What Is Sleep Restriction Therapy? Who Should Use It?
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ncbi.nlm.nih.gov/pmc/articles/PMC5353813/Cognitive behavioral therapy for insomnia (CBT-I). (2022).
sleepfoundation.org/insomnia/treatment/cognitive-behavioral-therapy-insomniaCrönlein T, et al. (2020). Cognitive behavioral treatment for insomnia is equally effective in insomnia patients with objective short and normal sleep duration.
sciencedirect.com/science/article/abs/pii/S1389945718305355How much sleep do I need? (2017).
cdc.gov/sleep/about_sleep/how_much_sleep.htmlKalmbach DA, et al. (2019). Improving daytime functioning, work performance and quality of life in postmenopausal women with insomnia: comparing cognitive behavioral therapy for insomnia, sleep restriction therapy, and sleep hygiene education.
jcsm.aasm.org/doi/full/10.5664/jcsm.7882Kalmbach DA, et al. (2019). Treating insomnia improves depression, maladaptive thinking, and hyperarousal in postmenopausal women: comparing cognitive-behavioral therapy for insomnia (CBTI), sleep restriction therapy, and sleep hygiene education.
sciencedirect.com/science/article/abs/pii/S1389945718306750Maurer LF, et al. (2018). How does sleep restriction therapy for insomnia work? A systematic review of mechanistic evidence and the introduction of the triple-r model.
sciencedirect.com/science/article/abs/pii/S1087079218300790Maurer LF, et al. (2020). Isolating the role of time in bed restriction in the treatment of insomnia: a randomized, controlled, dismantling trial comparing sleep restriction therapy with time in bed regularization.
academic.oup.com/sleep/article/43/11/zsaa096/5839766Maurer LF, et al. (2021). The acute effects of sleep restriction therapy for insomnia on circadian timing and vigilance.
pubmed.ncbi.nlm.nih.gov/33314496/Maurer LF, et al. (2021). The clinical effects of sleep restriction therapy for insomnia: a meta-analysis of randomized controlled trials.
sciencedirect.com/science/article/abs/pii/S1087079221000782Maurer LF, et al. (2022). The effect of sleep restriction therapy for insomnia on sleep pressure and arousal: a randomized controlled mechanistic trial.
academic.oup.com/sleep/article-abstract/45/1/zsab223/6360382Mitter P, et al. (2022). Sleep deprivation as a treatment for major depressive episodes: A systematic review and meta-analysis.
sciencedirect.com/science/article/pii/S1087079222000600Our ancestors probably didn't get 8 hours of sleep a night, either. (2015).
uclahealth.org/u-magazine/our-ancestors-probably-didn-t-get-eight-hours-of-sleep-a-night-eitherPeter L, et al. (2019). Effectiveness of an online CBT-I intervention and a face-to-face treatment for shift work sleep disorder: a comparison of sleep diary data.
mdpi.com/1660-4601/16/17/3081Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Current Version Oct 20, 2022 By Kimberly Holland Edited By Rayne Whitington Medically Reviewed By Suzanne Stevens, MD Copy Edited By Megan McMorris Share this articleMedically reviewed by Suzanne Stevens, MD — By Kimberly Holland on October 20, 2022
Sleep Restriction Therapy for Insomnia and Other Conditions
Medically reviewed by Suzanne Stevens, MD — By Kimberly Holland on October 20, 2022Share on PinterestWe’ve all been there — tossing and turning in bed, hoping you’ll eventually fade off into a blissful few hours of sleep, only to realize your alarm clock will be going off in 30 minutes. Just like the sun creeps above the horizon in the morning, the dread of going another night with little or no sleep creeps up on too many people. In fact, one study found that 33% of Americans experience one or more episodes of insomnia every year. What’s more, 27% of people with the condition in the study did not realize they had it. That means many people may not be seeking treatment for insomnia or working to overcome their sleep issues. Sleep restriction therapy is one type of treatment for insomnia. It aims to improve a person’s quality of sleep by consolidating how much time they’re spending in bed. It may sound counterintuitive, but hopefully this guide to sleep restriction therapy (SRT) will make it clear how spending less time in bed can actually lead to better sleep. Read on to learn more.What is sleep restriction therapy
Sleep restriction therapy is a type of behavioral treatment that aims to ease symptoms of insomnia. Many people who find it difficult to get adequate sleep — or to stay asleep — find their minds preoccupied with worries about sleep as the evening wears on. This pattern of worrying and anxiety can actually make sleep worse or harder to attain. What’s more, some people experiencing sleep problems will try to counteract that by going to sleep earlier and earlier, in hopes that the lengthy time in bed will translate to greater sleep totals. But the more time someone spends in bed unable to sleep, the greater odds are they’ll begin to experience anxiety and stress. The more time they spend in bed lying awake, the harder it may be to finally get sleep. Sleep restriction therapy restricts how much time a person is in bed to make their sleep time more efficient and hopefully more restorative. The goal isn’t to reduce how much sleep you’re getting. Instead, it’s to restrict it and condense it so that you’re only in bed as long as needed for sleep. This way, your personal behaviors align better with your body’s natural circadian rhythm. SRT can be used alone as a treatment for insomnia, but it’s often combined with cognitive behavioral treatment for insomnia (CBTI). This treatment plan includes steps like identifying and replacing negative thoughts about sleep and reshaping your feelings and behavior about sleep.Who can benefit from sleep restriction therapy
SRT is a first line of treatment for insomnia. But it’s useful for treating other conditions, too. One study found that shift workers who used SRT both online and in outpatient settings experienced improvement in sleep efficiency. A 2019 study found that SRT significantly reduced dysfunctional beliefs about sleep, as well as depressive symptoms. SRT also helped reduce pre-sleep arousal. This led to better sleep for the postmenopausal women who took part in the study. Some people with insomnia experience shorter periods of sleep; others have typical sleep duration. SRT can help both groups, according to a 2020 study. But people who have short-duration insomnia had better responses to SRT. Another study with postmenopausal women found that SRT helped improve quality of life, reduce daytime fatigue, boost productivity, and increase energy. However, the effects of SRT alone took longer to appear than SRT combined with CBTI.Side effects of sleep restriction therapy
Not everyone should attempt to use SRT. People with serious sleep disorders or significant health issues should not use SRT without a sleep specialist or sleep therapist. Furthermore, some people should take precautions when using SRT. In the first weeks of treatment, it is not uncommon for you to experience increased daytime sleepiness as you get acquainted with your new sleep cycle. For that reason, you should take caution if you drive trucks or operate heavy machinery. Do not get behind the wheel of a car if you’re experiencing daytime sleepiness.How to do sleep restriction therapy
A sleep therapist or sleep specialist will help guide you through the steps of SRT. These steps may include:Keep a sleep journal. Writing down how much you sleep, and what times you go to bed and wake up, will help the specialist get an idea of your current sleep patterns. You can also use smart devices like watches and sleep apps to help you record your time asleep.Calculate your average sleep time and time in bed. You need to know two numbers: your Time in Bed number and your Average Total Sleep Time. You can get your Average Total Sleep Time from your sleep diary. That’s how long you’re asleep each night in total. Your Time in Bed number is the Average Total Sleep Time plus 30 minutes.Decide on a wake-up time. This should be the time you typically wake up every morning. You can set it to be the time you wake up on your own or when an alarm should wake you up. This should not change on weekends.Set a bedtime. Subtract your Time in Bed number from the wake-up time to get your bedtime. For example, if you’re sleeping about 6.5 hours each night, you’ll want to move back 7 hours from a wake-up time of 6 a.m. That means you should set 11 p.m. as a bedtime. Be consistent. Your wake-up time and bedtime should be the same every morning and evening, no matter how much sleep you get or how tired you are. Stick with this routine for 2 weeks. Evaluate. Then, check in with how you’re feeling during the day. Are you tired? Do you need more sleep? Or are you feeling great and want to maintain this schedule? The goal of SRT is to get you sleeping better and feeling good and alert during the day.Adjust. If you need more sleep, add 15 minutes to your Time in Bed and bump back your bedtime to accommodate the additional sleep time. But don’t do more than 15 minutes at a time each week. For many people, SRT allows you to gradually add time spent in bed until you’re getting the recommended 7 to 9 hours each nightWarning You should not have a Time in Bed number below 5 hours. Even if you are not sleeping 5 hours, you shouldn’t condense the Time in Bed number below 5 hours. Fewer than 5 hours of sleep a night can cause job performance issues. You may also experience excessive daytime sleepiness and cognitive impairment.Sleep restriction therapy tips and tricks
A few tips can help you make SRT more successful:Avoid napping. Sleeping during the day will decrease your sleep drive and make falling asleep at night more difficult.Stay out of bed. The bed should be for sleep and sex, not watching TV or surfing social media. If your brain only associates your bed with sleep-related activities, it will know it’s time to shut down when you tuck in every night.Create a cozy environment. Sleeping in a cool, quiet, and dark room will help you fall asleep and stay asleep. These conditions trigger your brain to release sleep-inducing chemicals. Switch to warmer and dimmer lighting when you’re getting ready for bed to help cue your body that it’s time to relax. Bring in the light. When your alarm goes off in the morning, immediately change the cozy environment to one that is bright and stimulating. Open the blinds or turn on the lights. Take a shower, or go for a walk. Do anything but sit in bed. When you’re ready for sleep, switch to dimmer and warmer light.Is sleep restriction therapy effective
Yes, research continues to show that SRT is an effective treatment for insomnia. It also has some benefits for other conditions.One review of current studies found that SRT participants in 10 out of 10 studies reduced their restless time in bed and cut the amount of time it took to fall asleep. Another meta-analysis found that SRT improves the severity of insomnia and improves how long you stay asleep in the short term in the vast majority of studies it reviewed.SRT has also been shown to reduce symptoms of depression and negative beliefs and thoughts about sleep.Is it unhealthy to be awake in the middle of the night
SRT is designed to help people have prolonged sleep during the night and reduce the number of times they wake up. But the concept of sleeping through the night is actually relatively new in human history. Biphasic sleep refers to divided sleep, or people sleeping in two segments during the day. Sometimes, that means once at night and once during the day, such as a nap. But it also can mean sleeping in shifts at night. However napping can also be associated with poor sleep quality, and people who do not get adequate sleep have increased risks of conditions including type 2 diabetes and obesity. It is possible you are a biphasic sleeper, but before you adopt that lifestyle, you may want to talk with a sleep specialist.FAQs about sleep restriction therapy
Have more questions about sleep restriction therapy? These answers might help:How long does sleep restriction therapy take to work
It is not immediate, but each person’s response will be different. Most sleep specialists ask patients to stick to SRT for 2 weeks to best understand the results. For some people, the window may need to be longer. But be patient. It’s known to be an effective treatment, and you are likely to see some benefits.How can you stay awake during sleep restriction therapy
If you’re feeling sleepy during the day, that’s not unusual. Adjusting to SRT can take time, and you may feel more tired than usual at first. If so, help stimulate your brain by turning on bright lights, exercising or going for a walk, and steering clear of “comfortable” spots like a sofa or bed before bedtime. Avoid relying on stimulants like coffee or energy drinks as they can negatively affect your sleep schedule as well.What is the most effective sleep restriction method
The most effective part of SRT is restricting the amount of Time in Bed to a very specific window. Keeping a tight Time in Bed window helps consolidate the sleep schedule, and it is associated with reduced symptoms of insomnia. You can slowly expand the Time in Bed, but it should be done slowly. Add only 15 minutes at a time, and wait at least a week between additions.Is sleep restriction therapy safe
Most people will have no issue with SRT, but there are some things to consider. People undergoing SRT may experience higher daytime sleepiness in the first 1 or 2 weeks of the treatment. That can translate to difficulty with motor skills, according to a 2020 study. You should avoid operating machinery or driving a car when you’re feeling excessively sleepy. People with severe sleep disorders should not attempt SRT without supervision from a sleep specialist.What to do if sleep restriction therapy isn t working
It is possible that SRT won’t work for you, but before you give up, give it more time. Some people don’t see the impact of SRT for several weeks. Stick to your schedule. The results may come. If you’re still not seeing any changes, talk with your sleep specialist. There are other treatment options for insomnia and sleep-related issues, including medication and other therapies.Takeaway
Not getting enough sleep makes life challenging. You wake up tired. You’re tired all day. You want to go to bed the moment you get home. And yet, you find yourself, at bedtime, wide awake and unable to find any relief. Sleep restriction therapy may be able to help you fall asleep and get more sleep. This type of insomnia treatment aims to reduce the amount of time you’re in bed while maximizing how much sleep you’re actually getting. The early stages of SRT can be challenging, but stick with them. Most people see improvements in just a few weeks. And once you’re getting better sleep, other issues and symptoms of insomnia are likely to end. Last medically reviewed on October 20, 2022How we vetted this article
SourcesHistoryHealthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Bhaskar S, et al. (2016). Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities.ncbi.nlm.nih.gov/pmc/articles/PMC5353813/Cognitive behavioral therapy for insomnia (CBT-I). (2022).
sleepfoundation.org/insomnia/treatment/cognitive-behavioral-therapy-insomniaCrönlein T, et al. (2020). Cognitive behavioral treatment for insomnia is equally effective in insomnia patients with objective short and normal sleep duration.
sciencedirect.com/science/article/abs/pii/S1389945718305355How much sleep do I need? (2017).
cdc.gov/sleep/about_sleep/how_much_sleep.htmlKalmbach DA, et al. (2019). Improving daytime functioning, work performance and quality of life in postmenopausal women with insomnia: comparing cognitive behavioral therapy for insomnia, sleep restriction therapy, and sleep hygiene education.
jcsm.aasm.org/doi/full/10.5664/jcsm.7882Kalmbach DA, et al. (2019). Treating insomnia improves depression, maladaptive thinking, and hyperarousal in postmenopausal women: comparing cognitive-behavioral therapy for insomnia (CBTI), sleep restriction therapy, and sleep hygiene education.
sciencedirect.com/science/article/abs/pii/S1389945718306750Maurer LF, et al. (2018). How does sleep restriction therapy for insomnia work? A systematic review of mechanistic evidence and the introduction of the triple-r model.
sciencedirect.com/science/article/abs/pii/S1087079218300790Maurer LF, et al. (2020). Isolating the role of time in bed restriction in the treatment of insomnia: a randomized, controlled, dismantling trial comparing sleep restriction therapy with time in bed regularization.
academic.oup.com/sleep/article/43/11/zsaa096/5839766Maurer LF, et al. (2021). The acute effects of sleep restriction therapy for insomnia on circadian timing and vigilance.
pubmed.ncbi.nlm.nih.gov/33314496/Maurer LF, et al. (2021). The clinical effects of sleep restriction therapy for insomnia: a meta-analysis of randomized controlled trials.
sciencedirect.com/science/article/abs/pii/S1087079221000782Maurer LF, et al. (2022). The effect of sleep restriction therapy for insomnia on sleep pressure and arousal: a randomized controlled mechanistic trial.
academic.oup.com/sleep/article-abstract/45/1/zsab223/6360382Mitter P, et al. (2022). Sleep deprivation as a treatment for major depressive episodes: A systematic review and meta-analysis.
sciencedirect.com/science/article/pii/S1087079222000600Our ancestors probably didn't get 8 hours of sleep a night, either. (2015).
uclahealth.org/u-magazine/our-ancestors-probably-didn-t-get-eight-hours-of-sleep-a-night-eitherPeter L, et al. (2019). Effectiveness of an online CBT-I intervention and a face-to-face treatment for shift work sleep disorder: a comparison of sleep diary data.
mdpi.com/1660-4601/16/17/3081Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Current Version Oct 20, 2022 By Kimberly Holland Edited By Rayne Whitington Medically Reviewed By Suzanne Stevens, MD Copy Edited By Megan McMorris Share this articleMedically reviewed by Suzanne Stevens, MD — By Kimberly Holland on October 20, 2022