Written by Greg Potter, PhD
Sept. 16, 2019
In the previous blog, we briefly reviewed what insomnia is, as well as a few simple strategies you can immediately put to use to sleep better. In this blog, we’re going to focus on how to sleep through the night. In doing so, I’ll discuss a few things we can all learn from the treatment of sleep-maintenance insomnia, a disorder in which people wake frequently and for prolonged periods when they would rather be sleeping. So, if you’re tired of waking up at night, try these tips and let me know the results!
In a previous blog, Megan shared loads of tips about sleep hygiene. Here are some numeric guidelines for several particularly important sleep hygiene components:
Notice that these guidelines are all relative to your sleep timing, not time of day. There are very (very!) large differences between people in how their sleep is affected by these stimuli, but try these guidelines to begin.
If you’re struggling with your nighttime sleep, it’s critical that you avoid daytime napping whenever possible.
Yes, naps do confer many acute benefits, especially after sleep loss. These positive effects include reducing sleepiness, bolstering memory consolidation, enhancing subsequent learning, boosting immune function, and restoring strength and power performance.
However, when sleep is dysregulated, naps can be problematic. This is because of the way sleep is regulated.
Sleep regulation can be crudely modelled by the interaction of two processes:
Why do I mention this?
Because even a brief nap can potently reduce pressure to sleep. As a result, naps can make it harder for people to fall asleep and stay asleep.
So, if you’re struggling to sleep through the night, save naps for when you really need them. But please be responsible - if you work night shifts, for example, naps are at times essential to your safety.
The next habit is one that you should implement regardless of your circumstances.
Think about driving. When driving, if you see a red light ahead, your response is to put your foot on the brake to slow down. This is an example of stimulus (the red light) control of behavior (applying force to the brake). We are very efficient at forming these types of associations, which can work in our favour, as in this example. But sometimes the associations we form work against us, and this is often true of people who have sleep problems.
Stricken by looming weariness, people who have insomnia often start spending more and more time in bed in the hope that doing so will help them catch up on sleep. The problem is that they reinforce an association between the bed (the stimulus) and wakefulness (the behavior). They need to break this cycle, which entails doing a few things:
Sometimes, however, applying these strategies is still not enough. This brings us to bedtime restriction therapy (which is commonly referred to as sleep restriction therapy).
Of all the interventions used to help people get over sleep-maintenance insomnia, one reigns supreme: bedtime restriction therapy. Frankly, this therapy is no fun. And I wouldn’t necessarily recommend that you try it without guidance. But it is very effective, and we can all learn from it. Let’s use a case study to show how it’s implemented.
Amy seemingly always feels sleepy during the day. She is generally meticulous about practising good sleep hygiene, but she just can’t stop waking up for extended periods at night.
She begins tracking her sleep. She learns that, on average, she’s in bed from 10 PM to 8 AM each night - a 10-hour sleep opportunity. But she’s only asleep for 6 of those hours in total, so her sleep efficiency is 60 % (6 / 10 X 100).
Under supervision, Amy begins bedtime restriction therapy. This involves delaying her bedtime (which helps build extra pressure to sleep) such that she only spends 6 hours (her average sleep duration) in total in bed each night. So, her new sleep opportunity is from 2 AM to 8 AM, and she meticulously goes to bed and gets up at precisely the same times throughout this intervention.
At first, this is rough. She’s even more tired than normal. But very quickly her sleep efficiency improves dramatically. When her average sleep efficiency is above 85 % (which is generally considered healthy) for a week, she advances her bedtime by 15 minutes. Her sleep opportunity is now 6 hours and 15 minutes. This process then repeats itself - if her sleep efficiency at the new sleep opportunity is above 85 % for a week, she adds 15 minutes to her sleep opportunity.
Once she is spending as much time asleep as she needs, she retains her new bedtimes. Three months later, she settles on going to bed at 11:30 PM, waking up at 8 AM, and her sleep is 88 % efficient. She feels like a new person.
So, what can we all learn from this?
That’s all for now. If you’re struggling to sleep through the night, in addition to applying basic principles of good sleep hygiene during the daytime, minimise napping, use the 20-minute rule, and be meticulous about bedtime regularity! Do these things and you’ll reap the rewards of more restorative sleep.
In the next blog, we’ll transition to how to get over another common sleep complaint: sleep-onset insomnia.