25 CONSISTENT SLEEP TIME [Rev 11-1-2017]
One of the treatments for difficulty falling asleep from not being sleepy. Follows Section 46.
Having a regular and consistent sleep time is an important aspect of gaining control over insomnia. This means, as much as possible, going to bed at roughly the same time every night and waking at roughly the same time every morning.
25a. Rationale
Having a consistent schedule lets a person make use of normal circadian rhythms (see Section 4) to manage the need for sleep and the expectation – conscious and unconscious – of being ready for sleep when he/she gets into bed. A person whose sleep time varies widely is fighting those same circadian rhythms.
Having a consistent sleep time also increases the probability that a person’s physiological drive for sleep (Section 4) will be high at the time of going to bed, because of the amount of time elapsed since getting out of bed the previous morning. If a person tries to fall asleep when the time is convenient rather than when he/she is sleepy, normal body needs are being neglected, and sleep should be relatively difficult.
A person with trouble sleeping may be tempted to manage sleep by…
- staying in bed longer sometimes, especially weekends and holidays.
- Sleeping later sometimes, when it’s convenient.
- taking naps, sometimes
- going to bed earlier to compensate for going to bed later.
However, so long as the person’s sleep schedule is irregular, these and other irregular treatments may not be very helpful and can be frustrating. The may in fact contribute to the person’s insomnia by contributing to the person’s irregularity.
25b. Treatment Suggestions
The basic treatment is to find a way for the person to sleep at about the same time every night. How this is done will depend on the person, his/her life style, and internal and external pressures to do different activities on different days.
It fundamentally involves creating a consistent schedule and sticking to it. That may be difficult for a person, or undesirable for some reason. “Two nights a week, I’m online with a chat group of my buddies on Hawaii, and we’re usually up from 2AM to 5AM. I can’t give that up!” Often, though, a schedule can be changed, and some adaptation made; especially if the reasons for variability are minor or the consequence of sleep loss is serious enough.
Changing a schedule can involve several issues. The person should…
- pick a time to sleep that he/she can consistently follow every day, seven days a week, and stick to that.
- Ideally, it should match hours of daylight for being awake and darkness for sleep, to take advantage of normal circadian cycles. Otherwise, light management may need to be part of the plan (Section 27).
- Sticking to a schedule may mean staying up later than comfortable on nights the person would normally go to be early, and setting an alarm on mornings that he/she would usually sleep later.
- Limit use of the bed to sleep and sex (Section 20).
- wait until he/she is tired before going to bed at night, to encourage falling asleep quickly. (Bootzin and Perlis, 26-27, principles #1 and #5).
- consider it a good sign, to be tired during the day, because it may lead to an easier time getting to sleep at night.
- avoid naps (Section 32) because they will reduce the sleep urge at night.