CBT-I Sleep Restriction for Insomnia Improves Sleep

Do you ever lie awake, unable to sleep, getting more and more frustrated as the night goes on? It’s easy to worry your sleep’s never going to improve. But in this video, we’ll learn some really effective practical strategies to relieve insomnia and help you start sleeping better.

First, it helps to understand a bit about how sleep works. The longer we’ve been awake, the stronger our body’s natural pressure to sleep becomes. This is known as the homeostatic sleep drive, and it helps us fall asleep and stay asleep.

To increase this sleep drive, we need to be awake long enough for our brain to build up sufficient amounts of adenazine, a chemical involved in regulating sleep that accumulates while we’re awake. Without enough sleep pressure, it becomes difficult to fall asleep. And this is one of the main factors that contributes to insomnia.

And when we’re struggling with insomnia, there are a couple of common ways we can sabotage our sleep drive. We might go to bed earlier hoping to give ourselves time to get enough sleep. But this usually doesn’t work because our sleep pressure is still too low to allow us to fall asleep.

Or we might stay in bed longer trying to squeeze in some extra sleep, which can help us feel less tired that day. But the later we get out of bed, the less time there is for adenazine to build up before we try to sleep again that night, which means our sleep drive will still be low and we’ll probably find it hard to fall asleep.

So, when we’re having trouble sleeping, we don’t want to spend more time in bed and don’t want to sleep in, even on weekends, because this lessens our sleep drive and messes with our circadian rhythm, the body’s internal clock that signals when it’s time for sleep and time to wake up.

And instead, if we’re consistently finding it hard to sleep, we need to reduce the amount of time we spend in bed until it more closely matches the amount of time we’re actually asleep.

If we’re only getting 6 and 1/2 hours of sleep a night while spending an hour or two lying in bed awake, we limit our time in bed to 6 and 12 to 7 hours. We set a consistent time to wake up and don’t get in bed any earlier than 7 hours before we’re getting up.

This usually means that at first we’re spending less time in bed than we feel we need, which can leave us getting a little less sleep than usual and feeling more tired during the day. But after a week or two of struggling, our sleep typically becomes more efficient, which means we’re sleeping for more of the time we’re actually in bed.

And whenever our sleep efficiency reaches about 90%, so we’re asleep 90% of the time we’re in bed, we can extend the amount of time we give ourselves in bed by 15 minutes until we’re getting the amount of sleep we want without spending long periods lying awake.

By reducing the amount of time we spend in bed, we increase the time between when we get out of bed and when we try to go to sleep at night, which builds more sleep pressure and makes it easier to fall asleep and stay asleep.

And a consistent wake up time helps regulate our circadian rhythm. And when our circadian rhythm aligns with our sleep drive and sleep pressure, sleep naturally improves.

And spending less time in bed lying awake helps strengthen the connection between being in bed and being asleep. Which is important because with insomnia, our bodies often start to associate being in bed with being awake, tossing and turning unable to sleep, which makes it harder to fall asleep once we’re in bed.

So, we need to break this connection between being in bed and being awake. And we do this through what’s known as stimulus control. Using the bed only for sleep, not watching TV or scrolling our phones or reading for long periods of time, though 15 to 20 minutes as we’re falling asleep is fine.

And going to bed only when we feel sleepy. So our body learns to associate being in bed with falling asleep.

And once we’re in bed, we use the 20inut rule. If we’ve been lying awake in bed for about 20 minutes without falling asleep, we get up and do a quiet activity like reading, listening to music, doing a breathing exercise or meditation, or whatever helps us relax until we start feeling sleepy and only then we return to bed.

Or if we find that using one of these relaxation techniques helps us fall asleep, we can do that in bed. And if we’re lying in bed relaxed, but just not asleep yet, it’s fine to be in bed for more than 20 minutes as we try to fall asleep.

We want to practice good sleep hygiene, which involves building habits that support sleep, like not eating a large meal and avoiding caffeine and alcohol later in the day, winding down before bed with a relaxing routine, and staying off screens and avoiding stimulating activities right before bed.

And we want to set up our environment in ways that help us sleep. Keeping the room dark, quiet, and at a cooler temperature. And moving the clock out of our line of sight if we tend to check the time a lot when we can’t sleep.

Good sleep hygiene removes obstacles that can interfere with sleep, allowing our natural sleep drive and circadian rhythm to work more effectively.

And another effective strategy for reducing insomnia is to manage our thoughts about sleep that keep us awake and learn to think about sleep in ways that help us fall asleep, which I cover in another video that you’ll find in my free self-help course for insomnia at selfhelptoons.com

Sleep restriction therapy or sleep compression involves matching the time we spend in bed to the time we’re actually sleeping. The name sounds harsh because restricting sleep is the last thing anyone with insomnia wants. But while sleep restriction therapy sounds like we’re sleeping less, we’re actually just removing the frustrating hours spent lying awake, by adjusting the time we spend in bed so it better matches the time we’re actually asleep. It helps increase our sleep drive, and we sleep better.

At first, this sleep window will likely feel shorter than we’re comfortable with, and having a fixed wake-up time can make it feel even harder. We may worry about not getting enough sleep, and that worry itself can interfere with falling asleep.

This a common and natural reaction to sleep restriction therapy. So it helps to reassure ourselves that despite the initial discomfort, sleep restriction therapy is one of the most effective tools for improving sleep. Once time in bed better matches time asleep, we usually start falling asleep faster, staying asleep longer, and spending less time awake in bed.

The first week is often the hardest, with more daytime tiredness than usual. After one to two weeks, sleep typically becomes more continuous and sleep efficiency improves. Sleep efficiency refers to the percentage of time in bed that is actually spent asleep. When sleep efficiency averages around 90% over a week, we can extend the sleep window by 15 minutes.

We continue adding time in this way until we’re getting the amount of sleep we want without extended wakefulness in bed, and if efficiency drops below about 85%, we shorten the sleep window by 15 minutes again.