Improve your sleep efficiency using systematic sleep scheduling
Systematic sleep scheduling consists of making planned changes to your sleep schedule over the course of several weeks. It involves deliberately staying up later to harness the power of the sleep drive to help you fall asleep faster, stay asleep longer, and sleep more deeply. Each week as your sleep improves you gradually move your bedtime earlier. In this way, you first improve the quality of your sleep, and then gradually increase the quantity. Systematic sleep scheduling is highly effective and is perhaps the most powerful method in CBT-I. Here is how it’s done:
(A) For at least one week, maintain a Sleep Diary. The Sleep Diary will help us to estimate the average amount of sleep you are getting per night.
(B) It will also help us to estimate your sleep efficiency, which is the amount of time you actually slept (on average) divided by the amount of time you spent in bed (on average). For example, if you spent 8 hours in bed but only slept for 6, your sleep efficiency would be 75%.
(C) On the first week of sleep scheduling, you are to reduce the amount of time that you spend in bed to the average amount of sleep you were getting per night (as indicated by your Sleep Diary).
(D) Choose a rise time that works for your lifestyle that you are willing to consistently maintain. Set an alarm for that time, and consistently get out of bed at that time regardless of how well you have slept.
(E) Determine your target bedtime based on your average sleep time per night for the previous week.
(F) Implement your new sleep schedule and maintain your Sleep Diary. At the end of the week, calculate your sleep efficiency.
(G) If your sleep efficiency is 85% or better, move your bedtime 15 minutes earlier the following week. If it is not, we will troubleshoot and determine our course of action.
(H) Keep following this pattern over the course of several weeks until you are sleeping the desired amount of time while maintaining good sleep efficiency.
Frequently asked questions about systematic sleep scheduling
If I reduce my time in bed, won’t I get less sleep and feel worse? You might temporarily get less sleep and feel slightly worse. This typically only occurs for a few days during the first week. After that, it is likely that your sleep efficiency will improve and before too long you will be getting more sleep.
What if I have difficulty staying up until my prescribed bedtime? It can be helpful to create a list of activities that you can engage in to help you stay awake, such as reading, movies, or an art project. If you have difficulty staying awake you can try things like: avoiding lying down; placing cold compresses on different areas of your body (e.g., the small of your back), putting a cold washcloth on your face, walking around, or tidying up the kitchen.
What if I am unable to stay up until my prescribed bedtime? An alternative consists of a gradual, rather than abrupt, reduction of time in bed (TIB). For example, for a person who at baseline spends an average of 8 hours in bed, but sleeps an average of 6 hours, TIB could be reduced each week by 20 minutes. The process is continued until sleep quality has improved.
Continue to Strategy 10: Modify beliefs (Modify unhelpful sleep-related beliefs)