Restricting Bedtime to Improve Sleep

Most of us don’t sleep very well.  A majority of Americans  sleep far less than they like, particularly the elderly.  Yet to sleep better, the first step may be to sleep less.

Less is More

Cost effectiveness is important. Health care now costs 17% of GDP and Medicare promises to bust the budget for the next several decades.  Researchers at the University of Pittsburgh, led by Daniel Buysse, decided on a novel public health approach – let’s treat to treat insomnia in the elderly quickly and cheaply.  Have nurse practitioners do two sessions of outpatient treatment plus two long phone follow-ups.  The control group gets the same information in a written packet and a brief phone call.

The main treatment used was sleep restriction – allowing only the time in bed you normally do sleep.

If you normally sleep just five hours, you spend five hours in bed.  If you sleep six hours, spend six.

Sleep Efficiency

Sleep clinicians routinely measure sleep efficiency – sleep time divided by time in bed.

When we’re young, sleep efficiency can be 95% or more.  By the time we get into our sixties, it’s usually more like 80-85%.

Some people have high sleep efficiencies because they rarely provide enough time for sleep.  If you only allocate five hours a night to sleep, you may sleep the whole time.

It’s usually a different story if you’re older.

With sleep restriction, people are asked to spend only the time in bed of the total sleep averaged over the week or two before.  If you’re averaging six hours sleep a night, even if you were in bed ten hours, six hours bedtime is all you get to start.

Next, you’re asked to get to bed at the time you think you fall asleep, and set an effective alarm. So if you’re normally going to bed at 10 PM but not falling asleep until 11, averaging six hours of sleep a night, you set your alarm to 5 AM.

And there’s the rub.

Increasing Sleep Under Sleep Restriction

The point of sleep restriction is getting effective sleep consolidation.  When you give people only a certain number of hours for sleep they tend to sleep the whole time.  Critically, with more continual sleep, they have the chance to obtain the deeper phases of sleep.

Though deep sleep becomes mostly fugitive as we get older,  eventually almost disappearing in males, it’s important.  In deep sleep we produce growth hormone.  People need to regenerate their bodies in order to live.  Getting more growth hormone – naturally, that is – is a pretty good strategy.

You can increase deep sleep when you consolidate sleep.  Other ways to potentially increase deep sleep include properly timed exercise and hot baths.

Sleep restriction then proceeds to add sleep time after you’ve succeeded in consolidated sleep. If you’re sleeping 85-90% of the time you’re in bed under sleep restriction, you next  increase the bedtimes allowed. People generally do this in 15 or 30 minute increments. How to do it, and how quickly, is really an art.

You need to think of the process as not just consolidating sleep but improving it.  It’s something like picking up an instrument you have not played in many years.

At first you’ll sound pretty rusty. A returning violinist should not immediately begin playing the Tchaikovsky violin concerto.

Instead you start with individual notes.  Getting the pitch right.  Moving up and down the scale.  Playing scales.

Sleep restriction is about getting back to the basics of sleep once they’ve been disrupted.  It takes a while, and it’s not easy at the beginning. Yet it can pay off over time.

Back to Pittsburgh

The elderly insomniacs were told to do other things in the Pittsburgh study  – to get up from the bed if they were not sleeping, and to not bother going to bed unless sleepy.

Follow up was done at four weeks.  In the group that talked with the nurse practitioners, about 55% felt their sleep was markedly improved – compared with only 13% given the same information by pamphlet.

Conditioning Works

Many individual sleep problems are behavioral.  In Britain, and now in the US, the increasingly common problem is psychophysiologic insomnia – not sleeping because you’re worried about sleep.

The Pittsburgh sleep restriction study shows that simple behavioral programs can work.  If people are conditioned to fall asleep – if they rest before sleep time and are calm and relaxed coming to bed – body clocks will take over and put them quickly to sleep.  As sleep is necessary to survival, this process normally works very efficiently.

But only if you allow the process to work and give it sufficient time. Rest is regeneration.  During rest your body does not “turn off” like a light switch. Rest is extremely active, rebuilding and resculpting you.

Even when you sleep.  So try to make sleep what it should be – a pleasant adventure.  Try to get yourself a nice, cozy bedroom.  Set a sleep ritual before you sleep so you can rest and relax.  Pre-dream, imagining the new adventures you will experience possess that night.

And lie down comfortably in a comfortable bed, knowing your body will be rebuilding and renewing itself in a most natural way – through sleep.
Rest, sleep, Sarasota Sleep Doctor, well-being, regeneration, longevity, body clocks, insomnia, sleep disorders, the rest doctor, matthew edlund, the power of rest, the body clock, psychology today, huffington post, redbook, longboat key news