SCIENCE SPECIAL: sleep restriction
If your sleep patterns have become particularly bad and you’re spending hours in bed, lying there unable to sleep, it might be time to re-set your erratic body clock. Sleep specialists recommend a process called ‘sleep restriction’.
If you are more troubled by waking up during the night than falling asleep at night then sleep restriction can help. It might sound odd, but it really can work, and specialist agree it is one of the most useful non-drug treatments around.
Please note however that trying this takes a good chunk of commitment because it can be hard at first. You will be trying to keep yourself awake even when you feel exhausted can this can seem counterproductive but if you've been waking at 3 or 4am and struggling to get back to sleep again, it is DEFINITELY worth a try - especially for those of you who have tried everything else.
Try to plan the start of this exercise when you're not particularly busy and not at times when you have to make important decisions. You can feel really tired for the first few days so some practitioners even go as far as to say don't use heavy machinery or drive when attempting sleep restriction. It's best to think of the exercise as you would trying out a new sleep medication.
Here's what to do:
1) First calculate how well you sleep (your ‘sleep efficiency’) by dividing the time you are actually asleep by the time you are in bed at night, then multiply this by 100. Sleep efficiency = (time asleep ÷ time in bed) ×100
So if you are in bed for eight hours but sleep for only six your calculation would be (6 ÷ 8) ×100 = 75, meaning that your sleep efficiency is 75 per cent. 90 per cent sleep efficiency is good, but for many people even 75-80 per cent is a great goal to aim for. Insomniacs might only have 5 per cent sleep efficiency, and that can be really tough.
2) Next set your alarm clock for the same time each day (weekends too) and vow to stick to this for the duration of the exercise – no napping during the day either no matter how sleepy you feel!
3) The aim of sleep restriction is to limit the time you spend in bed to the actual number of hours you sleep. So even if you spend eight hours in bed on average but have found that you sleep for only six of these hours, your sleep restriction programme should start with a six-hour period in bed – but you will be asleep for a greater chunk of the time. This may seem quite shocking but by constricting the time you spend in bed, you maximise the chance of spending most of it deeply asleep, and this conditions your body and brain to associate bed with sleep.
Now, count in hours back from your set new waking time. So if your alarm is set for 8 a.m. you should aim to go to bed at 2 a.m.. Do whatever it takes to stay awake until your designated new bed time.
4) When you wake up in the morning you might feel a little groggy at first, but calculate your previous night’s sleep efficiency. You should notice that your sleep efficiency has risen slightly. Stick to this new schedule for the rest of the week.
5) If your sleep efficiency does not improve, you might have to shift your bed-time 15 minutes later to reduce the amount of time you are actually asleep even further.
6) However if your sleep efficiency DOES improve to 90 per cent by the end of the week, that’s great! It means the process is working! Now you can increase your time in bed by 15 minutes but do check every morning that this new bedtime hasn’t impacted your sleep efficiency. You can add another 15 minutes the following week if your sleep efficiency stays high.
A programme of sleep restriction should ideally be carried out slowly and gently over about six weeks, with the aim of getting you to sleep for most of the time you spend in bed.
* This is an adapted extract from Invisible Illnesses: Coping with Misunderstood Conditions written by Dr Meg with Prof Christine Dance (published by Sheldon Press)