There are two ways to improve your sleep efficiency: Increasing the amount of time you spend sleeping; and decreasing the amount of time you spend in bed.
Of these two options, the one most in your control is decreasing your time in bed.
By spending less time in bed each night, you will be more likely to be sleepy when you are in bed, strengthening the bed-sleep association. And staying out of bed increases your sleepiness, enabling you to get to sleep more easily and sleep more soundly with fewer awakenings once you hit the pillow. When you increase your sleep efficiency, you will sleep more soundly, awaken more refreshed, and feel more energetic during the day.
Want to try it? Here are the key elements of sleep scheduling for overcoming insomnia.
For one week, track how much time you actually spend sleeping each night. Keep a notebook next to the bed, jot down the time when you lie down, and make periodic entries to indicate that you're still awake (but not so frequently that it keeps you from falling asleep!) If you suffer from insomnia, your sleep time will be significantly less than the amount of time you spend in bed. Add up the seven nights' total and divide by seven to figure out the average amount of time you are actually sleeping each night.
Reduce your time in bed so it doesn't exceed your average amount of sleep per night plus one hour. So, if your average sleep time is five hours, limit yourself to no more than six hours in bed each night. (Don't limit yourself to less time than that, since cutting out too much time in bed could interfere with your daytime functioning.)
Decide what time you want to wake up in the morning, and make sure to get out of bed at that time each morning. Get out of bed at the same time on weekends as during the week. (Sleeping late on weekends can make it more difficult to sleep at night, thereby perpetuating the pattern of insomnia.)
So, if you plan to wake up at 6 a.m., and your maximum allowable time in bed is six hours, you would go to sleep at midnight.
If, on a given night, you don't doze off after 20 minutes, or you wake during the night and can't get back to sleep within 20 minutes, go into another room and read under low light, watch TV, or listen to relaxing music. Once you become drowsy, return to bed and go back to sleep.
The sleep scheduling approach can be challenging. During the first couple of weeks, you may feel sleep-deprived. However, if you stick with it, you can re-train yourself to get to sleep more easily and stay asleep longer.
Over the course of one to three weeks, this approach should improve your sleeping situation significantly. You will find that you spend less time awake in bed, and that it is easier to get to sleep and stay asleep. Once your sleep has improved to the point that you are sleeping soundly 90 percent or more of the time you are in bed, you can go to bed 15 minutes sooner. If you continue to sleep soundly 90 percent or more of the time you're in bed for one week, go to bed an additional 15 minutes earlier the next week. Continue going to sleep 15 minutes earlier each week (as long as your sleep efficiency is 90 percent or higher) until you reach your optimal sleep length.
If your insomnia is severe and long-standing, you may benefit from the support and guidance of a sleep specialist. To find a specialist in your area, ask your physician for a referral, or contact the American Academy of Sleep Medicine to find a certified sleep center in your area. Because there are many types of sleep disorders, working with a specialist can be particularly helpful for intransigent insomnia, since a professional can tailor an approach to best meet your needs.
To learn more about a cognitive-behavioral approach that can enhance the effectiveness of sleep scheduling, read Say Goodnight to Insomnia by Gregg Jacobs, PhD.
Jeffrey Rossman, PhD, is a Rodale.com advisor and director of life management at Canyon Ranch in Lenox, MA. His column, "Mind-Body-Mood Advisor," appears Mondays on Rodale.com.
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