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Sleep Restriction Therapy

From Medscape Today . The full article is http://www.medscape.com/viewarticle/462938_4 you will need to register at the site in order to view it.

Stimulus control treatment.

Stimulus control treatment consists of the behavioral instructions of:

(1) going to bed only when sleepy,

(2) using the bed and bedroom only for sleep and sex,

(3) whenever one is unable to fall asleep after 15-20 minutes, getting out of bed and going into another room and only returning when sleepy,

(4) having a regular time to get out of bed in the morning even if one only had a little sleep the night(s) before, and

(5) not taking naps during the day.

Stimulus control treatment is based on the concept that insomnia is a conditioned behavior to bedtime and bed/bedroom cues associated with sleep. The idea of this treatment is to retrain the individual with insomnia to associate the bed and bedroom with rapid sleep onset. This is accomplished by limiting activities not compatible with sleep that serve as cues for staying awake and also by adhering to a consistent sleep-wake schedule.

Sleep restriction treatment.

Sleep restriction treatment uses a paradoxical approach where less time is spent in bed. If an individual reports spending an average of 5 hours actually asleep, while spending 7 hours in bed, then that person should only be in bed for 5 hours and, after that point, must get out of bed (and should have an alarm clock set to remind oneself). The idea is to create a mild state of sleep deprivation that will eventually cause a more rapid sleep onset, more efficient sleep, and consistent sleep duration. Roughly on a weekly basis, time in bed is either increased by 15-20 minutes (when sleep efficiency increases) or decreased by 15-20 minutes (when sleep efficiency decreases). Time in bed is kept unchanged when sleep efficiency is roughly between 80% and 90%. Numerous studies support the effectiveness of this approach.

One possible treatment option for insomnia seems to be paradox: You  should try to restrict you sleeping time! This can help to reduce the time you spend awake in your bed and all the worrying about the problems to fall asleep. Restriction of sleep will cause you to become tired again and to establish new routines to fall asleep.

Usually one starts sleep restriction therapy at first with only a very short period of sleep during the night. Then this time will increase until a normal sleeping time is achieved. To start this kind of treatment you have to stick to a strict regime and stay awake even if you feel sleepy or have problems to spend the time in the late evening. If you start with a sleeping time of 4 hours you would have to stay up until 2 or 3 am if you decide to go up at 6 or 7 in the morning. And this not only for normal working days but also weekend or public holidays. If you find sleep for this short period you can increase the sleeping time by 15 or 30 min until you finally reach a normal sleeping time according to your personal needs.

Don't go to bed until you feel sleepy, even if this is later than your normal bedtime.

Set your alarm clock to wake you about 6.30 am, even if this means you only get a few hours sleep for the first few nights.

If you don't fall asleep within 30 minutes, get up until you feel sleepy again.

DO NOT NAP during the day, this way you are very tired at night.

As your sleep improves gradually go to bed earlier and continue to get up early so you get a full night's sleep and establish a regular routine.



Disclaimer:  The information contained in this website was not compiled by a doctor or anyone with medical training. The advice contained herein should not be substituted for the advice of a physician who is well-informed in the subject matter discussed. Before making any decisions about your health or treatment you should always confer with your physician and it is always assumed that you will do so.

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Last updated 21 July 2020