To help overcome insomnia, get out of bed: study

NEW YORK (Reuters Life!) - For insomniacs to get better sleep, spending less time in bed may be key -- one part of short-term behavioral therapy that could help older adults beat insomnia, according to a study.

A resident sleeps in a senior citizens' home in Svetlograd, about 100 km (62 miles) from Russia's southern city of Stavropol April 1, 2009. REUTERS/Eduard Korniyenko

Daniel Buysse, at the University of Pittsburgh School of Medicine, led a research team that found that a few short visits and phone calls with a nurse as part of a brief behavioral treatment helped overcome chronic insomnia among older adults.

Insomnia affects one in every five U.S. citizens, rising to one in three among the elderly, and has been linked to a range of physical problems from accidents to hypertension. Not surprisingly, it is also detrimental to mental health.

The keystone of the behavioral therapy involved, as reported in the Archives of Internal Medicine, was simple yet counter-intuitive.

“When you are sleeping poorly, the most important thing you can do is spend less time in bed,” Buysse said.

Three decades of research has shown that cognitive behavioral therapy is just as effective as a pill for insomnia, with fewer side effects. Yet the time and resource-intense strategy, usually involving between six and eight hour-long appointments with a clinical psychologist, is not widely available.

In addition, the cost, generally in the hundreds of dollars, is beyond the reach of many.

To see if the pill-free therapy could be shortened and simplified, Buysse and his colleagues studied 79 adults with chronic insomnia who averaged 72 years of age.

The participants were randomly assigned to receive either printed educational material about sleep or the brief behavioral treatment of one 45- to 60-minute in-person session, a 30-minute follow-up session and two 20-minute phone calls.

A mental health nurse practitioner focused the behavioral instruction on how to restrict time in bed and set regular sleep-wake schedules, while also discussing the biological reasons behind the strategy such as the body’s daily cycle of mental, physical and behavioral changes.

“This (therapy) has the effect of compressing your sleep into a more solid block,” Buysse told Reuters Health in an e-mail.

“More consolidated sleep is more refreshing.

Based on questionnaires and sleep diaries, the team found that two out of every three participants receiving the behavioral intervention responded favorably by the end of four weeks, while just one out of every four receiving the printed material experienced substantial sleep improvement.

On average, for every 2.4 participants treated, one responded favorably and one overcame insomnia -- improvements that were sustained for at least six months, and were backed up by data from a sleep monitor worn on the wrist or the ankle.

But when the researchers looked at information from a different, more in-depth sleep monitoring system, they failed to find significantly better outcomes with the behavioral therapy.

The new results were similar to those previously published on the more intense cognitive behavioral therapy.

“A lot of insomniacs spend a lot of time lying in bed worrying about their sleep, among other things. They expect to have insomnia,” said Thomas Neylan of the University of California, San Francisco, in an e-mail to Reuters Health. Neylan wrote a commentary to accompany the study.

Though Neylan said that sometimes the best thing to do is prescribe sleeping medicine, this can cause problems from dependence to grogginess during the day.

“If you’re not ready to fall asleep, don’t lie down in bed and try to force yourself to sleep. And if you wake up in the middle of the night and don’t fall back asleep easily, get out of bed,” Neylan said.

“You don’t want to have any linkage between the experience of lying in bed and being awake.”


Reporting by Lynne Peeples at Reuters Health; editing by Elaine Lies