The least fun insomnia treatment
(But one of the most effective)
           by Leon Altman

Let's just say it right off the bat. Sleep restriction therapy, also called sleep deprivation therapy, is no fun. But its effectiveness was demonstrated in a landmark study headed by Dr. Arthur Spielman of the City College in New York

The basic program goes like this. You keep a sleep log for a few weeks. Mark down when you went to sleep and when you got up. If you got up in the middle of the night mark down how long you stayed up. If you went to bed and didn't get to sleep, don't count that as sleep time.

Only count the time you think you were asleep. But don't be an obsessive clock watcher. Keep it turned away from you. You only need to glance at it when you get up or go to sleep.

Obviously, this will be a rough estimate because it is impossible to be precise as to the time you nodded off to sleep. Still, a rough estimate over a period of time will be accurate enough for this purpose.

Set a limit to the number of hours you are allowed to sleep every night
You or your doctor calculates the average minimum time you are actually asleep each night. Based on that number, you set a limited number of hours you are allowed to sleep every night. If your average number is 5 hours, set that as your limit.

(it is generally accepted that the limit shouldn't be less than 5 hours to prevent excessive daytime sleepiness).

Yes, this is way below the minimum recommended hours, but that is exactly the point. You set up a schedule of when you are allowed those five hours and you must stick to it. Say for example, 12 midnight to 5 in the morning.

Some sleep restriction rules
You set your alarm and get up at 5 no matter how few hours you slept. You don't go to bed before midnight (if that is the schedule you set up). And there is no napping during the day.

If you find yourself starting to nod off before the designated time, splash cold water on your face to stay awake.

A few more general rules. If you can't fall sleep at first, or you awaken in the middle of the night, wait about 20 minutes before getting out of bed. If you remain awake after that time, get up from the bed. Go to the couch or someplace else.

If watching TV makes you sleepy, you can put on the TV. If reading does it for you, do some reading (but be careful what you read or watch. (see our article "Dull reading for good sleeping").

Only when you feel drowsy do you go back to bed. Again, if after about 20 minutes you don't fall asleep, get up and repeat the process.

More efficient and higher quality sleep
This is not easy. There are days (and nights) that you will curse whoever convinced you to do this. That's okay. Just keep following the routine. As days go on, you will get more and more tired by the time its time to sleep. And before too long you will probably fall asleep much faster than before.

Also, what often happens is you get more concentrated and higher quality sleep. You start to sleep more efficiently (the amount of time you actually sleep when in bed). If you had been getting up in the middle of the night, you will tend to sleep longer before getting up and you will get back to sleep more quickly.

After some time, when sleep efficiency have increased sufficiently (to 90% of the time you were in bed) you gradually increase the amount of time you are allowed to sleep. Say about a half hour for another few weeks.

The theory is that this process builds up sleep debt. It increases endogenous sleep inducing chemicals that are connected to your desire and ability to sleep. Soon or later your body just needs to get more sleep. Ideally this both resets your body clock and trains you to sleep more efficiently.

In many patients after a few weeks or a few months, this has led to more concentrated, longer and better quality sleep. However it doesn't work as well with everyone. If the improvement is not sufficient, see a sleep specialist about either modifying your sleep restriction therapy or trying something else.