Sleep Restriction Therapy

Sleep Restriction Therapy

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 etc.

How Does SRT 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, both mind and body, before sleep

What Are The Steps In SRT?

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.

5. Adjust sleep window. Your coach may adjust the sleep window based on average sleep efficiency scores.

6. The sleep diary will help you and your coach to track your progress as sleep improves and core sleep requirements (the minimal amount of sleep the brain and body need to recover) are determined.

What Are Some Helpful Hints For SRT?

Caution! 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 (see second link below for details).

If you have any questions, do not hesitate to reach out to your coach.

For More Information

American Academy of Sleep Medicine (2020 ). Cognitive Behavioral Therapy. Retrieved 9.30.2020 from http://sleepeducation.org/treatment-therapy/cognitive-behavioral-therapy

American Academy of Sleep Medicine (2020 ). Sleep Education. Retrieved 9.1.2020 from

http://sleepeducation.org/essentials-in-sleep/healthy-sleep-habits.