Spend less time in bed and sleep better

Spend less time in bed and sleep better

Key points

Sleep restriction therapy is a technique commonly used in the treatment of insomnia. It involves a high level of commitment from the person undertaking it but sleep restriction is highly effective and can be very successful in helping to realign and reestablish good sleep.

In this article we’re going to cover:

  • the theory behind sleep restriction therapy
  • how long does sleep restriction therapy take to work?
  • our tips to help you stay the course
  • the benefits of sleep restriction therapy.

Introduction

Recent research shows that insomnia affects as many as 40% of adults and can be chronic in up to 22% of the population.1 This means that a lot of people experience fragmented, poor quality sleep.

Because of how important sleep is to overall health, it’s not surprising that poor sleep can lead to things like:

  • decreased performance across a number of tasks, like driving or working
  • general psychological distress
  • the worsening of depressive or anxious feelings.

With symptoms like these, lots of people try to get better sleep via increased alcohol consumption, prescription drugs or over-the-counter remedies.2

Although these strategies might work in the short term, they aren’t permanent solutions and come with their own problems i.e. side effects and addiction risk.

What would be better is a long-term, non-pharmacological approach, tailored to each individual.

One of the most effective non-pharmacological techniques to improve sleep over time is called sleep restriction therapy and is usually offered as part of a Cognitive Behavioural Therapy for insomnia (CBTi) programme. Let’s have a look at what it’s all about.

How does sleep restriction therapy work?

Sleep restriction therapy is based on the idea that the time someone with insomnia spends awake in bed leads to the formation of a negative set of beliefs about going to sleep (e.g. that they will never be able to get to sleep, or that their sleep is “broken”) and that having those beliefs makes falling and staying asleep harder.

This is because the person goes to bed dreading the time they’ll spend lying awake once there, which means they:

  • won’t be able to sleep due to the resulting worry
  • will have their negative beliefs about their own sleep reinforced.

This “worry pattern” makes it harder to get to sleep, making them more worried, which in turn makes it harder to get to sleep, and so on. Addressing these beliefs can help recovery from insomnia.

By intentionally limiting the time in bed and inducing mild sleep deprivation, two things happen:

  • the person with insomnia falls asleep more readily once in bed because sleep deprivation leads to deeper sleep with a faster sleep onset3
  • the high quality sleep that results enables the negative beliefs associated with sleep to be challenged.

This eventually helps to change your mindset, creating a positive association between bed and sleep, where going to bed is no longer associated with a battle to fall asleep.4

Sleep better with our support

Good support is key when you’re trying to fix your sleep especially if you’re using sleep restriction. At Sleepstation, our sleep coaches are on hand to support and guide you on your journey back to good sleep.

Fix your sleep
Sleepstation displayed on a laptop screen

How it works in practice

Because sleep restriction therapy is administered differently depending on individual circumstance,4 5 exactly what treatment looks like will depends on a number of things things, e.g:

  • a person’s age
  • pre-existing medical conditions
  • medication history
  • lifestyle choices and other factors.

It’s important to work with a good sleep therapist either in person or over the internet,6 using a service like Sleepstation, so that you get the best outcome possible.

The steps to getting started with sleep restriction therapy usually follow the sequence below.

  • A clinical interview will be conducted to see if sleep restriction therapy can help you.

  • You’ll then be asked to complete a sleep diary across a few weeks containing estimations of:

    • the length of time you were actually asleep
    • the total length of time spent in bed
    • any disturbances to sleep3
    • any activities that may cause sleep issues, such as drinking coffee or using a mobile phone before going to bed.
  • Based on this information, your therapist will set the total time permitted in bed (typically the average time you are actually asleep and no less than 5 hours per night to prevent excess fatigue.2

The times of the day that are set, for going to and getting out of bed, depend on the type of insomnia that you exhibit:

  • if you have trouble falling asleep, a later bedtime is likely to be recommended
  • if you can fall asleep easily but wake up too early, then bedtime is unaffected, but an earlier time will be set to get out of bed.7

You then follow the schedule until you and your therapist agree there’s a consistent increase in the time spent asleep versus the total time you’ve spent in bed. At this point, more time in bed will be permitted.

Once out of your bed for the day, you shouldn’t lie down, nap or be in bed at all until the next scheduled bedtime.

Throughout the process, you’ll be regularly monitored, so that adjustments to the sleep schedule are easily made. Treatment is usually completed within a few months.

inviting bedroom space

The first few weeks

Given the fairly drastic changes in sleep habit that sleep restriction therapy demands, it’s likely you’ll find the first few weeks on sleep restriction therapy somewhat difficult.

You may experience daytime sleepiness, reduced alertness, mood disturbance and impaired working or socialising.8 If you are experiencing daytime sleepiness do not drive or operate machinery.

Even though some of these effects may be down to your underlying insomnia more than the treatment,9 we understand that they can be rather discouraging.

Therefore, it’s important to have support available to you across a course of sleep restriction therapy.

That’s why we at Sleepstation provide access to a team of sleep coaches and therapists. Our team can provide perspective and motivation to see you through and help identify ways to make sleep restriction therapy more compatible with your lifestyle.

Sleep restriction therapy tips

We know that sleep restriction can feel tough, so here’s some simple tips to help you through it.

  • Acknowledge that willpower is key to this process. It can be hard to stay up later than you’d normally want to and it can be really hard to drag yourself out of bed at the set time in the morning. Getting into the right frame of mind from the start is going to improve your chances of success.
  • Try to avoid napping. This can be hard, but if you feel yourself nodding in the day, then get up and take a break from whatever you were doing. Even if it’s only to walk around the room to wake you back up, you need to remove yourself from the situation where napping is possible.
  • Get exposure to sunlight. Natural light helps to set our body clock, so being outdoors in the daytime signals to your brain that this is the time to be awake and alert. If you take a walk outside every day, then the benefit is doubled as you’re also exercising and we know that exercise can help you sleep better.
  • Embrace routine. Sleep loves routine, so adopting a consistent wind-down routine can help to create associations in the brain that bedtime is coming and it’s time to get ready to sleep. Start your day with an element of routine by getting up when your alarm goes off, as hard as this feel be at first!
  • Create a calm and cosy sleep environment. It shouldn’t be a place for watching movies or catching up on your social media feeds. Your bedroom should be your sleep sanctuary, and we have lots of ideas to help you create the ideal bedroom setup.
sleep tips 4 panel: routine, exercise, work, sunlight

Does sleep restriction therapy work?

Unlike a course of sleeping pills, sleep improvements from a course of sleep restriction therapy last for a number of months after treatment, with studies reporting consistent increases in the time in bed spent asleep and fewer awakenings while in bed.1 3 10 11 12

After the difficult initial period, many people report that their attitudes towards sleep and going to bed have changed because of the long-lasting sleep improvements resulting from sleep restriction therapy.12

Perhaps unsurprisingly, brain scans of some people with insomnia who have undergone sleep restriction therapy show brain activity that is closer to that of good sleepers while in deep sleep,13suggesting that the longevity of the improved sleep effects may be down to some physiological changes.

Furthermore, people who have undergone sleep restriction therapy report improved mood, reduced daytime fatigue, fewer sleep worries and napping tendencies compared to when they went untreated.14

contented lady relaxing in a chair next to a plant

Most importantly sleep restriction therapy can be successfully implemented as part of a wider array of nonpharmacological treatments on a diverse range of people.

These include people who have lived with insomnia for several years,2 those with complex mental health issues,11 and the elderly.15

So, no matter how bad you think your individual circumstance may be, if you have insomnia, sleep restriction therapy as part of a course of CBTi is very likely to help you.

Sleepstation’s DCBTi course can help

At Sleepstation we use a form of Cognitive Behavioural Therapy for insomnia that’s delivered digitally, so it’s called DCBTi.

As part of our programme, we use sleep restriction techniques and we know that having good support though this process is key, which is why you’ll have support from a sleep coach to help you at every stage.

If you’re experiencing problems sleeping and would like to improve your sleep, we may be able to help. Sleepstation offers a highly effective solution to your sleep problem, tailored to the individual, with sustainable results. You can get started in just a few clicks, so why wait?

man on sofa messaging sleep coaches

Summary

  • Negative beliefs about sleep and being in bed are thought to make insomnia worse.
  • Sleep restriction can help reset your brain’s focus away from being awake in bed to associating bed with sleep.
  • This breaks the link between negative beliefs and poor sleep, helping you to sleep better.
  • If you’d like us to develop a tailored sleep plan for you and to support you through those tough first few weeks of sleep restriction therapy you can sign up today. Simply answer a few short questions to find out which of our programmes would be best for you.

Reference

  • Falloon K, Elley C, Fernando A, Lee A, Arroll B. Simplified sleep restriction for insomnia in general practice: a randomised controlled trial. Br J Gen Pract 2015; 65:e508-e515.

  • Morin C, Hauri P, Espie C, Spielman A, Buysse D, Bootzin R. Nonpharmacologic Treatment of Chronic Insomnia. Sleep 1999; 22: 1134-1156.

  • Friedman L, Benson K, Noda A, et al. An actigraphic comparison of sleep restriction and sleep hygiene treatments for insomnia in older adults. J Geriatr Psychiatry Neurol 2000; 13: 17–27.

  • Glovinsky PB, Spielman AJ. Sleep restriction therapy. In: Hauri PJ, editor. Case studies in insomnia. Boston, MA: Springer US; 1991. p. 49–63.

  • Miller CB, Espie CA, Epstein DR, Friedman L, Morin CM, Pigeon WR, et al. The evidence base of sleep restriction therapy for treating insomnia disorder. Sleep Med Rev 2014;18: 415–24.

  • Zachariae R, Lyby MS, Ritterband LM, O’Toole MS. Efficacy of internet-delivered cognitive-behavioral therapy for insomnia – A systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev 2016;30: 1–10.

  • Sateia MJ, Buysse D. Insomnia: Diagnosis and treatment. CRC Press; 2016.

  • Kyle SD, Miller CB, Rogers Z, Siriwardena AN, MacMahon KM, Espie CA. Sleep Restriction Therapy for Insomnia is Associated with Reduced Objective Total Sleep Time, Increased Daytime Somnolence, and Objectively Impaired Vigilance: Implications for the Clinical Management of Insomnia Disorder. Sleep. 2014; 37: 229–37.

  • Whittall H, Pillion M, Gradisar M. Daytime sleepiness, driving performance, reaction time and inhibitory control during sleep restriction therapy for Chronic Insomnia Disorder. Sleep Medicine. 2018; 45: 44–8.

  • Sivertsen B, Omvik S, Pallesen S, Bjorvatn B, Havik OE, Kvale G, et al. Cognitive Behavioral Therapy vs Zopiclone for Treatment of Chronic Primary Insomnia in Older Adults: A Randomized Controlled Trial. JAMA. 2006 295:2851–8.

  • Breitstein J, Penix B, Roth BJ, et al. Intensive sleep deprivation and cognitive behavioral therapy for pharmacotherapy refractory insomnia in a hospitalized patient. J Clin Sleep Med 2014; 10: 689–690.

  • Kyle SD, Morgan K, Spiegelhalder K, et al. No pain, no gain: an exploratory within-subjects mixed-methods evaluation of the patient experience of sleep restriction therapy (SRT) for insomnia. Sleep Med 2011; 12: 735–747.

  • Smith MT, Perlis ML, Chengazi VU, Soeffing J, McCann U. NREM sleep cerebral blood flow before and after behavior therapy for chronic primary insomnia: preliminary single photon emission computed tomography (SPECT) data. Sleep Med 2005;6: 93–4.

  • Spielman AJ, Saskin P, Thorpy MJ. Treatment of Chronic Insomnia by Restriction of Time in Bed. Sleep. 1987;10: 45–56.

  • Morin CM, Colecchi C, Stone J, Sood R, Brink D. Behavioral and Pharmacological Therapies for Late-Life Insomnia: A Randomized Controlled Trial. JAMA. 1999;281: 991–9.