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

We all know how important good quality sleep is and how awful we feel after a string 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’s no big 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 slept well (ie, rarely had trouble falling or staying asleep) lived an average of 4.7 years longer than poor sleepers; for women, the increase in longevity due to good sleep was 2.4 years.

But if you’re a bad 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 is known, is one element of cognitive behavioral therapy for insomnia (CBT-I) that can be very effective. And it’s something I’m doing as part of a new study on sleep disorders.

Dr.  Michael Mosley says poor sleepers should try to spend less time in bed in order to sleep better

Dr. Michael Mosley says poor sleepers should try to spend less time in bed in order to sleep better

If, like me, you struggle with insomnia, then you know that one of the worst things is being able to lie in bed for what feels like hours worrying about how hard you are to sleep.

Night after night I wake up at 3am and I just can’t convince my brain to shut off.

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

Although this approach is not widely used by general practitioners, numerous studies show that it is effective.

A US study with postmenopausal women (who often suffer from bad insomnia, for example due to night sweats) showed that just two weeks of sleep restriction resulted in 30 minutes more sleep per night, a large reduction in fatigue and drowsiness, and a major boost in energy , reported Sleep magazine in 2019.

A more recent review of eight studies by the University of Oxford reached similar conclusions.

I’ve written about sleep restriction therapy before – and now I’m actually going to try it, as part of research being conducted 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 testing has shown that many, without realizing it, also have sleep apnea, where they repeatedly stop breathing during parts of the night.

It’s an important finding, because sleep apnea not only makes you feel shattered, but also increases your risk of heart disease, stroke, and car accidents while driving.

In my case, the problem is a common sleep disorder called sleep maintenance insomnia. I have no trouble falling asleep, but I wake up in the middle of the night and have a hard time getting back to sleep. One of the things the researchers recommended to me is sleep restriction therapy.

This isn’t for everyone, and while you can try it yourself, it’s best to seek professional help (and if you have a sleep disorder or serious health problem, you should consult your doctor first).

At first you may experience a lot of drowsiness during the day, so you should not drive. You start by calculating how long you sleep on average by keeping a sleep diary for a few weeks or by using a sleep tracker.

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

For the next few weeks, I’ll limit the time I spend in bed to just over six hours — this means going to bed at 11 p.m., but getting up shortly after 5 a.m.

(There is no standard number of hours in sleep restriction therapy, it depends on the individual: some people go as far as five, but I wouldn’t recommend doing 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’ve chosen a wake-up time, stick to it for at least two weeks. You should also keep track of how long you sleep now, as a percentage of the time you spend in bed (so if you wake up during the night, you should write that down, and for how long).

The amount of time you spend sleeping in bed is a measure of your “sleep efficiency.”

Someone who goes to bed for eight hours but sleeps only six hours has a sleep efficiency of 75 percent (to calculate, 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, or 75 percent), which is bad.

The goal is to spend 85 to 90 percent of your time sleeping in bed.

If you’re on a sleep restriction program and you spend 85 to 90 percent of your time sleeping in bed, you’re probably told to set your alarm clock 30 minutes later.

Bad sleepers should make sure they only associate their bed with sleep and sex - and nothing else

Bad sleepers should make sure they only associate their bed with sleep and sex - and nothing else

Bad sleepers should make sure they only associate their bed with sleep and sex – and nothing else

The idea is that week after week you gradually reduce the time you spend in bed until you feel you are getting enough.

It’s important not to take naps, as this will reduce your sleep urge, and also to practice good sleep hygiene: exercising regularly, cutting back on caffeine, and keeping computers, TVs, and smartphones out of the bedroom.

I’m told the first few weeks will be tough, but if it means getting better sleep, in the long run, then it’s worth it. I’ll let you know how I’m doing.


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