What Is Sleep Restriction Therapy and How Does It Work?

Findings from the CDC’s 2020 National Health Interview Survey indicate that about 14.5 percent of US adults experienced trouble falling asleep, while 17.8 percent had trouble staying asleep. In fact, one study shows that close to 33 percent of US adults experience one episode of insomnia every year, but a large proportion of participants didn’t realize they had the condition. It shows that many people could be struggling with sleep issues but not seeking treatment to address them.

Sleep restriction therapy is regarded as a highly effective treatment for people struggling with sleep issues. Though it’s not designed to make sure you get a full 8-9 hours of sleep per night, you can avoid tossing and turning in bed or waking up in the middle of the night.

What is Sleep Restriction Therapy?

Dr. Arthur Spielman, a New York-based specialist in sleep medicine, designed sleep restriction therapy based on the principles of behavioral therapy. Contrary to what the name implies, the goal of the therapy isn’t to reduce sleep but to restrict the amount of time you spend awake. It’s based on the concept that the longer you stay awake in bed, the less time you spend asleep. With SRT, you can correct this disturbance and achieve a balance.

Who is Sleep Restriction Therapy For?

Sleep restriction therapy is a highly effective treatment for insomnia, but it has the potential to address other conditions as well. Insomnia is a diagnostic criterion for various mental health disorders.

It’s why experts at treatment centers like URP Behavioral Health may recommend SRT to alleviate the condition. One research on the effects of SRT on postmenopausal women shows that SRT increases energy levels and productivity while reducing daytime fatigue.

How Does SRT Work?

The core idea behind SRT is that when you limit how much time you stay awake in bed, you take less time to fall asleep. This approach is highly effective because of a few key reasons.

Builds Sleep Pressure

When you spend less time lying in bed and more time working or doing other tasks, you’re bound to feel tired. This helps build pressure for sleep, also known as the homeostatic sleep drive, which builds up in the body as the wake time increases. The pressure grows stronger the longer you stay awake, which improves your chances of getting restful sleep.

Resets Your Circadian Rhythm

Your body’s internal clock, also known as circadian rhythm, responds to light and dark as signals to be awake and fall asleep, respectively. However, fluctuating sleep patterns can affect this clock, making it difficult to fall asleep. Sleep restriction therapy aligns your body’s internal clock with when you want to sleep. As a result, you’ll be able to follow triggers to stay awake and fall asleep.

Reduces Cognitive Arousal

When you start SRT, you’ll follow a routine that can help reduce pre-sleep arousal. This includes any mental and physical processes like racing thoughts and an increased heart rate, which keep you from falling asleep. Since you’ll be waking up at a consistent time, you build adequate sleep pressure and fall asleep on time.

Addresses Negative Thoughts

Because SRT gradually reduces the amount of time you spend lying awake in bed, it can alleviate negative thought patterns. Maladaptive thoughts are linked to depressive and anxiety disorders, which can also result in difficulties with sleep. Practicing SRT with a specialist can potentially improve symptoms.

Steps for Sleep Restriction Therapy

When you begin SET, the administration will vary depending on your age, medical history, and other lifestyle factors. Usually, a practitioner recommends that you do the following:

1. Maintain a Sleep Diary

Most therapists recommend that you keep a sleep journal or diary for about 2 weeks. This is so you can record how long you’ve been spending in bed and how much you’ve been sleeping.

Let’s say you go to bed at 9 PM but don’t fall asleep until 12 AM and wake up at 6 AM. This means you’re spending 9 hours in bed, but you’re only sleeping for 6. So, keep track of when you go to bed, fall asleep, and wake up.

You should also note down any factors that disturb your sleep, such as using your phone before bedtime, exercising, caffeine, or needing to go to the bathroom.

2. Calculate Average Hours of Sleep

At the end of two weeks, look at your sleep diary and determine the average number of hours you’ve been sleeping each night. Based on the previous example, if you’re only sleeping for six hours each night, there’s no need to stay in bed for 9 hours.

Instead, restrict your sleep window to six hours by going to bed by, say, 11 PM and then waking up by 5 AM.  That being said, you shouldn’t restrict your sleep window to any less than five hours, regardless of your average sleeping time.

3. Set a Bed Time

Once you know when you should be going to bed to get the same amount of sleep, make sure to go to bed at the same time each day. So, if you have to sleep at 11 PM to get your average 6 hours of sleep, then that’s your daily bedtime.

4. Maintain a Rise Time

You also have to set a specific rise time – when you’ll wake up each morning. It’s important that you consistently wake up at the same time, no matter how much sleep you get. This will be difficult, but it’s part of the process of ensuring that you start sleeping better.

5. Follow The Same Routine

You’ll need to stick to the same routine of going to bed and waking up at the same time each day of the week for two weeks. Make sure that the amount of time you spend in bed doesn’t vary based on how much sleep you get.

6. Adjust Your Bedtime

Once you start sleeping well through the night, assess how tired you feel during the day. Your sleep specialist will calculate your sleep efficiency score to determine whether you need to adjust your sleep window.

Your sleep efficiency is calculated by dividing the time you’re asleep (in minutes) by how long you spend in bed (also in minutes) and multiplying that figure by 100. If your sleep efficiency is low – within the 80 to 85% range – your permitted time in bed is restricted by 15 to 30 minutes. And if your sleep efficiency is higher than 90%, your time in bed can be increased by 15 to 30 minutes.

Each addition or subtraction from your total time in bed needs to be followed for at least one week before another adjustment. You’ll continue this pattern until you’re getting the recommended amount of sleep.

Side Effects of Sleep Restriction Therapy

If you struggle with a preexisting medical condition or sleep disorder, you shouldn’t try SRT without guidance from a sleep therapist. There are also other side effects, such as:

• Since you’ll be sticking to a consistent bedtime and rise time regardless of how much sleep you get, you’re bound to feel sleepy during the day. However, these shouldn’t be greater than usual and should resolve as you continue treatment.
• You may feel difficulties in concentration and focus, but these should be no greater than what you experience already. It’s best to avoid operating heavy machinery or driving while experiencing daytime sleepiness.
• For some people struggling with insomnia, time spent in bed provides them with stress relief. Sleep restriction can reduce the time they spend in bed, which can result in a temporary increase in anxious thoughts.

Effective Strategies for Sleep Restriction

When you begin practicing sleep restriction therapy, there are certain measures you can take to improve its efficacy. These will strengthen your bed as a cue for sleep and weaken it as a cue for wakefulness.

Don’t take naps.

Most importantly, you shouldn’t take many naps during the day. If you need to take a nap, make sure it lasts between 15 and 30 minutes and should take place about 8 to 9 hours after you wake up. This ensures the nap feels refreshing and doesn’t disturb your sleep pattern.

Only go to bed when you’re sleepy

Instead of going to sleep when it’s ‘time for bed,’ only go when you feel sleepy. This increases the probability of you falling asleep quickly, but make sure you can tell the difference between feeling fatigued and sleepy. Fatigue means that you have low energy, while sleepiness is when you’re struggling to stay awake.

Similarly, if you’re unable to fall asleep, whether it’s when you go to bed or in the middle of the night, get out of bed. Then, only go back to bed when you’re sleepy.

Comfortable ambiance when going to bed

When you’re ready to go to bed, keep the dim lights so your body starts relaxing. Keeping your room quiet, cool, and dark will help you fall asleep. That’s because your internal clock associates darkness with a cue to release melatonin, which regulates sleep cycles.

Turn on the lights when you wake up

Once your alarm rings in the morning, get up, turn on the lights, and open the windows. You can also take a shower and go outside – just make sure you get out of bed. The light acts as a signal that it’s time to wake up.

Conclusion

Sleep restriction therapy is helpful for people who struggle with insomnia and getting enough sleep. It’s based on the principles of behavioral therapy and follows a series of steps to ensure that you’re spending less time lying awake in bed. It’s best to work with a sleep therapist to make the most of SRT and follow their instructions by going to bed and waking up at the same time. Additionally, trying certain measures, like creating a cozy and stimulating environment at night and during the day, can improve your sleeping patterns.