sleep restriction often leads to mild sleep deprivationA new study confirms that in the early weeks of treatment, sleep restriction—a part of cognitive behavioral therapy (CBT) for insomnia—really is a cross to bear. Not only did the subjects in the study sleep significantly less than usual during the first three weeks of treatment. Sleep restriction also decreased their vigilance and reaction time on tests and made them sleepier in the daytime.

“Oh, please,” you may be thinking, “they had to do a study to figure that out? Wouldn’t sleep restriction by definition lead to sleep loss at night and sleepy days?”

Seems like a no-brainer to me. But in research, quantification is important, and what these UK researchers have done is actually a good thing. (I’ll explain why later on.) Here are five tips for insomnia sufferers planning to undergo treatment. (Sleep restriction has a pretty good track record, so it is worth trying, punishing though it may sound.)

Plan Ahead

  • When you go through treatment, expect to be off your game for at least a few weeks. Try to schedule therapy for a period when you’re not swamped with other commitments.
  • You’re going to have extra time on your hands for a few weeks—maybe even two or three hours a day. Don’t wait until the first night of sleep restriction to decide what you’re going to do with it. Before the short nights begin, come up with some activities that don’t require a lot of energy or concentration, but which are not so passive—watching TV, for example—that you find yourself drifting off. Hobbies, crafts, looking at photos or coffee table books, meal planning, and even light chores are all good choices.

During Treatment

  • This is the hard part: follow all the rules. If during the first week your sleep window is from 12 to 5 a.m., stay away from the bed at all other times. To do otherwise will lessen the effectiveness of the treatment and draw it out. Why suffer longer than necessary?
  • Make judicious use of caffeine if you feel logy or sleepy during the day. While caffeine may interfere with sleep at night when used later in the day, used sparingly in the morning or early afternoon, it can help you function better in the first weeks of treatment. If caffeine doesn’t agree with you, check with your physician about a short-term prescription for modafinil. This drug has been shown to cut down on daytime sleepiness in subjects undergoing sleep restriction.
  • Take special care when driving. Naps are generally off-limits when you’re going through CBT for insomnia, but drowsiness behind the wheel can be lethal. If you start to feel sleepy while driving, pull off the road and take a quick nap, or drink a cup of coffee.

The Benefits

The point of the pain associated with sleep restriction is to wind up with some gain: ease in falling asleep, fewer wake-ups, and sounder, more restorative sleep.

As for the benefits of the new study, it suggests that the current method for determining how much to restrict person’s sleep—based on sleep diaries—may be inadequate in some cases. Patients who report sleeping very little may be found in sleep studies to sleep more than they realize. When such a disparity exists, say the researchers, patients should start sleep restriction with a larger sleep window to avoid excessive daytime sleepiness.

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.

6 Comments

  1. Sleep restriction can be a powerful treatment for insomnia. As you described in the article, titrating time-in-bed based on sleep diary can be challenging. Motion-based sleep detection (actigraphy) can be a bit more accurate (Tryon 2004) than subjective estimation.

    When done correctly, with a motivated patient, improvements in sleep efficiency can come quickly. We first get the patient to hold the line with a consistent morning get-up time, then other aspects tend to fall in place more easily.

    Michael

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  2. Thanks for the comment, Michael. I’ll second your point about improvements in sleep efficiency coming quickly–at least in some people who go through sleep restriction therapy. I began noticing improvements toward the end of my first week.

    Starting with the right amount of time in bed seems like a pretty important part of the process. You’re right, motion detection would be a cheap and more accurate way to figure this out.

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  3. I’m trying sleep restriction now, and am happy to have the suggestion to start on the a.m. end. Both at once has been a little more stressful than I can handle now. It’s difficult to operate with such diminished brain capacity!!

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  4. Me too, brain fog was definitely my biggest complaint as I was going through sleep restriction!

    The consistent morning get-up time that Michael mentions is a key part of the SR process. For decades my wake-up times were variable, and looking back I’m sure they made my insomnia worse.

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  5. Thanks for this website, I just found it last night while struggling to stay away until my SRT-appointed bed-time. I just completed my first week of SRT and have had only minor improvement in sleep efficiency (as reported by my Fitbit Charge HR). For the week I averaged 3.5 hours of sleep per night. Some days I’m “completely exhausted”, other days I’m only “really tired”. It’s great to find this website to read comments from others going through this as well.

    Do you have any opinion on taking B12 supplements in the morning to help have a little more energy during the day until my sleep gets under better control? I’ve never been a caffeine user and didn’t really want to start that now.

    Thanks!

    Jenn

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    1. Hi Jenn,

      I’m glad you’re trying SRT—so many people with insomnia find that it helps improve their sleep.

      I can’t help with the B12 supplements, though. Whether they’d give you a little more energy now as you’re going through the first few weeks of sleep restriction is something I don’t know. I’m guessing they couldn’t hurt.

      People have told me that using caffeine helps during SRT. And a study was done in which investigators offered modafinil to people undergoing CBT for insomnia and sleep restriction. Modafinil (a wake-up drug) taken in the morning improved people’s alertness and did not interfere with sleep at night. But from the sound of things, you probably wouldn’t want to take this drug, either.

      Au naturel? Honestly, nothing I know of that comes in a supplement that would help fight your feelings of exhaustion. What I can recommend is plenty of movement, light during the daytime, a well-balanced diet, and lots of water.

      Best of luck! If you follow the protocol, chances are you’ll start to see better results soon.

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