Sleep restriction therapy for insomnia – spending too much time in bed in an attempt to compensate for disturbed sleep and in most cases showed little to serious improvement in insomnia treatment.
Definition of Sleep Restriction
Insomnia can sometimes be severe or cause to last indefinitely by behavioral factors, such as spending excessive time in bed in an attempt to compensate for disturbed sleep. Eventually, a conditioned association between disturbed sleep and the sleep environment develops. Thus, treatment involves re-strengthening the association between the bed and good sleep.
A meta-analysis concluded that sleep restriction therapy was the most effective treatment for chronic primary insomnia.
Sleep Restriction Treatment
The technique requires patients to limit the amount of time they spend in bed to an amount that equals their average total sleep time. Thus, if patients normally spend 8 h in bed, but sleep only 5 h, time spend in bed is initially restricted to 5 h.
The loss of sleep increases the homeostatic drive for sleep, resulting in decreases in sleep latency and wake after sleep onset, and increases in sleep efficiency and slow wave sleep. So profound are the improvements that despite decreases in time in bed by 1–3 h, total sleep time is often preserved. Moreover, patients undergoing sleep restriction therapy continue restricting their sleep by 1–3 h at 6–12 month follow-up assessments.
The best-documented efficacy of sleep restriction therapy has been established in older adults. This is not surprising, since aging is associated with increased wake after sleep onset, and often with spending excessive time in bed.
An important recent study found that 24 weeks of mild restriction of time in bed, approximately 30 min, increase sleep significantly in a group of older adults over 70 years who had no sleep deprivation.
Sleep restriction might produce sleep benefits with little or no adverse effects.
Recent study compared the efficacy of sleep restriction therapy combined with sleep hygiene, nap modification of sleep restriction therapy combined with sleep hygiene, and sleep hygiene alone as treatments for insomnia in 39 community-dwelling men and women 55 years and older.
Participants in the bed-restriction group showed a median increase in sleep efficiency of 6.1% versus 1.8% in participants receiving sleep hygiene instruction. Self-reported mood on awakening in the morning showed greater improvement over the first eight weeks in the sleep hygiene condition.
The use of sleep hygiene was associated with initial improvement in daytime well-being, whereas bed restriction led to sustained improvements in sleep continuity and sleep depth.
Potential Side Effects
One of the main difficulties in adhering to sleep restriction protocols has been difficulty staying awake, especially in the evening. Unintentional evening and morning napping is especially common in older adults, and might be more pronounced with sleep restriction. Sleep restriction might be facilitated by behavioral techniques that can blunt sleepiness without interfering with subsequent sleep, such as bright light exposure or moderate exercise.
Insomniacs undergoing sleep restriction therapy typically show a normalization of sleepiness levels after a few weeks, and this may correspond with a gradual increase in sleep consolidation.