Intensive Sleep Retraining and Total Sleep Deprivation for Treating Chronic Insomnia: A Randomised Controlled Trial

The aim of the study was to compare the efficacy of intensive sleep retraining (ISR) and total sleep deprivation (TSD) against a no-treatment control condition for treating chronic insomnia and examine two potential mechanisms: the resolution of conditioned insomnia and the increase in homeostatic sleep drive produced by sleep deprivation. Thirty-four adults with chronic sleep onset insomnia (with or without sleep maintenance difficulties) were randomised to ISR, TSD, or a control condition. The ISR condition consisted of a 38.5-h period of sleep deprivation, the last 21 h of which included 42 sleep onset trials; the TSD condition consisted of an equivalent 38.5-h sleep deprivation period without any sleep onset trials, and the control condition consisted of one night of habitual sleep in the laboratory. Significant decreases in insomnia severity were observed from pre- to post-treatment in both ISR and TSD, but not in the control condition. A significant reduction in sleep onset latency was observed during the same period for the ISR condition, but not for the TSD or control conditions, with no clinically meaningful change in anxiety or depressive symptoms. Significant decreases in fatigue were also observed for both ISR and TSD conditions during the same period. These results were generally significant at 3 months after treatment. Sleep improvements produced by ISR, and to a lesser extent by TSD, suggest that both the resolution of conditioned insomnia and the increase in homeostatic sleep drive represent important mechanisms responsible for the efficacy of ISR.