DR MICHAEL MOSLEY: How spending LESS time in bed could beat insomnia 

We all know how important good quality sleep is, and how awful we feel after a run of bad nights.

Poor sleep affects almost every organ in your body, from your brain to your heart, your immune system to your sex drive — so it is not a great surprise that being a good sleeper is linked to a longer, healthier life.

A recent study of more than 170,000 people, by Harvard Medical School, found that men who were good sleepers (i.e. they rarely had problems falling or staying asleep) lived, on average, 4.7 years longer than poor sleepers; for women, the longevity boost from good sleep was 2.4 years.

But if you’re a poor sleeper, what can you do about it? One solution could be to spend less time in bed.

It may sound counterintuitive, but sleep restriction therapy, as it’s known, is one of the elements of cognitive behavioural therapy for insomnia (CBT-I), which can be very effective. And it’s something I’m doing as part of new study on sleep disorders.

If, like me, you struggle with insomnia, then you will know that one of the worst things about it is that you can lie in bed for what feels like hours fretting about the fact that you are finding it so hard to sleep.

Night after night I wake up at 3am, and I just can’t persuade my brain to switch off.

The idea behind sleep restriction therapy is to counter this by spending a few weeks cutting down the amount of time you spend in bed. If you only go to bed when you are really tired, the idea is that this will retrain your brain to associate ‘bed’ with sleep and sex — and nothing else. That way early morning wakings should become less frequent and fleeting.

Although this approach is not widely used by GPs, numerous studies show it is effective.

A U.S. trial with postmenopausal women (who often suffer from bad insomnia, because of night sweats, for instance) showed just two weeks of sleep restriction led to 30 minutes more sleep a night, a large reduction in fatigue and sleepiness, and a big boost in energy, reported the journal Sleep in 2019.

A more recent review of eight trials by Oxford University came to similar conclusions.

I’ve written about sleep restriction therapy before — and now I’m actually going to try it, as part of research being carried out at a sleep research lab at Flinders University in Adelaide, Australia. 

They’ve recruited 30 patients with common sleep problems — everything from restless leg syndrome to chronic insomnia — but initial tests have revealed that many, without realising it, also have sleep apnoea, where they repeatedly stop breathing for chunks of the night.

It is an important finding because as well as leaving you feeling shattered, sleep apnoea increases your risk of heart disease, stroke and car accidents when driving.

In my case, the problem is a common sleep disorder called sleep maintenance insomnia. I don’t have difficulty falling asleep, but I wake up in the middle of the night and find it difficult to get back to sleep. One of the things the researchers have recommended for me is sleep restriction therapy.

This isn’t for everyone, and while you can try it yourself, you’d do better to seek professional help (and if you have a sleep disorder or a significant health problem you must first consult your doctor).

Initially, you may experience a lot of daytime sleepiness, so you should not drive. You start by working out how long, on average, you are sleeping by keeping a sleep diary for a couple of weeks, or by using a sleep tracker.

I typically go to bed at 11pm and get up at 7am. In theory, that’s eight hours’ sleep, but from my tracking I know I’m getting less than seven — and a lot of that is light sleep, rather than the more restorative, deep sleep.

For the next few weeks, I’m going to restrict the time I spend in bed to something more like six hours — this means going to bed at 11pm, but getting up soon after 5am.

(There is no standard set of hours with sleep restriction therapy, it depends on the individual: some people may go as low as five hours, but I wouldn’t recommend that unsupervised.)

The schedule you follow in terms of when you go to bed and get up depends on your lifestyle and what you think you can tolerate. But once you have chosen a wake-up time, you have to stick to it for at least two weeks. You also have to keep a record on how long you now spend sleeping, as a proportion of the time you spend in bed (so if you wake in the night, you need to write that down, and for how long).

The amount of time you spend asleep in bed is a measure of your ‘sleep efficiency’.

Someone who goes to bed for eight hours, but spends just six hours asleep, has a sleep efficiency of 75 per cent (to do the maths, divide your actual hours of sleep by how long you spend in bed, times 100: in this example, it would be 6/8 x 100, i.e. 75 per cent), which is poor.

The aim is to spend 85 to 90 per cent of your time in bed, asleep.

If you’re on a sleep restriction programme, once you are spending 85 to 90 per cent of your time in bed actually asleep, then you will probably be told to set your wake-up alarm for 30 minutes later.

Poor sleepers should ensure they only associate their bed with sleep and sex – and nothing else

The idea is that week by week you gradually increase the time you spend in bed asleep, until you feel you are getting enough.

It is important that you avoid napping, as this will reduce your sleep drive, and also that you practise good sleep hygiene: doing regular exercise, cutting down on caffeine, and keeping computers, TVs and smartphones out of the bedroom.

I’m told the first few weeks are going to be tough, but if it means getting better sleep, long term, then it will be worth it. I will let you know how I get on.