The Science Behind The Sleep On Cue App: Intensive Sleep Retraining (ISR)

 

“The findings of Harris et al. suggest that ISR holds great promise. Patients await a non-drug treatment for insomnia that brings relief as rapidly as medication. Clinicians in the community look forward to more widely applicable ISR-like procedures that can be implemented at home, without expensive and complicated sleep technology, by non-sleep experts. This stunning demonstration by Harris and colleagues should serve as a challenge to the field to create the next generation of non-pharmacological treatments for insomnia.”
– Spielman AJ; Glovinsky PB. What a difference a day makes. SLEEP 2012;35(1):11-12.

People with chronic insomnia often worry excessively about their sleep. This has been shown to be due to negative conditioning: frequent difficulty falling asleep or struggling to get back to sleep leads to worry/anxiety about sleep and alertness at bedtime. Because falling asleep is a passive event, people who “try harder” to fall asleep become less likely to fall asleep. A 2013 study by the CDC found that over 9 million Americans turn to prescription sleeping pills most nights, and the use appears to be on the rise. Untold millions are spent annually on other “remedies” for insomnia: alcohol, antihistamines, etc.

Cognitive Behavioral Therapy

The most effective non-drug treatment for chronic insomnia is Cognitive Behavioral Therapy (CBT). The CBT procedure is a multi-component and multi-visit. The traditional areas of focus with CBT for insomnia are:

  • sleep hygiene (sleep/wake habits)
  • relaxation (calming the body and mind)
  • cognitive restructuring (assessing negative attitudes/beliefs)
  • sleep restriction (limiting time in bed)
  • stimulus control (associating bed/bedroom/bedtime with sleep)

While effective, with CBT improvement in sleep is not rapid, and the availability of trained therapists is limited.

Intensive Sleep Retraining

Sleep research from Australia in 2007 and 2012 found that a behavioral technique called “Intensive Sleep Retraining” (ISR) can help people with chronic insomnia equally as well as traditional CBT in a fraction of the time. Specifically, the 2012 study compared ISR to the most supported component of CBT: stimulus control (associating bed/bedroom/bedtime with sleep).

In the ISR research, the research subjects with chronic insomnia were partially sleep deprived for a night, then asked to try to fall asleep every 30 min in a laboratory, starting and ending at their normal bedtime (all night – all day). For each sleep trial, the subjects were given 20 minutes to fall asleep, then woken after a few minutes. Subjects were asked if they think they fell asleep, then told whether or not they fell asleep. This procedure was repeated every 30 minutes, all night and all the next day.

ISR gave a person with chronic insomnia the experience of falling asleep over and over, essentially allowing them to “learn” how to fall asleep by practicing falling asleep, repeatedly, in a relatively short period of time. The ISR technique worked through behavioral conditioning. Ability, confidence, and awareness in sleep improved dramatically, leading about half of the “poor” sleepers to rate themselves as “good” sleepers after the 24 hour process. This improvement was the same degree of improvement as seen with the stimulus control group, and improvement was even better and longer lasting when ISR was combined with stimulus control instructions. Clearly ISR was the answer to the issue of the delay in sleep improvement with CBT.

In the ISR research, sleep was measured with electrodes attached to the head (EEG), the industry standard way to measure sleep. However, the ISR procedure required a laboratory setting, was too expensive, and was too impractical to use on a large scale.

The Sleep On Cue™ Advantage

At home, certain behavioral methods (without electrode wires on the head) can be used to determine when sleep has occurred. For example, when we start to fall asleep, we relax and lose muscle tone, causing us to drop the book we’re reading. Some famous historical figures used this phenomenon to wake them after short naps (e.g., Thomas Edison). An even more accurate and reliable indicator of the start of sleep is when we become unresponsive to auditory tones. We have all had the experience of talking or reading to someone very sleep who, after a little while, no longer is replying back to us. This natural phenomenon is at the core of the Sleep On Cue™ app: faint tones are emitted, and the user gives their smartphone a slight shake. Once shakes are no longer detected following the tones, sleep has begun, and following the ISR procedure, the user is woken (the app vibrates the phone). The user is asked: “Do you think you fell asleep?”, and then given the correct answer. Repeating this process is how to do ISR at home.

But the Sleep On Cue™ app goes much further than the ISR research, incorporating auto-adjusting sleep training time intervals for training at just the right intensity, performance feedback to develop better awareness of sleep, and a summary graph to keep track of or share your progress. The Sleep On Cue™ app is also designed with a user-adjustable nap module to take the perfect, customized nap anytime.

And perhaps most importantly, sleep training with the Sleep On Cue™ app can be done for little or as long as desired. Most users find improvement with an occasional hour or two of sleep training around bedtime, especially following a poor night of sleep.

Two prominent sleep researchers (Drs. Spielman and Glovinsky) expressed the need for a home-based method of the powerful ISR procedure. The Sleep On Cue™ app is this method!