Sept. 10, 2011 -- You probably have trouble sleeping at least once in a while. Worry, stress, late-night eating or drinking, travel, and illness can all cause transient sleep problems. And as we discussed last week, the seasonal return to Standard Time can throw your sleeping schedule off until your body adjusts. If you occasionally have sleep problems, there are many sleep-promoting strategies that can help you when you're tossing and turning.
However, if you frequently have difficulty sleeping, or if you rely on medication, you need a more in-depth approach to improving your sleep. Sleeping pills can act as a temporary insomnia remedy for acute sleep problems. If you are in severe pain, or going through a brief period of extreme stress, for example, the right medication can help you get much-needed sleep. However, over time these medications do lose their effectiveness. If you continually rely on sleeping pills, you lose the ability to get yourself to sleep and instead rely on artificially induced drowsiness. You're better off in the long run strengthening your natural ability to sleep, even if it's a bit of a challenge to tackle insomnia without medication. Fortunately, there's a powerful insomnia remedy that's available to anyone willing to put in a little time, effort, and planning.
The most well-documented method for overcoming long-standing insomnia is cognitive-behavioral therapy, a systematic approach to changing your thoughts and behavior around sleep. The cognitive aspect involves learning to stop worrying about sleep. Letting go of worry and anxiety about sleep allows you to relax and fall asleep more easily and sleep more soundly.
The behavioral aspect involves the various "sleep skills" you need to practice to support healthy sleep, such as engaging in a relaxing bedtime routine and reserving your bedroom only for sleep and sex. The most important behavioral part of this approach is sleep scheduling. Strategic sleep scheduling strengthens your body's sleep system, and creates a positive association between your bed and sleep. You do it by carefully planning when you go to bed, get out of bed, and how much time you spend in bed. The goal is to spend a high percentage of your time in bed actually sleeping. Over time, your mind and body will associate your bed with sleep, and you'll become increasingly confident of your ability to fall asleep and stay asleep.
Surprisingly, good sleepers don't necessarily sleep more than poor sleepers, they just spend a higher percentage of their time in bed actually sleeping! The ratio of time spent sleeping to time in bed is called sleep efficiency. Good sleepers spend 90 to 95 percent of their time in bed actually sleeping. People with insomnia, on the other hand, may sleep less than 65 percent of the time they are in bed.
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Improve Your Sleep Efficiency
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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