Understanding CBT-I: Limiting Your Time in Bed
When you have insomnia, you may spend time in bed awake, trying to sleep. You may spend 8 or 9 hours in bed, but only sleep for 6. You may stay in bed longer in the morning to try to rest more. When this happens, you disrupt your natural sleep cycle. This can make it harder over time to get a good night’s sleep.
Cognitive behavioral therapy for insomnia (CBT-I) has a tool to tackle this problem. It’s called sleep efficiency training. It’s also called sleep restriction therapy. Sleep efficiency training is a way to get your sleep cycle back on track. It’s done by following a prescribed bedtime and wake time based on how much sleep you are actually getting. It is recommended that you work with your healthcare provider to figure out this sleep window.
More hours, less rested
You may think that spending more time in bed is helpful. But this can actually make you feel less rested.
Sleep that is not efficient can:
Give you poor-quality sleep that leaves you feeling less rested
Weaken your drive for sleep
Make it harder to fall asleep at bedtime
Make it harder to get out of bed in the morning
Sleep efficiency training will help you fix these problems. When you spend less time in bed, your sleep will be more efficient and of better quality. Over time, you will be able to fall asleep and stay asleep with more ease. And you will feel more rested over time.
Sleep efficiency training will:
Make you more sleepy at bedtime
Help you fall asleep more quickly at night
Give you a more sound sleep
How it works
Your healthcare provider will talk to you about your sleep schedule and habits. Before starting, make sure to talk with your provider about any concerns or questions you have. Tell your healthcare provider if you have a history of epilepsy, bipolar disorder, sleep walking, night terrors, severe anxiety, sleep less than 5 hours per night, or if you are very sleepy during the daytime. In these situations, your healthcare provider will adapt the recommendations for your safety.
Together you and your healthcare provider will go through the process of adjusting your time in bed to be more efficient. You will need to:
1. Keep a sleep diary for a week or more. This helps show how much sleep you’re getting.
2. Work with your healthcare provider to set into bed and wake times.
3. Stick to your into bed and wake times every day of the week.
4. Set an alarm for your wake time. Get out of bed within 5 to 10 minutes of your set wake time.
5. Do not take naps during the day.
6. Keep your sleep diary.
7. Work with your healthcare provider to increase the amount time you spend in bed each week until your sleep schedule works well for you.
What to expect
You and your healthcare provider will work together to set your bedtime and wake time. You’ll also talk about ways to stay awake until your bedtime. You may be sleepy during the day, at first. The sleepiness you feel may help you get better sleep the next night. Over time, you and your healthcare provider will add time to your sleep window. You will then reach a sleep-wake schedule that contributes to good, quality sleep.
Help for daytime sleepiness
While your body is adapting, you will feel more sleepy during the day. There are activities you can do to help you feel more awake. These include:
Being outside in daylight as much as possible
Opening curtains or window blinds to let in light
Being around bright lights indoors
Doing errands and being active
Doing household chores
Talking to people
Stick with it
When you make a change to your sleep habits, it can take a while for you to feel better. You may feel more sleepy at first. CBT-I methods take time to work and require regular monitoring with a sleep diary. Be patient and keep using the methods your sleep therapist gives you.
Working with CBT-I
The tools of CBT-I are often used together. Sleep efficiency training is often done along with other CBT-I tools. These can include stimulus control, cognitive therapy, relaxation, and sleep hygiene. Your healthcare provider can tell you more about these tools and which can work best for you.
For more information
If you are a Veteran and you have insomnia, contact your VA health care provider about CBT-I or check out some of the below resources.