Myths About Sleep Series: LYING IN BED EARLIER TO GET MORE SLEEP

“Humihiga na nga ako ng maaga, Doctora, para makatulog ng mas mahaba” (“I lie down in bed earlier to get more sleep”). A majority of my patients say this when seeking consultation. And so I ask, “Anong nagyayari? (”What happens?”). Patient: “Hindi pa rin ako makatulog” (“I still can not sleep”).

Many people with insomnia believe that spending more time in bed will increase their chances of falling asleep or getting more rest. This seems logical on the surface – if you're struggling to sleep, prolonging your time in bed will help, right?

WRONG. This is often counterproductive and can actually worsen insomnia in the long run.

WHAT HAPPENS WHEN YOU SPEND TOO MUCH TIME IN BED?

While the intention is good, spending excessive time in bed when you're not sleeping can have several negative consequences:

• Your natural sleepiness weakens when you spend too much time awake in bed.

• Lingering in bed, trying to fall asleep, often leads to fragmented sleep. You might drift in and out of sleep, waking up frequently throughout the night. I often liken this to "hunger" for food - when you take frequent small snacks, you will not feel hungry when it's dinner time.

• The more time you spend tossing and turning, the more anxious you become about not sleeping. This anxiety further fuels insomnia, creating a vicious cycle.

• Your mind is trained to think of the bed as a place for wakefulness and anxiety, rather than relaxation and sleep.

CBT-I: RE-TRAINING YOUR BRAIN FOR BETTER SLEEP

SLEEP RESTRICTION is a key component of Cognitive Behavioral Therapy for Insomnia. It aims to improve sleep quality by reducing Time In Bed, contrary to the learned behavior of prolonging it. It is more effective than medicines and is the preferred treatment for insomnia. Let me give you an idea on how I do it:

• The amount of time you're allowed to spend in bed is initially restricted to match your average sleep time. For patient safety, I prescribe a minimum of 6 hours of sleep, even for those who claim to get only 3-4 hours of sleep per night.

  
  

I ask the patient her SUSTAINABLE IDEAL WAKE-UP TIME, then count back 6 hours or her average sleep time, whichever is longer. That will be the time she starts to attempt to sleep. If she feels sleepy before, then (many fall asleep early, only to wake up 2-3 hours later), they must plan activities to keep them awake before their scheduled bedtime.

If, after lying down in bed for 15 minutes, the patient is still awake, she MUST get out of bed (preferably outside the bedroom), do something relaxing, and go back to bed only when she feels sleepy again.

• As your sleep efficiency (actual time asleep/Time In Bed) improves to around 85% or higher, the time spent in bed is gradually increased in small increments (e.g., 15-20 minutes). This is computed from the Sleep Diary.

  
  

This is initially challenging, I know, but by restricting time in bed, it

• Makes you more sleepy at bedtime, leading to faster onset and more consolidated sleep. It lessens the time you lie down in bed worrying and getting frustrated.

• Teaches you to re-associate the bed with sleep only. It's not a place to use your phone, worry, argue, or envy a partner in deep sleep

• Reduces your anxiety and improves confidence in your ability to fall and stay asleep.

  
  

SUMMARY

Spending too much time in bed with the hope of increasing sleep usually backfires and worsens insomnia. Reducing your Time In Bed helps break this pattern by making you feel more sleepy, re-associating the bed only with sleep, and reducing anxiety. If you're struggling with Insomnia, consider seeking help from a doctor or psychologist trained in CBT-I to reclaim your sleep.