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How Does Sleep Restriction Therapy (SRT) Work?

Written by Beth Holloway, RN, M. Ed and medically reviewed by Ioannis Koutsourelakis, MD, MSc, PhD
2021-06-04

Contents:

What Is Sleep Restriction Therapy?

How Does Sleep Restriction Therapy Work?

How Effective is Sleep Restriction Therapy?

How Long Does It Take For Sleep Restriction Therapy To Work?

What Are The Steps In Sleep Restriction Therapy?

What Are Some Sleep Restriction Therapy Tips?

What Is Sleep Restriction Therapy?

Sleep Restriction Therapy (SRT) is a behavioral treatment for long-term (chronic) insomnia. With SRT, a person’s time in bed is limited to the time they’re sleeping (should not be less than 5 hours). They gradually increase the time in bed as their sleep improves.

SRT may be offered as a single therapy. However, it is often part of multi-component treatment, like cognitive behavioral treatment for insomnia (CBT-I). CBT-I, recommended as the first-line therapy for chronic insomnia, includes SRT as well as stimulus control, relaxation training, and more.

How Does Sleep Restriction Therapy Work?

Limiting the time in bed can shorten the time it takes to fall asleep and improve the quality of sleep by:

  • Building homeostatic sleep drive - increasing pressure for sleep, the longer a person is awake 

  • Balancing circadian control of sleep-wake cycle, the daily cycle of physical, mental, and behavioral changes

  • Decreasing hyperarousal in both mind and body before sleep

How Effective is Sleep Restriction Therapy? 

SRT is an effective component of our Cognitive Behavioral Therapy for Insomnia (CBT-I) program, although it may be a stand-alone treatment. Overall, more than 75% of people who use CBT-I achieve healthier sleep (Espie CA et al. Sleep 2012).

How Long Does It Take For Sleep Restriction Therapy To Work?

Goodpath offers SRT as part of our Cognitive Behavioral Therapy for Insomnia (CBT-I) program, although it may be a stand-alone treatment in other settings. It is introduced in one of the early sessions of our multi-week CBT-I program.  Although each person is different, we expect that our members will begin to see the positive effects of the overall program within a few weeks.

What Are The Steps In Sleep Restriction Therapy?

The steps of SRT may vary from one program to another, however there are some common parts. They include:

  1. Sleep diary/average total sleep time. Before starting sleep restriction, your coach may recommend that you use a sleep diary to record the total sleep time each night for 1 to 2 weeks. This will help calculate the average total sleep time per week.

  2. Sleep window. To start, your coach will recommend that you restrict the time in bed each night to equal the average total sleep time. This is also called the sleep window. For example, a person averaging 6 hours of sleep/night should restrict their time in bed to 6 hours.

  3. Sleep efficiency score. Continuing to use the sleep diary to track time in bed and time asleep allows your coach to calculate your sleep efficiency score: the time spent asleep, in minutes, divided by time in bed, in minutes.

  4. Average sleep efficiency score. Every week, this information is used to determine the average sleep efficiency score - percentage of time asleep while in bed over one week’s time.

Sample Section of a 1-Week Sleep Diary

Step 1: Add time asleep for the week = 2760 minutes

Step 2: Divide by time in bed for the week = 3360 minutes

Step 3: Average sleep efficiency score = 82%

This information, the Average Sleep Efficiency Score, is then used by your health coach or doctor to adjust the sleep window. The sleep diary helps you and your health coach/ professional track your progress as sleep improves and core sleep requirements are determined (the minimal amount of sleep the brain and body need to recover).

Related article:

When to See a Doctor for Insomnia

What Are Some Helpful Hints For Sleep Restriction Therapy?

Take care: Early in SRT treatment, a person may have an increase in daytime sleepiness and a decrease in the ability to function. If this occurs, do not drive or operate machinery.

  • Expect initial worsening of your daytime sleepiness.  The sleepiness will improve as your sleep becomes more regular and of higher quality i.e. more efficient.

  • It’s best to wake up and go to sleep at about the same time. Use average total sleep time to determine both. For example,  a person with an average total sleep time of 6 hours, who wishes to have a wake time of 6:00 AM, should go to sleep at 12:00 AM - allowing for 6 hours of sleep.

  • Avoid napping.

  • Practice good sleep hygiene.

If you have trouble sleeping, sleep restriction therapy is just part of Goodpath's sleep programs and is included in our CBT-I sessions. Our well-rounded sleep program also includes supplements, over-the-counter medicines, relaxation techniques, as well as exercises and nutritional support. To get started take a few minutes to complete our free sleep assessment.