Sleep deprivation can reset the brain

RESTRICTING the amount of time spent in bed might sound counter-intuitive. However, many people with insomnia spend more time in bed to compensate for their poor sleep, to give themselves more ‘chance’ to fall asleep.

Yet this merely increases their time in bed not sleeping, thus strengthening their negative thinking about being in bed or their conditioned response to bed.

By limiting time in bed to about five hours a night (the amount depends on the individual) for a couple of weeks during CBTi, the theory is that we end up strengthening the brain’s drive to sleep while in the bed.

Of course, this isn’t easy. Things often have to get worse before they get better during this element and other parts of CBTi.

At its most extreme, there is an experimental, if brutal, treatment in Australia called intensive sleep retraining.

Patients are asked to spend no longer than five hours in bed the night before going to a sleep laboratory for a 24-hour treatment. They are permitted to try to fall asleep at night, every 30 minutes, with electrodes attached to their scalp.

If they haven’t dropped off after 20 minutes, they are asked to get up.

Alternatively, if they are able to fall asleep, they’re woken again after three consecutive minutes of sleep. In all, they will have had 48 opportunities to fall asleep in 24 hours: the theory is they’ll be so sleep-deprived they will fall asleep as soon as allowed, re-establishing a conditioned response between bed and the relief of sleep.

Results from trials have been impressive. The short, sharp shock rapidly reconditions the response to getting into bed and results in quick improvements in sleep.

This technique is not yet used routinely in clinical practice and is not appropriate for everyone but it shows that retraining the brain to associate bed with sleep is fundamental to dealing with insomnia.