Insomnia and Napping: No One-Size-Fits-All Prescription

If you have insomnia, you’ve probably heard it’s best to avoid naps. Maybe you heard it from your doctor in a conversation about the rules of “good sleep hygiene,” or maybe you read it in a magazine. Is the advice to refrain from napping really sound advice and, if so, do you have to swear off napping completely to get a better night’s rest?

There are no one-size-fits-all answers to these questions, say researchers who recently reviewed the evidence behind the recommendation to avoid napping and other sleep-related do’s and don’ts. It depends on your age and situation.

Chronic insomniacs should avoid naps, but people whose sleep problems are less severe need not abstainIf you have insomnia, you’ve probably heard it’s best to avoid naps. Maybe you heard it from your doctor in a conversation about the rules of “good sleep hygiene,” or maybe you read it in a magazine. Is the advice to refrain from napping really sound advice and, if so, do you have to swear off napping completely to get a better night’s rest?

There are no one-size-fits-all answers to these questions, say researchers who recently reviewed the evidence behind the recommendation to avoid napping and other sleep-related do’s and don’ts. It depends on your age and situation.

Chronic Insomnia

If you’ve got chronic insomnia (trouble sleeping at least 3 times a week for at least 3 months accompanied by daytime impairments), then forgoing naps may improve your sleep. Research has shown that the pressure to sleep builds higher and higher during the daytime and is released at night during deep sleep. Napping during the daytime may result in the early discharge of some of the sleep pressure. This can make it harder for people with persistent insomnia to fall asleep and stay asleep at night.

Accordingly, if you go through cognitive-behavioral therapy (CBT) for insomnia, you’ll be asked to refrain from napping during treatment. The fact that CBT works as well as it does supports the idea that cutting out naps is a useful strategy for insomniacs who want to improve their sleep at night.

What should you do if you can’t survive without a nap? Sleep therapists may recommend the following:

  1. Keep the nap short—30 minutes or less—to avoid descending into deep sleep
  2. Refrain from naps in the evening, when the pressure to sleep is high.

Mild or Occasional Sleep Problems

If you’re basically healthy and your sleep problems are occasional or less severe, then it’s not so clear that cutting out naps will help. Nor is it evident, in insomnia associated with aging, that the benefits of napping don’t compare favorably next to the difficulties created when the nap is cut out.

Napping occurs more frequently as people age, so the subjects in most studies of napping in naturalistic settings have been older adults. The results have not been consistent from one study to the next. However, the majority have not identified a significant association between daytime napping and nighttime sleep in older adults. Nor did researchers who conducted a study involving healthy young and middle-aged nappers find such an association.

Adding a Nap

Researchers have also looked at how adding a nap into people’s daily schedules affects their sleep at night—mostly in middle-aged and older adults. Here, too, the results are mixed. In some studies, naps resulted in shorter, less efficient sleep at night; in other studies, the naps had absolutely no effect on nocturnal sleep.

Of note is the fact that no researchers have ever conducted a study to determine whether depriving habitual nappers of their naps actually improves their sleep at night.

So the recommendation not to nap that appears on the list of habits consistent with good sleep hygiene? Unless you have chronic insomnia, for now, take this recommendation with a grain of salt. There may be other more effective paths to reliably sounder sleep.

If you take naps, what effect do they have on your sleep at night?

Naps & Sleep Restriction: Could This Be a Happy Marriage?

Lesley Gale was a light sleeper who began to have insomnia about 8 years ago. She consulted doctors and tried the remedies they proposed, but nothing seemed to work. Investigating on her own, she came upon a treatment called sleep restriction therapy, or SRT.

“I had heard of SRT before,” Gale wrote in an e-mail, “having seen a couple of documentaries on TV about it, and then did further reading on the Internet. But for years I dismissed it instantly as being absolutely impossible for me.” Napping was off limits during SRT, and this was a deal breaker.

Sleep restriction for insomnia may be easier to comply with if insomniacs are allowed a brief afternoon napLesley Gale was a light sleeper who began to have insomnia about 8 years ago. She consulted doctors and tried the remedies they proposed, but nothing seemed to work. Investigating on her own, she came upon a treatment called sleep restriction therapy, or SRT.

“I had heard of SRT before,” Gale wrote in an e-mail, “having seen a couple of documentaries on TV about it, and then did further reading on the Internet. But for years I dismissed it instantly as being absolutely impossible for me, as I’m sure a lot of other people initially react.

“‘I need my 8 hours,’ I thought. I couldn’t possibly stay awake until the early hours of the morning—I’m a confirmed morning lark, not a night owl.” Having to stay up late was not the only problem Gale foresaw. Napping, too, was off limits during SRT, and for years, this was a deal breaker. “I can’t live without naps,” she said.

SRT and Naps

SRT, a behavioral treatment for insomnia, involves restricting time in bed for a while and then slowly adding time back in as sleep improves. Restricting time in bed is helpful because it enables a robust build-up of sleep drive during the day. The greater your sleep drive at bedtime, the more readily you’ll fall asleep and the more likely you are to sleep through the night. Anything that interferes with the build-up of sleep drive will retard your progress. So napping is generally discouraged.

But napping has never been strictly prohibited. In the first weeks of SRT, insomniacs tend to experience mild sleep deprivation, which can sometimes result in overwhelming sleepiness during the day. Sleepiness is dangerous if you’re driving a car or operating machinery. People are advised to avoid such dangers by taking a nap, but to keep the nap short. “No more than 30 minutes,” is the advice my sleep therapist gave me.

A New Perspective on Napping

Then a few months ago, I read about a study being conducted by Nicole Lovato, a postdoctoral research associate at Flinders University. The purpose of Lovato’s study is to find out if adding a 20-minute afternoon nap before 5 p.m. to the SRT protocol will not only keep from undermining the treatment but will actually increase its success.

“Even though we know this treatment [SRT] works very well,” Lovato said, quoted in Medical Express, “a lot of patients feel so sleepy that they find it difficult to adhere to their new bedtime, which is often much later than the time they normally go to bed. . . . We’re hoping that daytime napping will make it easier for patients to adhere to their bedtime and get through the day when they’re undertaking sleep restriction therapy.”

Unlike long naps, short naps are unlikely to interfere with the sleep restriction process. When you first fall asleep, you’re in the lighter stages of sleep, and hovering in the lighter stages will not diminish sleep drive. During long naps, on the other hand, you’re likely to descend into deep sleep. Deep sleep is the stuff that reverses sleep drive, and that is what you want to avoid.

A Testimonial

I wanted to have the results of Lovato’s study in hand before blogging about it. But I mentioned the study in the comment section of another blog, and Lesley Gale, whose desperation to find a solution to her insomnia had prompted her to start SRT despite her reservations, saw the comment and responded this way:

“I’m only 2 weeks into SRT, and I was so excited when I read . . . about naps maybe being OK with SRT,” Gale wrote. “Not being able to have naps has really put me off trying SRT before. 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 nighttime 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. Just having that possibility in the back of my mind has made me feel so much more relaxed about making it through till bedtime.”

The Results Aren’t In Yet, but . . .

Reading Gale’s story has prompted me to go ahead and write about adding brief naps to SRT. People are sometimes desperate for ways to manage their insomnia, and if being allowed a 10- or 20-minute power nap in the afternoon before 5 p.m. might make SRT more palatable and easier to comply with, surely the benefits of mentioning it will outweigh the harm. If you try it out, though, make sure to set an alarm clock to keep your nap short and sweet.

To Nap or Not?

Research shows there are many benefits to napping. But if you have chronic insomnia, they may not be such a good thing.

siesta2How I envy people who can nap! My husband, for instance, no sooner announces his intention and stretches out on the sofa than he’s down for the count. Or people I see on planes, trains, buses, and park benches. They settle down in their seats and then—bam!—their heads are lolling on their chests.

“That’s talent!” said an insomnia sufferer I interviewed for my book, and I agree. Drift into slumber amid the hubbub of people loading suitcases into luggage bins, or among strangers on a beach? I couldn’t do that in a million years. It’s rare that I can even catch a few minutes’ midday shut-eye within the quiet, protective walls of my home.

Benefits of Napping

But quite a bit of research suggests I’d be better off if I could. Not only does midday napping seem to make people more alert, but it also enhances thinking and memory. For example, in a study of medical residents, subjects that napped an average of just 8 ½ minutes were sharper and had fewer attention failures than residents who remained awake.

Longer naps appear to be even better if the aim is to consolidate memories. A study that compared three groups—subjects that napped 10 minutes, others that napped 60 minutes, and others that stayed awake—found that upon awakening the nap-takers recalled more of the information learned before the naps than did those who remained awake. The memory retention in the 10-minute nap-takers was temporary and disrupted by the learning of new information. But the 60-minute nap-takers were able to hold on to more material learned before napping despite the interference of new learning.

Napping and Insomnia

The benefits of napping sound fabulous. So why is it so hard for me and many others who suffer from insomnia to seize a few winks during the day?

The central nervous system has both alerting and inhibiting forces, and current thinking holds that on the arousal side, insomniacs are cranked up a notch too high. Even though we might feel tired and dull as mud, these overactive alerting forces make it harder for us to sleep both night and day.

Nor are naps—especially long naps—recommended for people who have trouble sleeping at night. Sleep drive, which builds higher with every waking moment and finally propels us into slumber, diminishes if we descend into deep sleep, which may occur during longer naps. So for people inclined to insomnia, the experts generally recommend cutting naps out altogether or restricting them to 30 minutes.

Recommended or ill-advised, naps are mostly out of the question for the likes of me for now. But I’m holding out hope that perhaps in my dotage I’ll be nodding off with my peers for little catnaps during the day. Aging is never a picnic, but the thought of being able to nap is a pleasant one.

Do you take naps? In what ways do they seem to help?

Medical Residents and a Midday Nap

Deep Sleep During a Daytime Nap