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Sleep Restriction Therapy for Sleep Disorders

Medically Reviewed by Dr. Sahil Chopra

What is Sleep Restriction Therapy?

Sleep Restriction Therapy (SRT) is a non-drug behavioural modification method for treating insomnia. It has been successful for many problem sleepers. Some people with insomnia sleep fitfully at night and nap during the day.

This form of therapy restricts sleep to a specified window at night, helping improve sleep in several ways:

  • First, SRT increases sleepiness, or drive to sleep, increasing the likelihood of falling asleep quickly and sleeping through the night.
  • Second, it trains the brain to associate the bed with sleep, instead of long stretches of tossing and turning without falling asleep.
  • Finally, it involves establishing and maintaining a strict sleep-wake schedule, a key component of good sleep hygiene.

How Does Sleep Restriction Therapy Work?

Although it might sound counterintuitive, forcing the body to sleep during a fixed time and remain awake the rest of the time can correct insomnia. Like an exercise or diet program, SRT requires dedication and consistency to work.

Steps for Sleep Restriction Therapy

  • Together with his or her doctor, the sleeper sets a bedtime and wake-up time based on the total time the sleeper currently spends asleep. For example, if the patient routinely spends 8 hours in bed every night but sleeps a total of 6 hours over that period, SRT might begin with a sleep period of under 6 hours.
  • During SRT, the patient is restricted from going to bed early or taking naps.
  • After the patient begins sleeping through the entire allocated sleep period, the period may be increased in small segments, like 15 minutes.
  • The sleep period is gradually increased until the patient is sleeping through the night with minimal daytime sleepiness.

What Kind of Sleep Schedule is Used for Sleep Restriction Therapy?

The initial sleep schedule for sleep restriction therapy is based on a patient’s history of insomnia and his or her sleep patterns. The schedule is designed to restrict sleep in order to increase the drive for sleep (i.e. tiredness). So a patient who normally goes to bed at 10 p.m. and gets up at 6 a.m., but reports sleeping for just 6 hours during that time window, may start with a schedule of an 11:15 p.m. bedtime and a 5 a.m. wake-up.

Does Sleep Restriction Therapy Have Side Effects?

Many behavioral treatments for sleep problems have few side effects, which is one reason they’re often the first line of treatment for sleep disorders. But unlike other behavioral therapies, SRT may carry a risk of side effects, most prominently daytime fatigue. When sleep is restricted and patients are not allowed to nap, it’s reasonable to assume that they’ll experience some fatigue as a result. In general, daytime fatigue disappears as insomnia symptoms resolve.

However, some research suggests that patients don’t experience excessive fatigue with SRT, because their total time spent asleep during treatment is similar to their total hours spent asleep before treatment.

Depression and Sleep Restriction Therapy

Insomnia and hypersomnia are both common symptoms of depression, even mild depression. Doctors who suspect depression ask patients about their sleeping patterns. People with depression frequently experience insomnia, fragmented sleep, and excessive daytime sleepiness. Sleep restriction therapy may serve as a treatment for short-term depression. However, insomnia can increase anxiety and depression, so sleep restriction therapy shouldn’t be used to treat depression unless patients work closely with a sleep medicine specialist.

Additional Resources
Depression and Sleep Disorders
Hypnosis for Insomnia

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