For Insomniacs, This Counterintuitive Sleep Method Might Be the Only Answer
When you first hear of the concept of restricted sleep, it may sound like some kind of bizarre medieval torture — but here’s what this type of sleep therapy actually looks like: Rather than tossing and turning with ever-increasing anxiety as you stare at the clock in the middle of the night, you’re sitting up, pleasantly working on a puzzle or watching Friends, until your brain is fully ready to snooze. Then, when you do turn off the light and get under the covers, you’re more likely to achieve that elusive goal of restful sleep.
Sleep restriction is a well-researched, highly effective tool that is used as a part of cognitive behavioral therapy for insomnia (CBT-I). In the American Academy of Sleep Medicine’s most recent guidelines for the treatment of insomnia, CBT-I has the strongest recommendation for treating insomnia, and the specific CBT therapy of sleep restriction is also recommended, with the academy stating that although there is a limited amount of research on this specific strategy, “studies demonstrated clinically significant improvements in responder and remission rates.” A separate study in Sleep Medicine Reviews in 2021 found that sleep restriction therapy “reliably improves sleep and insomnia symptoms.”
“The goal of sleep restriction therapy, which is also sometimes called ‘sleep rescheduling,’ is to better match your time in bed with your total sleep time, which is known as sleep efficiency,” explains Ellen Wermter, a board-certified Family Nurse Practitioner and behavioral sleep medicine specialist with the Better Sleep Council. “Ideally you should be spending around 85% of your time in bed asleep,” she says. It’s okay to be awake for some of the night, but when insomnia keeps you up for so much of the night that you associate the bed with frustration and anxiety, the brain doesn’t get the same cue to fall asleep, Wermter explains.
“In essence, sleep restriction prunes the overgrown tree,” says Dylan Petkus, MD, founder of Optimal Circadian Health. “It takes away excess and allows the healthiest parts to thrive. With continued use, it can help rebuild a more stabilized sleep pattern.”
How does sleep restriction therapy work?
The first step in this type of sleep therapy is keeping a sleep diary. For around two weeks, you will keep notes of when you go to bed, when you achieve sleep and when you get up.
Once you have enough data to figure out the average amount of time you’re sleeping per night versus the average amount of time you’re staying in bed, you and your therapist can come up with an appropriate schedule that matches that time frame (Wermter points out that you should still aim for a minimum of 5 to 5.5 hours of sleep, so if you have to be up by 7 a.m. for work, you shouldn’t go to bed any later than 2 a.m.).
So let’s say you’re attempting to consolidate sleep from 1 a.m. to 7 a.m. After you tuck in the rest of your family and pets at their earlier hours, you should spend the pre-bedtime hours sitting up doing something that occupies your mind. “We want you active, engaged and as awake as you can possibly be,” says Wermter. She points out that rather than lying on the couch with your eyes half-closed, this state of wakefulness actually increases your sleep drive, so that when you do get into bed, your body and brain are primed to fall asleep.
The key is to choose an activity that keeps you engaged but also calm. “We don’t want you doing burpees,” Wermter says. It should be both relaxing and distracting. Some suggestions:
- Read a book that keeps you turning the pages but doesn’t include any upsetting material (say, a charming romance or old-fashioned mystery rather than a history of World War II).
- Do a crossword or jigsaw puzzle
- Work on a knitting or crochet project
- Scribble in an adult coloring book
- Organize that photo album you’ve been meaning to finish since your trip to Yellowstone last summer
- Watch TV. It’s perfectly fine, says Wermter (though it’s obviously best to avoid potentially upsetting news shows and stream a comforting sitcom instead). But when you start to feel your eyes drooping, be sure to move into the bedroom rather than falling asleep on the couch. The goal, after all, is to start teaching the brain that the bed is a place to sleep, she adds.
The next day, though you may feel sleep-deprived, it’s important to power through. “You want to be active and talking to people and working because if you lie about and barely do anything all day, you’re not really building the same sleep drive,” Wermter says.
Once you power through that drowsy day, your sleep should become deeper and more satisfying as it becomes more consolidated. “It’s a form of muscle training,” says Dr. Petkus. “Over time, your brain consolidates a habit, so that your bed becomes connected with sleep, not sleepless frustration. This training should reinforce the healthy link between bed and sleep.”
And it’s important to remember, sleep restriction therapy is not meant to be long-term. Instead, it is a very powerful “reset button,” says Wermter. Once you consolidate your sleep into a five- or six-hour window, you can start backing up your bedtime, she says. If you had been staying awake until 2 a.m., move it back to 1:30. After a few nights, if you find you can fall asleep soon within a reasonable window, back it up again to 1 a.m.
Are there any risks?
The biggest risk is daytime tiredness, particularly at the start, says Dr. Petkus. “When you reduce your sleep too quickly, or without the benefit of proper training and support, the result can feel profoundly debilitating.” He suggests proceeding gently, and stresses the importance of working with a qualified sleep professional.
Because you may be very tired through this process, it is important NOT to attempt to drive if you are overtired or do any other activities that would risk your health or safety.
Who should and shouldn’t try SRT?
This therapy is not for everyone who has insomnia, and it’s best to consult with a therapist trained in CBT-I before starting. According to the American Academy of Sleep Medicine guidelines, the treatment “may be contraindicated in certain populations such as those working in high risk occupations (e.g., heavy machinery operators or drivers) or those predisposed to mania/hypomania, poorly controlled seizure disorders or excessive daytime sleepiness.”
Both Wermter and Dr. Petkus stress the importance of ruling out other sleep disorders before diving in. “If you have sleep apnea or restless leg syndrome, you’ll want to get that evaluated and treated before you attempt this,” says Wermter.
But if you are otherwise healthy, and you’re one of those people who lies awake at night for hours, this might be a good option for you, says Dr. Petkus.
Wermter also points out that for many people with insomnia, the idea of spending less time in bed can be a little scary, and there are other options to try first. In fact, sleep restriction is just one of many tools in the CBT-I toolbox. Other aspects of treatment may include:
- Reframing negative or unhelpful thoughts about sleep
- Learning mindfulness practices and relaxation exercises to use before bed
- Identifying and eliminating stimuli such as blue screens, food and alcohol before bed
Bottom line
For people with insomnia who spend a significant amount of their time in bed awake, feeling anxious and irritated, sleep restriction therapy can help boost their sleep efficiency, making the bed a more welcoming place to nod off to a restful sleep. For best results, consult a therapist trained in cognitive behavior therapy for insomnia.
