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:
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:
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.
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:
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:
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
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.
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:
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:
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.
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.
We know that sleep restriction can feel tough, so here’s some simple tips to help you through it.
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
Most importantly sleep restriction therapy can be successfully implemented as part of a wider array of nonpharmacological treatments on a diverse range of people.
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.
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?
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.↑