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Sleep Restriction is an Effective Behavioral Therapy for Insomnia

Too Much Time in Bed May Diminish Sleep Efficiency

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Updated June 23, 2014

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Sleep Restriction is an Effective Behavioral Therapy for Insomnia
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Sleep restriction, a behavioral therapy, may be just the treatment you need to fix your insomnia. It may seem strange, but spending too much time in bed can actually cause you to have difficulties sleeping. There are simple steps you can take to remedy this problem though.

How Time in Bed Causes Insomnia

Insomnia is defined as an inability to obtain a sufficient amount of sleep to feel rested and is often characterized by a difficulty falling or staying asleep. This inevitably leads to problems with daytime functioning. Importantly, these difficulties must occur despite adequate opportunity for sleep. However, can too much time in bed actually worsen your insomnia?

As part of better sleep guidelines, if you suffer from insomnia it is advised that you not lie in bed tossing and turning. Rather, if you are unable to sleep within 15 minutes, it is better to leave your bed. You should find another quiet place to lie down until you feel ready to fall asleep, and then return to your bedroom to sleep. This is recommended because otherwise you will learn to associate your bed with the anxiety of not being able to sleep.

If you do have trouble sleeping, you might convince yourself that you need to stay in bed for a longer period of time to make up for it. This can be a mistake. The later into the morning that you remain in bed will set you up to have difficulty sleeping that next night. You will cause a shift in your body’s circadian rhythm and diminish your drive to sleep. Therefore, you may obtain some additional rest, but at the expense of not feeling sufficiently tired later.

Consolidating Sleep May Require Sleep Restriction

Spending your night tossing and turning may set you up for fragmented sleep. Naturally, our body cycles through sleep stages. If, for whatever reason, you are constantly awakening, this won’t occur properly and you won’t feel rested.

People with insomnia will often claim they only get a few hours of “good sleep”. The rest of the night is spent flitting in and out of wakefulness, looking to the alarm clock, and trying in desperation to get back to sleep. This leads to poor sleep efficiency. Sleep efficiency is the amount of time you spend asleep divided by the time you spend in bed. If you sleep six hours out of the eight you spend in bed, your sleep efficiency would be 75 percent. Ideally, your sleep efficiency would approach 100 percent.

Sleep restriction is a behavioral treatment for insomnia. It works to improve your sleep efficiency by limiting the amount of time you allow yourself to sleep in bed. Imagine if you stayed up all night and tomorrow night you only allowed yourself to sleep two hours. Chances are you’d be pretty tired, and that time would be spent sleeping deeply. Sleep restriction works on a less extreme level to increase your desire to sleep (called sleep drive). This leads to a consolidation of your sleep, less fitful sleeping, and improved sleep efficiency.

How to Treat Your Insomnia with Sleep Restriction

First, you may find it helpful to keep track of your sleep patterns with a sleep log. This will record your bedtime, the time you spend asleep, the time you spend in bed, and the time you get up on a daily basis. You may wish to keep these records for a few weeks to establish your pattern. Based on these results, figure out the average amount of time you feel like you actually sleep each night.

You will use the amount of time you spend asleep to determine the amount of time you will spend in bed. For example, if you only sleep five hours per night on average based on your sleep log, you will only allow yourself to be in bed for five hours. Do not spend less than four hours in bed, not even if you feel you sleep less. Start restricting yourself to this amount of time in bed.

Each day you will calculate your sleep efficiency. Once you are sleeping at least 85 percent of the time you are spending in bed, you will increase the time in bed by 15 minutes. You will keep increasing the time in bed using this sleep efficiency as your goal until the time in bed stabilizes. Importantly, you are not allowed to take naps during the day and you should also follow sleep hygiene guidelines.

If you are older than 65 years old, your rules are slightly different. Your sleep efficiency goal is 80 percent and you are allowed a 30 minute nap during the day.

Hopefully with the simple process of sleep restriction you will be able to correct the changes in your sleep patterns and resolve your insomnia.

Sources:

Hoch, CC et al. "Protecting sleep quality in later life: a pilot study of bed restriction and sleep hygiene." J Gerontol B Psychol Sci Soc Sci. 2001;56:52.

McCurry, SM et al. "Evidence-based psychological treatments for insomnia in older adults." Psychol Aging. 2007;22:18.

Spielman, AJ et al. "Treatment of chronic insomnia by restriction of time in bed." Sleep. 1987;10:45.

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