A cure for insomnia?

81 Comments
Posted 26 Jun 2011 in Health, Hormesis

Do you have trouble getting to sleep at night or staying asleep?  About 30% of the adult population reports difficulties initiating sleep, sustaining sleep, or experiencing restful sleep. To deal with these problems, many people resort to medications or some form of supplement. But it now appears that there is an effective way to banish insomnia without the use of chemicals, by simply applying the principles of hormesis.

The remedy I want to discuss here is called Sleep Restriction Therapy (SRT). I credit Derek Haswell for bringing SRT to my attention. A 4-8 week course of treatment has been shown to be very effective in restoring normal sleep. The basic idea behind SRT is to limit your sleeping in a controlled manner until it renormalizes. As with any application of hormesis, the solution may at first seem paradoxical:  to combat a stress you should apply judicious amounts of that very stress to train the mind or body to adapt. It works for building muscles, improving eyesight, normalizing appetite, and improving immunity.  And sleep therapists have now found a way to use hormesis to improve the quality of sleep.

The protocol. Here is how Sleep Restriction Therapy works:

  1. Determine a fixed time to wake up every morning and set your alarm for that time. This is an absolute requirement: when the alarm goes off you must get out of bed immediately with no snoozing or exceptions.  If necessary, use a loud alarm and put it across the room.  Some researchers find that exposure to bright morning light upon waking is important to the success of SRT.
  2. Determine the minimum number of hours you need to sleep. This is usually done by keeping a sleep log for several nights to figure out the average number of hours you are actually sleeping. If you are in bed for 8 hours but are awake for 2 of those hours, then your sleep requirement is 6 hours. In general, the minimum sleep requirment should never be less than 4.5 hours.
  3. Do not go to bed or even go into your bedroom until the official bedtime. If your wake time is 6 a.m. and your initial sleep time is five hours, that means you cannot go into your bedroom to sleep until 1 a.m.  You have to keep yourself awake between 6 a.m. and 1 a..m. the next day.  No napping, lying down or nodding off is allowed.  This is difficult and can produce drowsiness and grumpiness during the initial days of treatment.  In some versions of SRT, slightly longer hours are allowed on weekends as a “reward” for making progress.
  4. Measure your “sleep efficiency” each night. Calculate sleep efficiency as the hours you actually sleep expressed as a percentage of the total hours you are in the bedroom.  To track sleep efficiency, keep a sleep log — a record of when you go to bed and wake up during the night, noting the related circumstances and activities. Your goal is 90% or better sleep efficiency. An alternative method is to use a home sleep monitor such as that made by Zeo.  The Zeo sleep monitor is an affordable and comfortble “headband” that wirelessly transmits data on your different sleep phases and sleep efficiency to a bedside “alarm clock”, with the ability to view your progress on your PC.  I’ve found the Zeo to be very useful in analyzing sleep patterns.  It reveals the inner workings of your sleep in a way that a manual sleep log cannot.
  5. Adjust your sleep time. If your sleep efficiency is greater than 90%, increase your sleep time by moving your bedtime 15 minutes earlier.  If your sleep time is less than 85%, delay your bedtime by 15 minutes.
  6. Allow your sleep to normalize. Continue the treatment until your sleep time can be increased to  “normal” sleep time of 6-8 hours with at least 90% sleep efficiency and subjective feeling of restfulness upon waking and during the day.

Case study. Here is a very compelling video about the success that one British man had using SRT to overcome insomnia:

A study of SRT in 10 elderly patients found that it significantly reduced both sleep latency (time to fall asleep) and subsequent waking during sleep. And the benefits were still in place 3 months after ending the therapy. SRT appears to be effective for most types of insomnia, except for sleep disturbances related to depression, bipolar disorder, sleep apnea or circardian disorders resulting from, e.g., shift work.  One of the immediate benefits that patients note is the reduction of “anticipatory anxiety” — the time and concern spent worrying about what the night will bring.  Many insomniacs see their bedroom as a prison or place of dread.  SRT very quickly compartmentalizes that anxiety. Once they begin to bank 5 or 6 good hours of sleep each night, the progress itself helps to dissipate the anxiety, which in turn tends to make for better sleep.

As with any application of hormetic stress, SRT at first involves “one step backward” by seeming to make things worse.  And indeed the first few days may bring increased drowsiness, while the benefits take weeks to become evident.  The reality is that our bodies adapt often slowly, over a period of weeks or longer.  And so it is with SRT.  But once patients begin to adapt to the new sleep regimen, the quality of their sleep usually improves markedly.  Several weeks of drowsiness and irritability seems a small price to pay for a cure that lasts.

Why does it work? Looked at from a behaviorist perspective, SRT is a form of behavior modification based upon stimulus control. Because patients are truly much more tired when they are finally allowed to climb into bed, the association between the action of getting into bed and the response of falling asleep is strengthened, and the association with “tossing and turning” is weakened.  Undoubtedly, at the level of neuropeptides and receptors in the hypothalamus, SRT must be restoring a  functional homeostasis.  The neuronal pathways, transmitters, and receptors involved in sleep regulation are quite complex.  The ascending arousal system located in hypothalamus interacts with sleep-active neurons in the ventrolateral preoptic nucleus (VLPO) producing a “flip-flop switch” that produces distinct sleep-wake states with abrupt transitions.  The sleep disruptions characteristic of insomnia are believed to involve an excess of corticotropin-releasing factor (CRF) secreted by the hypothalamic-pituitary-adrenal (HPA) axis.  This results in excess production of the hormones ACTH and cortisol, leading to hyperarousal.  It appears that Sleep Restriction Therapy quiets the HPA, leading to improved sleep.

Regardless of the underlying mechanism, Sleep Restriction Therapy appears to be an excellent example of hormesis, a chemical-free way to teach your body to adapt, by exposing it to controlled doses of the very same stress than you want to tolerate more effectively.

 

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80 Comments

  1. I’ve used sleep reduction therapy with great success. I have never had trouble sleeping, but the quality of my sleep wasn’t where it needed to be.

    I also used a Zeo to track my sleep patterns and have drastically increased the percentage of REM and Deep sleep. I think it’s interesting that so many people believe they have to be in bed for 7-8 hours a night. They might only sleep for 4 hours, but they force it anyway.

    Have you heard of any negative effects on circadian rhythms with people using SRT?

    I’m also curious to know whether or not this small period of sleep restriction can make someone more resistant to sleep loss in the future. Such as on a trip or when they might be sick.

    Great article. I’ll devour anything on sleep hacking :)

    Thanks man,

    -Armi

    Reply
  2. sanjay (uk)

    found your blog about three weeks ago and have been extensively applying hormetism in many areas of my life. cold showers, food, exercise, intermittent fasting, you name it i am trying it and experiencing significant gains. just wanted to share my thanks and that i look forward to reading more future posts. Sanjay

    Reply
  3. Dill

    This very method was recommended to me by a sleep specialist doctor in about 2005. He said this method almost never fails.

    Reply
    • Todd

      That’s good to hear, Dill. Did you try SRT? If not, why not?

      Reply
  4. Song Lee Kim

    I used SRT with great success.

    One tool that I have found very useful is an iPhone application called “Sleep by MoyionX”. This allows me to count my sleep cycles and wake up at the optimal time in a sleep cycle. It’s perfect for SRT.

    Reply
    • Todd

      Song Lee,

      Thanks for weighing in on this. I’d be interested if you could write a bit more about your actual experience with SRT. How bad was your insomnia before starting SRT and how long did it take to normalize your sleep?

      The iPhone app you describe looks interesting. I wonder how it compares with the Zeo system, which also has a feature that wakes you at the right time during your sleep cycles.

      Todd

      Reply
  5. Judy

    I’m first week into restrictive sleep therapy, 2 nights ago I couldn’t stay up till 12 went to bed at 11 and was up most of the night then last night went to bed at 12 and was up most of the night. I never have trouble getting up at 6am and am OK during the day but was so much better at the beginning of the week when I was getting 5 hrs!!! of sleep. Help? suggestions?

    Reply
    • Todd

      Judy,

      It’s clear that you are not staying up late enough. If you are still waking up a lot of the night, then your sleep efficiency is less than 90%, and you need to further DELAY your bedtime. Take a look at rule 5 in the protocol:

      5. Adjust your sleep time. If your sleep efficiency is greater than 90%, increase your sleep time by moving your bedtime 15 minutes earlier. If your sleep time is less than 85%, delay your bedtime by 15 minutes.

      .

      Following the protocol strictly is critical to success. You need to stay up until you are dead tired and can barely keep your eyes open. And you need to force yourself to wake up until 6 am. Do whatever it takes to get up by 6 am without fail.

      The key here is to first squeeze your sleep time down to whatever it takes to force sleep. From that point on, you can gradually lengthen sleep time. You will feel tired and drained during the beginning of the therapy. But if you stick with it, your sleep will improve, especially as you start to lengthen your sleep time.

      Let me know if you have any questions about this. Good luck, and let us know how it goes.

      Todd

      Reply
  6. stopwn

    Hi Todd,

    I have been struggling with sleep for 2 months – gone from 8 hours to 5.5 broken sleep and I am exhausted. I have always woke in the night, but generally got back off fine…now i lay awake. Middle of the night waking is my main problem. I had some stress at the outset of these problems but now I believe I have just got into a bad habit. I therefore, intend to try sleep restriction therapy. I have a couple of questions…

    I normally get up @ 7 but my wife gets up at 6. Should I get up at 6 when I try the therapy and if so, can I stretch my waking time back to 7 if the therapy works?

    Also will I be adding to my problems if I change to the spare room either just for the period of therapy or if i wake in the middle of the night. Is it best to tough it out in the marital bed???

    Finally if I wake a 5 and my wake time is 6 and I don’t drop back on in half hour should I get up or just lay in bed till 6?

    Many thanks,

    Phil

    Reply
    • Todd

      Hi Phil,

      Sleep restriction therapy should help with your middle-of-the-night waking. I’ll try to answer your questions:

      The therapy should work fine if you keep your wake up time at 7 a.m. and sleep together with your wife. The advantage of this is that once the therapy works, there are no additional changes required to your behavioral pattern. However, ask you yourself whether there is anything about sleeping in the same bed as your wife that leads to more waking or restlessness. Does she toss or turn, snore, get up in the night, talk to you, get romantic, or engage in any other behaviors that tend to wake you in the middle of the night? Or are there other disturbing noises or light in your main bedroom? If so, you may find it easier to temporarily move to the spare room, and maybe shift your wake time until 6 a.m. if that works better.

      Ultimately, however, the therapy will work either way you try it. The key is to set a fixed wake up time and to be ABSOLUTE about it. Do not hit the snooze button. If you don’t do anything else, be resolute about rising at a fixed hour.

      The second imperative is to keep delaying your bedtime by an additional 15 minutes each night, until you are able to sleep through the night. If you feel tired during the day, that’s typical. Don’t take naps. Force yourself to restrict your sleep time to as short a period during the night as necessary to force continous sleep through the night.

      If you wake up earlier than your set time, lay in bed and don’t get up until your set time. Even if it is boring. And resolve to stay up 15 minutes the next night.

      Be absolutely faithful to this protocol. It will be uncomfortable and you’ll feel sleep deprived for 2-3 weeks. Then you’ll start sleeping better. Make the investment, and you’ll be happy you did.

      It works.

      Todd

      Reply
      • stopwn

        Thanks for your quick reply Todd. I was just wondering whether knowing the wife’s alarm will go off @ 6am might mess up the process given that I get up @ 7. That’s why I considered getting up an hour early for a while. Two final questions. Should I use a light box upon waking to regulate the sleep cycle (I’ve read this makes therapy more likely to succeed)? Secondly, I have also read that you should stay up all night the night before starting the therapy to really up the sleep drive (like hitting the reset button). Any thoughts on these points?

        Oh and finally, finally some studies say that if you wake in night and cant get back to sleep within 20 mins to get up until you feel sleepy and then go back to bed (to break negative association with laying in bed awake). Do you advocate this approach or should you stay in bed no matter what between your sleep and wake times??

        Thanks,

        Phil

        Reply
        • Todd

          Phil,

          I think the question of whether to get up at 6 (with your wife) or sleep past that alarm and wake at 7 is really a judgement call. The therapy should work either way, it’s really a matter of what you find most practical. But once you pick a wake up time, stick with it rigidly and don’t waver for 2-3 weeks.

          The light box is an interesting option and may help. My recommendation would be to skip the light box for now. You want to do a “single variable test” of sleep restriction therapy. If you combine it with the light box and it doesn’t work, you don’t know what to conclude. You can always add the light box later, as a refinement, if you decide to.

          I would not stay up all night the night before you start the therapy. That seems pretty extreme to me, and it is likely to throw off your biorythms. I would also not get up and stay up if you wake up prematurely. That approach works on a different principle which has some validity, but in this case it’s counterproductive because you are trying to get your body to sleep continuously and without interruption. If you are waking up during your sleep time, you definitely need to delay your bed time further — but without changing your wake time.

          The real key to SLT is that it makes a single change (condensing your sleep time), followed by gradual adjustment of the sleep time by no more than 15 minutes per night, until you finally overcome your insomnia. Don’t complicate things. And try to avoid any stimulating foods or drinks during the evening. You want to feel dead tired when you head to bed.

          Keep things simple. Make only this change in your life and commit to it like a religious zealot, with no exceptions. It takes a few weeks to work its magic. You WILL feel miserable for a few days.

          Please let us know how it goes — both the good and the bad.

          Todd

          Reply
  7. stopwn

    Hi Todd.

    An update as requested on sleep restriction.

    Having averaged 6 hours of broken sleep for a while, I started out with 7 hours in bed. 12-7 (although I have used a window between 11:30 and 12:00 for bed and strict 7am get up.

    I have been averaging between 5.75 and 6 hours sleep. I get to sleep ok. I still wake in the the night but go back to sleep pretty quick which is good.

    HOWEVER, I seem to wake around 6:15 and am awake for my final 45 mins in bed.

    I am still tired during the day but not completely wrecked, although I have a low patch early afternoon and about 10pm. I generally feel more sleepy at 10 than at my 12 bedtime.

    I want to stay asleep for that final 45 mins but am worried restricting anymore will just train me to get by on less sleep. Perhaps I could bring getting up time earlier? But I want to wake at 7 really…

    Any advice?

    Also as the therapy starts to work should I increase time in bed per night or try a new bed time for a few nights/week before changing again? I have seen conflicting advice on this?

    Thanks

    Phil

    Reply
    • Todd

      Phil,

      For the short time you have been doing this, you are making reasonable progress. But you are waking up 45 minutes early and still waking during the night. Therefore, you need to further delay your bed time by an additional 15 minutes. I would target 12:15. I realize that you will feel tired during the day, but this is the temporary price you have to pay for ultimately normalizing your sleep. As hard as it is, try to gut it out.

      Once you are able to sleep through to 7 a.m., you can gradually move to earlier bedtimes, 15 minutes at a time. And when you are sleeping through the night, you’ll find that your daytime tiredness greatly diminishes.

      Like all good things, short term pain brings long term gain.

      Keep up the good work!

      Todd

      Reply
  8. Sleephack

    Hi Todd how are you? I came to your blog by searching “sleep restriction therapy”, because my sleep doctor told me to do it. I used to sleep very bad and wake up many times in the night, for many years, son I finally decided to go for the sleep test (polisomnography). The doctor saw the test and he told me I was in the bed for 7 hours, and I only slept 4 with many gaps. In those 4 hours, I woke up 20 times.
    So he told me to start with the SRT. My wake up time, 7. And he told me to start sleeping at 3 AM for a week, next week 2.30 AM, the other 2 AM and finally 1:30 AM.
    It was tough, but the SRT worked for me. The thing is strange, because my sensation is that you sleep and rest by being always restless. So when you finally go to the bed, you get the sleep very fast. But, as I told my doctor, it’s not magic. Before I used to sleep 5 hours more o less getting up many times. Now I can sleep 4 o 5 hours, depending on the day at a shot, then go to the bathroom and continue sleeping for 1-1.5 hours more or less but this last sleep is without quality. The first sleep that I catch is very good, and the thing is the sensation is better. I don’t know how to explain it, but it works.
    The only thing is that appart from no taking naps, you have to wake up in the weekends at the same time, at 7, even after finishing the therapy? That’s what my doctor told me. He told me to continue with this behavioural thing, and after 2 o 3 weeks, again put 3 or 4 days sleeping very late and continue waking up at 7.
    I am doing it, and I reach to the nights tired and many times I discover myself snoring ( I have never snored before!). The only thing is that SRT works, but in the middle you can get nights like before, waking up many times to the bathroom, or the little baby cries, or my wife, and that night your sleep and your rest is awful, and these nights are very depressing.
    The thing is that if these behavioral has to be always, sometimes it’s difficult many times with your life. For example, if today that it’s Saturday, I go with my wife to have dinner and some drinks, and sleep at 2 or 3 am, it’s difficult to continue sleeping till 7, even when my SRT has finished.

    What is the behaviour supossed after finishing the month of SRT?
    And the other thing is that, as I told you, when after finishing or in the middle you have a bad night (many times because of you or because of the circumstances (baby,wife,bahtroom, noise,…)) what to do? My doctor told me that nothing. Continue waking up as stablished and think that the other night you will sleep better.
    One of the positive things about the SRT is that you change your mind about sleeping, and even if you don’t sleep well, you tend to think positive. It’s like autocoaching for the mind :)
    But it’s very tough, and also the thing is that you have to be always tired to get good sleep. It’s a bit paradoxical.
    My wake up time it’s at 7, and I completed my therapy a few weeks ago. Yesterday It was holiday here in Spain, and I was woke up with my wife till 2 AM. Since 11 pm I was falling asleep, it was tough, we also were wathing a movie and I was falling asleep, but I carried till 2 AM. And today, I could not woke up at 7. I decided to woke up at 9:30, that too is early. Because the same thing a few months before, before knowing and experimenting with SRT I would have woken up today at 11 or 12, depending if the baby continued sleeping. But now , as I have completed my therapy, I don’t want to break the balance achieved.
    But even though, being in bed today for 7 hours and a half, did not get good sleep. My wife woke me up at 3, my baby at 5, I went to te bahtroom at 7. So it was like a typical night of before, before the SRT.
    These nights are a bit confusing, and you seem yourself lost, thinking that you could get the energy to complete the SRT, and you also continue with the same behavoiur (no naps, try to get up at same time weekends,..) but this has to be for always and same time it’s very tough.
    I look forward to hear your opinion , Todd.
    Thank you very much for your kind attention.

    Deepak

    Reply
    • Todd

      Hi Deepak,

      Thanks for sharing your experience with SRT. As your story reveals, sleep restriction theory is a mixed blessing. You do get much better quality sleep, but it is not always perfect. And you pay a price by having to stick to a pattern. So there is a trade off, but most people in your situation find it a trade off worth making.

      With time, perhaps many months, once your sleep pattern is normalized, perhaps you can make more exceptions. But as with learning any new behavior — to control eating, drinking or other habits — it is necessary to allow enough time for the new pattern to take hold, before you can trust it.

      Que decanses — sueños dulces

      Todd

      Reply
  9. Tamara

    I have been struggling with insomnia for the past five and a half months. This started when my son was 3 months and he started sleeping through the night. After much trial and mostly error with meds, I am trying SRT. My average sleep time is about 5 hours, so I have been allowing myself 6 hours in bed (midnight until 6am). I find that I am sleeping every other night. I will sleep the full 6 hours one night and zero hours the second night. I can’t seem to break this cycle. On the zero sleep night I can barely keep myself awake waiting for midnight, but once I get in bed I just lie there. Any advice?

    Reply
    • Todd

      Tamara,

      Keeping in mind that I’m not a doctor or therapist, all I can do is provide some ideas for you to look into. Much of the success of a technique like SRT will depend upon individual factors. For example, here is an interesting discussion of the potential roles that medications, anxiety, and body temperature play in insomnia and its reversal:

      http://www.benzobuddies.org/forum/index.php?topic=48905.0

      Now to your specific situation of alternating between restful and sleepless nights, here is what I suggest:

      1. Delay your bedtime on ALL nights by 15 minutes. Or alternately, move your wakeup time 15 minutes earlier. Keep shortening your sleep cycle by 15 minutes on both days, until you force sleep on both days. If this is too difficult, then at least delay your bedtime on the zero sleep nights.
      2. Exercise or engage in vigorous physical activity during the days on which you are having the zero sleep nights. Try to tire yourself out on those specific days.
      3. Minimize the use of caffeine or sugary foods on those days. Eat a protein dinner, preferably a food that is rich in tryptophan, like poultry, dairy, beans or nuts.

      Let us know how it goes, and good luck.

      Todd

      Reply
      • Tamara

        Thanks. I will try it. I have read a lot about insomnia and am currently reading “Say Goodnight to Insomnia.” http://www.amazon.com/Good-Night-Insomnia-Gregg-Jacobs/dp/0805089586

        I have found it helpful so far and have definitely improved my sleep from where I started (in January I was sleeping an average of 1 hour per night). I just seem to be in this holding pattern of every second night of sleep.

        My problems seems to be falling asleep. On the nights that I fall right asleep, I can wake up and fall back asleep fairly quickly. However, on the zero sleep nights, I just can’t get any shut eye.

        What is your feeling on getting up when you can’t fall asleep? Should I force myself to stay in bed for 6 hours, or should I get up and read or do something else that is boring.

        Thanks for your advice.

        Reply
        • Todd

          Thanks for the reference, Tamara.

          If your main problem is falling asleep (rather than staying asleep), further delaying your bedtime (but maintaining the same wake time) is called for. If you are not falling asleep within a few minutes, you are not staying up late enough. Get right up for another 15-30 minutes, rather than lying there.

          On the other hand, once you have fallen asleep for the night, if you then wake in the middle of the night, be sure to stay in bed until your wake time. It is important to condition yourself not to get up during the night, except for urgent bathroom visits.

          It may take several days to take effect, so expect to be tired.

          Todd

          Reply
  10. michele222

    I am a Biploar disorderer sufferer who has NEVER slept throught the night. I get up most nights each hour to eat, binge with no control. Sometimes I know I’m doing it other times I awake in the morning to see the remnants of a busy night. Needless to say this is not good, but especially for me with my particular imbalance. My sister suggested I look into this as one of her friends had a very positive experience. I’m concerned about changing up my “go to bed” time each night and if that will set off a manic episode. I’ve been hospitalized twice and REALLY don’t want to do that again. Have you had experience with this working for a Bipolar person?

    Reply
    • Todd

      Sorry, Michele, I don’t have experience with bipolar, or anything specific to recommend. I would discuss this with a doctor or psychotherapist.

      Reply
      • Thanks. Exactly as I thought, I appreciate you responding so quickly

        Reply
  11. Tamara

    So last Wednesday was my last dose of remeron (I tapered off over a couple of month and have only been on since January. I slept great weds-sat using sleep restriction. Then I didn’t sleep at all on Sunday. Monday I slept for about 2 hours. Tuesday I slept 6 hours with no problem. Then last night I was up all night with a racing heart. I don’t know if this is due to withdrawing or just a bad night. I was so hopeful after a great 4 night stretch. Thoughts?

    Btw I’m coming off of the remeron as it wasn’t helping me sleep, although no I worry that withdrawing will make the already bad sleep patterns worse.

    Reply
    • Todd

      Good to hear of your progress, Tamara.

      With regard to the racing heart, this is often due to a simple mineral imbalance. Inadequate or imbalanced calcium, magnesium or zinc in the diet can disrupt thyroid function and cause a racing heart especially at night. I’ve experienced this myself, and corrected it within a few hours by taking a calcium/magnesium/zinc supplement. Of these, I think that adding magnesium is the most significant. I’m not a believer in long term supplementation, as I prefer to get my minerals through whole foods. But to correct a short term imbalance, minerals are very safe. Here are a few good links:

      http://www.ithyroid.com/ca_and_mg.htm
      http://www.chelationtherapyonline.com/anatomy/p56.htm

      Interestingly, magnesium deficiency itself has been implicated as a significant cause of insomnia:

      http://www.medicalnewstoday.com/releases/163169.php

      So you may want to consider a magnesium supplement, either alone or in combination with calcium and zinc.

      Todd

      Reply
      • Tamara

        Thanks Todd, I will try that as well. I seem to be back to sleeping every second night again, allowing myself 5.75 hours in bed. Should I shorten by another 15 minutes? What is the minimum window for sleep? Should I still be expecting the odd bad night? Again, my only problem is initiating sleep.

        How many good nights in a row before you can starting increasing sleep time. Let me know and thanks for all of your help :)

        Reply
        • Todd

          Tamara,

          I would continue shortening your sleep time, by another 15 minutes. I would not go below 5 hours per night. I wouldn’t start increasing sleep time until you have 4 good nights in a row. And even then, increase the sleep time gradually.

          Don’t expect sudden or smooth improvement. You will have some difficult nights. The most important thing is consistent behavior, regardless of the ups and downs in how you experience it. Be as consistent as possible, and you should see improvement over time.

          Todd

          Reply
  12. Black D Rock

    Hi
    Started sleep restriction therapy two days ago.My sleeping schedule is 1.30 am -7.30 am.On first day I slept full 6 hours, on second day my sleeping was broken and I only had 4 hours with lot of walking during the night(my brain is thinking about new routine).
    I would like to know when I wake up during the night and don’t fall asleep in 10 minutes should I stay in bed and tray to sleep or get up for 20 minutes and then go to bed?Confused!
    Thanks

    Reply
    • Todd

      Once you go to sleep, never get out of bed until your official wake-up time. Even if it is boring and frustrating, stay in bed. Don’t read or watch TV or look at your cell phone or talk. Keep the room dark and minimize noise. Unless you must use the bathroom, just lie there. It may seem pointless, but you are actually re-training your mind and it may take several sessions. Don’t make exceptions, or you will unlearn these good sleep habits.

      Waking up during the night means that your bedtime is still too early. So delay it by another 15 minutes per night until you are sleeping through the night.

      Reply
  13. Tamara

    Hi Todd,

    The past three nights, I’ve struggled to stay up until 12:30. Then when I crawl into bed, I can’t sleep…each night I’ve fallen asleep after 3:30 and forced myself up at 6. Is this the getting worse before it gets better?

    I think that I nodded off on the couch for 10 minutes last night (sitting upright) right before I moved to bed (12:15-12:25am). Do you this that this screwed up my sleep for the rest of the night?

    I feel like I climb in bed and my heart just races. Can I expect this to reside over time.

    Sorry to keep bugging you!

    Reply
    • Todd

      Tamara,

      Sorry to hear that it’s hard going. I don’t think your 10 minute catnap was enough to mess things up. It actually is a sign that you are finally getting tired enough to sleep. Still, it is important to do you best to stay up until your official bedtime.

      What I will suggest here is my best judgment, based upon what I’ve read and what others have said. But, please, keep in mind that I am not a doctor or a sleep expert. That said, here are my thoughts:

      I think you need to delay your bedtime further. You are heading to bed at 12:30 and rising at 6. You could delay until 1 a.m. and still have 5 hours of sleep. This is not unusual, from what I have read. You need to give this 2-3 weeks before it really starts to kick in.

      Have you tried exercise or magnesium supplements? Magnesium can help slow the racing heart. (It did for me).

      Good luck!

      Todd

      Reply
  14. Tamara

    Hi Todd,

    I will push an extra half hour tonight and see what happens. I exercise daily by walking at least 5 km (no matter how tired I am). I used to run 5km/day, but just don’t have the energy. I am taking an adrenal support supplement that has 170mg of magnesium in it, plus I have Epsom salt baths a few times a week.

    I am desperate for SRT to work for me, but finding it hard to ride the highs and lows.

    Reply
    • Todd

      Tamara,

      I know it is hard, but stick with it and be consistent. You are forming a new habit. “The night is darkest just before the dawn”.

      Besides sleep habits and exercise, diet is a very important contributor to good sleep. I’m glad to hear you are taking adrenal support — it sounds like you are pretty run down. Besides magnesium, B-vitamins are a key element of adrenal support. What is your diet, if I may ask? Do you get plenty of balanced protein, natural fats, and green fibrous vegetables? Are you careful to control the amount of easily available carbohydrates (sugars and starches), and stimulants (like caffeine)?

      I’m routing for you. One of the best choices you have made is to turn away from dependence on sleep medication. That’s a seductive trap that many people follow, but it doesn’t get at the root problem, and is rarely an effective long term solution. So when you feel you are struggling with your new sleep habits, reflect on the positive choice you have made for your health.

      You’ll get there…stick with it.

      Todd

      Reply
  15. Margaret

    Just discovered SRT. I’ve taken Ativan/Restoril every night for sleep for over 10 years. Now I’m attempting to break the dependency using SRT. For years I’ve had the habit of waking up between 2-3 a.m. and working. I’m a freelance artist. Does it matter if the wake up time is that early? If it does matter, what would be the earliest acceptable time?

    Also, I’m going on vacation to the UK in a month. Any advice for dealing with time change while doing SRT.

    I’m very excited about this therapy. It sounds like it really could work.

    Thank you.

    Margaret

    Reply
    • Todd

      Margaret,

      I’m glad to hear you have made the choice to move away from dependence on sleep medication. It’s a real trap. You’ve made a very positive move in choosing to restore your natural sleep balance.

      There is absolutely no problem in waking up at 2-3 a.m., if that’s what works for you. Some people advise against being awake when it is dark out, or sleeping when it is light out, because of the influence of natural light on the circadian rhythm of sleep/wake hormones like melatonin. While there is some truth in that, I think humans are adaptable creatures, and many have no problems with atypical waking hours. The real key is consistency, and a willingness to suffer through several very hard weeks of tiredness and crankiness. Adaptation to new sleep habits takes time.

      If you are going to the UK for a month, you will experience a few days of disruption, but usually after about 3-4 days your sleep cycle will adjust. People vary. I’m fortunate in that I adjust readily to different time zones. I find the key is to stay active and busy, and I use the sun as my guide. When I first land in a new time zone, I force myself to stay awake until the late evening. I don’t usually drink caffeinated coffee (decaf is my preference), but when I visit Europe, I drink good full bodied caffeinated coffee the first few mornings. Coffee works best when you use it on special occasions, rather than as a habit.

      Todd

      Reply
      • Margaret

        Thanks for your quick reply, Todd.

        Margaret

        Reply
  16. Tamara

    Hi Todd,

    Still in sleep hell. Sleeping every second night and only getting about 4 hours on the sleep nights. Ugh.

    I am a vegetarian, but I do eat fish, eggs, and dairy. I am careful to make sure that I still get what I need. I eat very healthy. Lots of greens and very little sugar. I also take B12 on a daily basis (I was getting injections for a while to boost my levels). How much magnesium do you take and what form (pill vs. liquid)?

    As for caffeine, I have one cup of green tea first thing in the morning.

    I think I’m doing all of the right things, just growing impatient with the time it takes to heal. The less I sleep, the more anxious I get, which makes it harder to sleep.

    Hopefully with nicer weather around the corner, I will get more vitamin D!

    Reply
  17. Tamara

    Thanks Todd,

    I am taking fish oils as well, for the omega 3. I think that I’ve been at SRT for about 3 weeks, but I started at 6 hours and have cut back to 5.

    I tried various sleep meds in the early part of the year. Then I took 2 months worth of zoplicone before quitting that at the start of March. Since January I have been taking Remeron. It initially helped with sleep, but then I grew tolerant. I tapered off over 6 weeks, with my last dose being 2.5 weeks ago. My first 4 nights with no meds, I slept like a dream (ha no pun intended). Since then, my sleep has been choppy at best. I think that some of my issues are related to withdrawal.

    Since stopping the remeron, I have had some digestion issues. My naturopath suggested holding off on the magnesium until those issues clear up. What kind should I look for?

    Thanks again :)

    Reply
    • Todd

      Tamara,

      Hmmm, it does indeed appear that Remeron (Mirtazapine), as with other antidepressants, can produce withdrawal symptoms including anxiety and insomnia:
      http://www.recoveryconnection.org/remeron/

      If you Google “Remeron side effects” and “insomnia” you’ll find lots of reports of people struggling with insomnia as a side effect. So you are not alone. By the way, there is an excellent and well researched book, “Anatomy of an Epidemic” that traces the history and folly of the use of antidepressants and other psychotropic medications. You might find it interesting — or disturbing.

      Your naturopath is correct that magnesium in high doses has a laxative effect. But if you start at a half dose (125 mg) for a few nights before bed, you’ll probably find you can tolerate that, and then increase to the full 250 mg dose.

      Todd

      Reply
  18. Tamara

    I picked up some magnesium citrate today. Sun & mon were great sleeps, then last night felt super anxious for no particular reason and had a tight chest. In and out of bed all night. I must have gotten a little sleep though as I don’t feel like complete death…just partial death ;)

    How long before bed should I take the magnesium?

    Reply
    • Todd

      Magnesium works pretty fast. Take it 30-60 minutes before bedtime.

      Sounds to me like you are starting to see the first signs of improved sleep. Two good nights, one bad one. Progress will be like that – some steps forward, some backward. Hang in there!

      Todd

      Reply
  19. John

    I just want to add my name to the “Sleep restriction therapy worked for me!” pile. It really works. If you suffer from insomnia I strongly encourage you to try this.

    I’ve had insomnia for 5+ years, and I recently became hooked on zopiclone medication. After taking zopiclone nightly for a month, I found the medication didn’t work, but I also suffered horrible rebound insomnia when I tried to sleep without it. I was sleeping as few as 2 hours a night, and was barely functional. On one of these horrible nights, I stumbled across this website and decided to try sleep restriction. I was desperate and had nothing to lose. I arbitrarily chose a 6-hour sleep window (midnight to 6am).

    My sleep improved the first night! I’m about 5 nights into the therapy and I’m sleeping right through, and falling asleep in under 10 minutes. Daytime sleepiness was really bad the first two days, but it’s substantially improved now 5 days in. I find that ice cold showers during the day dispel the grogginess for up to 5 hours at a time, and regular exercise really helps.

    I notice that most Sleep Restriction webpages claim this therapy takes at least several weeks to make a difference. In my case, my sleep improved on the first night. So you may be pleasantly surprised!

    Reply
    • Todd

      John,

      Thanks for chiming in to report your good results with SRT. It does indeed appear that some people — like you — are able to get rapid results, while it can take weeks for others to achieve normal sleep. I’m also interested to see that you combined SRT with another of my favorite practices — cold showers. It’s an interesting combination that may help to restore a natural sleep/wake cycle.

      Todd

      Reply
  20. Tamara

    John, so envious that this worked so well for you!

    It’s now been four weeks for me and my sleep is worse than ever. The last 3 nights I’ve had zero sleep. I feel dead tired, but get in bed and can’t fall asleep. Don’t know how to get over this rut.

    I’ve been taking 150mg of magnesium at noon and 150mg before bed. I only have a five hour window for sleeping. If I don’t fall asleep rig away, I’m up all night.

    Any other suggestions?

    Reply
    • Todd

      Tamara,

      It saddens me that you are having such a struggle. It must be incredibly frustrating.

      I did some more research into SRT. It appears to work in well over 90% of cases – one source claims 98% — but some cases of insomnia seem particularly resistant, even to SRT. Hopefully you are not part of the 2-10% for whom SRT does not help. I bring this up not to dash your hopes, but to inject some realism into expectations.

      The resistant cases seem to be those involving patients who are experiencing withdrawal from benzodiazepine sleep medication. People who are coming off these sleep medications have less success with SRT than those with other causes of insomnia. Here is a posting on an internet forum by a benzodiazepine user, for whom SRT failed. I don’t want to dash your hopes, but to help you be realistic about how long it may take and what you can expect. Read the entire thread and responses by others, to get some idea of the wide range of experiences with SRT:
      http://www.benzobuddies.org/forum/index.php?topic=57751.0

      The sleep medication you were taking, Remeron (Mirtazipine), is not a benzodiazepine, but rather a noradrenergic and specific serotonergic antidepressant (NaSSA). Benzodiazepines work by a different mechanism — they stimulate the production of a different neurotransmitter: GABA. But withdrawal from Remeron can be tricky. Here is what Wikipedia has to say:

      Mirtazapine and other antidepressants may cause a withdrawal syndrome upon discontinuation. A gradual and slow reduction in dose is recommended in order to minimize withdrawal symptoms. Effects of sudden cessation of treatment with mirtazapine may include depression, anxiety, panic attacks, vertigo, restlessness, irritability, decreased appetite, insomnia, diarrhea, nausea, vomiting, flu-like symptoms such as allergies and pruritus, headaches, and sometimes hypomania or mania.

      Despite the challenge you face given withdrawal symptoms, I think it is still worth trying, for at least a month. Here are a few articles that might help:
      http://www.insomniatoolkit.com/articles/restrictiontherapy.php
      http://www.novisleep.com/sleep%20restriction.html
      http://m.psychologytoday.com/blog/sleepless-in-america/200907/cognitive-behavioral-therapy-insomnia-part-4-sleep-restriction

      One theme of several of these articles is that resistant cases may benefit by working with an experienced behavioral therapist or sleep therapist. While I am a great believer in self-help, there comes a time to get professional help — ideally, by someone who understands the dark side of sleep medications and will avoid that trap. You don’t deserve to languish in a sleepless hell — you deserve better.

      Good luck,

      Todd

      Reply
  21. Rayca

    I don’t agree with this protocol, at all. At least, not for all insomniacs. I haven’t used an alarm in over 20 years. I wake up automatically way too early for that. This protocol is great for people waking up in that stage 4 sleep. You force yourself up, you’re tired in the daytime and after a few weeks of that, yup, you’ll reset your hormones/clock/whatever. However, just laying there from 3 am until whenever (as in my case) is not resetting anything. The later I get to bed, the earlier I wake up. I’m sure this is due to anxiety over the issue (including log keeping). Also, there’s no way to keep pushing the bedtime hour later and later. I have found myself sleeping/dozing while sitting up. I even caught myself snoring!! while sitting straight up. Sometimes my eyes are open but I have lost track of time. This seems dangerous and it dozing doesn’t work for sleep restriction therapy. I’m not even tired during the day on 3 hours of broken sleep. My gut tells me this is very unhealthy and I will be learning how to function on way too little sleep. Nope. What I tried previously was getting up at that awful 3 am hour and starting my day. Not, laying there or doing light reading or whatever until 6 am. Then I can go to bed when I’m actually tired each night. Eventually I want to sleep past 3 am BUT I need to get up anyway. So I increase the 15 minutes thing at the back end of the sleep, rather than the beginning. That worked. I was tired during the day and couldn’t wait to sleep. Unfortunately I was so dogged tired, I couldn’t keep to the schedule. I needed more sleep!! So I’m going to try again and keep at it. Again I think this protocol has NOT taken into consideration that some folks don’t benefit because they will never need an alarm.

    Reply
    • ilkini

      Hello Rayca,
      (Thank you Todd, for a good blog by the way),
      I was reading the blog just to find an answer about the same thing you have mentioned in your post.
      I wondered if “your kind of protocol” of adding the sleeping time to the morning hours worked?
      I have had insomnia for over 2 years, almost never have a problem falling asleep, but I can wake only after 2 hours and after that I’m either not asleep at all or it’s a really light sleep I experience. I don’t seem to get into phase 3 or 4 (deep sleep). But, I have just started with SRT.
      My initial thought was exactly the same as you have mentioned; I am really awake after 5 and waiting an hour or so doesn’t really add anything (no matter what time I get into bed). So I started with getting up at 5, and it worked perfectly the first night.
      Now I’m confused – what should I do? Should I try to force the time I go to bed to a later hour instead, meaning staying awake in bed in the morning or should I do what my guts tell me?
      In short: Did your reverse method work for you?

      Reply
  22. Hello All,

    I, too, had good results with sleep restriction therapy. I tried it as part of cognitive-behavioral therapy (CBT) for insomnia.

    CBT typically involves both sleep restriction and stimulus control therapy (SCT). Along with restricting your sleep to a fixed schedule, you’re advised to get out of bed when you’re not sleeping (even if it’s during the brief time you’re allowed to be in bed). The goal is to get rid of the association between the bed and wakefulness and replace it with an association between the bed and sleep. All the while, of course, you must adhere to all the other guidelines set forth here.

    SRT and SCT were a challenge. I’ve had trouble sleeping almost all my life. By the time I got around to trying CBT, I’d developed quite a fear of sleeplessness. So undergoing therapy involved confronting some of my worst fears, and the process at first was scary. But fairly quickly, my sleep turned around. My sleep now is sounder and more regular. Probably the biggest boon has been that I’ve pretty much left my fear of sleeplessness behind.

    But, like so many people with persistent insomnia who go through SRT and SCT, my sleep is still on the fragile side of normal. I’m still prone to occasional stress-related bouts of insomnia. But now I can more quickly get back on course.

    This brings up a couple of comments about who can benefit most from SRT. I’m told by sleep experts that there’s very good evidence that these behavioral sleep therapies work well for people with psychophysiological insomnia (the most common type). Less evidence, though, that they will work for people with paradoxical insomnia (who perceive that they are awake most of the night when sleep studies suggest that they are sleeping). Also less evidence that SRT and SCT would work for people whose insomnia is primarily biologically driven.

    But, to end on a cheerful note, these categories are not mutually exclusive. Many people should be able to improve their sleep using SRT and other behavioral strategies.

    Reply
  23. JP

    Hi all,

    I’ve been trying SRT for the last couple of weeks, but I’m still waking up too early! I set my alarm for 5 AM but will regularly wake up between 30 min and an hour before that. Would staying up later help? I don’t have much to do in the evenings, so I usually go for a walk and then sit and read, but I get tired as soon as I start reading so I go to bed. Any advice would be much appreciated!

    Reply
    • Todd

      JP,

      When are you going to bed at night? Try staying up another 30 minutes before bedtime, and defer reading until right before going to bed. If you have trouble staying up until then, consider going for a walk 1-2 or mild exercise hours before bedtime, or if you are getting sleepy. Exercise helps in two respects: keeping you awake when you are starting to tire, but improving your ability to fall asleep and stay asleep a few hours after the exercise.

      Todd

      Reply
  24. JP,

    I had the same experience with SRT as you’re having right now, and I think Todd’s advice to delay your bedtime by 30 minutes is very good. Any kind of activity that involves movement–even if it’s just walking around the house–will do the trick.

    I’ve found this advice to be helpful even after going through SRT. Now, I don’t head to bed at the first sign of a yawn or when my head starts to nod over a book. If I do, I have trouble getting to sleep or I wake up too early.

    What works best for me is trying to stay awake a little longer doing whatever I’m doing. Then I’m more likely to fall asleep quickly and wake up at a decent hour.

    Reply
  25. jamaica Abare

    I really appreciate all of your input on sleep restriction therapy. I have struggled with insomnia since June. I finally went to the Dr. and he suggested this route but gave little specific guidance.

    I am 2 and a half weeks into this process and have averaged only about 3 days of 5 hours of sleep in a week (I am allowing myself 6 hours in bed). I wonder if I should cut back my time to 5 or even 5 and a half (scary!).

    My other concern is my wake time. Although I am very good about getting up at 4 am (I started and 5 am but this turned to 4 am with the time change and I didn’t want to mess with changing things) I wondered if/when I get to the point of adding more sleep if I can go the other way–adding time to the morning instead of an earlier bedtime.

    Bottom line I really want to sort out this sleep issue ASAP even if it is a painful process…

    Thank you so much for your time and willingness to be helpful to a total stranger!

    –Jamaica

    Reply
    • Todd

      Jamaica,

      That’s good to hear that your doctor was aware of SRT and recommended it for your insomnia.

      As to whether to cut back your sleep time to less than 6 hours: The test is whether you are successfully sleeping through until your wake time (4 am). If so, you can gradually increase your sleep time by 15 minutes at a time. You can do that either by setting your wake time later, or going to bed a little earlier.

      If you are still waking up during the night or having trouble falling asleep, you should further shorten your sleep time to 5.75 hours. Make the changes in either direction gradually, in 15 minute increments, and stay with each pattern for several days to a week, rather than changing every day.

      The key is being consistent and disciplined, and making changes gradually.

      Good luck!

      Todd

      Reply
      • Jamaica

        Thank you so much for replying! This therapy is brutal but I am seeing small changes. I have been sticking with the “program” for three weeks now. While I sometimes sleep for four hours at a time (out of the 5.5 that I am allowing myself) I always wake up at some point. Is the goal not to wake up at all or is it ok if I wake up and fall back to sleep once or twice in that 5.5 hour chunk? I don’t want to start watching the clock as it makes me anxious but I think I am starting to sleep better.

        I’d like to start adding time (15 min at a time) if I can get a few good nights in a row ( is thus sufficient to see a pattern of efficiency). I am afraid though of going backwards. If adding time doesn’t work should I go back? Once time is being added and not subtracted do you usually see that there is not regression?

        One more thing…. Would you recommend continuing even if sick?

        Thank you!

        Reply
        • Todd

          Jamaica,

          Sorry I somehow missed this last note of yours until just now. Hope your progress is continuing and that you aren’t sick anymore. Unless the illness is very fatiguing, I would think it is best to continue the therapy.

          Waking up once or twice during the night is no big deal as long as you find that you naturally fall back to sleep shortly.

          Adding or subtracting time is a matter of experimentation. Sometimes you may find you have to go backwards. I would try not to make changes too frequently, though. Whatever time you pick, stay with it for several days to a week before changing again.

          Good luck,

          Todd

          Reply
  26. shalini

    i’m 19 yrs old. suffering from insomnia since 2 months. i feel bit sleepy at 10pm but i wake up very early in the morning, around 4am. i don’t get sleep later even if i try. i feel very tensed as soon as i wake up. i don’t feel fresh after my sleep. can i apply this sleep restriction therapy? if so, how.?

    Reply
    • Todd

      Shalini,

      SRT works best precisely for the kind of insomnia you are describing — early waking and frequent waking during the night. No guarantees, but it’s worth a try. It takes effort, persistence and the ability to tolerate a hellish existence for several weeks. But it you can do it, you’ll be liberated.

      Todd

      Reply
  27. Magnus

    Hello,

    I’ve had trouble sleeping (or get to sleep early*) nearly all myf life, but this December I developed severe Insomnia when I tried to force sleep by using Zopiclone. My goal was to alter my circadian rhythm to fit in with my girlfriend’s. Unfortunately, due to stress I couldn’t sleep very well. I started to become very sensitive to sounds from her neighbour, and soon I became fixated with the idea of sleep. I panicked. My whole life was turned around.

    After starting with Remeron, I was able to get off the Zopiclone somehow, but the sleep remained fragmented and most nights I drifted in and out of dreams and felt uncomfortably awake. I lost the sensation of sleepiness – although some nights I slept noting at all I still didn’t feel tired in the morning. Even the need of napping vanished. This weird alertness has been constant since, and it makes it very difficult to sleep.

    A week ago I decided to continue with Zopiclone, and the nights I take a full pill (in combination with propiomazin) I usually sleep well. But I don’t want to lean on pills. I’ve been able to live without them for 25 years, even though I my sleep hygiene always’s been awfull.

    I’ve read a lot about sleep restriction, but it scares me. I’m afraid to go mad. What can I do about this thoughts? I really want to do SRT, but what to do if I can’t sleep two nights in a row?

    Reply
    • Todd

      Magnus,

      I sympathize with your desire to liberate yourself from sleeping pills. It’s so easy to become dependent, and so difficult to stop. Sometimes gradual weaning, using lower doses, works better than going cold turkey.

      Sleep restriction therapy might work well for you. You won’t “go mad”, but you can expect it to be difficult. The point is not to avoid sleep, but to delay the onset of sleep and force a rigid wake time. You’ll get less sleep than you like at first, but the focus is on getting quality sleep. Once your sleep quality improves, you can gradually lengthen sleep time by going to be a little earlier each night. There is little downside to trying. Give it a full two weeks to be fair.

      Todd

      Reply
  28. Elsa Kimak

    Hello – Been suffering with severe chronic insomnia for over 20 years. Tried SRT in the past and was not successful. I am trying it again because I have nothing tolose because I’m barely sleeping anyway. I’ve only been doing this for a few days but wake after perhaps an hour with my heart racing (anxiety) and cannot go back to sleep! My fear is that this anxiety will not go away and will make SRT not effective. OR, if I keep going with SR, will my body and brain push through the anxiety allowing me to sleep? I really am desperate for some hope that this can work.

    Thanks,

    Ellie

    Reply
    • Todd

      Elsa,

      SRT can be very helpful in normalizing sleep, but it might not be effective if you don’t simultaneously address your underlying anxiety. It’s important to uncover the root cause of your anxiety. Is it driven by stress or emotional factors? By an underlying medical condition? By caffeine or stimulants? By an unbalanced diet — too low in protein and too high in sugar and carbohydrates? By a mineral imbalance?

      I suggest getting a medical exam to see if you have some condition or imbalance that needs to be addressed. In the mean time, there are two easy things you can implement that may help reduce your anxiety and racing heart:

      1. Increase protein and fat in your diet, and cut back on (but don’t eliminate) sugars and carbohydrates.
      2. Take a magnesium supplement. Magnesium deficiency is a commonly overlooked cause of a racing heart. I experienced this myself at one point,, where I could hear my heart racing when going to sleep. Two things quickly reversed that — switching to decaf coffee instead of regular coffee, and taking a magnesium supplement. The magnesium supplement stopped the racing heart in less than one hour!

      SRT is worth trying again – but only if you deal with the anxiety.

      Good luck!

      Todd

      Reply
      • Elsa Kimak

        Todd – Thanks so much for speedy reply. The racing heart has everything to do with the fear of not being able to sleep and the anxiety that nothing is going to work. When I think about sleep in the middle of the day, my heart races! I never had this before until my insomnia took the turn of waking in the middle of the night and FEAR of how I would feel the next day etc. Now I have started another vicious cycle that perhaps SR can help. I have been checked out medically…nothing wrong…..just bought the Magnesium. I just started to see a CBT therapist too.
        I will continue with the SR because as I said, I have nothing to lose at this point!
        I appreciate your comments.

        Ellie

        Reply
        • Todd

          Elsa,

          Glad to hear you got checked out…it does seem that your anxiety may be a vicious cycle of self-reinforcing anxiety. If that’s the case, I think you are absolutely on the right track with SRT and CBT. As you say — nothing to lose. And even better, as you begin to succeed in normalizing your sleep, you will begin a “virtuous cycle” in which success begets confidence and anxiety melts away.

          I wish you great success! Please do report back how it goes.

          Todd

          Reply
          • Elsa Kimak

            Todd – I truly appreciate your feedback. Will keep on going …I feel if I can benefit from SR, anyone can, and I will be sure to post if it helps!

            Thanks again,

            Eliie

            Reply
  29. Elsa Kimak

    Hi Todd – I wrote before about the pounding heart/anxiety that was causing a new sleep nightmare. It has been been less than a week on SR. Bedtime 1:00 – 6:30 and have found that the racing heart has stopped (good news) and that is probably because of implementing SR and extreme fatigue. On the other hand, I’m feeling skeptical because I am so exhausted, fall asleep immediately but the quality and length of sleep is very bad. Four hours tops and not good quality. As I said, I have been doing this for less than a week and have had chronic insomnia for over 20 years. My question is, does it take the brain a while to sense a change in pattern? Do you think the quality of sleep will improve with time? I want so much to see improvement. I know you are not a sleep doc but you certainly sound like an expert….Also, plan to try to stay up a little later tonight 1:15.

    Thanks,

    Ellie

    Reply
    • Todd

      Ellie,

      Glad to hear the racing heartbeat has stopped.

      As you appreciate, I’m not sleep expert, so I rely on what I’ve read and what others who’ve tried SRT have reported. Those with experience indicate that it typically take 2-3 weeks before fatigue dissipates and quality of sleep normalizes. It’s important to be consistent and to avoid napping. Generally, expect to experience sheer hell and extreme fatigue before the curtain lifts.

      Here are some studies, recommendations, and anecdotal reports that may help answer your questions:

      http://cirus.org.au/publications/2011/Miller.pdf
      http://www.brodnermd.com/sleep-restriction-therapy.html
      http://www.benzobuddies.org/forum/index.php?topic=48905.20

      One interesting tip is ensure you sleep in a darkened room and then exposure yourself to bright light for 30 minutes upon waking. You might consider that.

      As hard as all these may be, isn’t’ it worth it to invest 3 weeks in this experiment, if the outcome is normal sleep — without dependence on drugs? I can’t say whether SRT will work for you, but the downside is limited to 3 weeks of hardship.

      Todd

      Reply
      • 156nh

        Todd,

        I have extremely bad insomnia and can hardly get an hour or 2 a night. I developed this pattern only the last few months. Do you think SRT will help me. I have difficult fall asleep and lost the feeling of sleepiness.
        I don’t know how I messed myself up so bad so quick.

        My medication of ambien and remeron might have causing my condition. Bug now I am off theses drugs for a month and my sleep pattern does not return and the anxiety of not getting sleep also fuels the chronic insomnia.

        I am desperate for help.

        Daniel

        Reply
        • Todd

          Daniel,

          Sorry to hear of your struggles with insomnia. You are not alone in reporting that resulting anxiety tends to reinforce the insomnia. Going on sleep meds and then stopping them can at least temporarily increase your anxiety. I think that SRT can definitely help, but it may take a while to “detox” from the Ambien and Remeron. You might try adding some exercise to your day in order to achieve some natural, physical exhaustion. Also consider increasing diet — making sure you are getting proper nutrition and adequate levels of tryptophan-rich protein in combination with carbohydrates:

          http://www.joybauer.com/insomnia/how-food-affects-sleep.aspx

          Todd

          Reply
        • Tamara

          Give it time. I was on remeron and zoplicone for sleep as well. It took about 4-5 months off of both before I started to feel tired on my own. In my experience, SRT did not work until enough time had gone by. I gave it a good 8 weeks of solid dedication with no improvement, only because I hadn’t been off of the meds for long enough. In the meantime, magnesium bisglycinate helps with the racing heart and anxiety.

          It is hell, I’m not going to sugar coat it. I’m going on a year of being off of the meds and am now getting on average 7 hours of sleep per night with one bad night of sleep per week (4 hours). Last year at this time I was averaging 2 hours per night.

          SRT did not work for me, but I do go to the bed and get up at the same time every night. If I don’t it throws me off.

          Reply
  30. wenche kirkeby

    Hi, thank you for a very good blog!
    I am on day 11 of SRT and have not seen any improvement of my sleep so far (I sleep 3-4 hours). I started out with 5 hours in bed for one week, and then reduced it to 4 h 45 min. Do you think I should reduce time in bed further to 4,5 hours? During the last few days I have been very tired and dizzy, and cannot see clearly. Work or car driving is out of the question. I wish so much to get this first, harsh period over with. On the other hand I am scared of being more sick. If I stick to 4 h 45 min, will I eventually sleep better? I must add that I must lie down on the coach instead of sitting during the day, because of back injury. I guess that this makes the insomnia worse.

    Reply
    • Todd

      Wenche,

      Your situation does sound quite difficult. Having to be on your back most of the day is difficult because it tempts you to nap and you don’t get much exercise. It would be good if you could at least get some kind of physical activity, like swimming, that would not hurt your back.

      There is no magic number of hours to sleep — 4, 5 or whatever. The key is to set a wake time, say 7 or 8 am, and stay up as late as you can so that you sleep through until the wake time. If you wake too early, then shorten the sleep by 15 minutes, progressively, until you are sleep through until your wake time. Then once you are sleeping uninterrupted, start to go to bed earlier by 15 minutes. Eventually, you should be getting restful sleep.

      Reply
      • wenche kirkeby (gonkenk)

        Thank you for Your answer. I do get exercise, but still I have to spend less time on the sofa. After 5 weeks I have now reached a sleep efficiency of 85 %, but I still wake up, either in the middle of the night or too early. I will not take the chance of increasing time in bed now, allthough I am very very tired!

        Do I have to further reduce time in bed to 4 hours in order to sleep through the night, or will it be sufficient to continue with 4,25 hours for another week?

        Has anyone else been needing as much as 6 weeks for the first fase of SR? I am struggling to maintain hope.

        Reply
        • Todd

          Wenche,

          If you are still waking up in the middle of the night or too early, it does mean that you need to maintain or further reduce your sleep time until the early waking stops. Even if you feel tired. I have too other suggestions:
          1. Are you eating a sufficiently balanced, nutritious diet? The tiredness and fatigue can often be helped by eating more nutrient dense foods — real meats & liver, fish, kale, cruciferous vegetables, nuts and dairy if you tolerate it.
          2. Do everything you can to cut back on the amount of time you spend “resting” on the couch. Try to stand up and walk around more, get fresh air. Even if you can only do this incrementally and gradually, a little at a time, it will help. Make it a routine to get up every 30 minutes and walk around.

          Todd

          Reply
  31. Ingrid Eadon

    I have suffered for a number of year from interrupted sleep pattern. Every night i sleep for approx 1hour, wake up, have a sip of water and go to sleep for another hour. This pattern continues through the night until around 7 am. I originally attributed the pattern to. “Dry mouth” problems but my GP assures me that this is more mental than physical. would SRT be a solution perhaps?

    Reply
    • Todd

      Ingrid,

      It depends. SRT helps mainly for cases of insomnia in which your sleep is not restful, and where you lie awake, wake easily, or wake before the morning. Typically, it goes along with a lot of fatigue.

      You can of course try SRT, but your case sounds somewhat different. You get to sleep on time without effort, wake on time, and are not fatigued during the day. It’s mainly a behavioral problem as your GP suggests. You are conditioned to wake at a routinely predictable time every night and get your sip of water. If I understand this correctly, the solution is behavior modification — finding a way to stop reinforcing the nighttime waking and reinforce continued sleep.

      Here’s a thought: It almost seems that getting up to get the sip of water has become a classical “reinforcer”. Subconscious expectation of the sip, and perhaps the routine associated with getting up, is driving the early wake-up. So the secret may be to avoid taking the sip of water. Even if it makes you uncomfortable at first, avoid taking that sip. Lay there in bed, even if it is an effort until you fall asleep. Then, when you get up at the normal time, take a sip, perhaps even a gulp or full glass of water. Reward yourself for getting up at the right time. Maybe even add other reinforcers — things that you really like — at that time.

      Try it daily for a week and see if that change in reinforcement patterns helps.

      Todd

      Reply
  32. Greta

    Hi there. greatly appreciate your blog too.

    This question is for my 12 year old son.

    We are seing a neuro who specializes in sleep disorder in two weeks.

    But, I want to know your thoughts on attempting this for him.

    I don’t know if he is a candidate for this type of therapy, but he is 10 hours in bed, but rouses all throughout the night. So many times it’s hard to count. He does seem to have a 1.5 hour period somewhere in the night where his body will let him be peaceful.

    I believe this happened due to a tincture I gave him 2.5 years ago for tick-borne infections. So, it is related to some chemical toxin. The pain of the situation is indescribable. His nightmares are gone, but we are left with this.

    Sadly, it has made him anxious as well, and I’m not really sure how tired he is each day after a sleep like this each night. Maybe sleeplessness is contributing to the fidgetiness….I don’t know.

    I was curious about the blog regarding the Cipro and sleep change, as it is chemically rleated as well.

    This is all I have since I cannot give sleep meds in good faith.

    Reply
    • Todd

      Greta,

      Really sorry to hear about your son’s condition. Sounds quite distressing for both him and for you. I don’t think I would try Sleep Restriction Therapy for him. First, it is difficult enough for adults to muster the willpower to get through the challenge of sleep deprivation for several weeks. But more importantly, it sounds like he has a serious underlying organic condition, possible medication-induced, that needs to be diagnosed addressed by a competent professional.

      Good luck,

      Todd

      Reply
      • Greta

        Thanks for your input . We’ve gone to several Neuros, and other misc doctors. They are aware of the situation, but bless everything off. MRI done, EEG done, etc. I have to try to improve his sleep quality. Do u know where I can get the ZEO sleep system now that the company is shut down? Aside ft this 3 rd neuro in July, I’m on my own.

        Reply
  33. Greta

    Hi Todd,

    I sent a reply to your message on my cell, but not electronically savy, so not sure if you got it.

    Just wanted to ask if you know where I can get the ZEO sleep tracker system since the company is no longer in business.

    I’m trying to learn about his sleep patterns. The neuros he has been to have only looked for seizure activity in his EEGs, but really don’t seem to know how to assess sleep waves. He’s also had MRI’s that are unremarkable. So, he is basically flying under the radar, and getting blessed off.

    His sleep study did show multiple arousals and his 24 hour EEG was a complete cluster of assessment due to the doctor assessing only seizures. So, the disk goes to another neuro that can hopefully assess for sleep. But if I could get this ZEO it would be a step in the right direction.

    Probably TMI, but I believe his sleep issue is tied to his enuresis, as the uro blessed off central diabetis insipidus, and last night he said he closed his eyes and then woke with it being morning. That used to hapoen everyday, now it’s random. He ate late and drank last night as he came back from Chicago on a trip. He only slept from 1-8 last night. I awoke him for camp. Granted he sprung up, but I needed to wake him. Interestingly, his pullup was DRY. He has had this enuresis since birth. But, I believe it would have gone away by now if not for the situation 2.5 years ago and the resulting sleep disruption.

    Thanks for listening and any thought to sleep, or the ZEO is sooosoooo appreciated.

    Reply

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