National Sleep Foundation

Chapter 2: Insomnia

CBT – Sleep Restriction

Sleep Restriction Therapy

Sleep restriction therapy aims to limit the time spent in bed to the actual time spent sleeping and to increase sleep efficiency by prolonging sleep time. Restricting the time spent in bed creates a mild sleep deprivation and can promote an earlier sleep onset, more effective and deeper sleep, and less night-by-night variability in the quality and quantity of sleep. This decreases insomnia and creates confidence in the ability to regain natural sleep.1

A typical sleep restriction protocol includes:

  1. Determine the individual’s Average Total Sleep Time (ATST) per night (this can be calculated from a sleep diary that has been filled out for one week).
  2. Restrict the individual’s time in bed each night to the ATST.
  3. Establish a fixed bedtime depending on the desired wake time in the morning, and do not permit any sleep to occur outside of the sleep window. (Do not, however, reduce time spent in bed to less than 4.5 hours per night, as this can lead to noncompliance with the sleep restriction therapy.)
  4. Monitor daily sleep efficiency, which is calculated by the Total Sleep Time (TST) / time spent in bed multiplied by 100.
  5. Extend the time spent in bed by 15 minutes when the weekly average sleep efficiency exceeds 90 percent. Reduce the time spent in bed by 15 minutes when the weekly average sleep efficiency falls below 80 percent.

References

  1. Spielman AJ, Saskin P, Thorpy MJ. Treatment of chronic insomnia by restriction of time in bed. Sleep. 1987;10:45-56.