When people ask what insomnia treatment helped me the most, I mention sleep restriction therapy (SRT) and exercise.
But I’d never seen SRT and exercise paired as equal partners in a therapeutic intervention for insomnia until last week. Trolling the Internet, I came across a study conducted in China to determine whether adding an individualized exercise program to SRT would result in better outcomes than SRT alone. The investigators came up with interesting results.
Getting Beyond “No” to “Yes”
For some readers neither SRT nor regular exercise will have much appeal.
Sleep restriction may sound difficult if you feel you don’t get enough sleep. Nobody wants to experience sleep deprivation. And sleep deprived is probably how you’re going to feel in the first week or two of therapy. Most people’s sleep eventually improves (and continues to improve following treatment), but the fact remains that in the first few weeks, SRT is not a picnic.
Many insomniacs are likewise turned off at the thought of exercise or physical training.
“Usually when I propose physical training to my patients,” sleep investigator Michael Bonnet told me in an interview, “they don’t like the idea. They’re resistant to the idea of exercise, and this may have contributed to their sleep problem in the first place.”
And just how realistic is it to think that people experiencing mild sleep deprivation will be motivated to step up their level of physical activity? Research has shown that exercise improves sleep, but it’s also shown that poor sleep makes people less willing to exercise. How could an insomnia treatment be set up to avoid these potential snags?
Sleep Restriction, Slightly Modified
The team from China, whose study appeared in Neuropsychiatric Disease and Treatment in October 2015, did so by using a slightly modified version of SRT and offering intensive one-on-one support for the exercise.
Usually people begin SRT by keeping a sleep diary and restricting their time in bed to their average total sleep time (but usually not less than 5 hours a night). In this study, all 71 participants began with a sleep window equal to their average total sleep time plus half an hour. So a person averaging 5 hours of sleep a night began SRT with a 5.5-hour sleep window.
The rest of the 4-week treatment went by the book. Participants used data from their sleep diaries to calculate sleep efficiency at the end of each week and adjusted their sleep windows accordingly.
An Individualized Fitness Plan
In addition to SRT, half of the participants attended weekly help sessions with a fitness counselor. The first week’s session consisted of creating an individualized fitness plan. It included
- an assessment of the participant’s fitness and information about the benefits of 30 minutes of moderate-intensity exercise at least 5 days a week;
- setting personal goals and drawing up a plan to do the exercise of their choice; and
- a prescription for how and when the exercise would be carried out, and a calendar for recording each exercise session and noting weekly follow-up visits with the counselor.
At the follow-up visits the counselor reviewed each participant’s progress, provided support, made adjustments as needed, and encouraged adherence to the fitness plan.
A Better Outcome
After 4 weeks of SRT, the sleep of both groups had improved: participants were falling asleep more quickly, experiencing fewer middle-of-the-night wake-ups, and sleeping 20 to 30 minutes longer every night. They were also more alert during the daytime.
But the sleep efficiency of the exercisers improved significantly more than that of the non-exercisers (20% vs 13%). In other words, the exercisers were spending less time awake in bed.
Also, the exercisers reported significantly less sleepiness and fatigue during the daytime. This might be a direct effect of the increased physical activity during the daytime. But the authors suggest it might also be a sign of improved sleep quality.
These results don’t surprise me. If I hadn’t kept up my workouts on the elliptical trainer during SRT, getting past wakefulness to sleep would have been harder. I’m almost certain my sleep wouldn’t have improved as quickly as it did.
If you’re considering SRT, consider stepping up physical activity as well. It can only help.
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