

        I took your advice to heart and did find sleep therapists willing to treat me, however it wouldn’t be until February! Since my ohs-gyn wasn’t too concerned about my insomnia I decided to go ahead and begin SRT anyway. It took a good 2 weeks to see any improvement (and that’s why it’s so important not to give up hope!) but now I am sleeping a good 5.5 hours solid and then another 1.5 hours or lighter REM-type sleep. I am taking a little break from keeping my sleep diary, but always make sure to wake up at the same time every morning. I wanted to thank you for your advice and encouragement, you were a great help!

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      2. Hi Sylvie,

        I’m really happy to hear about your improved sleep! And thanks for sharing the news. You’re welcome for the advice and encouragement, but it sounds to me like you yourself were most responsible for the change. You stuck to SRT guidelines and have gone on to reap the rewards.

        Best of luck going forward. If you ever need a sleep “tune-up,” now you know what to do.

        Lois

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  21. Aishwarya Gawde January 7, 2015 at 10:12 am

    Hey, i have difficulty in sleeping in mid december. i couldnt sleep for more than five hours for 4-5 days straight. but however, it ironed out and i started sleeping my regular 8 hours after that. However, in the past 3-4 days, i am having trouble sleeping again. i can sleep for 6 hours and that is affecting my concentration and mood very much. Please help!!

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    1. Hello Aishwarya,

      You might want to start by keeping a sleep diary for a week or two to get a clearer picture of the problem and figure out whether anything you’re doing, taking, eating or drinking is setting you up for shorter nights. You can download a diary approved of by the American Academy of Sleep Medicine here:

      http://yoursleep.aasmnet.org/pdf/sleepdiary.pdf

      Undergoing cognitive behavioral therapy for insomnia–which typically includes sleep restriction therapy, as discussed at length in this blog–is a good way to improve sleep. Depending on where you live, though, you may not have access to a trained sleep therapist who could lead you through it.

      In that case, you may want to investigate online resources. Two I can vouch for can be found here:

      http://www.Cbtforinsomnia.com

      http://www.Sleepio.com

      If you want a really comprehensive guide to improving your sleep, I’d recommend that you read my book, The Savvy Insomniac: A Personal Journey through Science to Better Sleep. Here’s the URL:

      https://thesavvyinsomniac.com/store/products/the-savvy-insomniac-the-book

      Good luck!

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      Reply

  22. Aishwarya Gawde January 9, 2015 at 6:03 am

    Thank you, lois! I am so frustrated by this lack of sleep. Hope that the sleep restriction method works!

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  23. Deborah Calderon January 11, 2015 at 1:29 pm

    I am getting ready to try this, but measuring how much I sleep is tricky. Some nights I don’t sleep at all. This can go on for a couple of nights. Should I just choose a number, like 4 and 1/2 hours of sleep to start with?

    Thanks for your help and your book, I have found it not only enlightening, but very comforting.

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    1. Hi Deb,

      I’m glad you found the book helpful. I wanted to write a book strong in empathy and support.

      As for where to start with sleep restriction when you can’t get a clear read on how much you’re sleeping at night, therapists I’ve spoken with don’t usually recommend starting with anything less than a 5-hour sleep window. At night, it might be the case that part of your brain is sleeping while another part is behaving as if you were awake. If this is what’s happening with you, to set a sleep window of less than 5 hours might make your night way too short.

      Good luck with the sleep restriction, and feel free to write back with questions as you go along.

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  24. My insomnia started during a period of stress about 3-1/2 months ago. After about a month and a half of struggling on my own, I started sleep restriction therapy with a counselor. I averaged about 6 hours of sleep during the first week, in which my sleep was unrestricted, and my therapist started me off with 6-1/2 hours in bed.
    I struggled to stick to the prescribed bed time during the first two weeks of sleep restriction, “fell off the wagon” several times, and saw no improvement. My therapist then cut my time in bed back to 5-1/2 hours, and, since then, I have been very diligent about obeying all the rules. However, I am now on week 8 (week 6 if you start counting when I went back to 5-1/2 hours) and, with few exceptions, I have maintained the alternating good night/bad night pattern that I’ve been in since before I started therapy: typically 5-6 hours one night, 2-4 hours the next, 5-6 hours the next, etc. I’ve averaged about 4-1/2 hours of sleep/night for the last 8 weeks. While my original problem was sleep maintenance, I now have difficulty falling asleep at least as often as I have difficulty staying asleep, even though I start getting drowsy by early evening every night.
    My therapist has gradually increased my time in bed to 7 hours, based on improvements in my sleep efficiency and my reporting feeling sleepy outside my bedtime hours every day, but I’m not getting congruent sleep consistently and, on average, I’m not sleeping anywhere near the 7 hours I’m allowed.
    I feel very confident in my ability to sleep the night after a “bad” night, and very anxious about sleeping the night after a “good” night. How can I get out of this pattern?

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    1. Hi Katie,

      I’m sorry you’re so far along in the sleep restriction process and have yet to see results. It sounds very frustrating.

      But you’ve done a really good job of describing the problem. I can certainly give you my take on your situation and offer a few suggestions.

      It’s common for insomnia to occur when people are under stress. For some people it clears up once the stress goes away. Other people go on to develop some type of chronic insomnia.

      Are you still feeling the stress that triggered your insomnia 3 1/2 months ago? If so, in addition to the SRT, you might benefit by doing some kind of regular practice to relieve the stress.

      Nothing works as well for me as vigorous exercise late in the afternoon. (Once I realized how much of an impact exercise has on my sleep, I decided to exercise every day.) Other people I know do something like tai chi, yoga, or meditation. Doing any one of these things regularly might help with the anxiety you’re now feeling about your sleep.

      The fact that you’ve identified a pattern to your sleep–one good night followed by a bad night, followed by a good night and then another bad night–is helpful. But to get sleep restriction to work, you’ve got to begin by restricting your time in bed to the average amount of time you’re actually sleeping. If I understand you correctly, that would be 4 1/2 hours.

      So I can’t see how beginning at 6 1/2 hours, or even 5 1/2 hours, would set you up to succeed. (Some therapists feel that 4 1/2 hours is too little time, and that no one should start with less than 5 hours in bed. Others have said they recommend 4 1/2 hours for some of their clients.)

      I know you’ll probably hate to hear this, but if you want to continue with SRT, you may need to restrict your time in bed further than your counselor has recommended. And only if your sleep efficiency is at least 85 percent (and better yet, 90 percent) by the end of the week should you allow yourself 15 more minutes in bed the next week.

      The other thing is this: when you find you can’t sleep, even though it may be really, really late, it’s a good idea to leave the bedroom and do some quiet, distracting activity until you feel ready to sleep again. The idea is to break the association between your bed and wakefulness. Getting out of bed when you can’t sleep is the best way to do that.

      These rules are hard to follow in part because sleep restriction often causes mild sleep deprivation. But this enables sleep drive to build up to the point where it puts you to sleep and keeps you asleep EVERY night–not just one in two. And once your sleep drive is high and sleep becomes more regular, the process gets much easier.

      One challenge for me in the beginning of SRT was to find ways to keep myself awake in the run-up to my very late bedtime. If you haven’t already looked at this blog, maybe it will help.

      https://thesavvyinsomniac.com/pre-sleep-activities-for-the-sleepless

      Anyway, good luck with whatever changes you decide to make, and feel free to write in again.

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      1. Thanks, Lois, for your prompt reply.

        Regarding the original cause: the event is over and done with, but there may be some issues that the event brought up for me that are ongoing. I will be working with my therapist on those.

        I am doing many of the things you recommend: I have always exercised regularly and have been doing at least an hour every day, usually mid- to late afternoon. I do get out of bed when I can’t sleep and go to another room to read or do some activity until I feel sleepy. It took me a while to find ways to stay awake until bed time, but I think I’ve got that problem solved.

        Your recommendation that I cut back on my sleep time makes a lot of sense to me – I suspected that was the problem. I will discuss that with my therapist.

        I am not clear on how the decision is made to increase sleep time. I understand that sleep efficiency is a factor, but what about hours of sleep? As I understand it, sleep efficiency is the number of hours slept divided by the actual number of hours in bed (not the number of hours allowed) – is that correct? If so, let’s say I go to bed at midnight, fall asleep quickly, wake up at 3:30 AM (my target is 7:00 AM) and can’t get back to sleep, get out of bed, and never feel drowsy enough to go back to bed. My sleep efficiency would be pretty high, but I’m only sleeping 3-1/2 out of the allowed 7 hours. I would think I shouldn’t get more time in bed until I’m sleeping a pretty high percentage of the time that I’m allowed – ??

        Thanks again for your help. I’m really glad I found this site – it is very helpful to hear the experiences of other people who are doing SRT and to see your feedback.

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      2. Hi Katie,

        It sounds like you’re already doing lots of the things that should help you improve your sleep. That’s great.

        But now I’m realizing what the issue for you may be. Somehow when you wrote before, the numbers just weren’t adding up. Miscalculation may have contributed to the problem.

        You’re already keeping track of the hours (or minutes) you sleep every night (just as you should be), and adding them up at the end of the week. But this Total Sleep Time for the Week should be divided by the Planned Sleep Time for the Week (the number of hours or minutes allowed)–NOT by your actual time in bed. Then you multiply by 100 to find your sleep efficiency.

        If sleep efficiency is less than 85%, subtract 15 minutes from your time in bed the following week. If SE is 85—89%, stay the course. If SE is 90% or higher, add 15 minutes to your time in bed. Continue the process as long as your SE remains high. The goal at the end of the process is to allow yourself as much time in bed as possible while maintaining a sleep efficiency of at least 85%.

        You’re welcome for the responses. I hope what I’ve said here helps. It really sounds to me like you’re on the right track.

        Like

      3. Thanks again, Lois, for your prompt reply.
        My therapist uses tools from the VA, including an iPhone app and a spreadsheet. Both calculate sleep efficiency as sleep hours divided by actual hours in bed. Your calculation makes a lot more sense to me, but almost everywhere I look on-line, it looks like actual hours in bed are being used. Can you point me to a definitive reference that supports your calculation?

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      4. Hi Katie,

        When I first put myself through SRT, I was using a guidebook for therapists. Here is the reference:

        Michael L. Perlis et al., Cognitive Behavioral Treatment of Insomnia: A Session-by-Session Guide (New York: Springer, 2005).

        Appendix 1 is called “The Calculation of Sleep Efficiency.” It contains the answer you are looking for. You may not be able to locate this book easily, so I will do some quoting here.

        TIB (Time in Bed) = The difference between PTTB (Prescribed Time To Bed) and PTOB (Prescribed Time Out of Bed)

        “Under the simplest of circumstances, where the patient is compliant with the Prescribed Time To Bed and the Prescribed Time Out of Bed the calculation [of the denominator] is indeed straightforward. If the patient is prescribed a midnight to 6 am sleep schedule, then the denominator is 360 minutes.”

        I could also scan and email the full page to you if you like.

        The second time I went through SRT (as part of CBT-I), I was a patient in a group that received treatment at the Behavioral Sleep Medicine Clinic at the University of Michigan Medical School.

        We got lots of handouts, and here is the formula for calculating sleep efficiency that we received:

        Sleep Efficiency (SE) = Total Sleep Time / Planned Sleep Time X 100.

        I could scan and email this sheet to you, too.

        “Time in Bed” is an ambiguous term. It needs to be defined, and maybe that’s the problem with the materials your VA therapist is using. The materials really should be clarified and corrected. Otherwise, SRT is not likely to work.

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  25. Sounds like a challenging sleep pattern Katie. As Lois indicated, relaxation, mental and/or physical, can be really helpful and definitely worth doing.

    If you have an iPhone, I would like to offer you a gift (free) copy of my SleepQ app. It can be used for an hour or so around bedtime following rough nights. It is for sleep training, an efficient way to strengthen the association between going to bed and falling asleep. In her reply to you, Lois suggested you might leave the bed when you are alert, which is the core activity of stimulus control.

    So again, I’d be more than happy to email you a gift copy of my SleepQ app for iPhone if you’d like one.

    Best to you,

    Michael
    michael@sleeponQ.com

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  26. hello! i am hoping for some help. Up until some stressfull events around the November/December timeframe i completelly lost my sleep. i used to get a good 9 hours nightly but for the past two months have really struggled. latelly my issue has been sleep maintenance, where on most nights i can get to sleep within 20 minutes but cant maintain sleep past 4.5/5 hours. overall i go to bed at 9/9:30 and am in bed till at least 7:30, which i know is a problem, as in that 10 hour span i get a maximum of 7 hours of sleep, probably 6. So, last night i started sleep restrictoin by going to bed at 11 and waking at 5 (which is WAY too early but i am always early to bed and cant imagine staying up past 11). Sadly, though getting to sleep has been less of a problem, i could not get there all night and basically slept only a few hours. i for sure have anxiety over sleep. so, my question is, how long should i expect for this to take to work? should i work with a sleep specialist or can i do this on my own. i do have a therapist who has been working with me on anxiety issues, but want to have her focus more on sleep. my appt is not until Thusrday and I would like to get a head start!

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    1. Hello again, Alli,

      One more thing. You asked how long the CBT-I process usually takes. Once you start restricting your sleep, you may start to notice improvements in your sleep during the first week (I did). But some people don’t start seeing improvements for 2 or 3 weeks.

      CBT-I is not a quick fix for insomnia. But it is an enduring fix for many people with insomnia. For this reason, it is worth going through.

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  27. Hello Alli,

    I’m sorry to hear you’re having trouble sleeping. Sleep restriction–what I’ve written about in this blog–is one component of cognitive behavioral therapy for insomnia (CBT-I). Based on what you say about your sleep, I suspect that undergoing CBT-I would be a great way to improve your sleep.

    Before you start the process, though, you need to understand the rationale behind the treatment and get acquainted with all the guidelines. (Plus you’ll need to spend a week or two simply gathering information about how much time you sleep and how much time you spend in bed.)

    Many people get this information from a therapist trained in behavioral sleep medicine. You may be able to locate one in your area at one of these URLs:

    Absm.org/BSMSpecialists.aspx

    Behavioralsleep.org/findspecialist.aspx

    Trained sleep therapists are few and far between in some areas of the country. If you can’t find one near by, or if you don’t happen to have health insurance that will cover the charges, you may want to investigate online resources. Two I can vouch for can be found here:

    http://www.Cbtforinsomnia.com

    http://www.Sleepio.com

    If you want a really comprehensive guide to improving your sleep, I’d recommend that you read my book, The Savvy Insomniac: A Personal Journey through Science to Better Sleep. It has a chapter on CBT-I. Here’s the URL:

    https://thesavvyinsomniac.com/store/products/the-savvy-insomniac-the-book

    Here are 2 blogs you may also find helpful. They lay out the basics of sleep restriction:

    https://thesavvyinsomniac.com/q-a-is-sleep-restriction-as-bad-as-it-sounds

    https://thesavvyinsomniac.com/sleep-restriction-in-a-nutshell

    Good luck getting started with CBT-I. And feel free to write in again.

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  28. Hi Louis, its Alli again. thank you so much for your reply! i defianatly understand the concept and rationale for the program and did do sleep logging to come up with 6 hours. i am however nearing week 2 and am not seeing much progress. first week i was at getting about 5.5 hours now im regressing. i fall asleep within minutes of hitting the pillow but just cant stay asleep. this week im at 80% efficiency. im tempted to throw in the towel but at the same time need a solution. i cant imagine decreasing my sleep time any more as im already soooo tired. i was so motivated at the begining and am now loosing hope. any advice is greatly appreciated. side note – ive been sticking to the schedule pretty diligently besides two slightly delayed wake ups.

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    1. Hi Alli,

      I’m sorry to hear you haven’t yet gotten the results you were looking for with sleep restriction. I have a couple thoughts about your situation.

      First, 2 weeks of sleep restriction may feel like a lot, but some people don’t start seeing results until the end of the 3rd week. If I were you I wouldn’t throw in the towel just yet.

      It’s good that you did some sleep logging before you started the restriction. If you found that on average you were actually asleep for 6 hours, then that would be the correct place to start restricting your time in bed.

      If your sleep efficiency is only 80 percent, though, the guidelines would call for restricting your sleep still further–to 5 hours and 45 minutes, for example. Doing this would probably make the restriction process work more quickly. You’ll have to decide whether this is something you can tolerate or not.

      What I’m about to suggest is an idea that’s under investigation right now. It’s not part of sleep restriction canon, but the fact that it’s being studied suggests that some researchers believe it might work.

      Here it is: you could try taking a 20-minute nap in the afternoon. A nap might reduce your feelings of fatigue. But it wouldn’t likely interfere with the build-up of sleep pressure because it normally takes longer than 20 minutes to descend into deep sleep. If this makes sense to you, and especially if taking a nap would make the idea of restricting your sleep a little more at night more palatable, you could try it.

      You say you’re able to fall asleep quickly but then can’t stay asleep. Then, you mention 2 slightly delayed wake-ups. Getting up at exactly the same time every morning is probably THE most critical part of the restriction process. Going forward, you’ll have a better chance of success if you hold fast to your established wake-up time.

      I wonder if delaying your bedtime and wake time would help. You haven’t mentioned what hours you’ve set for yourself. But if you’re now going to bed at 11 and getting up at 5, could you change the schedule to 11:30 to 5:30 to see if that would help?

      Finally, if you continue to wake up during the night, if after 15 minutes you find you aren’t falling back to sleep, you should leave the bedroom and do some quiet activity (like reading) in another room until you feel sleepy enough to return to bed. Tossing in turning in bed tends to make people anxious. It’s something you want to avoid.

      Good luck moving forward. Sleep restriction can feel like a slow process. But, if you can hang on and stay the course, there’s a good chance you’ll see results.

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      1. I’m only 2 weeks into SRT, and I was so excited when I read Lois’s first mention of it naps maybe being ok with SRT. I have always found naps really refreshing and not being able to have naps has really put me off trying SRT before. But I know some people feel worse after a short nap, my husband is one of them. But a ‘micro nap’ has worked wonders for me twice this week. About 10 minutes each time, I felt invigorated afterwards, and it didn’t affect my night time sleep at all. I can’t express what a massive relief it has been! Will keep this new favourite tool only for when I’m feeling really, really sleepy during the daytime. But just having that possibility in the back of my mind has made me feel so much more relaxed about making it through till bed time.

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      2. Hi Lesley,

        Thanks so much for writing in to share your experience of taking a short afternoon nap while going through SRT. Sometimes I hesitate to recommend practices that haven’t been tested out yet. But I really can’t see where this idea could go wrong. If it could ease fatigue during the day without interfering with the build-up of sleep drive, what’s to lose?

        All the same, there is a study on naps and CBT for insomnia going on right now in Australia, and I’ll be very interested to hear about the results. I’ll certainly blog about them when they come out.

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  29. Hi Lois,

    I stumbled upon your blog and it was the nudge I needed to try sleep restriction. I’ve had insomnia that started about 12 years ago but didn’t get really bad until about 4-5 years ago. The symptoms feel so physical that I always brushed off any kind of “therapy” as useless. Lo and behold though, it is only early on and I’m already seeing improvements. I actually CAN sleep without Unisom or Ambien! Now granted it’s only a 5.5 hour window, but wow. I’m actually feeling optimistic and hopeful for the first time in a long time!

    I would love to hear about what’s next after completing the 6-week regime. Do you go on adding 15 minutes after each successful week, until you reach a point where you start regressing? Then dial it back 15 minutes and see if that’s your true equilibrium? Are there any stats about what kind of sleep windows people are maintaining a year or more after completing therapy? Personally I would be ecstatic if I worked my way up to a 7-hour window. I also wonder if they have to continue to be so strict with the wakeup time forever? Are there often regressions that require hitting the restart button and going back through the program?

    One thing that has me cautiously optimistic is the fact that most people writing to you for advice seem to be in the early stages of sleep restriction. People who start seeing success are probably far less likely to write in and say, “hey! It’s going great! Just wanted to tell you that.” So the relative lack of people writing about experiences further down the road makes me hopeful that they are mostly positive!

    Thanks a bunch!
    Kim

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    1. Hi Kim,

      I’m glad you’re feeling optimistic about sleep restriction therapy and already starting to see some improvement in your sleep. While it’s true that SRT and cognitive-behavioral therapy are not effective for every person with insomnia, 70 to 80 percent of those who go through the program are successful at improving their sleep. So the odds are in your favor!

      You’ve spelled out the process pretty well: as long as your sleep efficiency stays high, you increase your sleep window by 15 minutes the following week. If your efficiency starts to drop, you may need to reduce your sleep window by 15 minutes. Eventually you find your ideal sleep window: the place where you have the greatest amount of time in bed while continuing to maintain high sleep efficiency. (Some therapists suggest aiming for 90% and above; others suggest aiming for 85% and above.)

      Continuing to wake & get up at the same time every day is the single most important thing you can do make sure that your sleep stays on track. If you sleep in, you may not build up enough sleep drive to get to sleep and stay asleep the next night. There’s much more to this, and I delve deeply into it in my book, The Savvy Insomniac. But I’ve also addressed the topic of sleep drive in some of my other blogs.

      Personally, I’ve just accepted having a fixed wake-up time as part of my lifestyle now. And with the exception of some minor blips, my sleep continues to be much better than it was before.

      I don’t know how often most people who go through sleep restriction feel the need to have a “tune-up.” I did once, and I found that I was back in a better groove with my sleep in less than a week. I haven’t found a need to restrict my sleep since then. My fear of sleeplessness, which used to kick in when I couldn’t sleep, is now pretty much gone. That, for me, has been one of the biggest benefits of sleep restriction and CBT.

      I honestly don’t know, either, how many of the people who write in to this blog are successful with sleep restriction and how many are not. Observing the rules to the letter is one key to success.

      But, as Katie points out below, there may be other medical and psychological conditions interfering with your sleep. So it’s a good idea to see a sleep specialist if you find you’re struggling with the sleep restriction process.

      Anyway, it sounds like you’re moving in the right direction, and I wish you the best of luck going forward!

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      1. Thanks so much for the reply! I think that “life after sleep restriction” would be an interesting blog topic. Does your book address the best ways to handle difficulties such as international travel, sickness, or a new baby once you’re in the maintenance phase? These could make sleep during your designated phase impossible, or drain you so much physically that you could need more sleep temporarily.

        Also what about dietary supplements? I saw a blog post but there weren’t too many details. Perhaps there’s more in your book? I feel like I’m very sensitive to certain supplements, especially those known to increase energy levels (such as b-vitamins or those intended to support thyroid function). However I do wonder if I’m just blaming them out of desperation, because I’ve struggled for years to identify triggers so I could have some sense of control over my insomnia. I tried keeping food diaries in the hope of identifying some common ingredient or supplement, but it always seemed to be a dead end. I wonder if that is a common theme among desperate insomniacs?

        Anyway, there is no lack of interesting topics to write about … especially when you’re up all hours of the night. 😉

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      2. Hi Kim,

        You’re right, “life after sleep restriction” would make a good topic for a future blog. Thanks for the idea!

        My book covers some of the topics you’ve mentioned: herbal supplements sold as sleep aids, melatonin, and how to control jet lag. All the remedies I’ve included in the book are research based.

        As far as food triggers for insomnia go, it’s an intriguing topic that not much is known about yet. But here are a couple of blogs that may interest you:

        https://thesavvyinsomniac.com/sleep-friendly-diet-for-long-term-health-part-i/

        https://thesavvyinsomniac.com/a-sleep-friendly-diet-part-ii/

        When I’m sick is the one time I allow myself to sleep as much as I can whenever I can. Sleep is so important to recovery from illness that I doubt many sleep therapists would advise doing otherwise.

        If you’ve got a new baby at home, obviously you’ll have to modify your sleep schedule with that in mind. This is one topic not covered in my book. But a book I look forward to reading just came out in December: “The Happy Sleeper,” by Heather Turgeon & Julie Wright. Anything you can do to help regularize your children’s sleep patterns in turn will allow you to better regularize your own.

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      3. Thanks for your reply! I just ordered your book on Amazon. I’m looking forward to reading evidence-based information. I feel as though most of the suggestions out there are not for true insomniacs. I dutifully tried all of them, but they never did much good!

        Thanks again for devoting so much time to this topic.

        Kim

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  30. Katie Replogle March 12, 2015 at 4:03 pm

    Hi, Kim –

    I’m someone who is “further down the road.” I hesitate to post because my experience with SRT has been very disappointing, and I don’t want to bring other people down. But perhaps my experience will help someone.

    I developed chronic insomnia after a period of stress about 5 months ago. I’ve been on SRT for 4 months and am still struggling. I spent the first 3 months with a CBT-I-trained therapist, re-starting the restriction three times because, I believe, my time in bed had been increased when it shouldn’t have been.

    I am now using the on-line Sleepio program. My time in bed is currently 5 hours. I’m seeing some improvement but still having at least 2 “bad” nights per week, which keep my overall efficiency below the 90% needed to increase time in bed. It looks like it could be a long haul.

    I read with envy the posts from people who fall asleep “as soon as their head hits the pillow” after the first few days or weeks of SRT. I have never fallen asleep that easily, even though I struggle to stay awake until bedtime.

    I think my difficulty may be higher-than-normal anxiety – or maybe my anxiety level is normal and I just haven’t found a relaxation technique or cognitive approach that works for me. Next week I will begin working with a new therapist who I hope can help me with the anxiety.

    I’ve also been to a doctor who takes a nutritional approach to healing. She suspected adrenal fatigue (a condition which not everyone in the medical field believes exists). We had my neurotransmitter levels tested. The results showed that some were abnormally low and some abnormally high. I will be taking some adrenal supplements to try to correct that imbalance.

    The take-aways from all this are:
    (1) The high sleep drive that develops from the mild sleep deprivation caused by SRT is not necessarily enough to overcome insomnia. The cognitive part is important. (Most people seem to think that the sleep restriction is the “hard” part of CBT-I – for me, the cognitive part is much harder.)
    (2) If CBT-I isn’t working, it’s worth getting a medical check-up to see if there are chemical imbalances that are making it hard for you to calm your anxiety.

    I hope your sleep quest is successful!

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  31. I just started SBT and have a couple questions. One thing that is confusing to me is that I’m not supposed to “clock watch” yet I also need to track how much I’m sleeping. Also, the guidance is to get out of bed if I cannot fall asleep in about 15-20 minutes. Again, in order to track that, I end up being really focused on how long it’s been. I find that I can surprise myself thinking it’s only been 15 minutes that I’ve been trying and it turns out it’s been an hour! Any advice on how to balance tracking and not becoming overly obsessed with how many minutes have passed?
    Thanks!

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    1. Hi Naomi,

      You’ve put your finger on one of the more difficult aspects of cognitive behavioral therapy for insomnia. (CBT-I mainly consists of 2 behavioral therapies: sleep restriction therapy [SRT] and stimulus control therapy [SCT].)

      Going through SRT, you have to observe a fixed bedtime and a fixed wake time. So in the evening you’ve got to glance at the clock at least occasionally or you might go to bed too early.

      But people with insomnia often find that watching the clock makes them anxious. Particularly if your trouble sleeping usually comes at the beginning of the night, keeping an eye on the clock as it grows later and later at night is arousing–exactly what you want to avoid if you’re aiming to relax and fall asleep.

      I can’t see any way around this problem. One thing I did to reduce my anxiety as I waited to go to bed at night was play an electronic piano–an activity I normally find relaxing. If you haven’t yet seen this blog, you may find it somewhat helpful:

      https://thesavvyinsomniac.com/pre-sleep-activities-for-the-sleepless/

      After you go to bed, though, you should never look at any clock. The guidelines for SCT state that you should get out of bed and go to another room if after 15 or 20 minutes you’re not asleep. But this rule is not hard and fast. You should observe it based on what you ESTIMATE to be true. The idea is to avoid staying in bed if you can see that you’re not sleeping. If you do stay in bed, the association between your bed and sleeplessness will be strengthened rather than relaxed.

      In the morning, you know exactly what time you went to bed and exactly what time you got up. As for what happened in the period in between, you make the best guess you can. That’s what you record in your sleep diary and what you use to calculate your sleep efficiency at the end of the week. But at no time during your sleep period should you be looking at a clock.

      I hope this is helpful. CBT-I is imperfect–but for now it’s the best drug-free therapy there is. Good luck with it!

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      1. Thank you! This is really helpful!

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  32. I have sleep maintenance insomnia, I’m now into my fourth week of SRT. My sleep quality and efficiency are excellent, and improved dramatically from night 8 onwards. That first week was really, really tough, but I’m now averaging 4 hours 45 minutes of excellent sleep per night. I do seem to be stuck at this level but hopefully gradually I’ll be able to extend this time.

    This week I’ve accidentally discovered a new toy to help me stay awake in the evenings. I struggle to keep my eyes open from about 8pm onwards (clearly I’m not a night owl), especially if I want to sit down and watch TV. I work out 5 mornings a week, of which 3 times are with weights, and find I get a lot of knots in various muscles. Nodding off in the evenings, despite sitting bolt upright and cross legged on the floor, doesn’t do my neck any favours either!

    So this week I bought myself a shiatsu massage cushion to use when I sit down in the evenings. It gives a surprisingly strong massage, imagine Popeye on steroids, it’s wonderful and just what I was hoping for. The one excellent bonus I wasn’t expecting is that it totally keeps me from nodding off, so far anyway. Although it is relaxing in one way, I still find the constant rotating pressure enough to keep me awake. Ideal for habitual ‘nodder offers’ like me who fight to stay up, although maybe not for those who would find it too arousing before bedtime.

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    1. Hi Lesley,

      I’ve just read your post here and I think you’ve found something that could be REALLY useful to others who visit this blog. In many ways, this shiatsu massage cushion sounds like the ideal tool to use as you’re going through sleep restriction.

      One of the hardest things for many people in the first few weeks of SRT is to keep from nodding off before their scheduled bedtime. Activities involving a bit of movement will help you stay awake. Yet these activities are not very appealing when you’re sleepy. You feel more like being stationary–yet passive activities will almost certainly lead to nodding off.

      This shiatsu massage cushion could solve that problem. It gives you the stimulation you need to stay awake in the evening without your having to move a muscle. In turn, it may hasten the sleep restriction process and ultimately lead to longer nights, which is what you really want.

      Thanks for sharing your experience here, Lesley. It could be really helpful to others who are trying to improve their sleep with sleep restriction.

      Another thought about your early bird tendencies. Working out in the morning (vs. later in the day) is probably going to make you sleepy earlier in the evening. If that’s your routine, if that’s what makes you feel good, then I doubt you should change it.

      But doctors who work with people who feel like nodding off as early as you do will sometimes prescribe use of a light box in the evening between 7 and 9 p.m. Light exposure, like movement, is a way of delaying sleepiness and sleep. You’ve got my book, so you can read more about it in chapter 6 and decide if you feel a light box would help.

      But you yourself may have hit on the perfect solution to keeping yourself awake with this shiatsu massage cushion. Again, thanks for writing in.

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  33. Hi Lois,
    Whenever I exercise it always really perks me up. Mentally and physically I’m at my peak during and after exercising. So the findings of the research you’ve told us about in your book and on this website, and of course your own experience, all make total sense to me. Physical activity can give you an endorphin buzz can’t it, so hopefully this will last long enough to make staying awake in the evenings easier.
    So I’m going to give it a try starting this afternoon. I’ll start with half an hour on the treadmill, two afternoons a week, building up if necessary. This will be in addition to my normal 9am gym visits on other days, and I’ll keep track of any sleep changes.
    One massive mindset change for me these first few weeks with SRT has been changing my perception about what sleep I really need, as opposed to what I think I need. For the whole of my life I’ve said I need 7 or 8 hours’ sleep. I’ve now proved to myself I can function fairly normally most of the time on about 5 hours’ sleep, as long as it’s good quality sleep, which it certainly is now. It’s not killed me (so far!), and it’s not even made me ill. To be honest I now find it very liberating not to have to dread or endure those lost hours at night tossing and turning, trying but usually failing to get that elusive extra sleep.
    I’ve also found it extremely reassuring from your book to find out how many others suffer from one of the various forms insomnia. Up to 10% is an amazingly high number, and I find it comforting to know we are not alone!

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    1. Wow, Lesley, you are really going all out in your efforts to improve your sleep. I can see you have a sort of experimental mindset, and that’s a real advantage when you’re looking for ways to improve your sleep. I’ll be really interested to hear what effect the afternoon exercise ends up having on your sleep.

      The mindset change you write about–that it’s the quality of the sleep you get that matters more than the number of hours you sleep–is a conclusion I came to as well. Lots of people are very skeptical of this idea. We’re always being told that we all need 7 to 8 hours’ sleep a night to be healthy and to live long lives.

      Well, it may be true that a majority of people need 7 to 8 hours. Yet research suggests that not all of us do. And when the sleep you get starts to feel like quality sleep–that’s when your thinking about your sleep need may start to change.

      One thing that motivated me to write The Savvy Insomniac was the loneliness I felt about my insomnia. I wanted to know how other people experienced the problem, and when I reached out to others and conducted my interviews, I found that many insomniacs felt the same sense of loneliness that I did.

      I wanted their testimonials to be a part of my book. I hoped that readers might take heart on discovering they were not alone. I also wanted to convey the idea that, in part because of our numbers, insomnia is a problem worthy of attention and further research.

      Anyway, thanks, Lesley, for sharing your thoughts.

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  34. Now that was a total shock – I slept for 45 minutes longer – 45 minutes longer!!! No way did I expect it to affect me on the very first night. I really am gobsmacked. I expected it to take some time to make a difference, and then be a far more gradual change.

    I was glad I wrote on here about my intentions yesterday to exercise late afternoon, otherwise I might have talked myself out of trying it. I won’t pretend it was easy to force myself exercise at that time of day, and my performance was definitely poorer than it would have been earlier in the day, it was slower and felt harder work. Maybe my mind and body were rebelling, knowing Friday is always a rest day.

    The evening was clearly different as well. I did get sleepy, but only a couple of times, and not enough that I couldn’t fight it off. Then the shiatsu massage cushion came to my rescue, and the evening was over. I told myself at that stage it was all psychological – I so wanted the late exercising to have helped, I’d made myself more alert thinking about it, so that was keeping my mind more active than of late. But the night time was the real test, and it worked, yaaaayyyy!

    I’ll be repeating the process tomorrow, Sunday afternoon. If the outcome is this positive again, I’ll be radically re-planning my exercise routine. Such a shame the only Leisure Centre in the area doesn’t do one single exercise class in the afternoons, but it will be worth making compromises if it continues to be this effective.

    Thank you soooooooo much Lois, you are an absolute star!

    PS Oops, I should have set my alarm last night shouldn’t I, 45 minutes was a too big a step in one go wasn’t it. I’ve not been managing to sleep until the alarm so simply forgot about setting it, shows you I wasn’t expecting that immediate impact. I still have to keep re-counting the hours I slept on my fingers as I still can’t believe the figures!

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    1. Hi Lesley,

      I’m glad you went through with your plan to see about the effects of afternoon exercise on your evening alertness and your sleep, and that it went so well. May this trend continue!

      Do remember to set your alarm clock every night, though. Oversleeping in the morning can leave you short on sleep drive the following night.

      Best of luck!

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  35. Hi Lois, I read your book and I am following the therapy for the 6th night with no progress. My sw is from 12:00 to 5:00. My biggest problem is that I wake up consistently at 2:00, no matter when I go to bed, its like an inner setting. Sometimes i wake up with panic and then there is no getting back to sleep. I have got 2 to 3 hours sleep per night. I felt very fatigued during the day yesterday, more than on all other days. But again it did not happen for me. I take 75ml trazodone at night which seems to help falling asleep but not to maintain. My insomnia was caused by a neck injury, taking painkillers and ruining my stomach afterwards now having to battle gerd. 3 months I am sleeping poorly and cannot function. Still off work but need to get back. I am very lost.

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    1. Hi Susanne,

      It sounds like you’ve had more than your fair share of medical problems. I’m sorry that it’s reached the point where they’re interfering with your sleep. Sleep problems are linked to pain and stomach issues, though, so it’s really not surprising that now you’re having trouble with sleep.

      Many people with insomnia DO have other health issues, and these days people who study insomnia are studying it in relation to other conditions–everything from depression and anxiety to cancer and chronic pain. The thinking now is that sleep problems should be treated jointly with related health problems–not separately.

      For this reason, I’d first suggest putting yourself in the care of a sleep specialist who’s experienced in treating people with insomnia (there are many people who specialize in treating sleep apnea but who may not know much about insomnia). That person should be able to address both your insomnia and related health issues at the same time, with the right mix of medications and behavioral therapy techniques.

      I know of some sleep specialists here in the US, but the only one I know of in the UK is Colin Espie. I believe he’s at Oxford now. Perhaps he could give you a referral to a colleague whose practice is in your area?

      In the meantime, I can say a few things I hope you’ll find helpful. First, cognitive behavioral therapy for insomnia (CBT-I), which includes sleep restriction, is not a quick fix for insomnia. When I went through CBT-I, my sleep started to improve fairly quickly. But it can take some people 2 or 3 weeks before they start to experience sounder, more reliable sleep. If I were you I wouldn’t give up on it just yet.

      After you go to bed at 12, you should should turn all clocks to the wall. Looking at clocks at night makes some people with insomnia very anxious. Of course, you have to glance at the clock in the evening to know when to go to bed. After that, do not look at any clock until your alarm wakes you up in the morning.

      When you wake up in the middle of the night, are you getting out of bed and going to another room to do some quiet activity until you start feeling sleepy again? I know it’s a drag to have to do this, but staying in bed will only reinforce the association between being in bed and the feelings of anxiety you have. You want to break that association, and the best way to do that is to get out of the bedroom. In the morning, when it comes to recording your total sleep time for the previous night, ESTIMATE the time you were awake.

      It’s possible that a stomach issue is awakening you in the middle of the night. You may already know to do these things, but just in case you don’t, I’ll mention them. Eat dinner early rather than late, and avoid alcohol after dinner, or any other food or beverage that disagrees with your stomach.

      I hope something here is helpful. I will make it a point to blog about insomnia and GERD in the future, so stay tuned. And good luck.

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  36. I’ve had chronic, severe insomnia for the last 10 years. I have never had a problem falling asleep, however I typically wake up one to three hours after falling asleep and am unable to fall back asleep. The majority of the last 10 years I have been on Trazodone, which worked about half the time and stopped working most of the time a few months ago. Since then I went under the care of in excellent PNP who tried multiple medications, none of which worked.

    Two years ago I worked with a nationally renowned sleep specialist here in Arizona who introduced me to SRT. Since then I have spent countless hours of research and participated in multiple trainings (I am a licensed mental health professional). I began the program and it worked for about four months. However due to life stressors and an inability to maintain perfect sleep hygiene, and exact bed times, I eventually became reliant on medication again on a nightly basis. I made the mistake of waiting two years to try SRT again.

    I’m currently on date 18 of SRT. I set my bedtime for 4.5 hours with a bed time of 1:15 AM and a wake up time of 5:45 a.m. The first night I slept 40 minutes. The second night I slept 30 minutes. The third night I slept 2.5 hours. It took a week to get to the 4.5 hours and almost three weeks to get to approximately 5 hours of sleep. However, I’ve never been able to sleep more than two nights in a row consistently with a sleep efficiency of 90%. Four nights ago I started to regress to the point of 3 to 4 hours of sleep. Last night it took me THREE hours to fall asleep and I ended up with 1.5 hours of sleep! Obviously this is very perplexing and frightening because I’ve never had a problem falling asleep and this is a drastic regression.

    I should note that the first week of SRT I had the stomach flu. The second week I came down with a cold which turned into a sinus infection. As soon as antibiotics began to work, I came down with the stomach flu again which I’m now on second day of keeping food and liquids down. Obviously going 10 years with out consistent and restorative sleep has completely depleted my immune system. However, in spite of being sick the entire time on SRT, I have persevered and never cheated in anyway whatsoever. I have followed the protocol to the very letter.

    I am beginning to lose all hope and fearful that this is not going to work. My sleep deprivation symptoms are becoming severe and I am desperate for any and all suggestions and willing to try anything. Thank you in advance and apologies for length of post.

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    1. Hello James,

      I’m sorry to hear that sleep has been such a problem for you all these many years. Chronic insomnia does have a negative effect on quality of life and overall health. It’s a good thing that you’ve tried to address it but discouraging that you haven’t yet met with success.

      After reading your post, I think you need to be working one-on-one with a sleep specialist capable of diagnosing and treating a person with your history as you’ve explained it to me: neither the medications you’ve tried nor your attempts at SRT have helped to improve your sleep. I will see what I can do about suggesting a referral. The process may take a couple of days.

      Regarding SRT, my feeling is that it may be causing you a lot of anxiety. This could be part of what’s holding you back. Anxiety about sleep is not uncommon. Many people with insomnia are anxious about their sleep. SRT works for a substantial majority of the people who try it, but because it requires such close scrutiny of the number of hours in bed and the number of hours of sleep, it can create even more anxiety in people already anxious about their sleep. At least, this is how it affected me at the beginning of the process.

      SRT is normally offered as part of cognitive-behavioral therapy for insomnia (CBT-I). CBT-I includes both behavioral components (such as SRT) and a cognitive component that addresses anxieties and catastrophic thinking about sleep. You might find it very helpful. It could be that going through a full-blown course of CBT-I with guidance from an expert therapist would help you more than attempting to improve your sleep with just SRT.

      Another possibility is that you might have a type of insomnia called “paradoxical insomnia.” This is a diagnosis given to people who say they get just one or two hours’ sleep a night but who, when they undergo polysomnography, are found to sleep a normal 7-hour night. It seems that while most of their brain is sleeping, a few areas are behaving as though they’re awake and alert, taking in and processing information from the environment.

      In any case, seeing the right sleep specialist and getting a proper diagnosis is the best thing I can suggest that you do.

      If you continue SRT on your own, here are a few thoughts about ways to avoid feeling anxious. Avoid looking at clocks during your prescribed bedtime. If you’re not asleep during part of that time, when you record it in your sleep diary the next day, ESTIMATE the time you were awake. Also, do not calculate your sleep efficiency every night. Sleep efficiency should only be calculated at the end of the week, when you’re setting your sleep window for the following week. In fact, try to steer clear of all calculations except at the end of the week.

      I’ll be back in touch with you in the next few days.

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  37. Hi im mike, ive been struggling with terrible insomnia for about 10 years now. I go through various stages at different times. For instance about a year ago i couldnt stay awake at night, id fall asleep on the couch every night at 10 or 11 but my quality of sleep was terrible. Now for the past 6 months i cant fall asleep and when i do my quality of sleep is terrible. It feels like im daydreaming all night. Like im just barely asleep. Feels like i get no more then 1-3 hours of sleep a night.
    If just seen a sleep doctor and he thinks its anxiety and a learned behavour so he wants me to do sleep restrictive theropy. My question is there is no way for me to know how much sleep im getting at night as im not really awake but just barely asleep. But it feels like no more then 3 hours. So should i restrict my time in bed to 3 hours? Thks for the help.

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    1. Hi Mike,

      I’m sorry to hear you’ve had such trouble with insomnia. Your nights sound very unsatisfying, and it’s a good thing you’re out there looking for help.

      First, for people like you, who describe experiencing a sort of daydreaming state rather than sound sleep at night, there’s no accurate way to determine how much sleep you’re getting short of going in for an overnight sleep study. But that costs a lot of money. So sometimes physicians will advise people to undergo actigraphy (which involves wearing a wristwatch-type device to measure the duration of your sleep) instead. That, too, would give a fairly accurate read on how much sleep you’re getting each night.

      If the sleep doctor you’re working with thinks anxiety and learned behaviors are interfering with your sleep, then sleep restriction would be an appropriate therapy. But most sleep therapists do not recommend beginning the restriction of time in bed with anything less than 5 hours.

      That would be especially true for people like you, who really don’t know how much sleep they’re getting. Maybe you’re getting just 3 hours a night, but maybe you’re getting more. In any case, the hope would be that sleep restriction would help you sleep more soundly (and possibly longer) and wake up feeling more refreshed.

      On a personal note, I’ll add that daily exercise has really improved the quality of my sleep. I sleep more deeply now, and I feel more alert when I wake up in the morning.

      Finally, I’ll suggest that you take a look at this blog about paradoxical insomnia, which I wrote a few weeks ago. Here’s the link:

      https://thesavvyinsomniac.com/paradoxical-insomnia-what-it-is-how-its-treated/

      I wish you much success in finding a way or ways to improve your sleep, and feel free to write in again with other questions and concerns.

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  38. Thank you for responding. Think ill try 4 hours in bed instead of 3. One more question if u dont mind. I cant seem to fall asleep without pills. Thing is the pills dont make me sleepy in the least, so i know that all they do is give me confidence which removes my anxiety. Are there any tricks u could give me that might allow me to fall asleep without taking a pill.
    Thk u so much.

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    1. Hi Mike,

      I too was anxious about my sleep as I went through sleep restriction. Many people are. I can suggest a couple ways of handling the anxiety so that it doesn’t keep you from following through with sleep restriction.

      What worked best for me, as I was staying up until my prescribed bedtime, was doing something I found absorbing but that didn’t require too much brain power. (After all, how well can most people think at midnight or 1 a.m.?) I ended up playing my electronic piano on several nights, wearing headphones so I didn’t disturb my husband. Playing relaxed me and made me less tense.

      I also found that moving–simply walking around the house–eased some of the tension I felt. In chapter 8 of my book, The Savvy Insomniac, I describe the whole process of going through sleep restriction in quite a bit of detail.

      Some people have luck with progressive relaxation–methodically tensing and relaxing each muscle in the body one by one. Others practice mindful meditation. Here’s a blog I wrote about it:

      https://thesavvyinsomniac.com/insomniacs-weigh-in-on-mindful-stress-reduction/

      There are also pencil and paper exercises you can do to ease anxiety. This blog will give you an idea of what they involve:

      https://thesavvyinsomniac.com/ease-insomnia-by-changing-negative-thoughts/

      Of all the therapies I tried for insomnia, sleep restriction was the one that was most effective in helping me get rid of my anxieties about sleep. I hope it works as well for you.

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  39. Hi Lois, I decided to give it a try. My first night was very rough. I got exactly zero sleep. I am prepared for a rough ride and am praying for strength.

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    1. Hi Matt,

      I’m so sorry that on the first night of sleep restriction, you didn’t get any sleep. I too got very little sleep on the first night. It was discouraging.

      But here are a couple things to keep in mind. One is that some people with insomnia actually get more sleep than we realize. It’s a bit complicated, but it has to do with the fact that sleep may not be a whole brain state–at least, in those of us who experience insomnia. It’s possible that while the rest of the brain is asleep, a few key parts are continuing to take in and process information. This feels like wakefulness, even though most of the brain is sleeping.

      The other thing to keep in mind is this: if in fact you got no sleep last night, the pressure to sleep will be very strong tonight. If still you don’t get much sleep tonight, then by tomorrow night the pressure to sleep will be even stronger. Eventually–and I’ll venture to guess fairly quickly–your drive to sleep will be so high that you simply can’t not sleep.

      When this happens, and I’m sure it will, then take care not to oversleep your alarm clock. Stick to your prescribed bed and rise times. This will help you maintain the pressure to sleep every night. It’ll also help reset your body clock so that you want to fall asleep and get up at pretty much the same time every day.

      I wish you strength and easier nights ahead. And keep us posted on how you fare.

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      1. On night 4 and improvements are significant. The key is that I was on a lot of prescription sleep medication and last night I slept without it. The first night was very rough but after that I started to sleep. Night 2 was still a bit shaky but nothing like night one. The hardest part was not knowing how many nights of struggle it was going to take and the anxiety associated with that. I will keep you posted and thanks for the advice.

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      2. Hi Matt,
        It sounds like you’re managing pretty well. I’m glad to hear that, and you’re certainly welcome for the advice. One thing that helped me was finding a somewhat enjoyable activity to do in the run-up to bedtime. I ended up playing my electronic piano (using headphones so I wouldn’t wake my husband up) and somehow that eased my anxiety.

        Thanks for the update on your progress. Best of luck moving on from here.

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  40. Hi
    I have an important questions, your answer to them may solve my whole anxiety and make my life better:
    – With Sleep deprivation, will your brain betray you (hallucinations, making big mistakes) first or you collapse sleeping first…?
    – Is there any medication that make me sleep each night for the next 40 years without huge side effects or damaging my brain or altering my next day activities?

    Please answer me

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    1. Hi Rob,

      When you’re sleep deprived, you’re just not on top of your game. You may feel fatigued, washed out, unable to think very well or learn new things. Your judgment is impaired. But you’d have to be pretty sleep deprived to reach the point where you were having hallucinations.

      Back in the 1950s-1970s, there were a few people who gained fame by staying awake for several days. Randy Gardner was one. He actually went 11 days without sleeping. A couple friends of his took turns keeping him awake, and kept notes on what they saw. I’ve written about Gardner’s experience in my book, THE SAVVY INSOMNIAC. Gardner seems to have come through that experience without any ill effects.

      Sleep deprivation is different from sleep restriction, the therapy used for people with insomnia. Sleep restriction may involve mild sleep deprivation, especially in the first week or two. But you’d need to lose a lot more sleep than that to reach the point where you were experiencing hallucinations.

      About sleeping pills, they’re different one from another. If you click on the menu item “Blog,” you’ll find a page where you can do a site search for “sleeping pills.” From there, you’ll find a bunch of blogs I’ve written about various pills prescribed for insomnia. There’s a whole chapter in my book on sleeping pills.

      There’s no clear answer to the questions you ask. No, not many sleep medications on the market now are known to be absolutely safe for long-term, nightly use. Few long-term studies have been done on most sleep meds, and some studies suggest that sleeping pill users are more susceptible to colds, GERD, depression, cancer, and other illnesses. With sleeping pills, there’s no free lunch!

      That said, some seem to be safer than others. Again, I suggest you look at some of my blogs (or read my book). Same advice if you’re looking for more information about sleep restriction. I’ve written a lot about that because I really believe in it and it’s helped so many people improve their sleep.

      Good luck whichever way you decide to go.

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  41. I have been insomniac for a year and a half now. I have read that insomnia or being sleep deprived can cause diabetes. This terrifies me. Have any of you that have had insomnia long term get diabetes from being sleep deprived for a long period of time?

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    1. Hello Nick,

      First off, apologies for the delay in my response. I’m sorry to hear that insomnia is causing you to worry about your health.

      It’s true that chronic insomnia increases people’s vulnerability to several medical and psychiatric conditions. But to say that it can CAUSE diabetes is not quite accurate. The results of a handful of studies show that there is a correlation between insomnia or short sleep and diabetes. But the fact that there’s a correlation does not imply causality. It simply means that people with insomnia are more likely to have diabetes than people without insomnia. There is a difference. Read this blog for information about risk factors:

      https://thesavvyinsomniac.com/short-sleep-a-dose-of-perspective-on-the-risks/

      I’d suggest, rather than worrying about the consequences of insomnia, that you focus on improving your sleep. Cognitive-behavioral therapy for insomnia (CBT-I) and sleep restriction can help you do that. But there are other paths to better sleep, too. I’ve blogged about many of them and written about them in my book, THE SAVVY INSOMNIAC. Click on treatments that interest you in the topic cloud toward the top and on the right side of this page.

      Good luck moving forward.

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  42. Hello!

    I have recently started sleep restriction therapy after years of insomnia and use of OTC/hypnotic medications. I am currently in my second week of restriction and I’m finding it harder to function in my daytime hours. I know that stimulus control is embedded into sleep restriction therapy and I wondered if my husband should be sharing the bed with me during this therapeutic period? He has moved himself out of the bed and to the floor, as a result of my tossings and turnings. However, we would like to share a bed again. Should he share the bed with me to be consistent in the stimulus I am exposed to during the night? Or should we wait until I am sleeping 8+ hours to introduce him to the bed? How long does sleep restriction therapy take to make me feel alert and fully functional again? Thanks for all you do! I love your thoughtful insights and videos!

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    1. Hi Hannah,

      It’s good that you’re trying out sleep restriction and stimulus control therapy. In the process you may find a better way to manage your insomnia and be able to cut down on your use of sleep meds.

      As you’re going through these therapies, you’ll want to make sure your bedroom is quiet, dark and free of any distractions that might keep you up, like TV, movies, thrillers, and the like. But unless your husband is contributing to your insomnia in some way (e.g., keeping you awake by snoring, thrashing, talking in his sleep), I see no reason that the two of you shouldn’t be sharing a bed.

      You mention that you yourself tend to toss and turn in bed. That’s something you want to avoid. The more you toss and turn, the more you reinforce the expectation that you will be awake in bed. What you want is for your brain to learn to pair the bed and the bedroom with sleep.

      So if you find yourself tossing and turning in bed, or if after lying in bed for about a quarter hour you’re still awake, go to another room and do some quiet activity until you start to feel sleepy. Only when you feel you’re ready for sleep should you get back in bed again.

      It is normal to feel somewhat sleep deprived in the first few weeks of sleep restriction therapy. The pressure to sleep is building up and you’re not exactly on top of your game. This suggests to me that process is working and that you may start to see your sleep improving fairly soon.

      As for how long it will be until you’re sleeping well and feeling fully functional during the day, I wish I could give you a firm answer but I really can’t. If you’re following the protocol for these therapies to the letter, then I can say, based on my own experience and the experience of people who went through treatment with me, that you may start noticing positive changes within 2 or 3 weeks.

      Here are some blogs you may find helpful:
      https://thesavvyinsomniac.com/be-your-own-sleep-scientist
      https://thesavvyinsomniac.com/sleep-restriction-in-a-nutshell
      https://thesavvyinsomniac.com/pre-sleep-activities-for-the-sleepless
      https://thesavvyinsomniac.com/sleep-restriction-what-you-need-to-succeed/
      https://thesavvyinsomniac.com/qa-sleep-restriction-tempted-to-give-up/

      I discuss sleep restriction and stimulus control in depth in my book, THE SAVVY INSOMNIAC.

      Stick with this process and chances are you’ll be happy with the result.

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  43. Thank you so much for your reply! I very much appreciate the time and thoughtfulness you put into your response and your book. This week has been better, and I look forward to future success!

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    1. You’re welcome for the response, Hannah. Stay the course and most likely you’ll find better days ahead.

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  44. Hi Lois,

    My name is Roman. Thank you for such a great web site, it’s really helpful!

    I have insomnia for the last 8 months. I started sleep restriction therapy 4 days ago. It would be great if you could answer my question about the correct calculation of sleeping time during the night. I am tracking sleep efficiency using a smartphone with Sleep as Android application (it uses accelerometer to track sleep efficiency). I started restriction therapy with 5 hours. For the last 4 nights of restriction therapy my sleep duration was in the range from 2h 51m to 3h 52m according to the program, and the average sleep duration was 3h 21m (average sleep efficiency was 69%). On the other hand as I remember during restriction therapy I fell asleep very quickly and woke up two time each night for the total time around 30 minutes per night. So, it gives me a sleep efficiency of 90% but not 69% as per the program. In any case I feel drowsy each day after beginning of sleep restriction. Here is a question: how I have to calculate the actual amount of sleep during a night (my feeling and the program give me totally different results)?

    Thank you!

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    1. Hi Roman,

      I’m glad you’re finding the website helpful and that you’re taking some positive steps toward improving your sleep.

      I’m no expert in fitness trackers. But everything I read about them on the Internet leads me to be skeptical about their accuracy in measuring sleep. Accelerometers work by detecting motion, the premise being that when there’s movement a person is more likely to be awake than asleep. This may be true for most people—but not for everyone. You might be fidgety sleeper, prone to movement when you’re dreaming (let’s say hypothetically). The tracker, detecting movement, would count this as time awake when in reality you were asleep.

      Also, if for 4 nights you got an average of just 3 hours and 21 minutes of sleep, by now you’d be feeling severely sleep deprived. You’d find yourself starting to nod off several times during the daytime, and you’d be irritable and have trouble focusing. It’s normal for people going through sleep restriction to feel drowsy during the first couple of weeks—but not to feel extremely sleep deprived.

      People’s perceptions of sleep may not always be accurate, either. But since sleep restriction therapy was created and has been shown to be effective when people use their own estimates of time awake and time asleep, I think your best bet is to use your own judgment when it comes to recording how much time you slept the night before.

      But I suggest that you avoid getting hung up on numbers. Record your time to bed, wake-ups during the night, time out of bed, and total sleep time each morning. But save the calculation of sleep efficiency until the END of each week, at which time you’ll adjust your sleep window for the following week.

      Calculating sleep efficiency every day could easily lead to anxiety as you’re going through sleep restriction. And extra anxiety is something you do not need!

      Best of luck with this process. And thanks for writing in.

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      1. Hi Lois,

        Thank you for a quick response and your help!

        Last night I didn’t wake up at all and I slept through all the night from 1:30am to 6:30am (5th night of my restriction therapy). This was for the first time that I didn’t wake up during the night since I got an insomnia 8 months ago. I can say that restriction therapy really works. I hope it help me to fully restore my sleep.

        Thanks,
        Roman

        Like

      2. Hi Roman,

        You’re welcome for the encouragement, and how great that you got a night of uninterrupted sleep! Stick with the sleep restriction protocol, being very conscientious about observing your prescribed bed and wake times and recalculating what your sleep window should be at the end of each week. Your progress may not be exactly linear—some nights will be better than others. But in the long run, I think you’ll find you’re sleeping as much and as soundly as you were before.

        Like

      3. Lois, thank you for help!

        Roman

        Like

  45. Shannon Petlichkov October 8, 2015 at 11:17 am

    Hi Lois,

    First off let me say how wonderful I think it is that you support people with this condition the way you do. It is so helpful to read info about other people’s situations and to relate to their challenges.

    My concern is that I am about 11 days into my SRT and I am sleeping worse than I did at the beginning. Therapist is allowing me 7 hours in bed and after reading a lot of the info found here I think I need to reduce it to 6 which was the average amount of sleep I was getting entering into the SRT. Do you think I will see better benefits if I restrict to six? I’m sleeping less than six still as it is so that is kind if what I am thinking.

    Thank you so much,

    Shannon

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    1. Hi Shannon,

      I’m glad you’re finding the website helpful. My aim is to write blogs that are useful and informative for people with insomnia and help them get a better night’s sleep.

      The guidelines for sleep restriction therapy suggest that before you begin restricting your sleep, you spend a week gathering information about how long you’re actually sleeping. You take the average amount of sleep you’re getting at night and start by restricting your time in bed to that number of hours.

      If you did that during the first week and found you were sleeping an average of 6 hours a night, 6 hours would become your prescribed time in bed for the following week. So I’m wondering if your therapist has reason to believe that you’re actually sleeping more than you think? That is one reason he or she might suggest that you start by restricting your time in bed to 7 hours rather than to 6.

      I don’t know the details of your situation (and I’m presuming the therapist does) so I can’t offer a well-informed opinion. But if you’re 11 days into therapy and your sleep isn’t starting to show a little bit of improvement, why not let your therapist know that the 7-hour sleep window doesn’t seem to be helping and try restricting your time in bed to 6 hours a night to see if that makes a difference?

      As I was gathering information for my book, The Savvy Insomniac, I asked a sleep therapist why CBT for insomnia (which normally includes sleep restriction) was effective for just 70 to 80 percent of the people who try it. He thought that among those who hadn’t benefited there were probably several who, if their sleep had been restricted further, might actually have had success with the therapy.

      It sounds like your attitude toward the sleep restriction process is quite positive overall. I’m sure if you’re persistent you’ll find a way to make it work. Good luck!

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      1. Shannon Petlichkov October 9, 2015 at 7:57 am

        Hi Lois,

        Thank you for your reply.

        Yes I think he is saying that 7 hours is fine because more nights than not my sleep percentage is above 85%.

        I tried 6.5 hours last night and got up to 91%. I’m going to leave it at this at least for a few nights and see if I can maintain a 90% or higher before going back to 7.

        Thank you,

        Shannon

        Like

  46. Shannon Petlichkov October 10, 2015 at 9:30 am

    Hi Lois,

    I am just wondering about your experience with setbacks during sleep restriction.

    Last night was an awful night as my sleep onset anxiety was at its max after falling asleep for about ten minutes, fifteen minutes before my bedtime. I fell asleep about a half hour after my bedtime only to awake about (what I am guessing as I did not look at the clock) an hour later. Then my six month old son who is teething woke up crying. This time I did look at the clock and it was 2:40. I was falling asleep in the rocking chair so my husband took over. Fell back asleep and woke to my cat jumping on the bed. I realized her cat litter needed scooping so I went down and did that. Fell asleep again and awoke at about 6:20 to back pain due to a new bed that we had delivered this week.

    The bed issue has been going on for almost a year and began with my pregnancy. I have had seven beds in total and hated every one of them. I can’t seem to get past the break in period as I have a bad back and I keep exchanging them and buying new ones. We wanted a king bed but it seems like an impossible task to find one I like. I am sure this has also had contributed heavily to my insomnia as I do not even look forward to getting into bed. And I also look at sleeping in my old bed that is in the spare room as a failure so I am screwed no matter where I sleep.

    I guess I should also mention that I am just coming out of the darkness that is postpartum depression. It with in combination with the bed fiasco and stress at work is what I believe to be the sources of my insomnia. I yo-yo back and forth from dwelling over the bed problems and having severe sleep anxiety that is fueled by my daytime stress.

    As much as the therapist has shed a lot of light on this I can’t keep it up much longer as he is in NYC (I am in Canadam, we skype) and the cost is adding up quite heavily.

    I guess what I am looking for is some kind words of encouragement and some advice on how you think I can get through this and stick with the sleep restriction. It has been almost two weeks and I am starting to loose faith.

    My heart and intentions are in the right place. I desperately want to feel better.

    Thank you,

    Shannon

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    1. Hi Shannon,

      I missed seeing your comment over the weekend so I’ll respond today. It sounds like several aspects of your life now could be interfering with your sleep.

      So many parents of infants experience sleep deprivation for the first several months of their babies’ lives. But as babies start to sleep through the night, parents are more in control of their own sleep. That at least is something to look forward to!

      For now, though, I can see why your therapist may have suggested a 7- rather than a 6-hour sleep window. You’re bound to be up a certain amount of time at night taking care of the baby. The time you’re up feeding him shouldn’t count as time in bed for you. Setting a 7-hour sleep window would be one way to handle that problem. (But if 6.5-hour nights work better for you, stick with that.)

      Also, while you’re working on improving your sleep, make a point of tending to the cat before you go to bed. And would you feel comfortable making the cat sleep outside the bedroom until your sleep improves? It would be one less disturbance you’d have to contend with at night.

      Postpartum depression is nothing to fool around with. If you’re still experiencing symptoms related to that, you’ll want to see that they get attention. Make sure you get plenty of exposure to sunlight during the day. Exercise, too, helps elevate mood. If you can do nothing else, take a walk every day.

      I myself have lower back problems due to scoliosis. Having the right mattress has always been a must for me. Firmer mattresses work better. With a too-soft mattress, I wake up with backaches. If the firmness of the mattress is an issue you and your husband can’t agree on, there are some companies that make king-size mattresses in which one side is firmer than the other. Tempurpedic is one of those companies, I think.

      Still, my back issues never really went away until a physical therapist looked at the alignment of my spine as I lay in sleeping position. (I sleep on my side only. Any other position leaves me with a terrible morning backache, for sure.) She suggested that I bring the knee of the top leg forward and elevate it with a pillow. This simple suggestion has pretty much gotten rid of my nighttime backaches completely. I blogged about it here:

      https://thesavvyinsomniac.com/insomnia-and-back-pain/#.Vhvdr6Rzqt8

      Lots of people who have trouble sleeping get anxious about sleep. I was a big worrier myself, and my anxiety interfered a lot with my sleep. I go into detail about struggling with this in chapter 8 of my book. Yes, I experienced some set-backs. But eventually I lost my fear of sleeplessness over time. Scheduling my sleep (as one does during sleep restriction) and sticking to a firm wake-up time for weeks and months played a big part in helping me leave my anxiety behind.

      I’ve also come to believe that doing relaxing activities in the run-up to bedtime is helpful. You might be interested in this blog:

      https://thesavvyinsomniac.com/pre-sleep-activities-for-the-sleepless

      Anyway, I hope something here will help you find ways to improve your sleep. Feel free to write again.

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      1. Shannon Petlichkov October 13, 2015 at 8:27 am

        Hi Lois,

        Thank you for all of your informative advice.

        I would just like to inquire about how you place the pillow under knee when sleeping. I too have mild scoliosis and perhaps this would help me.

        Do you put the pillow between your knees while on your right side? Or do you put it under both knees? Sorry I am just a bit confused by this.

        Also, do you have any advice on how not to “sleep hot”? The final mattress we have is making me hot and I have already tried to put the sleep cool mattress protector on, tried bamboo and cotton sheets but neither are working very well. I’m thinking of getting a breathable blanket as opposed to the synthetic one we are currently using but it seems as if its the mattress that s the problem it may not help. Also, any opimions on wool matress toppers as cooling options?

        Thank you,

        Shannon

        Like

      2. Hi Shannon,

        I’m glad to help. About the placement of the pillow: whichever side I’m on, I start with both legs out straight. (The lower leg will remain straight.) The pillow, a small one with good loft, is in front of my body at about the position of my hips and thighs. Still lying on my side, I then draw the knee of my upper leg up and forward so it’s resting on the pillow. The leg is bent in two places: at the hip and at the knee.

        Somehow this straightens out my spine and allows for a good night’s sleep. If I have to shift sides, I take the pillow with me. Someone has also suggested placing a second pillow behind me so when I shift sides, the pillow is already in place. Good luck with this!

        I haven’t found that mattress pads are the culprit when I wake up hot. But I’m definitely in favor of getting rid of so-called comforters and replacing them with thinner, breathable blankets. I’ve written a couple of blogs on body temperature issues at night, and you might interested in reading them if you haven’t already:

        https://thesavvyinsomniac.com/tips-for-overheated-sleepers/#.Vh4zkKRzqt8

        https://thesavvyinsomniac.com/too-hot-to-sleep/#.Vh4zxaRzqt8

        I don’t know what to think about the wool mattress topper. There’s no harm in trying it, though.

        Like

  47. Hello can this work for me if i cant fall asleep at all? Well i can sleep with meds seroquel 300 mg but it gives me unrestorative sleep or a knockout. In the morning i lay in bed for extra hours after waking and dont want to do anything. End up dragging myself out of bed but getting very little if anything at all done for the day. Can everyone with insomnia be able to overcome this debilitating symptom?

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    1. Hi Derrick,

      The situation you describe—being unable to fall asleep without medication and then feeling drugged in the morning—sounds terrible. It’s good you’re looking around for a better way to manage your sleep and your waking hours.

      In my opinion, cognitive-behavioral therapy for insomnia (CBT-I)—which includes sleep restriction—is without question the best next step. If you go through the program, you’ll likely improve your sleep more than you ever thought possible and learn a lot about yourself in the process. And, depending on the therapist you work with, you may find you’re able to give up meds entirely or at least use them less often.

      If what concerns you is the prospect of giving up your medication, take a look at this blog, which I wrote last year:

      https://thesavvyinsomniac.com/qa-during-cbt-do-i-have-to-stop-my-sleep-meds/

      Research suggests that CBT-I is effective for a majority of people who try it regardless of whether they’re on medication or not, and regardless of their age. Here’s another blog post that may be helpful:

      https://thesavvyinsomniac.com/sleep-restriction-what-you-need-to-succeed/

      Finally, I had many reservations about going through CBT-I myself. So many, in fact, that I avoided it for over a decade of my life. (I’ve documented the struggle I had in chapter 8 of my book, The Savvy Insomniac.) Now, several years after I went through therapy myself, I look back and wish I’d done it much, much sooner.

      I hope you’ll have the courage to do it in the near future, and I wish you the best of luck!

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  48. Hi, I’ve just started SRT 4 nights ago (12:30am – 6:30am) and I got 5h and 6h of sleep in 2 nights and 1h+ from 2 nights ago and 2h+ from last night. Can I know if it’s normal for this to happen? Whenever I get enough sleep, I will not be able to sleep on the next night because I dont feel sleepy at all (no heavy eyelid, no nodding etc). I feel tired but not sleepy enough to drift off. I did not take naps in the day or take any caffeine drinks. Am I doing anything wrong or it’s just too early to see the effect?

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  49. Sorry, just to add on. Ever since I’ve started on SRT, I’ve followed the protocols really closely, getting up the bed if I am not asleep, keeping myself awake in the morning when I am sleepy. Somehow my brain is doing the same thing when I am trying to sleep now. It will wake me up when I’m about to fall asleep, waking up every 20 – 40 mins if I managed to get some sleep. It’s like it has become a task for the brain to wake me up. I didn’t really experience this kind of startle from the brain before SRT. Any advice? 😦

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    1. Hello YummyC,

      Many people with insomnia have an erratic sleep pattern similar to yours. Nights of good sleep alternate with nights of bad sleep, and sometimes it feels like there’s no predicting when the next good night’s sleep will come. That can be scary, or at least it was for me. (I document my fears and my experience of sleep restriction in Chapter 8 of my book, The Savvy Insomniac.)

      What you want, of course, is for your sleep to be fairly stable and predictable. SRT is one way to achieve that, and I hope you’re willing to stick with it.

      It’s normal to experience some sleep loss during the first few weeks of sleep restriction. But let me ask you this: did you keep a sleep diary for a week before beginning to restrict your sleep? This is an important step in the process. It enables you to get a better idea of just how much time you’re actually sleeping (and not just lying awake in bed). You then take the average number of hours you’re sleeping and begin by restricting yourself to just that much time in bed and no more.

      If you disregard that first step—keeping the sleep diary—and set your sleep window arbitrarily, you might be inclined to start with too large a sleep window. If you did, you’d probably experience a fair amount of wakefulness during the time you were supposed to be sleeping—similar to what you’re experiencing now. If you haven’t kept a sleep diary for at least a week to get an accurate reading on just how much time you’re sleeping, I’d suggest doing that before you go any farther.

      As for what’s now going on in your brain and causing the wake-ups, I can only speculate. Maybe having to pay more attention to the timing of your sleep is making you more anxious about your sleep. That anxiety could be arousing and make it harder to stay asleep. You do need to keep tabs on the time at night to make sure you stay awake until your designated bedtime. But once you’ve gone to bed, turn all clocks to the wall!

      In any event, if you stick with SRT and follow the guidelines to the letter, chances are you’ll start sleeping better within a couple of weeks.

      If you haven’t already read these blogs, you may be interested in reading them now:

      https://thesavvyinsomniac.com/be-your-own-sleep-scientist
      https://thesavvyinsomniac.com/sleep-restriction-in-a-nutshell
      https://thesavvyinsomniac.com/pre-sleep-activities-for-the-sleepless
      https://thesavvyinsomniac.com/sleep-restriction-what-you-need-to-succeed/
      https://thesavvyinsomniac.com/qa-sleep-restriction-tempted-to-give-up/

      Good luck!

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      Reply

  50. Dear Louis, I’m so happy to find it on the internet. I am a Brazilian woman, 35 years old and since 24 years, I am sleepless. I take medication every night and I am desperate because I know I’m addicted and that my body has developed tolerance … I’ve already had trazodone, melatonin, bromazepam, clonazepam, lorazepam, and many others. Since September 2014 I take amytriptilina (50 to 75mg) and alprazolam (0.5 mg). My great desire is to leave the medication and sleep well again, but actually I am not able to do this without the drugs, because even with the drugs, I’m not able to sleep. I really want to try to sleep restriction technique, but I saw you saying it is not recommended to SR with medications. So what do you think is best for me? Taking medicines (slowly, even going through withdrawal symptoms) and then try to SR? Or is there another way for me?

    Thank you so much. I was looking for so many things abour insomnia and never seen anything so serious and encouraging as your words.

    Thanks,
    Ana.

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    1. Hi Ana,

      It sounds like sleep has been really difficult for you for a long time, starting in childhood. Obviously you’ve consulted doctors because you’ve used many medications. But most sleep medications tend to degrade the quality of sleep when used nightly for a long time. Tolerance may develop as well. So it’s good to search for alternative solutions that are either drug free or involve less medication.

      I don’t know what resources you have access to in Brazil. But given the severity of your sleep problem, the fact that it began in adolescence and that the drugs you’ve taken for it have not been particularly effective, I’d advise you consult a sleep specialist if you haven’t already done so.

      Here in the United States, general practitioners and internists are not always well informed when it comes to treating insomnia. They may simply prescribe pills because it’s easy.

      In contrast, a sleep specialist would likely be more thorough in diagnosing your problem, more knowledgeable about the variety of existing treatments for insomnia, and more likely to prescribe an appropriate treatment. My guess is that a sleep specialist would also ask you to undergo a sleep study (if you haven’t already) as part of the diagnostic process.

      Here in the United States, sleep restriction therapy (SRT) is often offered as part of a more comprehensive treatment for insomnia called cognitive-behavioral therapy for insomnia, or CBT-I. I went through CBT-I twice: first, on my own, and second, as part of a group. (I document those experiences in my book, The Savvy Insomniac.) SRT was the part of CBT-I that I found to be most effective in helping me improve my sleep. So I’ve blogged about it quite a lot for more than 3 years now.

      CBT-I (and SRT) work well for people whose diagnosis is psychophysiologic insomnia. Here’s a blog post explaining that diagnosis:

      https://thesavvyinsomniac.com/psychophysiologic-insomnia-what-it-is-how-to-cope/

      CBT-I and SRT might not be very effective, though, if your diagnosis were paradoxical insomnia:

      https://thesavvyinsomniac.com/paradoxical-insomnia-what-it-is-how-its-treated/

      As I said before, a sleep specialist would be the person to turn to for an accurate diagnosis of your problem. If that doctor determined that your insomnia would be responsive to CBT-I (and SRT), then you’d want to find a sleep therapist who was willing to guide you through treatment while at the same time helping wean you off medication.

      The prevailing thinking among sleep experts used to be that patients needed to stop using sleep medications before starting CBT-I. The thinking on that has changed, though, in recent years. Some behavioral sleep therapists work with people just like you, who may be taking some medication during CBT-I but who by the end of treatment are either off medication completely or using less of it (and whose sleep has improved!).

      Take a look at this blog post for more information:

      https://thesavvyinsomniac.com/qa-during-cbt-do-i-have-to-stop-my-sleep-meds/

      Anyway, good luck in finding a specialist and/or therapist who can help you find a better way to manage your sleep.

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    2. Hi dear Lois

      I’ve been to a specialist neurologist and sleep medicine this week and he told me that I do not need to worry about medicines, the continuos use of alprazolam won´t cause side effects me because I Take Low doses (I do not believe it because I am already 11 years taking drugs Z). He says that I will not benefit me to sleep restriction therapy, because my Greater ptrouble is Keep sleep, this point he is right because my sleep is not restorative. YOUR suggestion was yoga associated with acupuncture and take alprazolam Just when I Really Need. HE DID NOT understand that I need alprazolam all Nights and that I really want to be free from Z drugs .. He says he can help me to Get More Quality of Life and that My insomnia and fibromyalgia has the SAME CAUSE, and That Is more psychological than physical. I’m very disappointed .. Because I Had Any Hope, but now, I really DO NOT know what I should do. I will try acupuncture and yoga, but to be honest, I don´t think that will be enough. When I asked if one day I could go back to sleep well without drugs, he told me “no, we cn try just improve your quality of life”. Do you have some clue for me? Should I try or not try sleep restriction technique? Every night I´m going to my bed at 10 or 11:00pm and I wake up at 7:00am.

      Thank you. God bless you.

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      1. Hi Ana,

        It sounds like your doctor in Brazil does not know much about cognitive behavioral therapy for insomnia (CBT-I) or sleep restriction therapy (typically offered as part of CBT-I). These therapies work well for insomnia regardless of whether you have trouble falling asleep or trouble staying asleep.

        Even here in the United States, though, it can be hard to find therapists certified to provide CBT-I. There may not be any CBT-I providers in Brazil.

        Just to correct the record, I never suggested that you try yoga and acupuncture (see my reply above your last post). Yoga and acupuncture might help you out, and I have written a couple of blog posts about both of these treatments. But my recommendation to you was to consult a sleep specialist and, if insomnia disorder turns out to be your diagnosis, consider CBT-I.

        There are some online resources for people wanting help with CBT-I. In my book, I recommend these:

        http://www.cbtforinsomnia.com
        http://www.sleepio.com
        http://www.shuti.me

        I would also recommend them to you.

        But if you also want to stop taking the alprazolam, the best idea is to look for a doctor who’s willing to help you do that. Sometimes it’s hard to find the right doctor, but if you’re persistent, you may well succeed. Again, good luck.

        Like

      2. Sorry my bad english Lois. Last night was a terrible night. Who suggested me to try yoga and acupuncture was the doctor.

        I will try to stop alprazolam and find the right doctor. I believe in the sleep restriction and I´d like to try it too.

        Thanks a lot!

        Like

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