To Get Better Sleep, Maybe Try Staying

Awake
By Melissa Dahl Follow @melissadahl
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Photo: Geon-soo Park/Sung-Il Kim/Corbis

So you cant sleep. An estimated 30 percent of Americans suffer from chronic insomnia, and the
sensible, standard advice given to them is to practice sleep hygiene and simply try going to bed
earlier. If (or when) this fails, there are of course dozens of sleep medications available over the
counter or via prescription.
And yet the best treatment for chronic insomnia, according to the scientific literature, is one that
most people havent tried, no doubt at least in part because it sounds insane: The secret to getting
better sleep may be to purposefully get less of it, at least for a time.
Its called sleep restriction therapy, and its a component of CBT-I that is, cognitive behavioral
therapy specifically for insomnia. The idea is to reduce the amount of time you spend trying to
sleep to the actual number of hours you are capable of sleeping. Heres how it works: You keep
careful track of how much sleep you are really getting for several weeks lets say its about
five and a half solid hours per night. Then you set a nonnegotiable wake-up time, usually the
latest possible hour you can get up and still manage to get to work on time say, 6:30 a.m. So,
under the guidelines of sleep restriction therapy, you dont allow yourself to go to bed until 1

a.m. If youre successfully sleeping during that time, you gradually allow yourself to go to bed
earlier, in about 15-minute increments, until youre sleeping a sound seven to eight hours per
night.

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Of course, the last thing a person who cant sleep wants to do is intentionally deprive himself of
the very thing hes after. And yet the bulk of the evidence shows that it works, at least as well as
or, according to some studies, better than medication. Late this summer, for example, a
review of 20 studies examining the efficacy of CBT-I was published in the Annals of Internal
Medicine, finding that this approach to fighting insomnia was about equally as effective as
medication. Other, earlier clinical trials have compared CBT-I to popular drugs such as Ambien
and Restoril and have found that the therapy worked better than the medications in helping
people overcome their insomnia.
CBT-I is more than just sleep restriction it focuses on changing an insomniacs thoughts and
behaviors regarding sleep, and much of it does include the typical sleep advice, like shutting off
your electronic devices about an hour before sleep or going to bed and getting up at the same
time every day. This is all fine and good, says Dr. Michael Perlis, director of the behavioral sleep
medicine program at the University of Pennsylvanias Perelman School of Medicine; its when
he introduces the sleep restriction part of CBT-I that he tends to lose people. The minute they
find out what theyre supposed to do, thats the end, he said. Theyre done. And this, Perlis
and other sleep specialists Science of Us interviewed said, is no doubt a big part of the reason
why the therapy is woefully underutilized, despite the raft of evidence backing it up. "People get
very focused on total sleep time, on how much sleep they got," Perlis said. "And they forget what
actually pisses them off is not six hours of sleep that's not great. But waiting for sleep, being
in bed at the middle of the night staring at the ceiling? That's what you want to get rid of."
But sleep restriction, to put it mildly, is hard. Really, really hard. For insomniacs, resisting the
pull of sleep when it blessedly, finally makes itself known goes against their every instinct. Ben
Johnson, a librarian in Seattle, tried it for about four weeks in September, after a nine-month bout
of chronic insomnia. By nature and by profession Johnson is a meticulous researcher, so he
thought he knew what he was in for, yet it was still much more difficult than he expected. The
first week was hard, but then by week two the cool new factor of the whole thing had worn off.
You know, This grand experiment! This will help me out! By the second week I was just sort of
like, Well, this is helping, because Im sleeping more soundly, but at the same time I was also
like, Screw this, this is terrible, Johnson said. It was difficult enough to stay up at night; during
the day, at work and at home as he tried to play with his young son, he felt like a zombie. It was
really hard to be a person, he said. "It was really difficult to do anything [other] than, like, stare
into space. Still, he kept at it, until he stretched the five and a half hours he had been sleeping to
seven.
As it turns out, the reason why sleep restriction and CBT-I as a whole works may be as
simple as some old-fashioned classical conditioning, that staple of psych 101 classes, explained

Perlis. You're so exhausted by the time you hit the pillow that you immediately fall into a deep
sleep, so, in time, your mind starts associating your bed with actual, restful sleep. The flip side of
this explains why insomnia can be so hard to get over, too: Too many panicked, sleepless nights
and you start associating the act of trying to sleep with failing to sleep.
Besides, you likely know from experience that the amount of time it takes to get something
important done tends to shrink or expand to the amount of time you allow it. Its why many new
parents report their productivity at work increases after they have children; when they can no
longer stay late at work to complete a project, suddenly they're able to get it done during the
workday. When things absolutely have to get done, they have a curious way of getting done,
wrote Oliver Burkeman in a recent column at The Guardian regarding his own experience with
sleep restriction, and it appears to be true. The same principle that applies to deadlines seems to
apply to sleep, too.