HOW COULD GOING TO BED TOO EARLY IMPAIR SLEEP QUALITY?
As long as you feel sleepy before going to bed, it is okay to go to bed earlier. However, one of the biggest mistakes that I see in clients with insomnia is that they try to go to bed before they are feeling sleepy in the hope that they can get more sleep that night.
This usually backfires, as their body and brain aren’t ready for sleep yet, and they end up lying awake in bed in a restless, worried and frustrated state. If they do eventually fall asleep, it becomes a poorer quality sleep, they feel even more tired the next day, and then try to go bed even earlier the next night.
For the first week, I tried to go to bed as early as possible and before my usual bedtime of 11:30pm. By going to bed before I felt sleepy, I was trying to see if it would negatively impact my sleep, as it goes against what I recommend to the clients that I see.
For the second week, I followed the rules of stimulus control very strictly. The stimulus control instructions aim to limit the time in bed awake so that the bed becomes reconditioned with the feeling of sleepiness and the behaviour of well-consolidated sleep. These include only going to bed when tired, waking up at the same time every day, just using the bed/bedroom for sleep and sex, avoiding naps during the day, and getting up if unable to fall asleep within 20 minutes of retiring to bed (Lieberman & Neubauer, 2007).
Let’s see which strategy was best for my sleep…
Comparison: Bed Too Early vs Stimulus Control
Based on my sleep diary data, the findings were as follows:
- The number of awakenings:
- Stimulus control – 0.66 per night
- Bed too early – 1.88 per night
- less is better
- Time in bed:
- Bed too early – 8 hours 29 minutes
- Stimulus control – 7 hours 18 minutes
- 8 hours is ideal for me
- Time to bed:
- Stimulus control – 11:59pm
- Bed too early – 10:19pm
- 11:30pm is ideal for me
- Total sleep time:
- Bed too early – 7 hours 36 minutes
- Stimulus control – 6 hours 46 minutes
- 7 hours 30 minutes is ideal for me
- Sleep onset latency:
- Stimulus control – 12.86 minutes
- Bed too early – 16.43 minutes
- quicker is better
- Wake after sleep onset:
- Stimulus control – 21.43 minutes
- Bed too early – 46.48 minutes
- less is better
- Rise time:
- Stimulus control – 7:19 am
- Bed too early – 6:58 am
- 7:30am is ideal for me
- Sleep quality:
- Stimulus control – 4.14/5
- Bed too early – 3.43/5
- higher is better
- Sleep efficiency:
- Stimulus control – 92.21%
- Bed too early – 87.89%%
- higher is better
AND THE WINNER IS…
With a count of 7 points to 2 points, stimulus control is a much more successful intervention for me than going to bed too early and before I am sleepy. Even though I still managed to fall asleep relatively quickly the first week, with stimulus control I woke up less, spent a lot less time awake during the night, and had better sleep quality and sleep efficiency.
The main advantage of going to bed early was that I slept 50 minutes more per night. However, because the quality of sleep was worse, I didn’t feel any more rested or refreshed the next day than I did with less sleep. Quality is sometimes more important than quantity!
IS STIMULUS CONTROL A GOOD SLEEP STRATEGY?
IS IT EFFECTIVE?
Absolutely. It’s one of the main strategies I will turn to if my sleep ever starts to get worse. By learning the difference between tiredness and sleepiness and only going to bed when sleepy, keeping the bed for sleep only, and getting out of bed if I can’t sleep, it’s a super reliable way to ensure that my sleep gets back on track.
I, therefore, give the effectiveness of this strategy a 22/25.
CAN IT BE APPLIED?
It can be applied and doesn’t require any costs or much time either, but it can be hard for clients with insomnia to follow it properly. The hardest part to stick to is the getting up during the night if you can’t sleep. It seems quite counterintuitive, as does the staying up later if you worry that you aren’t sleeping enough, but it does get easier after a week or two. As you can see with my data on the second week, I didn’t have to get up at all during the second week, and that is because my brain and body equate the bed with sleep.
I, therefore, give the applicability of this strategy an 18/25.
IS IT SCIENTIFIC?
Stimulus control as a stand-alone therapy is a supported behavioural treatment for chronic insomnia, according to the American Academy of Sleep Medicine (Morin et al., 2006). It has reliable and robust effect sizes in the available research in the field (Lacks, Bertelson, Gans, & Kunkel, 1983; Riedel et al., 1998; Turner & Ascher, 1979). The main difficulty with stimulus control is adherence to the instructions (Riedel & Lichstein, 2001).
Espie, Inglis, Tessier and Harvey (2001) found that stimulus control is one of the most effective stand-alone interventions for insomnia when it is applied consistently. High adherence to stimulus control instructions 12 months post-CBT-I treatment also significantly predicts continued reductions in the time taken to get to sleep at the start of the night and time awake during the night (Harvey, 2002).
I, therefore, give the science of this strategy a 45/50.
Overall, stimulus control as a way to sleep better gets a score of 22/25 + 18/25 + 45/50 =
85/100: High Distinction
WHAT I RECOMMEND
Only go to bed around your usual bedtime if you feel sleepy. If it is 20 minutes before you normally go to bed, that is okay. By listening to your body, you will get a better sense of what you need.
Minimise non-sleep activities in bed, especially if it lasts for more than 20 minutes at a time. If you like to read or meditate in bed to help you fall asleep, that is okay, as long as you are already feeling sleepy before you go to bed. If you like doing these activities to wind down and relax at night, it’s better to do it out of bed if you think it will be for more than 20 minutes at a time.
If you do not feel sleepy yet, even if it is your bedtime, stay up a bit later and do something relaxing that is likely to bring on sleepiness for you. As soon as you feel sleepy, go to bed.
If you are in bed and feel really anxious, hot, restless, frustrated or just super alert, get out of bed or sit up if you really don’t want to get out of bed. Don’t keep trying to sleep. Just try to calm down, lower your arousal or distract yourself until you feel sleepy again, then return to bed or lie back down.
Then set an alarm and try to wake up and get out of bed in the morning at the same time each day, even on weekends.
Finally, keep naps to under 30 minutes and before 4pm if you can. Anything longer can lead to sleep inertia during the day and more difficulties getting to sleep that night.
Dr Damon Ashworth