Insomnia: A Plan for Restoring Your Sleep

 By Dr. Julie Davelman

The word insomnia has been used to describe any problem with sleep. Different sleep problems however, have different solutions, and this week’s discussion will focus only on true insomnia.  Insomnia is clinically defined as difficulty in falling or staying asleep or experiencing non-restorative sleep for at least half of the nights for three months or more. 

If you find yourself fighting sleep all day and still nodding off, this is usually a sign that what you have is not insomnia, and the plan proposed below is unlikely to work for you.  The technique described below (based on the research of Colleen E. Carney, Ph.D.) may seem counter-intuitive and challenging, but try it for several weeks before making up your mind because the alternative is continuing to sleep poorly. Let’s get started…

Most people who have trouble sleeping underestimate how much sleep they actually get.  It is not uncommon for people who have sleep problems to say, “I don’t sleep at all,” which is rarely true.  Thus, the first thing that a person needs to do is track how much sleep they are actually getting. Here is the information you need to gather:

Try to fill in this chart as close to waking in the morning as possible, as that will help to maximize accuracy.  Also, you should track for at least one week, preferably two.  Once you complete the tracking phase, it is time for some math.  Do the following calculations for each day:

1. Total time in bed: E – A
2. Total time spent awake during the night: (B-A) + C
3. Total time awake in the morning: E – D
4. Total time awake: Step 2 + Step 3
5. Total asleep time: Step 1 – Step 4
6. Total average sleep time: The sum of step 5 across all days divided by the number of days you were able to track

The Total Average Sleep Time represents the amount of sleep your body can currently produce.  Moreover, although people would love to fall asleep the moment they get into bed, it is normal to take up to 30 minutes to fall asleep.  So, you should ideally be spending 85-90% of the time in bed asleep.  Since you cannot force or wish your body into producing more sleep, you need to reduce the amount of time you spend in bed.  As you read the steps that follow remember, this seemingly draconian plan is temporary and meant to restore your ability to sleep well.  Plus, it is based on how much you are actually sleeping, so it is not causing less sleep. Here is the plan:

1. Identify the earliest time that you have to be awake during the week. This will be your wake up time EVERY DAY since you need to train your Body Clock
2. Add 30 minutes to your Total Average Sleep Time. This is how much time you can spend in bed.
3. Start at your waking time and add the amount of time in Step #2.
4. This is the earliest time you can go to sleep.

For example, if you have to wake up at 6am, and you currently produce 4.5 hours of sleep.  Adding 30 minutes gives you 5 hours in bed.  Thus, the earliest you can go to bed is 1am.

That being said, you should only go to bed when you are very sleepy (that means almost unable to keep your eyes open and not just tired), so if you are not sleepy at bedtime, continue to stay up until you are.  If you get into bed, and within 15 you realize that you will be unable to fall asleep, get out of bed and do something non-stimulating but pleasant.  Go back to bed, once you are sleepy.  However, it is critical that you still wake up at the predetermined time. Since you need to make sure that you are building enough sleep drive, DO NOT sleep in regardless of how badly or how little you slept the previous night.  Also, DO NOT nap the following day, and DO NOT go to bed until your predetermined bedtime.

Once you can regularly sleep for 85% of the time you are in bed, try extending this time in 15 minute increments.  If your body is able to produce more sleep consistently, keep increasing the time.  If you find that you are awake for those 15 minutes, go back to the previous amount.