[ezgeez]

One-day “Intensive Sleep Retraining” is the new “wonder kid” in behavioural treatments for insomnia. It was the subject of a shorter study in 2007 and, very recently in 2012, a more extensive randomized controlled trial showed that it is very effective:

http://www.ncbi.nlm.nih.gov/pubmed/22215918

Here is another description:

http://www.health.harvard.edu/blog/overnight-treatment-for-chronic-insomnia-201202074207

Unfortunately, in its current form it is difficult to administer at home (a polysomnograph is used), however DIY versions are being considered.

It seems to use a similar approach to the other main behavioural treatments (stimulus control therapy and sleep restriction therapy), i.e. willing sleep deprivation is to used to demonstrate to the insomniac what falling asleep quickly and succesfully is like, many times over. In this way the association between sleep and chronic anxious effort is broken.

[ezgeez]

I think there is something consoling in the realisation that, in all of these treatments, sleep deprivation is paradoxically used as a tool to effect better sleep.

[Martin Reed]

Thanks for sharing. I think it's an interesting field of research; maybe it could be replicated at home (in terms of the forced sleep deprivation and repeated awakenings) if you have a committed partner?

—

If you are ready to stop struggling with insomnia you can enroll in the online insomnia coaching course right now! If you would prefer ongoing phone or video coaching calls as part of a powerful three month program that will help you reclaim your life from insomnia, consider applying for the Insomnia Mastery program.

The content of this post is provided for informational and educational purposes only. It is not medical advice and is not intended to diagnose, treat, cure, or prevent any disease, disorder, or medical condition. It should never replace any advice given to you by your physician or any other licensed healthcare provider. Insomnia Coach LLC offers coaching services only and does not provide therapy, counseling, medical advice, or medical treatment. All content is provided “as is” and without warranties, either express or implied.

[ezgeez]

Yes… I wonder if you could improvise an approximate version of it yourself (for those of us who are chronically single), say by setting your alarm to go every 30 minutes or so for a whole night. However being told by someone else that you have, indeed, fallen asleep, seems to part of the learning process in this therapy.

[wonderhussy]

Holy hell, I really want to try this!! I've been thinking about it ever since Martin sent out the link to that ABC news story about the Australian doctor who is also doing it (http://abcnews.go.com/blogs/health/2012/01/12/rebooting-the-brain-new-progress-in-the-treatment-of-insomnia/). I find this idea intriguing…it sounds like it might actually work!!

It is SO FRUSTRATING that there is an option out there that I have no access to. I guess I'll just have to wait and see if someone opens another clinical trial in my area… I don't have health insurance, so I could probably never afford it otherwise :/

[delv-x]

I know this thread is very old but there are two at home options:

1. Sleeponcue app for Android and iOS

2. Thim ring $199AUD

For me I deal with mostly sleep maintenance and also early awakenings so I am not sure how much it will help but I may try out the sleeponcue app. It’s cheap.

This could be an alternative to stimulus control. Rather than getting up and reading a book, you could try staying in bed listening to the tone. Then if you fall asleep or not, get out of bed for a few minutes and go back in. The interesting thing is you may not need to do a 24 hour run but rather 2 hours a night for a few days.

[Steve]

I don’t know Delv. It is only $9.99 US Dollars but there seems to be only one review of it. Kind of hard to believe that something that was designed in a sleep lab could be replicated on a smart phone. If you get it, let me know how it goes.

[delv-x]

On the itunes store there are a few more reviews. I am sure this isn’t as comprehensive as a lab. The issue is finding a lab and out of pocket cost if not covered (probably $1000+). Even if there were a lab down the street I couldn’t afford it. The other option is Thim device at $199AUD. The app Ill probably try out and let you know. The other advantage is that this can be done at home vs 24 hours in a clinic.

[Martin Reed]

I am close with Michael Schwartz, the creator of Sleep on Cue. I have invited him to contribute to this discussion with further information about his app. I also recorded a podcast with him very recently where we discussed his app in more detail. I am hoping this will be live later this week. More to come!

—

If you are ready to stop struggling with insomnia you can enroll in the online insomnia coaching course right now! If you would prefer ongoing phone or video coaching calls as part of a powerful three month program that will help you reclaim your life from insomnia, consider applying for the Insomnia Mastery program.

The content of this post is provided for informational and educational purposes only. It is not medical advice and is not intended to diagnose, treat, cure, or prevent any disease, disorder, or medical condition. It should never replace any advice given to you by your physician or any other licensed healthcare provider. Insomnia Coach LLC offers coaching services only and does not provide therapy, counseling, medical advice, or medical treatment. All content is provided “as is” and without warranties, either express or implied.

[Steve]

Martin – Would this app undo my work with you? Not sure if I could use it with my hearing impairment but definitely don’t want to try it yet if it would undo everything I worked so hard for so long.

[Harpoleptic]

Hi All,

Wanted to share a couple thoughts about ISR.  I like to describe ISR as a way to essentially “practice” falling asleep: repeated sleep-onset opportunities, done for awhile around bedtime, with immediate awareness feedback.  In a lab, sleep onset detection is simple (EEG).  At home, stimulus response seems to be simplest.

The Sleep On Cue app uses audio stimulus (faint tones) and behavioral response (slight smartphone movement).  Thim uses vibration/slight finger movement via ring device linked to smartphone via Bluetooth.

The 2012 RCT used a 24 hour protocol, with sleep trials on the half hour.  The SOC app (and I think Thim too) uses a variable sleep trial time, so the user can achieve a larger number of sleep onsets per hour.  This is why I suggest 15-20 sleep trials, around bedtime, ideally after a poor night of sleep.  At the end of the sleep training session, no need to engage with the phone – just put it down for the night.

It’s not a sleep tracker – it’s a sleep trainer.  The 2012 RCT study looked at 3 treatment conditions: 24 hour ISR, multi-week stimulus control (SC) therapy, and 24 hour ISR + multi week SC.  The combined ISR + SC condition showed the largest positive effect.  And all positive effects were maintained at 6 months.

Hope this help with the discussion!

[delv-x]

I am not sure if ISR can help with those who are able to fall asleep but wake up shortly after most likely due to hyperarousal, self monitoring, anxiety. It feels like ISR would “train” and further exacerbate the issue because of falling asleep and waking up so frequently.

I did get the sleeponcue app and although I’ve only tried it for maybe 20 minutes in total so far, the sensitivity or timing feels off. There are times where I would distinctly hear the tone and shake (this could be trial 1 or 2) and ask if I’ve fallen asleep and I would say no because I am still awake and it’s only been a minute or so and say that I’ve fallen asleep. Not sure if there are any tips or suggestions for accuracy.

[Steve]

Hi Mike (Harpolectic). It does sound like this is more for people who have trouble falling asleep rather than those whose problem is staying asleep. I have a question. I am a client of Martin and he is putting me through the usual Sleep Restriction and Stimulus Control. So this app wouldn’t be good for me, would it? Sleep Control tells me not to go to bed, and therefore go to sleep, before a certain time. But this app wants me to keep practicing falling asleep. so it kind of contradicts the SR in that I would be falling asleep before my window begins, doesn’t it? Thanks.

[Harpoleptic]

Hi Delv, Hi Steve,

The 2012 RCT used subjects who primarily struggled with SOI, not SMI.  Some struggled with both.  So the positive benefits to SMI were not as clear.  Anecdotally, I will get various messages from users that comment about how the app did help with their SMI.  One such person for example was Dennis, the host of the Sleep to Healthy podcast.  And a common experience seems to be “the app helped with my insomnia but it’s hard to articulate how”.  Again, this is all anecdotal and I want to make sure I’m clear on that.

In my mind, the seems to be a productive use of time for someone doing CBTI waiting for their target bedtime.  Not every night, just after particularly poor nights.  Maybe more helpful than watching TV perhaps.

As it follows the ISR research idea, the app is programmed to not allow more than about 2 min of sleep.  Then user is instructed to physically get out of bed for a couple min, then repeat.  It is not a perfect measure of sleep onset, but it’s not too bad:

https://www.researchgate.net/profile/Hannah_Scott32/publication/318016666_A_pilot_study_of_a_novel_smartphone_application_for_the_estimation_of_sleep_onset/links/5a136bea0f7e9b1e5730856f/A-pilot-study-of-a-novel-smartphone-application-for-the-estimation-of-sleep-onset.pdf?origin=publication_detail

Hope this helps.  Always happy to try to explain ISR or my SOC app.

Mike

[Author]

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