Sleep Restriction: New Thoughts on How It Works

Sleep restriction therapy helped me a lot. In fact, even without the other insomnia treatments usually offered with it, sleep restriction alone (enhanced by daily exercise) would probably have turned my chronic insomnia around.

Sleep researchers at Oxford recently proposed a new model of how the therapy works. If you haven’t yet tried sleep restriction, here’s why you’ll want to check it out.

Sleep restriction therapy involves postponing bedtime

Sleep restriction therapy helped me a lot. In fact, even without the other insomnia treatments usually offered with it, sleep restriction alone (enhanced by daily exercise) would probably have turned my chronic insomnia around.

Sleep researchers at Oxford recently proposed a new model of how the therapy works. If you haven’t yet tried sleep restriction, here’s why you’ll want to check it out.

Benefits of Sleep Restriction Therapy

Why would a person with insomnia even consider undergoing sleep restriction therapy (SRT), when what we want is to get more sleep and not less? Well, consider first the benefits. After 4 to 6 weeks of SRT, people typically

  • spend considerably less time in bed awake (a boon to sleep onset and sleep maintenance insomniacs alike)
  • fall asleep about a half hour sooner (particularly helpful for sleep onset insomniacs)

A few studies suggest that by the end of treatment, sleep timing is less variable than before treatment began. Total sleep time may be slightly longer, especially in the young and middle-aged.

If these benefits pale compared with what we really want (one to two hours more sleep, thank you very much!), consider next this new theory of how SRT works.

The Triple-R Model of Sleep Restriction Therapy

Chronic insomnia develops from a mix of physiological, psychological, and behavioral factors, and SRT, the Oxford researchers say, influences all of these factors at once. In effect, SRT walks us back to a time when sleep was less of a problem by doing three main things. It

  1. Restricts time spent awake in bed
  2. Regularizes the timing of sleep and wake
  3. Reconditions the association between bedroom factors and sleep

All together, the Triple-R process produces physiological and cognitive-behavioral alterations which in turn lead to better, healthier sleep.

This new model of SRT is theoretical, describing mechanisms the authors would like to see put to the test. It caught my attention because it pretty well describes what I saw happening when I went through SRT.

Restricting Time in Bed

The concept of restricting time in bed is foreign to many of us with insomnia. To get more sleep, it’s reasonable to think we need to spend more time in bed.

But the minute we find ourselves lying awake in bed for any length of time, we’re on a slippery slope. Lying awake in the darkness, our stamina low and our defenses down, we’re probably not fantasizing about a trip to Hawaii. We’re worrying instead about car payments or a mortgage, we’re obsessing over the latest political crisis. We’re anxious about sleeplessness itself and how it’s going to drag us down the next day.

Thoughts like these trigger physiological arousal—the heart beats faster, the body gets warmer—in turn feeding the mental anxiety, in turn arousing the body still more. Several nights like this can condition bodies and brains to associate the bed not with sleep but rather with wakefulness.

Then we’re cooked: Learned associations like this are hard to unlearn. I tried and failed for over 20 years.

Restricting Time Awake

When I considered sleep restriction, I assumed it would curtail the amount of time I slept. Some curtailment of sleep did occur during the first week of therapy, and that was rough.

But this early stage of SRT didn’t last long. Later the first week, the pressure to sleep increased to a point where by my prescribed bedtime I was falling asleep the minute my head touched the pillow and sleeping right through the night. With improved sleep efficiency, the sleep restriction protocol allowed me to increase my time in bed. So that by the end of therapy what I’d done was not decrease my total sleep time (in fact, I gained about half an hour) but rather decreased my time awake in bed.

What’s not to like about that?

Regularizing the Timing of Sleep and Wake

Regularity may sound boring but looking back, I think my insomnia was one of many signs my body actually craved it. And SRT delivered on that score. Starting from the first week of treatment I had to adhere to the same sleep schedule for one entire week. I made small adjustments on a weekly basis only, according to the protocol, adding time in bed as my sleep became more robust.

Why was regularity so important? Sleep and wake are controlled by two internal forces, the circadian pacemaker (the body clock) and the homeostatic pressure to sleep. Together, they dictate when we feel sleepy and when we feel alert. An erratic sleep schedule will tend to push these forces out of alignment, setting up the conditions for persistent insomnia.

A regular sleep schedule helps these forces remain in sync, in turn promoting better sleep. In myself, what I’ve observed is that regularity in almost everything I experience on a daily basis, including meals, exercise, light exposure, and even socializing, seems to benefit my sleep.

Reconditioning Myself for Sleep

Once sleep became more predictable, and once I was mainly sleeping when I was in bed (rather than lying in bed awake), my anxieties about sleep began to fade. Fear of sleeplessness wasn’t so quick to ambush me en route to the bedroom or when I glimpsed the clock at 2 a.m.

This last step in process — replacing my expectation that I’d be wakeful in bed with the expectation that I would sleep — came about gradually. During a couple of insomnia flare-ups, I needed to restrict my sleep again to keep my recovery on course.

But by the end of the first year post-SRT, my anxieties about sleep were pretty much a thing of the past. And that is truer now than it was 10 years ago. I’ve stuck with the habits I developed in SRT, and my sleep is much more robust as a result.

SRT is not a magic bullet, but by my lights it’s the most effective insomnia treatment available today. Anyone with chronic insomnia will want to check it out.

Six Tips for Overcoming Sleep Onset Insomnia

Poor sleeping conditions such as those found on planes can interfere with anyone’s sleep. But sleep onset insomniacs may find them particularly challenging, accustomed as we are to not falling asleep very quickly and being bothered by things that other sleepers readily tune out.

Why is it so hard for some insomniacs to fall asleep and what can help? Following are six ways to hold sleep onset insomnia at bay.

Poor sleep conditions compound the problem of sleep onset insomniaIt’s been 10 years since I experienced persistent sleep onset insomnia, but I was reminded of what my nights used to feel like when recently I took a red-eye flight on Spirit Airlines.

Conditions on that plane were not conducive to sleep: seats locked in the upright position; flight attendants whose nattering could be heard over the noise of the engines; dim lighting rather than darkness; kicks to my seat as the 6-footer behind me shifted around in his coach class cubicle; turbulence. I didn’t sleep a wink.

Conditions like these can interfere with anyone’s sleep. But sleep onset insomniacs may find them particularly challenging, accustomed as we are to not falling asleep very quickly and being bothered by things that other sleepers readily tune out.

Why is it so hard for some insomniacs to fall asleep and what can help? Following are six ways to hold sleep onset insomnia at bay.

What Brain Waves Reveal About Insomnia

Research has shown that people with insomnia have a different pattern of cortical activity as we’re drifting off to sleep. Compared with good sleepers, insomniacs are more prone to high-frequency brain waves in the sleep onset period. Once sleep onset has occurred, delta, or slow, waves take longer to appear. This is often taken as evidence of hyperarousal. At night, and possibly during the daytime as well, people with insomnia have higher levels of cortical arousal.

Results of recent study argue otherwise. Here, in the sleep onset period, sleep onset insomniacs were found to experience less high-frequency brain activity than sleep maintenance insomniacs (those who tend to wake up in the middle of the night). But the high-frequency activity in the sleep onset insomniacs took longer to decline. Authors of this study suggest that sleep onset insomnia may be the result of “some form of fast wakefulness inhibition” rather than an expression of cortical hyperarousal.

Relief for Sleep Onset Insomnia

Whatever may be the case, habits I’ve developed over the past 10 years enable me to fall asleep quickly now (barring nights when I’m trying to sleep on a plane). They may help you, too:

  1. Adopt a regular sleep schedule. Be especially regular about getting up at the same time every day—even on weekends. This can be a challenge if you have an erratic daytime schedule or an active social life. If you find you’re really sleepy, catch up on sleep by allowing yourself to go to bed somewhat earlier than normal rather than sleeping in late. The problem with sleeping much later than usual to catch up on sleep is that it sets you up for trouble falling asleep the next night.
  2. Break the association between your bed and wakefulness by reserving your bed (and the bedroom) for sleep and sex. Reading, TV and movie watching, surfing the net, playing video games—all this should happen outside the bedroom. Only go to bed when you’re sleepy enough to fall asleep.
  3. Exercise late in the afternoon or early in the evening. Exercise warms your body up. This triggers an internal cooling mechanism, and when your body is cooling down it’s easier to fall asleep. Aerobic exercise is best but rigorous strength training may work as well.
  4. Observe a wind-down routine in the hour leading up to bedtime. Have the same routine—shower, put on pajamas, brush teeth, read or look at picture books—every night. Your brain will learn to expect that this sequence of activities ends in sleep.
  5. If clock watching at night makes you anxious, turn your clocks to the wall starting at about 9 or 10 p.m. Use a backlit alarm clock on your bedside table—the kind that stays dark at night except when you press the button on top.
  6. If you have to fly at night, arm yourself beforehand with all the accoutrements I forgot to pack in my carry-on: neck pillow, eye mask, earplugs. As for Spirit Airlines, they may say they’re the company with the newest fleet of planes, but seats that keep you locked in an upright position do not lend themselves to a good night’s sleep!

If you often fly at night, what measures do you take to get a decent night’s sleep?

11+ Nighttime Activities for Sleep Restriction

Here’s a complaint I often hear from insomniacs going through sleep restriction therapy: it’s hard to stay awake until bedtime. A related frustration comes with suddenly having extra time on your hands.

“I don’t know what to do with myself till 2:30 in the morning!” an insomnia sufferer groused to me.

Here are variations on 11 activities aimed at keeping you awake until the clock says it’s time to head to bed.

Sleep restriction less difficult with enjoyable activities that keep you awakeHere’s a complaint I often hear from insomniacs going through sleep restriction therapy: it’s hard to stay awake until bedtime. A related frustration comes with suddenly having extra time on your hands.

“I don’t know what to do with myself till 2:30 in the morning!” an insomnia sufferer groused to me.

Here are variations on 11 activities aimed at keeping you awake until the clock says it’s time to head to bed.

A Trivial Topic? Think Again

Sleep restriction therapy involves first restricting your time in bed to just the number of hours you’re actually sleeping. Then you gradually add time in bed until you find your ideal sleep window. Normally, this means starting therapy with a later-than-usual bedtime, an earlier-than-usual rise time, or both.

If you’re new to sleep restriction, planning what to do in the run-up to a later bedtime may seem unnecessary.

“I’ll read,” you say, “I’ll watch TV, I’ll catch up with friends on Facebook. I’ll do what I always do at night, only I’ll stay up longer.”

Sticking to the familiar may not work and here’s why:

The first week you’re restricting your sleep you’ll probably feel somewhat sleep deprived. If even mild sleep deprivation is involved, passive activities like watching TV and reading can lead to nodding off well before the prescribed bedtime. This interferes with establishing a regular sleep schedule, which is one thing you’re trying to accomplish. The more you stick to your prescribed bed and wake times, the quicker the therapy will take effect.

Devices with screens (computers, iPads, iPhones) emit blue light, which blocks secretion of the sleep-friendly hormone melatonin. It’s helpful to install an app called f.lux or wear blue-blocker glasses if you use devices at night. Even so, being wedded to the screen in the hour leading up to bedtime is not a good idea, especially for people with sleep onset insomnia (people whose insomnia occurs at the beginning of the night).

Other Constraints on Nighttime Activities

Evening activities have to be quiet unless you live alone. Playing the saxophone may be fun for you but obviously not for other members of the household.

Evening activities can’t require a lot of physical or mental stamina. By then you’re usually low in the tank.

A walk outside might have appeal. But depending on who you are and where you live, it may not be safe to leave home after dark.

The Special Challenge of Sleep Anxiety

What to do in the run-up to bedtime can be especially challenging for sleep onset insomniacs, whose anxiety about sleep tends to escalate the later it gets. Clock watching adds to (or is a part of) that sleep-related anxiety. When undergoing sleep restriction there’s no getting around use of the clock for information about when it’s OK to go to bed.

Waiting until anxiety sets in to decide what to do can be risky. A glass of wine? A sleeping pill? You’re off the rails before you’ve even begun. Why add stress to the sleep restriction process by waiting too long to decide what you’re going to do in the extra time you’re up?

Take it from one who’s been there twice and who, knowing what she knows now, would do it somewhat differently. In the week before you start restricting your sleep (as you’re collecting information about your sleep and recording it in your sleep diary), come up with a list of activities you’re going to do when restriction begins, acquiring any supplies you’ll need in advance. Ideally, these activities should (a) be somewhat enjoyable (or at least tolerable), (b) offer mild mental stimulation, and/or (c) involve some movement.

This list of activities is hardly comprehensive. But maybe it will motivate you to come up with other activities that would suit you as well or better.

  1. Do (or Take Up) an Art or Craft:

  • Needlework (quilting, knitting, crocheting, embroidery).
  • Jewelry or beadwork.
  • Woodworking or leatherworking
  • Calligraphy.
  • Origami.
  • Sewing. Lay out a pattern and cut the fabric.
  • Any artistic activity, such as sketching or watercolor painting, as long as it doesn’t require much clean up.
  1. Make Lists:

  • To-do lists and grocery lists.
  • Travel checklists for different kinds of trips (road trips, air travel [overseas and domestic], business trips, camping.) Printed out before each trip, they make packing a lot easier.
  • Gift lists. Avoid panic during the holidays and at birthdays and other special occasions.
  • A bucket list. Think of everything you’d like to see and do while you’re still able to do it.
  1. Organize or Reorganize:

  • Your tool bench.
  • Your jewelry box(es).
  • Your music. If you have CDs, tapes, albums, or sheet music, arrange them by style, period, composer, or instrument.
  • Your herbs and spices. Group them as powders, whole spices, and herbs, or arrange them alphabetically.
  • The garage or the basement.
  1. Sort and Discard:

  • Books. Do one shelf at a time, separating them into keepers, throw-aways, and give-aways.
  • Clothing in closets and drawers.
  • Old photos. Put the ones you want to keep into albums or photo boxes.
  1. Redecorate:

  • Your walls. Take down wall art and replace it with other paintings, photos, prints, or posters.
  • Your shelves. Replace pottery and art objects with others.
  1. Bake Cookies or a Coffeecake.

  2. Do Light Housework:

  • Dust furniture.
  • Fold or iron clothes.
  1. Prepare for the Day Ahead:

  • Set the breakfast table.
  • Pack lunches.
  • Do prep work for the evening meal.
  1. Do Things You Enjoyed in the Past:

  • Play Solitaire.
  • Do a thousand-piece jigsaw puzzle.
  • Get out a telescope, look at the stars, and identify constellations.
  • Gather every small thing you’ve collected outdoors—flowers, nuts, leaves, shells, stones, feathers, pine cones—and look at them under a microscope.

The following two categories of activities may be too passive for some people but could work if combined:

  1. Look at Publications with Images:

  • Art books.
  • Coffee table books.
  • Catalogs.
  • Family albums.
  • Cookbooks. Use a post-it note to mark every recipe you want to try out.
  1. Using Headphones, Listen to:

  • Music.
  • Books on CD.
  • A podcast. (But avoid looking at screens.)

Before you start to restrict your sleep, make a list of activities you’re going to do in the run-up to bedtime. And who knows? You might even enjoy some of that extra time awake.

If you’ve gone through sleep restriction, what activity did you find was most helpful in keeping you awake till bedtime?