Sleep deprivation to treat insomnia?

Could we one day treat insomnia by using sleep deprivation? This approach may seem counterintuitive, but it has produced encouraging results in some people suffering from chronic insomnia, reports a team from Université Laval and the CERVO Research Center in the Journal of Sleep Research.


Currently, the best non-pharmacological treatment for chronic insomnia is cognitive behavioral therapy (CBT). This approach aims to change thought patterns and behaviors that interfere with sleep. "This is what should be prescribed as a first intervention. About 70% to 80% of people who undergo this therapy experience significant improvement in their sleep quality and daytime functioning," explains Jacques Le Bouthillier, a PhD student at the School of Psychology at Université Laval and lead author of the study published in the Journal of Sleep Research.

Hoping to find a solution for those who do not respond to CBT for insomnia, Jacques Le Bouthillier, Hans Ivers, and Charles Morin conducted an exploratory study to test the effectiveness of two interventions based on sleep deprivation.

To test these approaches, the researchers invited 34 adults who had experienced sleep-onset problems for nearly 10 years on average to their lab. These participants were randomly assigned to one of the following interventions: continuous sleep deprivation (12 people), sleep deprivation with repeated sleep attempts (12 people), or a control group with no intervention (10 people).

The first intervention, as its name suggests, involves keeping participants awake continuously for about 38 hours. The second intervention, called intensive sleep retraining, is of the same duration but includes a variation. "During the last 21 hours, twice an hour, we ask participants to go to bed and allow sleep to come," explains Jacques Le Bouthillier. "If they fall asleep, which happened in 96% of attempts, we wake them after 2 to 4 minutes."

This method, approved by an ethics committee, is not as harsh as it may seem, the PhD student notes. On one hand, there were no dropouts among participants subjected to sleep deprivation. Additionally, feeling drowsy could be therapeutic for people suffering from chronic insomnia.

The three-month follow-up showed a significant reduction in insomnia severity and fatigue among participants who underwent a session of sleep deprivation, with or without sleep attempts. Three months after the intervention, 25% of the total sleep deprivation group and 33% of the sleep deprivation with sleep attempts group showed a decrease in severity index of at least 8 points compared to their pre-intervention score.

"A change of more than 7 points is considered clinically significant. We don't know if this effect lasted beyond three months because the study had to end at that point," specifies Jacques Le Bouthillier.

The PhD student acknowledges that the number of participants in the study is too small to draw definitive conclusions about the clinical effectiveness of sleep deprivation for chronic insomnia. "However, our results, though preliminary, are encouraging and suggest it's worth continuing research in this direction. The rapid and impactful nature of sleep deprivation could make it an interesting option for those who don't respond to CBT for insomnia and don't want to take sleeping pills."