coffee-in-bedJessica recently wrote to Ask The Savvy Insomniac with concerns about sleep restriction.

I’m on Day 6 of sleep restriction and I don’t think it’s working. The first 3 nights were miserable. I kept looking at the clock and thinking, just 4 more hours to sleep, just 3 more, just 2 . . . I had so much anxiety I hardly slept at all!

But on the 4th night I passed out and overslept my alarm in the morning. I FELT GREAT. And I’m like, sleep restriction rocks! But . . . the next night was terrible. I barely got 2 hours, and the same thing happened again last night. Today I feel so bad I called in to work—something I never do unless I’m sick.

Now I’m wondering if it’s worth the punishment.  Am I just going to have to resign myself to insomnia for the rest of my life? Honestly I’m on the verge of giving up.

An Erratic Sleep Pattern

I can so relate to Jessica’s plight. The sleep pattern she describes was mine for several decades. Terrible sleep for 3 to 5 nights in a row, followed by a night where I conked out so completely I could sleep through ear-splitting thunder.

Mornings after super long nights felt great. But nothing is comforting about this kind of sleep pattern. Lurching from one bad night to the next, never knowing when I was finally going to pop off a good one, raised my anxiety sky high. I wanted good sleep to be regular. I wanted it to be dependable.

With Restriction, a Payoff

My first week of sleep restriction was pretty close to hell. Like Jessica, I had 3 really bad nights before I was sleepy enough to fall asleep at the bedtime I’d chosen. But sleep restriction also required getting up at a fixed time every morning. This rule contradicted one of the most ingrained notions I had about my sleep, namely, that on the rare nights when I could sleep, I’d better let myself sleep as long as possible—because I never knew when I’d get another chance.

So when the alarm rang at 5 a.m., the temptation was simply to roll over and go back to sleep. It felt like the middle of the night. It felt like I needed more sleep. Why deny myself something my body evidently needed?

By that time I was far enough along in my research to understand the theory behind sleep restriction; I understood the forces driving my insomnia well enough to know that letting myself sleep late was probably a road to nowhere. So I mustered up my willpower and hauled myself out of bed and into the day–and the next day, and the next.

Wasted is how I felt after those short nights, and definitely lame in the head. But I held fast to my sleep window, recalculating my time in bed at the end of each week. And in time my sleep became deeper, longer and more dependable. Amazing gifts for a guerrilla sleeper like me.

Rest for Success

Not every insomniac will benefit from sleep restriction. But research suggests many can. Set yourself up to be one of them by

  • choosing to go through treatment at a time when you’re not too busy with other things.
  • avoiding clocks after bedtime. Looking at the clock creates anxiety, and that’s something you want to avoid.
  • setting appropriate bed and wake times and observing them to the letter.

What problems have you encountered during sleep restriction?

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.

42 Comments

  1. Dear Lois,

    How critical are relaxation techniques (progressive muscle relaxation, deep breathing, etc.) to the success of sleep restriction therapy? I was under the impression that the heightened sleep drive produced by SRT would be sufficient to conquer any anxiety that is preventing me from sleeping.

    I am in week 12 of CBT-I, which includes sleep restriction (currently 5 hours in bed), and am still struggling. I can make myself stay up as late as necessary and get out of bed when the alarm goes off, but I have a really hard time calming my anxiety.

    For the record: I do not have PTSD or any other clinical mental health issue, I am working with a CBT-I-trained therapist, and I am religiously following the sleep hygiene, stimulus control, and SRT rules.

    Also, I assume that SRT, effective as it is, doesn’t work for everyone. How do you know if you’re one of the unfortunate few who doesn’t respond to this therapy? I’m wondering how long I should beat my head against a brick wall.

    PS – I have ordered your book and look forward to reading it.

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    1. Wow, Katie,

      I’ll say up front that my hat goes off to you. You’re working with a CBT-I-trained therapist, you’re observing all the rules–sleep hygiene, sleep restriction, and stimulus control–and you’ve stuck with the program for 12 weeks. That must take incredible discipline. Though you haven’t yet solved the anxiety issue (and I strongly suspect you’d rather be spending more time in bed!) the conscientious way you’ve gone about trying to improve your sleep is truly admirable.

      You’re not seeing the results you’d like yet. But my guess is that a person who moves through life with as much care and sense of purpose as you do will eventually find an answer.

      Where to look next? The main goal of the behavioral components of CBT-I (sleep restriction and stimulus control) is to increase sleep drive. Restricting time in bed is a good way to do that.

      Take any normal sleeper and restrict her time in bed to 5 hours a night and she’s going to feel it. She’ll start falling asleep the minute her head hits the pillow and she won’t wake up until the alarm rings. Then she’ll have a really hard time getting up. She’ll feel increasingly sleepy during the daytime and it’ll be harder and harder to stay awake until bedtime rolls around again.

      Some sleep scientists speculate that in people with insomnia, there’s something a little bit sluggish about the build up and discharge of sleep drive. The solution is to restrict time in bed, which typically results in mild sleep deprivation. This should boost sleep drive enough to enable even problem sleepers to fall asleep quickly and sleep through the night. Or so the thinking goes. And once you’re falling asleep on cue, night after night, you’re less likely to be anxious about your sleep.

      But this has not been your experience so far. Nor are you complaining about trouble (1) staying up until your prescribed bedtime, (2) getting up, or (3) staying awake during the day. It doesn’t sound like you’re showing signs of sleep deprivation.

      Some sleep scientists say that the main problem for people with insomnia is a kind of mild physiologic hyperarousal right around the clock. To drop off to sleep easily, you have to be relaxed. But relaxation doesn’t come easily to people who are hyperaroused.

      That’s where the relaxation techniques come in. Anything that reduces arousal (vigorous exercise, yoga and other mind-body practices, meditation, deep breathing, progressive muscle relaxation) will be conducive to sleep. Some experts have suggested that adding relaxation techniques to the behavioral components of CBT-I will make it more effective.

      There’s also a cognitive component of CBT-I that’s supposed to address sleep-related anxieties. Since your main complaint is the anxiety you feel at night, talking with your therapist about your thoughts and attitudes about sleep and insomnia might help.

      In any case, moving forward, whether with your current therapist or another, and whether or not you continue restricting your sleep to 5 hours a night, I’d suggest making anxiety the focus of your treatment, or having the sleep and anxiety issues addressed simultaneously.

      I’d never suggest medication as a first-choice strategy, but you don’t want to continue with something if it feels like you’re beating your head against a brick wall. If other forms of treatment fail, some type of medication might work, at least as a temporary assist.

      Good luck and good night.

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  2. Thanks, Lois.

    It is usually a struggle to stay awake until bedtime, but I am able to do it. And I don’t like getting out of bed in the morning, but I almost always wake up at least 10 minutes before the alarm goes off. I don’t usually feel sleepy during the day, though I have once or twice fallen asleep (unintentionally) during the day; intense sleepiness usually begins between 8 and 10 pm.

    I exercise every day for at least an hour – I’ve been an avid athlete all of my adult life. It’s the stationary relaxation techniques that I have difficulty with; I guess I’ll just have to work on that.

    -Katie

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    1. Hello again, Katie–

      OK, so you are struggling to stay awake until bedtime. You’re probably mildly sleep deprived, which suggests that relief may be on its way.

      About exercise: like you, I enjoy vigorous exercise but haven’t had a lot of success with slow or stationary mind-body practices. Have you experimented with changing the time of your daily workouts (and would this be feasible)? You’ll read in my book that late afternoon/early evening workouts may be most helpful for people with insomnia, particularly when depression or anxiety are involved.

      I’ve found this to be true for myself. Exercising early in the day–no matter how hard–does absolutely nothing for my sleep. Exercising later–between 4:30 and 7 p.m.–helps quite a bit. Especially when I’m stressed out, pushing myself to do a strenuous workout late in the day can make the difference between sliding over the hump of consciousness into sleep and staying awake at night for several hours.

      Here’s a blog I wrote on this topic:
      https://thesavvyinsomniac.com/timing-your-exercise-for-optimal-sleep/

      I also promote the mind-body therapies because, though I haven’t a lot of success with them myself, other people with insomnia have. Among sleep researchers there are a few who study the effects of yoga, tai chi, or mindfulness meditation on people with insomnia, and they’ve come up with some positive results.

      I’ll be checking into these and other insomnia therapies from time to time in the future, so stay tuned.

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  3. I finally had about 4 good nights after starting sleep restriction (about 11 days ago) but had a horrible night of anxiety last night. I was anxious about not being able to continue my good nights of sleeping. I find it hard to practice relaxation exercises when I’m that anxious.

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    1. Hi Sherry,

      I’m sorry to hear about your night of anxiety last night. It’s not uncommon to experience anxiety as you’re going through SRT, especially at first. After all, you’re limiting your time in bed. And for people who have trouble sleeping, that can feel scary.

      Continuing to restrict your sleep should help–at least, physiologically. The less sleep you get, the greater the build-up of sleep drive, which should make it easier to sleep tonight.

      I was super anxious on the first 3 nights of sleep restriction, and I hardly slept at all. Then, the 4th night, I went to sleep as soon as my head hit the pillow. Hauling myself out of bed at my prescribed wake-up time in the morning was really difficult. But I continued to be very conscientious about observing my bed and wake times. I’m sure, looking back, that this helped.

      Even so, sometimes I’d feel the old fear of sleeplessness steal over me, and that felt like a setback. Especially at first, I hadn’t experienced enough good nights to be really convinced that good nights were the new normal. So occasionally I’d feel anxious and have a bad night (with time they became rarer).

      My solution, for the nights when I felt anxious and couldn’t sleep, was to involve myself in activities that were low-key but interesting. Reading is the thing I like to do best in the run-up to bedtime, so I made a point of keeping myself well-stocked with novels by authors I really liked. For me, feeling engaged by characters I was reading about helped to calm me down.

      Relaxation exercises work for some people, and I myself have had moderate success with diaphragmatic breathing. Some people have a lot of success with mindful meditation, too. But I found that the best strategy for me was focusing on something interesting outside myself. Here are a couple blogs you might like to read:

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

      https://thesavvyinsomniac.com/laying-fear-of-sleeplessness-to-rest/

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

      I would encourage you to stay the course with sleep restriction and count on having more and more good nights in the future.

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

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  4. Dear Lois,
    Thank you again for your last response. I kept with SR and had 2 great weeks of sleep improvement (easy falling asleep and getting more than 6 hours each night.) However, I’ve had 2 bad nights these past 2 days. I know this too will pass but just wanted to reach out and hear some encouragement about “set backs” along the way. Thanks in advance.

    Sherry

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    1. Hi Sherry,

      I think most people who go through the sleep restriction process experience ups and downs with their sleep, especially at first. But your having had two good weeks suggests to me that the process is working as it should. The thing to remember is that because of the way sleep drive works, bad nights–despite the anxiety they may create–will ultimately set you up for better nights ahead.

      You haven’t speculated about why you had the bad nights. One possibility that comes to mind is that you might have tried to enlarge your sleep window too much too fast. I’ve seen this happen in other people who’ve written in–that’s why I’m suggesting it as a possibility.

      They restrict their sleep a few nights or for a week and then, because they’re sleep deprived, there comes a night when they ARE able to fall asleep quickly and stay asleep. Which leads them to think that the problem is fixed and that now they can let down their guard and go to sleep and get up whenever they choose to.

      But that’s not the way sleep restriction works. If you’re doing it by the book, you have to be very firm about your sleep schedule and stick to it. At the end of the week, you calculate your sleep efficiency. If it’s 90% or better, you allow yourself 15 more minutes in bed the following week. If your sleep efficiency doesn’t reach the 90% mark, you stick with the same sleep window for another week.

      Extending the sleep window slowly helps keep your sleep drive high–which helps you avoid bad nights. Eventually you’ll find your ideal sleep window. By that time your sleep will feel pretty solid and dependable. The way to keep it that way is to observe that same sleep schedule night after night.

      Again, I think you can only benefit by staying the course. Best of luck!

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  5. Hi Louis, I’m from amsterdam and here in the Netherlands sleeprestriction isn’t well known.
    I’ve had inmsomnia for 8 weeks now. Every night was different. My doc prescribed pills, but they scared me too much. 2 days ago I went to a sleep specialist and she advised me too start with Sleep Restriction therapy. My average sleeptime over these 8 weeks was 4 hours. But because that was too low, we decided to start with 5 hours.
    From 01:00 till 06:00.
    I was very hopefull the first night, but that sure changed the second 😦
    I had a very hard time keeping myself busy untill 1 ( Felt very loneley ) and thought about my bed all the time, and counting the minutes untill I was allowed to go there. But when I went to bed I was wide awake. After 2 hours I went out of bed for 5 minutes then back, I felt asleep around 3. But then woke up at 5, and didn’t fall back asleep. Allright this was the first night, I was kind of expecting this. Yesterdag my day was like hell. I was extremely tired and scared the whole day. But then at 01:00, lying in bed awake again. Same routine as the day before. I felt hardbroken. Tears are behind my eyes. I am so tired and scared. Why didn’t I fall asleep? I’m so scared I’m damaging my body with this little sleep. So scared this won’t work for me.

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    1. Hello Kelly,

      When I went through sleep restriction therapy, I had the same doubts and fears as you do. I was determined to stick closely to my sleep window–which in the beginning was 4 hours and 45 minutes, very similar to yours. But though I might catch myself yawning at night before my bedtime rolled around at 12:45, when it came time to get in bed, I was wide awake, and anxious!

      I went to bed, got out of bed, went to bed again, got up again so many times. I document the process in chapter 8 of my book, THE SAVVY INSOMNIAC. My fear of sleeplessness overwhelmed me, so much that I got maybe 1 1/2 or 2 hours of sleep every night for 3 nights in a row.

      After the 3rd night, I was too tired to think or do much during the day. But by the 4th night I was so tired–and the pressure to sleep had built up so high–that I fell asleep the minute my head hit the pillow and slept right through the night. For me that was the turning point, when I realized that sleep restriction therapy just might work.

      If a sleep specialist has advised you to try sleep restriction therapy, then there’s a very good chance that it will work. I would urge you to stay the course and stick with the program she has recommended.

      You’re bound to feel tired during the daytime. This is normal, and it will not cause any long-term harm. But allow yourself to lighten up on your workload so you don’t feel stressed out about what you do or don’t accomplish while you’re in the first week or two of therapy.

      If on these first two nights of therapy you’ve slept as poorly as you think you have, your situation is bound to turn around fairly soon. And once you ARE sleeping through the night, hold fast to your wake-up time though you might feel like sleeping an extra hour. Only by strictly observing your sleep window will you keep the sleep pressure high enough to sleep well night after night.

      Good luck!

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  6. Hi lois. I just had 2 weeks of srt, and I see no improvement. I started out with a sleepwindow of 5 hours. But I didnt respond well to that. I got so anxious and depressed that we devies to try 6 hours. That felt somwehat better. But of the 9 night’s i’ve obly had 3 night’s where I slept for 5 hours or more. Even had 1 night I didnt sleep at all. I go to bed at 0:00 and I am tired. Really really tired. But as soon as my head touches the pillow I am wide awake. I’ll try some relaxing exercieses or get out of bed. ( not after 30 minuten, somehow im just too tired to get up again) but when I go bed to bed, awake again. This is so extremely frustratie! I just dont understand, how I can be so tired all day long and when the time too sleep comes, I am up. Im losing hope. Also I have a very hard time feeling the difference between being asleep and being awake. It’s just one big blur. I feel so awfull and scared.

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  7. Hi lois, I’m in my 4th week of srt. Ive had 3 nights in a row where I slept for more then 5 hours. But last night only had 4 hours. I know there is an improvement but I just feel so tired the entire day. Fighting to stay awake. My short time memory is gone and I’m having a very hard time concentrading longer then 5 minutes. This makes me scared and depressed. Im also very scared I will always have trouble sleeping and I will neer feel myself again. Does insomnia stil affects your live? Or do you feel happy and healthy now. It just feels like srt may help but will never cure the insomnia.

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    1. Hi Kelly,

      First, your comment posted on July 22 somehow slipped by me, and I’m sorry that I didn’t respond to it then. I’ll respond to both your posts now.

      It takes some people longer than others to reach the point where improved sleep becomes reliable. It sounds like anxiety about sleep is part of the problem you’re having, so I’ll talk about that first.

      Fear of sleeplessness was part of my problem, too. Sleep-related anxiety is learned unconsciously and, because of the associational triggers (which may or may not be obvious), it is hard to unlearn. In THE SAVVY INSOMNIAC (chapter 8), I document the process I went through get rid of it. You may also be interested to read this article I wrote:

      http://psychcentral.com/lib/putting-the-fear-of-sleeplessness-to-rest/00018758

      There’s evidence that relaxation, meditation, and acupuncture are helpful in reducing anxiety and arousal and promoting better sleep. Sleep anxiety is a specific type of anxiety, though, and although many people use relaxation, meditation, and yoga to manage it, I had better luck with daily aerobic exercise late in the afternoon or early in the evening.

      I was also very disciplined about observing my sleep window (I started sleep restriction at 4 hours and 45 minutes a night.) My sleep became more regular fairly quickly. Yet it took several weeks–maybe even months–before I was sleeping as well as I felt I could.

      My sleep is way better than it was before I learned better sleep habits and changed my way of thinking about it. It’s not that my insomnia is cured; it’s that I know how to manage it so it’s no longer a monkey on my back. Yes, I do feel happy about my sleep and healthy overall. When something stressful comes along to knock my sleep off track, I mostly count on sleep restriction and exercise to get my sleep to be regular again.

      Given that you’re 4 week in to sleep restriction and still have doubts about whether the treatment is going to work, I think it’s time to look for the kind of one-on-one help that a trained sleep therapist can provide. Here are some places to start: Absm.org/BSMSpecialists.aspx and Behavioralsleep.org/findspecialist.aspx.

      Best of luck in getting the help you need.

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  8. Hi lois. Thanks for your answer. I’m now in week 6 and I have to say it’s getting better. I mostly sleep for 5.5 hours a night. When I started it was 3. My window is now between 23:00-0:00 untill 6:00 I can go to bed when I have trouble staying awake. As a result I’m falling asleep faster. But the last couple of night’s. I keep waking up in the middle of the night and having trouble falling back asleep. I am completly calm and have no idea why I woke up. Do you have any tips for staying a sleep and if I do wake up falling back a sleep? Gr. Kelly

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    1. Hi Kelly,

      I’m glad you stuck with the sleep restriction program and that your sleep is improving. But of course you’d like to get rid of the middle-of-the-night wake-ups.

      I notice that you’ve set a variable bedtime for yourself: between 11 and 12 at night. It sounds like you’ve done that because you’re having such a hard time staying awake until midnight, your prescribed bedtime. I know that problem myself.

      When I was going through sleep restriction, I had to change the things I typically do before bed to keep myself awake until my bedtime. Activities involving a bit of movement were best: playing an electronic piano, doing light housework, and simply walking around the house. One reader found that a shiatsu massage pillow was the perfect solution to keeping herself awake until her prescribed bedtime.

      Allowing yourself to go to bed at 11 sometimes may be why you’re waking up and having trouble falling back to sleep. You say you’re sleeping about 5.5 hours a night. On the nights when you go to bed at 11, your sleep window is from 11 to 6, for a total of 7 hours in bed. On this schedule, your sleep efficiency (5.5 X 100 ÷ 7) is 79%. So it’s not surprising that you’re experiencing some wake-ups at night. If consolidated sleep is what you’re aiming for, your sleep efficiency needs to be at least 85% and preferably 90%, which it would be if you set your sleep window from 12 to 6.

      Maintaining a regular sleep window is really important as you work on improving your sleep, and it will help you maintain the gains you’ve already made. My first suggestion would be to continue with a 6-hour sleep window for a week and, if your sleep efficiency is at least 85%, add 15 minutes to your sleep window the following week, 15 minutes more the week after that, and so forth, until you find your ideal sleep window, and then stick with it.

      Sometimes adjusting the start and end points of your time in bed can help. If you’re finding a 12-to-6 sleep window too difficult to work with, how about trying 11:30 to 5:30? You may eventually work up to a sleep window of 6.5 or even 7 hours but the extra time in bed needs to be added slowly for the sleep restriction process to work.

      If you do wake up in the middle of the night and find you can’t fall back to sleep, leave your bedroom and do some quiet activity, like reading, until you feel sleepy again. Avoid devices with screens.

      In your case I think tightening up your sleep window at least for a while will get you where you want to be.

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  9. Hi lois. Thanks again for your answer. You’re such a big help. Here in the netherlands srt is almost unknown. If I tell people what I do they look at me like I’m crazy. As long as I can remember I didnt fall asleep right away and always woke up in the night. I am a really light sleeper. The normal srt rules didnt work for me. I felt completly miserable and awfull during the first couple of weeks. 90% of sleep efficiency, was never part of the deal. In the six weeks im doing this I have had 5 night’s of 90% or more. So the docter decided the srt needs to be made custom for me. Normal srt would take far too long. So after some research we found out that I would get really sleapy right before my allowed bedtime, but as I walked to the bedroom I woke up again. So we tried reading in bed. Which is not really allowed. But worked like a charm for me. My eyes would become so heavy that I couldnt continue reading. Then I would fall asleep. I still have about 2 bad night’s a week. But the other ones are usually above 80%. You are right about maybe moving too fast. I will go to bed later tonight. Im glad I’m improving. Almost lost hope. Now hoping I will feel physicly better soon, but the doc warned me this might take a while. Srt works 4 me, but custom made haha

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    1. Hi Kelly,

      Custom-made sleep restriction is the best kind of insomnia treatment there is. It’s great that you’re sticking with the program and finding ways to make it work.

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  10. Hi Lois,

    Thank you very much for this post on Qs and As on Sleep Restriction, it’s very reassuring to hear that the progress is not usually linear and that a lot of people experience ups and downs. I’ve now been practicing sleep restriction for 18 weeks, and it seems to be working – usually I get 5.5 to 6 hours of sleep each night, and my sleep window is 6.5 hours. I still have some nights, once or twice per week, when I don’t sleep well, but I do get about 4-5 hours of sleep on those nights.

    However, in the last two weeks, I had two bad nights where I hardly slept at all – and this hasn’t happened since I started SR and CBT-I 18 weeks ago. And it is so very discouraging when a bad night happens, brings back all of those feelings associated with being afraid of sleeplessness! And also of being scared that SR will stop working somehow.

    I wonder, it is normal to still have bad nights like that once in a while, even when following CBT for insomnia for a few weeks now? In your book you mentioned that you’ve been practicing sleep scheduling for a few years now, ever since undergoing CBT-I, I’m wondering what’s your experience with bad nights nowadays? Do they still happen?

    Also, I wanted to thank you for your web-site, blogs and your book. I read your book and I found it extremely informative and helpful! I did CBT-I on my own since there are no sleep specialists in my area, and it was good to read in your book that doing it on your own is pretty much the same as in a group setting.

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    1. Hi Natasha,

      Thanks for sharing your experience of CBT-I and sleep restriction. I’m glad that overall the experience has been positive.

      I had to think a minute before making this next statement: it’s been 8 years since I first went through CBT-I myself. My sleep is now so much better than it was before. It’s regular (before, I never knew when I was going to sleep) and it feels pretty stable.

      Even so, when something stressful comes along, I may feel wound up at night. I’ll notice I’m just not sleepy when bedtime rolls around. The first year or so after I went through therapy, feeling wound up like this almost always brought my fear of sleeplessness back. As you know, anxiety like that is hardly conducive to sleep! It made me wonder if I was reverting to my old insomniac self again.

      Eventually, though, the short nights and sleep loss I experienced would lead to such a build-up of sleep drive that by the 3rd or 4th night, my body simply had to sleep. And as long as I stuck to what I’d figured out was my ideal bed and rise times, (a few times I had to restrict my sleep a little bit) my sleep would become regular again fairly quickly.

      Stress can still knock my sleep off track. But having had so many years of relatively good sleep, and seeing that whenever my sleep takes a turn for the worse I can usually get it back on track in a matter of days, I have more confidence in my ability to do that the next time sleep takes a turn for the worse. So I’m less likely to feel that fear of sleeplessness overtaking me again.

      I never like to have a wound-up night, but when I do, I don’t fall to pieces the way I used to. I’m more likely just to observe that it’s happening and simply go with the flow. I always try to have a good novel on hand, and when I can’t sleep, I immerse myself in the story. Sometimes I even find myself thinking that it’s nice to have an extra hour or two for reading.

      Another thing that helps is that I’ve discovered that after one bad night, I can function perfectly well the next day. I can even function pretty well after a second bad night. Knowing that has probably helped lower my anxiety when I can’t sleep.

      I’m glad you’ve found the blogs & the book so helpful, Natasha, and thanks for saying so. Continue to observe your usual bed and rise times and my guess, as the weeks and months pass, is that your sleep will continue to improve and that fear of sleeplessness will come to occupy a smaller and smaller place in your life.

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      1. Hi Lois,

        Thank you very much for your quick reply! It made me feel so much better to know that bad nights can happen and that it’s ok, I feel more relaxed about it now. I have to say that I did start to think: oh no, am I reverting back to my old insomniac again, and how could this be happening after 18 relatively good weeks.

        My insomnia was in a pattern of a one sleepless night followed by one good night, when I would binge sleep for about 10 hours – and I find that I’m still scared of returning to that pattern. Although after learning CBT-I, I now know that back then I was doing everything that actually contributed to my insomnia pattern, like sleeping for a long period of time, sleeping in, taking naps. And now, after my first bad night which happened 2 weeks ago, I stuck to my sleep window and I didn’t go back to that horrible sleep pattern that I used to have. Learning this also made me more hopeful that SR is working and will continue to work.

        It was good to hear that it may take over a year to build confidence in regular sleep and as a result, for the fears of sleeplessness to start diminishing. I know that the process takes a while, and it’s good to know that as long as one sticks to the program, and fixed bed time and rise time, SR continues to work in the long term. It’s so great that it’s been working for you for 8 years!

        I have to say that after 18 weeks, I also started to develop hope that I can get my insomnia under control. And having a bit of regularity with sleep feels amazing and empowering. I also noticed, when those two bad nights happened, that I functioned pretty well the next day. I’m glad to hear that you’ve had the same experience with being fine after a bad night.

        Thank you for your recommendation, I will stick with my sleep window and continue to practice SR, and hope that my insomnia will remain under relative control. You mentioned that you restricted your time in bed a few times when your sleep took a turn for the worst and that it helped in getting in back on track in a matter of days. By how much did you restrict your time in bed, and for how long? Also, is there anything else that you do to get sleep back on track?

        Thank you!
        Natasha

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      2. Hi Natasha,

        When my sleep went off track and I couldn’t stabilize it by exercising longer during the daytime (sometimes that works), I restricted my sleep by an hour for 3 or 4 nights. That’s all it took to return to a more regular sleep pattern. It was reassuring.

        But here’s a summary of the instructions I received when I went through CBT-I at the University of Michigan Sleep Clinic:

        If you relapse, the first thing to do is follow stimulus control procedures (i.e., don’t lie awake in bed for more than 15 to 20 minutes. Get up, go to another room, and do something quiet until you are sleepy).

        If your sleep is still bad, restrict your sleep by 1 hour or more for a few days. Be strict about getting out of bed at a consistent wake time, even on weekends.

        Once your sleep is solid again, you can extend your total sleep time by half-hour periods every 2 nights until you return to your desired bedtime.

        I hope this helps!

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  11. Hi Lois,

    Thank you very much for this information. It’s so very important to have a plan in case bad nights return. Knowing what to do and what works to get back on track makes a huge difference, I feel less anxious!

    Thank you for all you do!
    Natasha

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  12. Hi there, I have suffered from sleep maintenance insomnia for several years and am currently doing Sleep Restriction therapy for the first time. My doctor told me to sleep from 12-6:30 but after 2 weeks of doing this there is not much improvement. I always wake up before my alarm and am averaging 5 hours sleep. I think the sleep window is too long. Should I scale it back to 12-5 instead? Thanks for your help.

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    1. Hi Nathan,

      It’s good to know you’re taking action to improve your sleep. Before you started restricting your sleep, did the doctor you’re working with have you keep a record of how much time you were actually sleeping? That’s a crucial step and, for whatever reason, it often gets skipped.

      If now you’re discovering that you average 5 hours of sleep a night, then it suggests to me that a 6.5-hour sleep window is too big. If you’re not seeing much improvement, why not try scaling the window back and see if you get better results? Here’s another blog post you may be interested in reading:

      https://thesavvyinsomniac.com/qa-start-sleep-restriction-right-for-best-results/

      Anyway, good luck with the sleep restriction. I think narrowing the sleep window will move things along.

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  13. Hi Lois

    I’m all over the place!

    Suffering from huge anxiety around falling and staying asleep for three months.

    I’ve commenced CBT-I, started running every AM and have a plethora of mindfulness apps.

    I have spent the last ten days going to bed around 10pm, popping a tablet but still don’t get more than 4-5hrs some nights even though I experience a few days of 7+ hrs each week. My therapist asked me get out of bed at 6.30am, which I’m doing but if that didn’t work, head down the SRT path.

    I tried 2 X nights of SRT (11.30pm – 6.00am) per his plan but anxiety got the better of me and I quit.

    I’m sick of anxiety and my reliance on pills.

    Any tips? Does SRT work and does even severe anxiety abate eventually? Can’t overcome this fear!

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    1. Hi Richard,

      I’m sorry to hear about the sleep problem and the anxiety. I know the spot you’re in pretty well myself. But, as I went through CBT-I (and sleep restriction), my sleep began to stabilize. Sure, especially for the first few weeks, I wasn’t sleeping as much as I’d have liked. The first few days of sleep restriction, I was terribly anxious. Because of that anxiety, I hardly slept at all. But I stuck with it. And as I realized that as long as I stuck to a schedule, I could basically count on being able to sleep, my sleep anxiety started to fade away. Now I don’t experience it much at all.

      It helped me to understand something about why I was experiencing insomnia and sleep anxiety and what might be going onside my body to keep me awake. That’s part of why I did all the research I did as I was writing my book.

      I’ve written several other blog posts about stress and anxiety, fear of sleeplessness, sleep restriction, and CBT. Just click on “Blog” and type whatever you want more information on in the site search box at the top right corner of the page.

      One more thing. You mentioned running in the morning. Would it cramp your style to start running in the late afternoon/early evening instead? I’m a fanatic about exercising later in the day because I’ve found that’s the only time when exercise helps me get to sleep. There’s research to back this up, too. When you exercise, your body gets hot. That triggers an internal cooling mechanism, which is favorable to sleep. Exercise in the morning does absolutely nothing to help me sleep at night.

      Good luck in finding a therapy or therapies that help you manage your anxiety and your sleep.

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  14. Thanks Lois – into day 4 and struggling but will stick to the plan.

    I will try exercising in the evening per your recommendation.

    I don’t understand how I can be so exhausted and nodding off all evening then, shortly before my prescribed bedtime (11.30pm), I’m supercharged. Taken me 1-2 hrs to sleep these past few nights and I’m awake before my wake up time (6.30pm).

    Bizarre! Until 3mths ago I could sleep through a tornado.

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  15. Hi Lois,

    I’ve had forms of insomnia going on 5 years. I definitely have anxieties around sleepiness, which I think is tied around when I first developed insomnia I had ptsd, depression and anxiety. I still have anxiety but haven’t had ptsd or depression symptoms for some years now and saw a psychologist to deal with the issues I was facing the time. My problem is that I can usually fall asleep okay but regardless or how early or late I wake in the night I won’t go back to sleep. Sometimes I only get two hours. I study and work as well as volunteer. Throughout the semester I cant try these kind of approaches on my insomnia because of the effect it has on my study so I usually take medication. I just finished exams and want to try sleep restriction therapy because I never have before.
    However it’s three nights in and regardless of the time I set myself (which was 3 as I usually wake up at 7) I still wake up before 7. It takes me roughly 30 to get to sleep but I won’t sleep longer than two or three hours.
    I understand that I should set my designated sleep time for less however another problem arises. I am about to do an internship in Geneva for 5 months (I’m from Australia). In 4 weeks I’m about to change time zones and I seriously doubt that’s enough time for me to fix my sleep patterns. Do you think I should stick with the program now or wait until I will have a better chance of completing it successfully without interruptions?

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    1. Hi Emma,

      It doesn’t sound like you’re sleeping very well. It’s good that you’re looking out for ways to improve your sleep.

      Sleep restriction might well help. (And it might be even better to go through cognitive behavioral therapy for insomnia—CBT-I—which includes sleep restriction as well as other insomnia treatments.) But sleep restriction usually involves some sleep loss, mainly at the beginning of the treatment. So it’s better to go through it when you’re in a low-demand situation.

      Your upcoming move to Geneva from Australia could be stressful. Temporarily, it’ll upset your sleep. So you might want to wait to begin sleep restriction until you’ve established yourself in Geneva and are moving on an even keel.

      That said, if and when you do undergo sleep restriction, it’s important to prepare for the treatment by keeping a sleep diary for a week BEFORE restricting your sleep. Take a look at this blog post for information on exactly how to determine how much to restrict your sleep:

      https://thesavvyinsomniac.com/qa-start-sleep-restriction-right-for-best-results/

      Best of luck in Geneva and in improving your sleep.

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  16. Hi,
    I started suffering Insomnia 3 months ago. Just one night i woke every 10ish minutes basically the whole night….this continued night after night. I booked appt with sleep therapist and i logged a sleep diary. I was averaging 2-3 hours of broken sleep a night. I felt i was dying….i was barely functioning. I was put on sleep restriction therapy which after a couple weeks i saw improvement. Over the past couple months I have increased my sleep window to 7.45 hours of sleep and i sleep most of this time (average 3/4 night time wakings for toilet or kids! But fall straight back to sleep so it doesn’t bother me).
    3 weeks ago I had 3 bad nights in a row….where i felt the ‘insomnia feeling’ came back. I was upset by this as i thought i was well on the road to recovery. I stayed up an extra hour for few nights and it kind of resolved itself. I have been back to sleeping well since then apart from the last 2 nights. Insomnia has returned worse the the previous lapse. Why is this happening. I still adhere to strict bedtime and rise time and never nap. Is this just my life from now on? Would love your adivce on relapses?
    Thanks
    Jodi

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    1. Hi Jodi,

      It’s not at all uncommon to have the sort of experience you’re describing here. Even good sleepers have bad nights. But since they don’t have the experience of chronic insomnia, bad nights don’t make them anxious the way they do people who’ve experienced persistent insomnia in the past.

      Like you, I keep to fairly strict bed and rise times. Even so, when I’m feeling stressed out or anxious, I have trouble falling asleep. After going through sleep restriction 9 years ago, every time this happened, my fear of sleeplessness was quick to come back. That of course made it harder to return to sleeping well. But I did what you did, narrowing my sleep window for a couple of nights, and eventually I got my sleep back on track.

      Over the years my fear of sleeplessness has faded quite a lot. So now when I have a bad night or even 2, I don’t get anxious about it. I’m back to sleeping well again much sooner than I used to be.

      Learned patterns like this die hard. But I’ve found that they can be replaced by new patterns with persistence.

      My advice would be to do just what you’re doing with the expectation that your sleep will continue to improve, that bad nights will come more rarely and, when they do come, your sleep will return to normal more quickly than it’s returning now.

      Hope some of this is helpful!

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  17. Elaine Greenwood-Hyde September 9, 2016 at 1:48 pm

    How do you calculate your average amount of sleep before starting SRT? I can’t figure out how to do it. My sleep varies from 2.5 hours to a very fitful non restful 7. I go to sleep ok, but either wake up many times and only hover lightly in sleep, or I wake up a few times, then have a long period before being able to go back to sleep, or I wake up and don’t go back to sleep at all. I’ve only had severe insomnia since starting to go through the menopause. I’m very tired.

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    1. Hi Elaine,

      Several women I’ve spoken to say they start having trouble sleeping as they’re heading into menopause. I’ve posted a blog about this very thing:

      https://thesavvyinsomniac.com/insomnia-in-midlife-and-older-women/

      It’s also common for people with persistent insomnia to experience a mix of good and bad nights. So before you start sleep restriction therapy, you need to keep a sleep diary for a week. Each morning, jot down how much time you think you slept that night. As an example, let’s say you recorded in your sleep diary these sleep times for the week:

      2.5 hours
      7
      5
      4.25
      6.75
      4
      5.5

      You add these figures up and get 35 hours. You divide this number by the number of nights for which you recorded your sleep time: 7. 35/7 = 5. So you’d start restricting your time in bed to just 5 hours a night for the first week of sleep restriction.

      You continue to keep the sleep diary throughout the sleep restriction process. At the end of each week, you calculate your sleep efficiency, which determines whether you’re ready to add time in bed or continue with the same sleep window for another week.

      I describe how to calculate your sleep efficiency in this blog post:

      https://thesavvyinsomniac.com/qa-sleep-efficiently-for-a-better-nights-rest/

      Good luck getting started. I hope you see improvements in your sleep and stamina fairly soon.

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  18. Hi there,
    I used to have completely normal sleep but I spent 14 or 15 months waking 5+ times a night with my infant son. He had various health problems that made it hard for him to eat during the day but all are resolved now. I bed shared with him during this whole time until I hit a wall and sleep trained. When I first started sleeping I was getting about 5 hours a night and felt amazing but then after a couple of months I realized that 5 hours was all I was getting! To make a long story short, I have been allowed the time to sleep for a year but my sleep never returned to normal. I fall asleep fine but I wake up at 2 or 3 every night and often never fall asleep again. My son wakes at 5 or so. I do generally feel a hyper awareness of any sounds in the house. I jump and feel a surge of adrenaline even when it is just the heater clicking on. My son has always been a very “energetic” cryer since the day he was born. He makes sure he gets your attention when he wants it!

    I just started trying to do some sleep restriction therapy a few nights ago. The first two nights were awful, barely slept. Last night I slept well but I think I nodded off too early and probably caught up too much. But I am wondering if it is all futile because my nights aren’t consistent. I still have a toddler and he will certainly never be a champion sleeper. He has regressions and wakes up needing attention off and on. I’m considering giving up until he’s older and just dealing with this. I just can’t remove the thing that is causing sleep stress…I love him and he is really cute! I have started to improve my sleep hygiene much more seriously. Do you think I should even bother with this sleep restriction at this time? or should I just continue with sleep hygiene and hope for the best? I’m tired!

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    1. Hi Kaily,

      It is harder to stabilize and consolidate your own sleep when you’ve got young children whose sleep and needs are sometimes unpredictable. But all humans, no matter the age, sleep better on a regular schedule. You’ve said your toddler is not a champion sleeper! Some toddlers certainly aren’t. But I wonder if by changing some habits you could help your son consolidate his sleep and, in turn, help yourself.

      I reviewed a book called The Happy Sleeper a couple years ago. It was written by two women with lots of experience working with parents to help them develop habits that would better facilitate their children’s sleep. You might want to get that book and try the strategies they recommend. Here’s the URL to my blog post: https://thesavvyinsomniac.com/2015/03/30/helping-baby-sleep-like-a-baby/

      Once your son’s sleep is more stable and predictable, it’ll be easier to figure out your own sleep needs and see to it that they get met.

      Meanwhile, I’d suggest being as regular in observing your own bedtime and rise time (most likely 5 a.m. since that’s when your son wakes up) as possible. Good luck!

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  19. I plan to start SR again. It’s so very hard. I have to get off lunesta and xanax. I am so anxious about tonight. My prescribed bed time is 12 am and I have to get up at 6 am. Should I continue even if tonight might be absolutely awful ?

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    1. Hi Monika,

      You can probably tell from this post and others I’ve written that I’m a big believer in sleep restriction therapy (and cognitive behavioral therapy for insomnia—CBT-I—in general). I give most credit to SRT for regularizing my sleep and helping me get rid of my fear of sleeplessness. I sleep much better now as a result.

      Your situation, at least what you’ve written about it, sounds somewhat different from mine. If you’re taking Lunesta and Xanax regularly and wanting to stop, you’ll need to be working with a sleep specialist to figure out a tapering regimen that seems reasonable to you. I wrote the following blog post on people going through CBT-I (which includes SRT) while continuing to use (or tapering off) sleep medication. I think you’ll find it useful if you haven’t already read it:

      https://thesavvyinsomniac.com/2014/08/18/qa-during-cbt-do-i-have-to-stop-my-sleep-meds/

      Also, the fact that you’re planning to “start SRT again” suggests to me that you’ve tried it before but not had much success. All the more reason to find someone to assist you who can set you up to succeed this time around. The ideal thing would be to find a healthcare professional who could both administer CBT-I and help you wean off your meds at the same time. For assistance in locating someone who is trained to help, this blog post may be useful to you:

      https://thesavvyinsomniac.com/2016/12/28/improve-your-sleep-with-cbt/

      Good luck with your project to improve your sleep. It sounds like you’re moving in the right direction!

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  20. Hi Lois,

    Thank you for your very helpful information! You may not feel like you can answer this question, but I thought I would give it a shot. Long story short, I am tapering off clonazepam (.25mg/night for 6 weeks) which a neurologist gave me to help me sleep. He doesn’t support me getting off the drug, so I can’t get help from him (in fact, he wanted to put me on an SSRI). Before I went on the drug, I was experiencing hypnic jerks (which resulted from sleep deprivation caused by UARS – I finally found an ENT who diagnosed UARS and is treating it). They went away while on the meds, but as I taper, they have returned full force. All night. I fall asleep and wake up instantly from a jolt that makes me gasp. Since the hypnic jerks are exacerbated by sleep deprivation, I am hesitant to try SR, but I really want to get this insomnia under control. Do you have any experience with hypnic jerks and sleep restriction? If so, how did you cope? Also, what are your thoughts on attempting SR while tapering off a benzo (I have 9 weeks before I am completely off the drug)? Insomnia is one of the side effects of withdrawal, so I’m trying to figure out if I should implement SR to combat it now or wait until withdrawal symptoms have peaked (11 weeks from now). I just started stimulus control last night, but by 3 am, I just decided to lay in bed and deal with the jolts.

    Kind regards,
    Laura

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  21. Oh, my goodness! I just saw your post above!! I am so sorry – it’s the sleep deprivation.

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  22. Hello, I am also insomnia sufferer. Started sleep restriction therapy this week and currently on day 6. I managed to get through 5 days with 4-5 hours of sleep, was still waking up and could not go back to sleep. My sleeping window is 7 hours, from 10-5. Today is Saturday and I am finding really difficult not to nap, feeling extremely tired and thinking when this is going to work.

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    1. Hi Ina,

      It’s good that you’re taking action to improve your sleep. Sleep restriction therapy has been helpful to many people with insomnia and it certainly has helped me. But for it to work, you’ve got to do it right. Your chances of success are good if you work with a trained sleep therapist; invest in an online program for cognitive behavioral therapy for insomnia (such as Sleepio, Shuti, or CBTforInsomnia); or learn about the therapeutic process yourself by reading books (such as The Insomnia Workbook or The Insomnia Answer) or read information available online. If you choose to do it on your own, before starting, you have know exactly what the sleep restriction process entails.

      The first step is simply observational. You keep a sleep diary for a week to discover the average amount of time you’re sleeping (NOT how much time you’re spending in bed). Once you’ve ascertained how much you’re sleeping, you begin restricting your time in bed to exactly that amount of time—and no more.

      It’s not clear to me how you determined that your sleep window should be set at 7 hours if you’re sleeping only 4 to 5 hours a night. Starting the process with a too-generous sleep window can be a set-up for failure. Or, if not failure, then it’s likely to result in the process dragging on much longer than it needs to. Here are a couple blogs that may help to start you off on the right foot:

      https://thesavvyinsomniac.com/2016/01/18/qa-start-sleep-restriction-right-for-best-results/

      https://thesavvyinsomniac.com/2014/10/20/sleep-restriction-what-you-need-to-succeed/

      https://thesavvyinsomniac.com/2015/08/24/qa-sleep-efficiently-for-a-better-nights-rest/

      If you start the process correctly, during the first week or so you probably will feel tired during the day. But soon after that you should start seeing improvements in both your sleep and your daytime stamina. I recount the process I went through during sleep restriction in chapter 8 of my book, The Savvy Insomniac. The first few days were incredibly rough. But I stuck to the protocol, didn’t cheat, and by the 4th night I was starting to fall asleep as soon as my head hit the pillow and sleep right through the night. Sure, that meant I was getting approximately 4 hour and 45 minutes of sleep a night. But gradually—again following the protocol—I was able to enlarge my sleep window enough so that I eventually reached the point of feeling like I was getting enough sleep.

      Good luck with SRT whichever way you choose to go.

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  23. Thank you very much Lois for your kind support! I did not follow 2 weeks writing diary before I started this process, since I knew without writing approximately that I get 6-7 hours of very fragmental and interrupted sleep on the most (was going to bed about 10pm sleeping until between 12a.m. – 1a.m., waking up from 12a.m. or 1a.m. and staying up until 3-4 a.m. and then falling asleep for fragmental 2-3 hours)however I was spending in bed about 10 hours to make up for it.of course sometimes I might not sleep at all since I have a 3 year old baby who still might wake up about 2 times per night and after this happens I can not fall back to sleep.i am usually extremely exhausted in the evenings therefore do not have usually problem to fall a sleep, but have problem staying asleep for several hours at once and if I wake up I can not fall asleep again. I chose 7 hours since I don’t know when I can be interrupted at any time,I dint think that I could function during the day otherwise since I also have a very demanding full time job and already feeling a zombie.today is my 7th day and tonight I slept about 4.30 hours.maybe I will try to do my best to cut my sleeping window even more.when usually this treatment starts working? Thank you so much again!

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