Estimated reading time: 6 minutes
Fort Lauderdale psychologist, Dr. Dennis London reviews the concept of sleep restriction, an important technique in the treatment for insomnia.
Are you frustrated because it feels like you’ve tried just about everything but you still can’t fall asleep at night? Let me guess, you’ve tried:
- Making the room dark, cold, and comfortable
- No more caffeine in the afternoon
- Avoiding alcohol or nicotine near bedtime
- Eating a light snack before bedtime
- Avoiding fluids near bedtime
It’s frustrating if you’ve read everything about sleep hygiene, have tried all of the methods written by sleep experts, doctors, and therapists, but you still can’t fall asleep. Why is that?!
I have one guess: You’re spending too much time in bed.
Sleep hygiene strategies are wonderful and are commonly recommended as a component of sleep interventions. They have been shown to be helpful for individuals with mild insomnia or as a preventive measure for sleep disturbances. However, sleep hygiene strategies may not be sufficient to treat severe or chronic insomnia on their own. Studies have shown that a more comprehensive approach, like CBT-i, that combines sleep hygiene with other strategies like sleep restriction, may be more effective.
CBT-i is a structured and evidence-based approach for treating insomnia, which is a common sleep disorder characterized by difficulty falling asleep, staying asleep, or experiencing non-restorative sleep. Click here to learn more about CBT-i, offered as an evidence-based therapy at The Psychology Group Fort Lauderdale.
CBT-i includes both sleep hygiene and sleep restriction strategies, in addition to other components. It’s important that you find a provider who is knowledgeable about sleep restriction, in addition to sleep hygiene, if you have chronic insomnia and want to try CBT-i.
What is Sleep Restriction?
Sleep restriction is a therapeutic technique commonly used in CBT-i. Sleep restriction aims to improve sleep efficiency and consolidate sleep by manipulating the amount of time spent in bed. It was developed to eliminate long awakenings in the middle of the night that make it difficult to fall back asleep. Its aim is to not actually restrict total time asleep; rather, it restricts the total amount of time spent in bed, which affects sleep efficiency.
What is Sleep Efficiency?
Sleep efficiency, or SE for short, is usually expressed as a percentage. That is, of the time you spent trying to sleep, how much time were you actually asleep? It can be calculated by taking your total sleep time (TST), dividing that by the total amount of time you spent in bed (TIB), and multiplying that by 100.
SE = TST/TIB*100
For example, let’s say you had a pretty good night last night. You spent 8 hours asleep, and spent 8.5 hours in bed between the amount of time it took you to fall asleep and get out of bed in the morning. Your sleep efficiency would be 94.12%.
SE = 8/8.5*100
Rationale of Sleep Restriction
People frequently alter their sleeping patterns when sleep difficulties first appear in an effort to make up for lost sleep or to make sure they obtain the recommended amount of sleep. For instance:
NappingSleeping in (especially on weekends)Going to bed too earlyWaking up naturally but trying to sleep for longer
What do all of the above have in common? A person spends more time in bed.
Although these adjustments might be beneficial in the short term, they actually prolong the insomnia over time. Imagine you are anxious about sleeping at night, so you decide to try to cope by getting in bed one hour earlier. That may seem like a good idea, but what is likely to happen is you will spend that extra hour in bed awake, tossing and turning, and feeling anxious. The more you do this, overtime, you will begin to associate the bed with anxiety, instead of restful, calming sleep. This is the opposite of what we want!
How Sleep Restriction Works in CBT-i
One of the main goals of treatment is to increase sleep efficiency. Throughout treatment, your sleep efficiency will be monitored by your therapist. They will ask you to complete a sleep diary that tracks how much time you spend in bed vs. time asleep. Every session, your therapist will calculate your SE score and adjust how much time you should spend in bed each night over the next week in order to maximize your sleep.
The Goals of Sleep Restriction in CBT-i Are to:
- Increase sleep efficiency by reducing the amount of time spent in bed awake.
- Strengthen the association between the bed and sleep, helping you fall asleep more quickly.
- Consolidate sleep and improve overall sleep quality.
Here is an overview:
- Baseline Assessment: The first step is to gather information about your sleep patterns. This includes tracking your sleep habits, such as bedtime, wake time, and any daytime symptoms related to poor sleep.
- Establishing a Sleep Window: Based on the information gathered, a sleep window or “prescribed time in bed” is established. This sleep window is initially shorter than the typical time you might spend in bed to increase your sleep efficiency. For example, if someone usually spends eight hours in bed but only sleeps six hours, their sleep window might be set to six hours initially.
- Strict Adherence: You will be instructed to adhere strictly to the established sleep window. This means you should go to bed only during the designated time and wake up at the set wake time, even if you have not slept the entire duration of the sleep window. Remember, you are retraining your body to improve your sleep quality long term!
- Gradual Adjustment: Over time, as sleep efficiency improves, the sleep window can be gradually extended by 15-30 minutes every week. This adjustment is made based on the sleep diary and your ability to fall asleep and stay asleep within the prescribed time. For reference, a sleep efficiency of about 85-90% is on track, and a SE over 90% is great.
- Sleep Monitoring: Throughout the therapy, you will keep a sleep diary to track your sleep patterns and any improvements or setbacks. This will be used to monitor progress and adjust your prescribed time in bed each week.
Remember the Long Term Goal
It’s important to note that sleep restriction can be challenging, especially initially, as you may experience increased sleepiness during the day. If you find yourself struggling, speak to your therapist. Also, remind yourself why you are doing this.
As your sleep efficiency improves and the sleep window is gradually extended, any daytime sleepiness tends to decrease. Towards the end of treatment, you should be spending most of your time in bed asleep, getting restful and good quality sleep.
Florida Licensed Psychologist:
License PY 12050
Dr. Dennis London is a licensed psychologist in Fort Lauderdale and is an expert in PTSD and trauma-related issues, depression therapy, anxiety therapy, couples and marriage counseling, Psychological Testing/Evaluations, mood disorders, and LGBTQ+ specific issues.
Call 954-488-2933 or email today to discuss how our services can help you.
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