Sleep restriction therapy
Research has shown that sleep problems and insomnia are maintained, in part, by spending too much time in bed, and getting up and going to bed at inconsistent times, which cause fragmented sleep. Time in bed lying awake further contributes to insomnia because the brain may learn to associate the bed and bedroom environment with wakefulness over time, and may trigger feelings of alertness and cause sleep fragmentation as a result.
Using sleep restriction therapy (SRT), we will prescribe personalised going to bed and getting up times over several weeks, which will lead to improved sleep efficiency and reduction in sleep difficulties.
Sleep efficiency is based on the simple assumption that we go to bed in order to sleep. So if you’re in bed but can’t sleep or not intending to go to sleep, you might be doing things that weaken your sleep-bed association.
During session 3, you and your therapist will set-up a sleep plan for the upcoming week and discuss how to adjust it over time. You can already have a look at your own sleep diaries you completed so far and try to think about your sleep patterns. To understand more what your current patterns look like, just look at these two sleep patterns below (pattern A and B) and identify which represents your current sleep pattern. Think about what usually fills the gaps between periods of being asleep? Perhaps emotions such as anger or frustration? Worries and unwanted thoughts? Write them down so we can discuss and address this during your upcoming session.
Which sleep pattern do you prefer? Which pattern in your opinion is likely to have higher sleep quality?
Both sleep patterns have the same overall amount of sleep. Sleep pattern A is when this amount of sleep is spread over a longer duration, resulting in fragmented and low-quality sleep. In fact, going to bed early and before our biological clock is ready to call it a night, and spending a lot of time laying in bed awake can weaken our sleep pressure, resulting in sleep spreading thinly across the night. On the other hand, staying up for longer before trying to sleep, increases our sleep drive until we reach our optimal sleep gate, which can then result in it taking less time to get to sleep and more deep sleep. This results in overall shorter but continuous sleep similar to pattern B.
Two weeks ago, we discussed sleep homeostasis, and how it regulates our need to sleep with our need to be awake. Accordingly, in this programme, the changes we are going to suggest are about working with your sleep homeostasis and helping you shift your sleep pattern from A to B to achieve a better sleep experience. It is about compressing your sleep, not reducing it. It is about increasing your sleep efficiency. When the sleep pressure is high, sleep onset becomes easy and you will tend to get better quality sleep after a sustained period of sleep sleep restriction therapy.
Do you want to calculate your sleep efficiency easily yourself? Input your data in this spreadsheetLink opens in a new window and calculate your sleep efficiency!