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Insomnia Treatment Option: Sleep Restriction

Limiting Time in Bed May Improve Sleep Efficiency

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Updated February 10, 2014

For those who suffer from the sometimes self-perpetuating ailment of insomnia, it might be helpful to finally break this cycle through a treatment called sleep restriction. What is sleep restriction? How does sleep restriction break the cycle of insomnia? What are the steps needed to restrict your sleep?

To answer these questions, let’s review an excerpt from UpToDate -- a trusted electronic medical reference used by health care providers and patients alike. Then, read on for additional information about what all of this means for you.

"Some people with insomnia try to deal with their poor sleep by staying in bed longer in the morning to 'make up' some of their lost sleep. This additional sleep later in the morning may make it more difficult to fall asleep that night, resulting in the need to stay in bed even longer the following morning. Sleep restriction breaks this cycle.

  • The first step in sleep restriction therapy is to estimate the average number of hours per night that you sleep. Decrease the total time allowed in bed per night to that average sleep time, as long as it is not less than four hours.
  • A rigid bedtime and awakening time are recommended and naps are not permitted. This causes partial sleep deprivation, which increases your need to sleep the next night.
  • Once sleep has improved, you may slowly increase time in bed to improve alertness during the day.

"During the first few days to weeks, you may feel sleepy during the day and may have difficulty being alert. You can deal with this by increasing activity levels when sleepy, avoiding sedentary activities, and discussing the sleep restriction therapy with your therapist, who may need to fine tune sleep times."

In order to come to terms with why sleep restriction may work, you should first understand what insomnia means. Insomnia is difficulty falling or staying asleep or, alternatively, sleep that is not restorative. Sleep restriction is a behavioral intervention that, at first brush, may seem counter-intuitive: it seems to require you to sleep less. This isn’t exactly so, however. Instead, it attempts to condense your sleep and maximize the time in bed that you spend sleeping.

Rather than allowing yourself additional time to sleep by staying in bed, you instead cut your losses and increase your desire to sleep at the next opportunity. This is the first step in breaking the cycle. It relates to building a desire for sleep (called sleep drive) and taking advantage of the best timing of sleep (which has to do with circadian rhythms). Circadian rhythms reinforce our desire for sleep at regular intervals, most often during the night.

In an ideal world, you would have perfect sleep efficiency, meaning that every moment you spend in bed you spend asleep. Sleep efficiency is the time spent asleep divided by your total time spent in bed. When insomnia becomes severe, sleep efficiency decreases as you lie awake waiting for sleep to come. Sleep restriction attempts to improve this by eliminating "extra" time spent awake in bed.

The first task is to determine how much sleep you need. This need changes during our early life and it may be different for each person. The average amount of sleep needed is about eight hours, but some people feel rested with less and others need more. Four hours is selected as the minimum as very few people will truly function well on less sleep. Once you determine your sleep needs, you should set this as the maximum amount of time that you will spend in bed.

Next, you should focus on strictly maintaining a regular sleep schedule. This relies upon some of the important tenets of better sleep guidelines: a regular bedtime and wake-time along with consolidating sleep to the night by eliminating naps. Your body responds to regular patterns and training it to follow a regular sleep schedule will require discipline. You really must commit yourself to going to bed and getting up at the same time. Your total allowance for time in bed must be limited to the sleep need you determined. Naps will break this pattern and will undermine your ability to sleep well at the next opportunity.

The biggest obstacle to overcome in the initial weeks may be fighting off excessive daytime sleepiness. Your nights may start off just as disrupted as they have ever been. You may spend extended periods awake, struggling for sleep to come. However, as time passes, the sleep deprivation will gradually build your desire for sleep. Your body will learn to again sleep during the time that is available to it. As a result, you will be trained to sleep more and more at night.

Once you have corrected your insomnia with sleep restriction, you may discover that your self-selected sleep need is inadequate. Perhaps you always thought you needed eight hours, but when you get this amount you still find yourself too tired during the day. You may, at this point, desire to allow yourself a little more time to sleep at night to see if your sleep deprivation improves. If you continue to struggle, though, you may wish to speak with a doctor to see if another sleep disorder is compromising your ability to get the sleep that you need.

Want to learn more? See UpToDate's topic, "Insomnia treatments," for additional in-depth medical information.

Source:

Bonnet, Michael et al. "Insomnia treatments." UpToDate. Accessed: November 2011.

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