I love spring, especially the longer days. As the inhabitant of a windowless office, I welcome the arrival of Daylight Savings Time. Seeing the sun come up during my morning commute and going out for an evening walk with the dogs while it’s still light lifts my spirits.
Or it would have this spring, if only I’d been sleeping better.
I’d already been developing a mild case of insomnia due to a stressful period in my life when we lost an hour to DST. I never fully recovered. When I found myself going to the Starbucks down the block nearly every day for a grande iced coffee with an extra shot, I realized I needed to do something about my broken sleep before the problem became intractible.
Fortunately, I know all about cognitive-behavioral interventions for insomnia, having attended an intensive training workshop on CBT-I. So I put myself on the treatment protocol.
First, I collected detailed data by monitoring my sleep patterns for two weeks. I recorded the time I got into bed, when I turned off the lights, how long (approximately, without looking at the clock) it took me to fall asleep, how many times (again, a rough estimate) I woke during the night, how long I stayed awake, when I woke up in the morning, and the time I got out of bed. I also noted how rested I felt. Then I tallied the time I spent in bed and the time I actually spent sleeping and came up with an average for each. Finally, with a formula I’d spent way too much time learning about during the CBT-I training (Average Sleep Time/Average Time in Bed x 100%), I calculated my “sleep efficiency.” Mine was 92%. Not bad, to my surprise. Anything over 85% is considered clinically sufficient.
One of the two main targets of a CBT-I intervention is “sleep consolidation.” This usually requires shortening the time in bed, an approach many insomniacs often view skeptically and with considerable resistance. It’s counterintuitive. After all, shouldn’t you go to bed earlier with the hope of becoming drowsy and taking advantage of the increased opportunity for sleep?
The answer is no. If you’re spending a lot of time in bed not sleeping (i.e., your sleep efficiency is poor), you’re actually training yourself to be more wakeful when you hit the sack. So the solution is to restrict, not extend, your time in bed. This is usually accomplished by going to bed later, since most people’s waking time during the week is less flexible than their bedtime. It also requires sticking to the same bedtime and waking time every day, even on weekends, until the sleep problem has resolved. And no “catching up” on lost sleep by napping.
My not-bad sleep efficiency number resulted from a few factors. My “sleep latency” (the length of time it took me to fall asleep after turning out the lights) was usually less than ten minutes—not very long from a clinical perspective, though it sometimes felt interminable to me. And even though I was waking up three to four times during the night, making me feel less rested than I would have liked, I fell back asleep quickly. I never had the luxury of hitting “snooze” more than once, at least during the workweek, so I wasn’t staying in bed long after the alarm went off. I also stopped reading in bed before turning out the lights, further limiting my non-sleeping time in bed.
The second focus of CBT-I is modifying the environmental and cognitive triggers for wakefulness. Some of the well-known impediments to sleep include consuming caffeine too late in the day, going to bed hungry or overly stuffed, watching the clock, drinking alcohol (which causes sleepiness but poor sleep quality), and exercising right before bed. Another, less obvious culprit is the habit of lying awake in bed. Worrying also makes it hard to fall asleep, particulary when the worrier focuses, as insomniacs so often do, on not being to sleep.
For me, seeing the numbers helped alleviate my concerns about my sleep patterns and relieve the mounting anxiety—as stimulating as a double cappucino—I’d started to feel every night when my head hit the pillow. I realized I wasn’t sleeping as poorly as I’d thought and, even more important, discovered I could get by quite well on far less sleep than I’d believed I need.
Not everyone requires eight hours of sleep a night to function optimally. In fact, the cure for insomnia can sometimes be as simple as improving sleep efficiency by cutting back on the hours spent staring at the ceiling, waiting for sleep to come. If you feel adequately rested after six and a half hours of sleep, as I seem to, there’s no added health benefit in pushing for more.
My insomnia wasn’t longstanding and didn’t present a hazard. I wasn’t falling asleep at the wheel or waking short of breath. If my sleep difficulties had been more serious, I would have needed to undergo a sleep study to pinpoint the nature and cause of the problem. CBT-I isn’t appropriate or effective for some sleep disorders, such as sleep apnea or narcolepsy, or for sleep disruptions caused by a psychiatric disorder, such as depression.
But for “primary insomnia”—sleeplessness not due to an underlying neurological, physical, or environmental cause—modifying your sleep schedule and improving your nighttime routines by following a few basic guidelines can help.
Above all, be patient. Don’t expect to sleep soundly right away. It takes time to resolve insomnia, and hoping for a quick fix will only make you more worried about not sleeping. But if you get on a tighter schedule and stop trying so hard to catch the elusive ZZZs, you may find yourself getting a better night’s sleep before you know it.