A 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.)
- 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.
- 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 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.