What Is Sleep Restriction Therapy?

Unable to fall asleep at night? Try sleep restriction therapy.

By Nicole Gleichmann

Do you spend time at night lying awake in bed, unable to fall asleep despite insufficient sleep the night before? If this has been going on for three or more months, you might have the sleep disorder, insomnia.

When someone with insomnia heads to bed, they often spend hours tossing and turning before they manage to fall asleep. Once asleep, they may awaken in the middle of the night, unable to get back to sleep. 

Not only can these experiences make nighttime incredibly frustrating, but the resulting sleep loss has deleterious consequences. In the short-term, people with insomnia can experience daytime fatigue, poor work performance, and frustration. The fatigue can become dangerous as people drive to and from work.

In the long-run, inadequate sleep poses a risk to health and happiness. Chronic sleep deprivation increases the chances of experiencing health conditions like diabetes, depression, and cardiovascular disease. It can even make it harder to lose weight or say no to unhealthy food cravings. 

While many people turn to sleep medicine for insomnia, pharmaceuticals come with unwanted side effects. As a natural alternative, countless people are trying sleep restriction therapy (SRT).

Defining Sleep Restriction Therapy

Sleep Restriction Therapy (SRT) is a form of cognitive behavioral therapy for insomnia. Human studies have found restrictive therapy to work as well as pills while lasting longer.  In a nutshell, SRT is a behavioral strategy designed to promote restful sleep by using restricted sleep time and a sleep schedule. 

How Does Sleep Restriction Therapy Improve Insomnia?

1. Changes Neuro-Associations Linked to Your Bed

Dog owners know a thing or two about conditioning. The first time you take your puppy to the vet, they are all wiggles and joy. But after a few times of having some not-so-fun moments, they will begin to panic the moment that they walk into the vet’s office. 

The same thing happens in the human brain. When you lie in bed unable to fall asleep, you experience negative feelings. Whether it’s stress or boredom or annoyance, none of these are emotions that you want connected to your bed. The more time you spend feeling this way in your bed, the greater the chances that you will again the following night.  

SRT is designed to limit your time in bed to the point that you’re only in there when you are asleep or within minutes of falling asleep. This rewires your brain to associate your bed with sleep, rather than anxiety. 

2. Increases Deep Sleep

Many people with insomnia sleep in fragmented sections throughout the night. This disturbed sleep is not as high of quality as deep, uninterrupted sleep.

SRT limits your total sleep time, often creating a sleep deficit. After a week of restricted sleep, drowsiness can lead to rapid sleep onset and deep, restful sleep. Not only is this deep sleep more beneficial than bouts of sleep interrupted by periods of wakefulness, but it retrains your brain to stay asleep once it falls asleep. 

3. Solidifies a Sleep-Wake Schedule

Humans have an internal clock known as our circadian rhythm. This biological clock evolved alongside the natural light/dark cycle, and it influences when we feel tired and when we feel alert. 

Nowadays, many people sleep at seemingly random times that vary by many hours from one day to the next. Plus, these hours are often misaligned with day and night. Improper sleeping habits themselves can be a contributor to insomnia. 

To encourage a healthy relationship with sleep, a regular sleep schedule is essential. When you follow an SRT schedule, your body can adjust to a regular sleep schedule. A regular schedule rebalances the release of chemicals within the body that regulate when you feel tired and when you feel alert. 

Sleep Restriction Therapy Step-by-Step Guide

Step 1: Calculate Your Total Current Sleep

To setup the appropriate sleep schedule, you need to know how much time, on average, you are sleeping each night. For two weeks, keep a diary of how much time you actually sleep each night. Add that up and divide by the number of days (14) to determine your Average Total Sleep Time (ATST).

Step 2: Determine How Much Time to Spend in Bed

Take your ATST from step 1 and add 30 minutes. This is going to be the total amount of time that you spend in bed for the next two weeks, called your time in bed. To support your health and energy levels, you should spend no less than 5.5 hours in bed, even if you are currently sleeping less than 5 hours each night. 

Note: Do not take any naps during your sleep training period. Naps can make it harder to sleep at night, exacerbating insomnia. 

Step 3: Choose a Wakeup Time

You must pick a wakeup time that you will follow daily for the next few weeks. You must wake up at the same time every day, even if you sleep less than planned the night before. This means that if you need to get up at 6 A.M. for work on the weekdays, you must also wake up at 6 on the weekend. 

Step 4: Calculate Your Bedtime

Take your wakeup time and count back by the number of hours that you calculated in step 1 (your average total sleep time). This is the time that you should be in bed each night. Do not enter your bed before this time, no matter how tired you are. This includes doing things in your bed like reading or watching TV—your bed must be saved for sleep only. 

Step 5: Stick to Your Sleep Schedule for 1-2 Weeks

Now that you have your bedtime and wakeup time, adhere to these as closely as possible for 2 weeks. This gives your body and mind time to adjust. 

Note: If you feel excessively sleepy to the point that you’re struggling to go about your daily activities, consider adding 15 minutes to your sleep window. But only add time if you are sleeping well when in bed.  

Step 6: Adjust Your Total Sleep Time

The ultimate goal is to overcome insomnia and find the right quantity of sleep for you. To do this, you will calculate your sleep efficiency following the first two weeks. Sleep efficiency is the percentage of time that you spend sleeping when you’re in bed. So, if you are in bed from midnight to 6 A.M. and sleep 5.5 hours, 5.5/6 = 92% sleep efficiency. 

If your sleep efficiency is less than 80%, the sleep restriction therapy has not yet succeeded. At this time, decrease your sleep window by 15-30 minutes for the next week.

If your sleep efficiency is 80% or greater, you can either stay with your current schedule or add 15 minutes. Only add 15 minutes if you find that you are tired during the day. The key is determining the right amount of total sleep where you sleep well and are not overly tired during the day. 

Try to stick with every change for 1 week and then reevaluate for the following week. 

You’ve found your ideal schedule once you are regularly attaining 80%+ sleep efficiency while feeling good during the day. 

What to Do If Sleep Restriction Therapy Doesn’t Work for You

One way to increase the chances that sleep restriction will work for you is by practicing good sleep hygiene. This includes things like reducing light exposure late in the day, limiting caffeine intake, and more. 

Many people with insomnia or other sleep disorders can struggle to treat it themselves. Working closely with your doctor or sleep specialist may be necessary to help set you on the right track.


Conclusion

Sleep restriction therapy can help you to develop a healthy sleep pattern by restricting the time spent in bed. With a limited amount of sleep, achieving restful sleep at night becomes easier. Over time, you work to increase how much time you spend asleep until you find a routine that improves insomnia symptoms.


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