Sleep Restriction Therapy for Insomnia

Sleep restriction therapy (SRT) is a treatment that can help people with insomnia. Insomnia is when a person has trouble falling asleep or staying asleep. Having insomnia can leave you feeling tired, frustrated, and stressed.^1,2

SRT is part of cognitive-behavioral therapy for insomnia (CBT-I). CBT-I is usually the first thing your doctor will recommend for insomnia. That is because CBT-I does not involve any medicine.^2,3

How does SRT work?

SRT works by limiting the amount of time you spend in bed. That might sound odd. But over time, this makes sleep more restful and can improve overall sleep quality.^1,2

The main goal of SRT is to match the time spent in bed with the actual time spent sleeping. This is known as sleep efficiency. Simply put, it means if you are in bed, you are sleeping instead of tossing and turning.^1,2

Many people with insomnia spend extra hours in bed trying to fall asleep. They may go to bed early or stay in bed longer in the morning. But spending too much time awake in bed can make insomnia worse.²

With SRT, a person sets a specific sleep window. This window is a limited amount of time they are allowed to spend in bed. The amount of time is based on how much sleep the person actually gets each night, not the time they spend in bed trying to sleep.^1,2

For example, if someone usually sleeps only 5 hours per night, they might start with a 5-hour sleep window. The sleep window may be set from midnight to 5 AM. Over time, as sleep quality improves, the window can be increased in small steps. The goal is to eventually reach a healthier amount of sleep, around 7 to 8 hours.^1,2

Why is SRT used to treat insomnia?

Although it may not sound logical, SRT can improve sleep. When a person limits the time they spend in bed, they become sleepier. This sleepiness can help them fall asleep more easily and stay asleep through the night. As the brain gets used to the new routine, it learns that the bed is only for sleeping. This can help break the cycle of tossing and turning.^1,2

SRT also helps people develop a regular sleep schedule. When someone has insomnia, their sleep schedule is often inconsistent. SRT creates a routine by having set times to go to bed and wake up. This regular schedule helps the body's internal clock, known as the circadian rhythm, to regulate sleep.^1-3

What is involved in SRT?

A person doing SRT will typically work with a sleep specialist. The specialist will help set up the initial sleep window and make changes based on the person's progress. Here are the basic steps:^1-3

Track sleep

To begin, you will need to keep a sleep diary. In it, you must record how many hours you actually sleep each night. This helps the sleep specialist set an appropriate sleep window.

Set the sleep window

Based on your sleep diary, your specialist will determine how many hours you can stay in bed. This window is usually less than the time you have been spending in bed.

Follow the schedule

Each night, you should only be in bed for the sleep window that has been set for you. You should get out of bed at the same time each morning, even on weekends. This helps your body and internal clock get used to its sleep-wake cycle.

Make any adjustments

After 1 or 2 weeks, your sleep specialist may increase the sleep window by 15 to 30 minutes if you are falling asleep and staying asleep easily. Over time, the sleep window will increase until you reach a healthy amount of sleep.

How to know if SRT is right for you

SRT is a safe, drug-free treatment that may be effective for people with insomnia. That being said, it takes commitment. Studies show that sticking to the set sleep window is very difficult. This often results in people abandoning SRT. SRT requires discipline and patience.^3,4

SRT may not be suitable for everyone. If you have certain health conditions or severe daytime sleepiness, discuss your options with your doctor.