Overnight treatment for chronic insomnia

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Each night, as millions of Americans slumber peacefully, millions more can't fall asleep or stay asleep. For some, it's just a now-and-then hitch. For others, insomnia is a chronic problem that affects mood, daytime alertness and performance, and emotional and physical health.

Chronic insomnia often starts out innocently enough. Stress or trouble at home or work interferes with sleep for a few nights. But then the habits that come along with not sleeping—looking at the clock, lying in bed wide awake, worrying about not getting to sleep—can stick. Soon just the sight of your bed or the tick of the clock toward 10:00 pm can trigger anxiety and render you wide awake.

Loosening the grip of chronic insomnia can take time and effort. Some of the sleepless turn to medications. One widely used behavioral approach, called stimulus control therapy, aims to break harmful sleep habits and thoughts over the course of several weeks. A new approach that uses a 25-hour program called intensive sleep retraining may be enough to break the cycle in a day.

Sleep boot camp

Intensive sleep retraining works like this: The night before undergoing the program, a person with chronic insomnia sleeps (or stays in bed) no more than five hours. The next day, he or she reports to a sleep lab around bed time. The next 25 hours are divided into 50 thirty-minute sessions. During each one, the person tries to fall asleep. If successful, the participant is woken up after just three minutes of sleep, asked if he or she had been asleep, and told that he or she had indeed fallen asleep.

The sleep deprivation that builds up over the course of this pattern helps even the most hard-core insomniac fall asleep a few times. The goal of the therapy is to help people feel what it's like to fall asleep rapidly and learn that they can do it.

In a head-to-head trial, Australian researchers tested intensive sleep retraining against other treatments for insomnia. They randomly assigned 79 people with chronic insomnia to four groups: one session of intensive sleep retraining, one session of intensive sleep retraining followed by five weeks of stimulus control therapy, five weeks of stimulus control therapy alone, or no treatment. All participants attended five weekly information sessions in which they learned about better sleeping habits (called sleep hygiene).

Six weeks after beginning the trial, participants who got intensive sleep retraining were falling asleep faster than those who didn't get it. The combination of intensive sleep retraining and stimulus control therapy worked best. The results were published in the journal Sleep.

Do this at home?

An editorial accompanying the article called the work a "stunning demonstration" that should help drive the development of new non-drug therapies for insomnia.

As the researchers themselves point out, though, intensive sleep retraining is expensive. Many people who need it can't afford it. A self-administered version that could be done at home would bring it within reach of anyone with a good alarm clock, a steadfast partner, and the fortitude to sleep no more than three minutes every half hour over the course of an entire day. Let's hope that the Australian study stimulates the creation of such home programs.