“Sleep Restriction not working”

Q:  Even though I try to lead a healthy lifestyle — eating right, exercising, no tobacco or alcohol — insomnia is causing me huge problems.  I have used various sleep drugs in the past, and none helped for very long.  So I tried sleep restriction, but now that isn’t working either.  I started with limiting myself to 5 hours of bed per night, and I did sleep better.  But I was so exhausted during the day I added in more time, then my sleep got worse again.  Needless to say, I’m very frustrated.  Any ideas on what else I can do?

A:  Getting a handle on negative sleep thoughts is one key element you are not describing as part of your sleep management efforts.

As always, we suggest working with your doctor to ensure you have either ruled out or are treating any underlying medical issues that could be affecting your sleep.  But in the absence of an underlying medical issue, most insomnia is caused by some nonmedical combination of bad sleep habits and excessive worry about the idea of sleep.

That’s why sleeping pills alone typically are not a permanent solution for nonmedical or primary insomnia.  Drugs usually don’t get to the true root of the problem.

With sleep restriction therapy (SRT), you are employing one of the core components of CBT-I, cognitive behavioral therapy specifically designed for insomnia.  CBT-I is a proven, drug-free method to permanently improve sleep.

SRT leverages the law of prior wakefulness, the fact that we cannot not sleep.  SRT tends to rev up your homeostatic sleep drive, which in concert with your circadian rhythm, are the two most important internal processes controlling sleep.

That said, SRT is just one behavioral part of the equation.  Another of the core CBT elements is the mental part, the cognitive component.

For many if not most of us, excessive worry about sleep is the potent underlying fuel that prolongs and perpetuates insomnia.  This worry typically manifests as recurring negative sleep thoughts.  By making an effort to cut off and control insomnia’s negative fuel — by getting a handle on the negativity and worry — sleep tends to improve.

CBT provides effective methods to first recognize and disregard negative sleep thoughts, then to replace them with better, more accurate positive sleep thoughts — a process known as cognitive restructuring.  Addressing worry about sleep is well worth the effort, because this may be the true root of your insomnia.

It’s important to understand the various CBT methods are complementary.  They tend to reinforce one another synergistically.  CBT works best when all the components — both behavioral like SRT and the cognitive tools — are applied simultaneously in one unified program.

Your frustration is understandable.  Consider adding the other CBT methods to what you are now doing with SRT.  By doing so, you stand a much better chance of permanently improving your sleep.

Explore posts in the same categories: Insomnia, sleep

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