– How to Fix Insomnia –

4: Follow These Steps

This is the point where we translate what we’ve talked about so far into a concrete plan. This is also the point where you need to decide how committed you are to improving your sleep. Because I’m writing to a wide audience, I know that people are at different starting points with their willingness to change sleep-related behaviors, and also that different people struggle with different sleep-related behaviors. Some have been sleeping in every weekend, or have been taking naps almost daily, or have been getting into bed at 8:30 pm every night only to lie awake for 2-3 hours. For years! So certain behavior changes may represent a huge commitment and a difficult process for certain people. For others, these commitments may not be too difficult to make.

I think it’s important for you to take a moment to be honest with yourself and assess how easy/difficult each of the behavior changes will be for you and also your level of commitment to following through with these changes. If you’re not ready to go through this sleep re-training period at this time or are looking for a sleep improvement strategy that is less involved, check out the Good Night’s Sleep Guide.

Setting a new sleep schedule

Step 1 – Calculate average nightly sleep (hours)

  • This can be accomplished by a number of different methods. Easiest, but probably least accurate, would be to just guess. On average, how many hours of actual sleep do you think you’re getting per night?
  • A second method would be to use a sleep tracking device like Fitbit, Garmin, Beddit, smartwatch, or app that can give you this average. Be warned, though, that these trackers are notoriously inaccurate for people who have sleep problems. Take the data with a grain of salt.
  • Still, the most reliable and studied method is to record approximately 2 weeks of sleep logs and then calculate the baseline data – average time spent in bed per night, and average time spent actually asleep.

Step 2 – Determine consistent wake-up time

  • This is usually pretty easy. What wake-up time makes most sense if you’re going to be getting out of bed every morning at the same time? Or: what time do you wake up on weekdays? You’re going to set your alarm for this time 7 days a week.

STEP 3 – Calculate new bedtime

  • This step can a bit harder because of some required math, but the idea is simple: your new bedtime will be your wake-up time (step 2) minus the number of hours of average nightly sleep (step 1). Start with your wake-up time and go backward the number of hours and minutes you came up with in step 1.
  • Important: don’t restrict your time in bed to less than 5.5 hours, even if you calculated a smaller sleep number. Start with 5.5 hours, and you’ll likely see results, but if you feel you need to go lower, it’s probably a good idea to seek help from a medical professional.
  • Adjust as necessary: If the new bedtime and wake-up time combination sounds unusually harsh or impossible to follow, consider adjusting it by 30 or 45 minutes. You want to pick a bedtime that you know you’ll be consistently sleepy by, but you’re not trying to engage in sleep deprivation torture.

Now you have calculated a bedtime and a wake-up time – your new sleep schedule. This is not a fixed sleep schedule, but merely a starting point. So don’t worry if you aren’t sure you got the calculations right or if you don’t think you can adopt this new schedule permanently. It’s not permanent.

And, if you remember the three sleep systems we talked about, you’ll see pretty clearly how we are targeting the sleep drive and biological clock. With this new sleep schedule, you are aiming to keep the sleep drive consistently high by the time you get into bed, and to correctly cue the biological clock by waking up at the same time. Lastly, combined with consistent behavioral conditioning, you are reinforcing a pattern of falling asleep and staying asleep in bed, which should cement into a new positive sleep pattern by the end of the training period.

And finally, now that we have a new sleep schedule…

Follow these rules

  1. Stick to the new bedtime and wake-up time every day.1
  2. If you are not sleepy at bedtime, delay getting into bed until sleepy; however, do not go to bed before your bedtime.
  3. Avoid naps.2
  4. Eliminate all non-sleep activities from bed, such as watching TV, using smartphone, etc.3
  5. If you’re in bed but wide awake and unable to fall [back] asleep within approximately 20 minutes, get out of bed and wait until you feel sleepy.4

Practical considerations

You will be extra sleepy. If you follow these rules and have set an appropriately later bedtime, you will feel increased sleepiness at your bedtime and likely throughout the day as well. You may be surprised at how hard it is to stay up until your bedtime or how quickly you’ve been falling asleep. You may feel acutely sleep deprived. These are great signs! They mean that your sleep drive is consistently high, and that your body is responding to the behavioral changes.

Safety first. This increased sleep drive is an important part of consolidating your sleep. However, you should never sacrifice safety while going through the sleep training. Never get behind the wheel if you feel drowsy, or operate machinery or engage in other potentially hazardous tasks. Do take a nap to fight off the drowsiness, maybe coupled with caffeine. Also consider increasing the amount of allotted time in bed or seeking professional/medical guidance.

Plan ahead. These rules are pretty simple, and when you connect them to the sleep biology (the three systems), they make a lot of sense and are easy to understand. That simplicity can be deceptive, though, because it requires a great deal of discipline and commitment. After all, you are engaging in a period of sleep “training”. And long-term behavior changes are rarely easy. Planning ahead greatly increases the likelihood you’ll actually do the thing you’ve set out to do when the time comes. For example…

Plan some activities. Getting out of bed just because you’re not sleepy or can’t fall asleep can be mentally unpleasant. However, now that you see how important behavioral conditioning is, I hope you view it as a non-negotiable. Plan ahead for times when you need to get out of bed or delay getting into bed until sleepy: you’ll want to engage in relaxing, sleep-promoting activities. Make a list of some low key, low light, calm activities you can do for these times.5 Conversely, you’ll also want to plan ahead for the opposite: having to do activities to help you stay up until your new bedtime. Remember, you will be extra sleepy and likely have a hard time staying up. Plan some activities that are physically and mentally stimulating, and keep the lights bright. You’ll want to transition from “trying not to fall asleep” to “winding down before bed” about 30 minutes to 1 hour before your bedtime.

Sleep meds/aids. There isn’t a hard and fast rule about having to be off sleep meds or sleep aids in order to do behavioral treatment of insomnia. If you’re on prescription sleep meds, obviously only make changes to your medication usage under the guidance of the prescribing provider. Hopefully, you can discuss slowly tapering down the dosage and weaning off the meds, since they are not meant to be used long-term anyway. Same goes for over the counter sleep aids – make a plan to wean off of them so that you can experience the full effect of the behavioral changes. Ideally, you’d do this step before starting sleep training, but this can be done during the sleep training or even after. It’s really up to you.

Finally, go to the last page to learn about what comes next.

  1. Including weekends, mornings following a rough night, holidays and other possible excuses.
  2. Unless for safety reasons or otherwise necessary. In those cases, favor naps that are shorter and earlier. Rule of thumb: 20 min or less, 2 pm or earlier.
  3. With the exception of intimacy.
  4. This includes both when you first get into bed and also if you wake up in the middle of the night are are wide awake.
  5. Here are some things my clients commonly come up with: books (print, not digital), podcasts, audiobooks, puzzles, gentle yoga, stretching, breathing exercises, low key hobby (like art or knitting), etc. Avoid engaging in things that are too interesting or stimulating, and also avoid using light-emitting electronics.