Do you think you could benefit from better sleep?

Spend less time in bed and sleep better

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 patient.

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 CBT for insomnia (CBTi) programme. Let’s have a look at what it’s all about.

The theory behind sleep restriction therapy

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 a sufferer 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 onset 3,
  • The high quality sleep that results enables the negative beliefs associated with sleep to be challenged.

This eventually translates to a change in mindset, where going to bed is no longer associated with a battle to fall asleep 4.

How it works in practice

Because sleep restriction therapy is administered differently depending on individual circumstance 45, 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.

Therefore, 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 this sequence:

  • A clinical interview will be conducted to see if sleep restriction therapy can help you.
  • You will 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 sleep 3
    • any activities that may cause sleep issues, such as drinking coffee or using a mobile phone before going to bed.
  • Based on this information, the 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 the 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 will be regularly monitored, so that adjustments to the sleep schedule are easily made. Treatment is usually completed within a few months.

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.

What are the benefits?

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 13101112.

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

Furthermore, patients 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.

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.

In short:

  • Up to 40% of adults have insomnia.
  • Negative beliefs about sleep and being in bed are thought to make insomnia worse.
  • Sleep restriction can be used to challenge those beliefs by effecting good quality sleep.
  • This breaks the link between negative beliefs and poor sleep, leading to lasting sleep benefits.
  • Sleep restriction can be used in cases of insomnia across a diverse population.

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 package would be best for you.

References


  • Falloon K, Elley CR, Fernando A, Lee AC, Arroll B. Simplified Sleep Restriction for Insomnia in General Practice: A Randomised Controlled Trial;65(637):e508–e515. Available from: bjgp.org/content/65/637/e508.

  • Morin CM, Hauri PJ, Espie CA, Spielman AJ, Buysse DJ, Bootzin RR. Nonpharmacologic Treatment of Chronic Insomnia;22(8):1134–1156. Available from: academic.oup.com/sleep/article/22/8/1134/2749982.

  • Friedman L, Benson K, Noda A, Zarcone V, Wicks DA, O’Connell K, et al. An Actigraphic Comparison of Sleep Restriction and Sleep Hygiene Treatments for Insomnia in Older Adults;13(1):17–27. Available from: journals.sagepub.com/doi/10.1177/089198870001300103.

  • 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 Medicine Reviews. 2014 Oct;18(5):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 Medicine Reviews. 2016 Dec;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 Feb 1;37(2):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 May;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 Jun 28;295(24):2851–8.

  • Breitstein J, Penix B, Roth BJ, Baxter T, Mysliwiec V. Intensive Sleep Deprivation and Cognitive Behavioral Therapy for Pharmacotherapy Refractory Insomnia in a Hospitalized Patient. JCSM [Internet]. 2014 Jun 15; Available from: jcsm.aasm.org/ViewAbstract.aspx?pid=29515

  • Kyle SD, Morgan K, Spiegelhalder K, Espie CA. No Pain, No Gain: An Exploratory within-Subjects Mixed-Methods Evaluation of the Patient Experience of Sleep Restriction Therapy (SRT) for Insomnia;12(8):735–747. Available from: linkinghub.elsevier.com/retrieve/pii/S1389945711002061.

  • 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 Medicine. 2005 Jan;6(1):93–4.

  • Spielman AJ, Saskin P, Thorpy MJ. Treatment of Chronic Insomnia by Restriction of Time in Bed. Sleep. 1987 Jan 1;10(1):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 Mar 17;281(11):991–9.