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.

Sleep Restriction: What You Need to Succeed

My video and blog on Sleep Restriction Therapy get lots of comments, and certain questions about SRT come up again and again. Here I’ll review the concepts behind this treatment for insomnia and offer pointers on how to succeed.

Sleep restriction guidelines should be carefully followed for sounder slumberMy video and blog on Sleep Restriction Therapy get lots of comments, and certain questions about SRT come up again and again. Here I’ll review the concepts behind this treatment for insomnia and offer pointers on how to succeed.

Why Restrict Sleep?

If you struggle with insomnia, chances are your sleep is not very efficient. You may toss and turn a long time before actually falling asleep, or awaken several times at night. You may wake up at 3 a.m. and not be able to get back to sleep.

Researchers have found that restricting sleep—or, more accurately, restricting time in bed—leads to increases in sleep efficiency, quality, and even length. Efficient sleep tends to be deeper and more satisfying. You wake up feeling more refreshed in the morning.

Right now you may not be sleeping very well. But if you build up sufficient sleep drive, the urge to sleep becomes so powerful that you can’t resist. The goal of sleep restriction is to enable a daily build-up of sleep drive that puts you to sleep more quickly and keeps you asleep longer—night after night.

Here’s How to Get Results

Have realistic expectations. Sleep restriction is not an overnight fix for insomnia. In fact your sleep may get worse before it gets better, and you may feel logy in the daytime, especially during the first week of therapy. (Don’t worry: this may actually speed the process up.) It’s realistic to expect to see signs that your sleep is improving within a few weeks.

Begin by keeping a sleep diary. Diving into sleep restriction without first gathering information about the length and timing of your sleep is a mistake. Sleep ability varies from person to person, and you can’t know how much to restrict your time in bed without first getting a clear picture of how much you’re actually sleeping. Download this sleep diary from the American Academy of Sleep Medicine, and make copies so you can maintain the diary throughout therapy.

Keep the diary for a week before starting treatment. Write down when you go to bed and get up in the morning, and how much of that time you’re actually sleeping. At the end of the week, calculate the average amount of time you sleep each night (disregarding for the moment how much time you spend in bed).

Make a list of quiet activities you can do at night once therapy begins. Passive activities like watching TV are not as helpful in the early stages as activities with a bit of movement—folding clothes, sorting through old photos, rearranging bookshelves. For more ideas, click here.

Establish your initial sleep schedule and stick with it. If you find you sleep an average of 5 ½ hours a night, in Week 1 restrict your time in bed to 5 ½ hours. Decide on a wake-up time and set your alarm for that time every day. Then count backwards 5 ½ hours to set your bedtime. Your sleep schedule could be from 12:30 a.m. to 6 a.m., or it could be from 10:30 p.m. to 4 a.m. Whichever one you choose, stick with it, staying up until your chosen bedtime and getting out of bed when the alarm rings. If you drift off early or if you oversleep your alarm, this will lessen the accumulation of sleep drive and retard your progress.

Avoid looking at the clock at night. Clock-watching tends to arouse anxiety in people with insomnia. Once your bedtime arrives, turn all clocks to the wall. If you can’t sleep, go to another room and do something quiet until you feel sleepy. But don’t look at the clock! In the morning when you’re filling out your sleep diary, estimate the time you were awake.

Calculate your sleep efficiency at the end of the week and set your sleep schedule for the following week. (See this blog for how make the calculation and reset the sleep schedule.) Continue the process for as many weeks as it takes to establish a solid sleep pattern and maintain a sleep efficiency of at least 85%.

Once you’ve found your ideal sleep schedule, observe that schedule night after night. Most important is getting up at the same time every morning (and resisting the urge to nap). This will prime you for sleep when bedtime rolls around and stabilize the sleep you get.

For more detailed guidance with sleep restriction therapy, see chapter 8 of THE SAVVY INSOMNIAC.

Pre-Sleep Activities for the Sleepless

During Sleep restriction therapy for insomnia, I discovered less can be more. I sleep better when, instead of going to bed with the first yawn, I postpone going to bed until I’m good and tired.

I rediscover this every time I fly out west. As long as I don’t stray from getting up at my usual time in the morning (which, on the west coast, means getting up well before dawn), postponing bedtime actually has a positive effect on my sleep.

When undergoing sleep restriction, do activities involving a bit of movement before bedDuring sleep restriction therapy for insomnia, I discovered less can be more. I sleep better when, instead of going to bed with the first yawn, I postpone going to bed until I’m good and tired.

I rediscover this every time I fly out west. As long as I don’t stray from getting up at my usual time in the morning (which, on the west coast, means getting up well before dawn), postponing bedtime actually has a positive effect on my sleep.

Why? Staying up later consolidates my sleep, and this is helpful for many people with insomnia. If it usually takes you a long time to fall asleep, or if you experience frequent wake-ups during the night, consolidating your sleep is a good idea, and you can do it by postponing your bedtime. Staying up later increases sleep drive. If you continue doing this night after night (while maintaining a consistent wake-up time), chances are you’ll wind up falling asleep more quickly and sleeping through the night with fewer wake-ups.

What to Do When You’re Up at Night

Especially if you’re experiencing sleep deprivation, as can occur during the first week of sleep restriction, or if your insomnia comes on suddenly, the biggest challenge can be finding things to do at night to keep yourself awake. Activities can’t be too stimulating (and they should not involve exposure to computer screens or iPads) or they’ll keep you up too late. Yet they have to be stimulating enough to postpone slumber a little while.

The low-key socializing I do when I’m visiting friends on the West Coast is the perfect stay-awake activity: engaging and yet not too engaging. After evening heart-to-hearts, I sleep like a log. But here are some activities to consider for use on a more routine basis at home:

  • Activities involving use of the senses rather than the mind: paging through picture books, photo albums, or catalogs, or playing an instrument like a digital keyboard (which won’t keep others awake)
  • Reading novels with interesting characters (but no thrillers). No reading matter that’s work related or sure to work you up (such as newspaper articles about politics and social issues)
  • Crafts such as knitting, spinning, weaving, woodworking, bead stringing, and the like.
  • Light chores such as folding clothes, unloading the dishwasher, or making shopping lists.

When your eyelids start feeling droopy, your first thought is probably to head to bed. But the sleep-challenged may be better off staving off sleep a little bit with activities that, if not thrilling, afford at least some pleasure or simply need to be done.

Other quiet activities that could be helpful before going to bed? Please share them here!