Could Intensive Sleep Retraining be a New Approach to Insomnia?

Hannah Scott, PhD

A new study reveals the use of intensive sleep retraining (ISR) in clinical practice could provide a brief and effective alternative to the traditional treatments of insomnia, like medications or cognitive-behavioral therapy (CBT) or medications.¹

Insomnia can lead to daytime fatigue, decreased productivity, and reduced quality of life in those affected. While there are several treatments available for insomnia, they often require several sessions or may be accompanied by side effects.

Hannah Scott, PhD, Flinders Health and Medical Research Institute: Sleep Health, Flinders University, and a team of investigators aimed to evaluate intensive sleep retraining, a new approach to treating insomnia, which is administered in a single overnight treatment session.

Intensive Sleep Retraining Results

The results of the systematic review show that ISR is effective in reducing sleep-onset insomnia symptoms. This finding was especially profound when observing sleep latency, the increase in total sleep time, and sleep efficiency.

According to the investigation, these data were derived from sleep diary findings. All 3 studies included in the review reported significant improvements in these measures post-treatment, with most of the improvements maintained at follow-up. However, the reductions in wake-after-sleep onset were inconsistent across the studies.

Investigators found the reduction in sleep latency following ISR noteworthy because it indicated a key symptom of sleep-onset insomnia. The increase in total sleep time and sleep efficiency also suggests that ISR is effective in promoting better sleep quality and duration.

The promising findings from this systematic review suggest that ISR could be a valuable treatment option for patients with insomnia. However, more research is needed to determine the efficacy of ISR in different populations with insomnia.

Mechanisms of Therapeutics Effect Need Further Study

This systematic review evaluated previous data from trials about the efficacy of ISR for treating insomnia in an attempt to inform and recommend its use for clinical practice. ISR is a behavioral treatment for sleep onset insomnia that involves sleep deprivation followed by a period of intense sleep consolidation.

In this process, patients are kept awake longer than usual and then allowed to sleep for an extended period the following night. The aim of ISR is to retrain the patient's sleep-wake cycle, so they can fall asleep quickly and maintain sleep for longer periods.

A systematic literature search was conducted across 3 databases, yielding 108 results. Of these studies, only 3 were deemed suitable for inclusion in this review.

The team acknowledged that even though results suggested ISR was a promising treatment for insomnia, more research is needed to confirm its efficacy and determine the optimal treatment parameters for different populations with insomnia. Future studies should explore the underlying mechanisms of therapeutic effects and identify the patients who are most likely to benefit from this approach.

It was further noted that the development of new technology can improve the delivery of ISR and provide more effective care to patients. ISR could potentially serve as a brief and effective alternative to the traditional treatments of insomnia.

Since more practical modalities of ISR administration have been developed, such trials are more feasible to conduct now than ever before. The development of new technology such as digital platforms can improve the delivery of ISR and provide more effective care to patients.

References:

1. Scott H, Bensen-Boakes DB, Lovato N, Reynolds A, Perlis M, Lack L. The efficacy of intensive sleep retraining for insomnia: A systematic review and research agenda [published online ahead of print, 2023 Mar 21]. J Sleep Res. 2023;e13894. doi:10.1111/jsr.13894