What is sleep restriction?

Can spending less time in bed improve insomnia? Short answer, yes.

Think back to a night when you were unable to fall or stay asleep. Perhaps you tossed and turned only to notice the early morning hours pass on the clock — 1:21, 2:42, 3:56. Your mind raced. And with every waking minute you grew more and more frustrated by your inability to drift off. This cycle — trying to sleep and being unsuccessful — is one of the drivers of poor sleep and, over time, can actually reinforce the belief that sleeping well is impossible. The goal of sleep restriction therapy is to alter that negative cycle contributing to poor sleep.

It may seem counterintuitive, but for those struggling with poor sleep, reducing the time spent tossing and turning in bed could be the key to a good night’s sleep. Thankfully, one evidence-based sleep treatment is highly effective and readily available: sleep restriction therapy.

What is sleep restriction therapy?

Sleep restriction therapy is a psychological sleep treatment — originally developed by Arthur J Spielman in the 1980s — that limits the time a person spends in bed so that it more closely aligns with the time they are actually asleep. By reducing the time spent in bed, the goal is to increase sleep efficiency, or the percentage of time spent asleep compared to time spent awake while in bed. For example, an 82% sleep efficiency means that 82% of the time a person is in bed they are asleep. By restricting the sleep window — say from 8 hours to 6 hours — the percentage of time spent asleep increases and sleep becomes more consolidated. Additionally, the bed-sleep connection — an important learned association between the bed and sleep — improves.

Increasing sleep efficiency leads people to steadily feel more confident that they can achieve a night of restful sleep. But don’t worry, the restricted time in bed is not permanent. As an individual begins to sleep more soundly, they’re steadily allowed to spend more time in bed — and ideally that time is spent fast asleep.

I have had sleep problems for many years and was feeling completely hopeless that I would ever be able to resolve them before I started the course [Sleepio]. I’ve been amazed by how much the sleep restriction has had an impact on my ability to get to sleep quickly and my ability to stay asleep without waking frequently.” 

— Female Sleepio User

How does sleep restriction improve sleep?

It is not known exactly how sleep restriction therapy helps to improve sleep, but it may be partially due to its direct influence on the key drivers of sleeplessness. For example, by going to bed later the need for sleep increases, which makes falling asleep and staying asleep easier. In turn, as good sleep becomes more common, beliefs about sleep improve (e.g. I will be able to sleep tonight) and nightly feelings of worry and anxiety reduce as the bedroom is no longer associated with restless nights

Irrespective of exactly how it works, the scientific research supports its place as a powerful technique to improve poor sleep. Recently, a large study that reviewed all of the evidence available on sleep restriction, found that it was effective in improving poor sleep, reducing the time it took people to fall asleep, and increasing sleep efficiency

The digital health care revolution

Sleep restriction is a key cognitive behavioral technique for helping people overcome even the most stubborn poor sleep. The technique can be delivered in various ways — digitally, such as a session in Sleepio, via a self-guided book, or during traditional face-to-face care.

As difficult as I have found sleep restriction, there’s no doubt that technique, above all others, is what’s made the positive difference to my sleep. Sleepio has introduced structure to my sleep which has helped enormously.” 

— Male Sleepio User 

However, there are some important differences in digital delivery of sleep restriction therapy that give people an advantage over traditional approaches. For example, fully-automated sleep solutions are incredibly flexible. They can be completed anytime, anywhere. This helps increase the availability of care by overcoming some of the main barriers to access (e.g. a lack of trained sleep specialists, difficulty coordinating care with work schedules). And unlike books or face-to-face care, digital solutions have built in systems to help people adhere to care, such as automatic text reminders and online support systems.

I am very grateful. I have tried the sleep restriction in the past (from the book) but lapsed many times. Having a course to do plus all the online support has been invaluable. I can’t thank you all enough.” 

— Female Sleepio User

While delivering sleep restriction therapy digitally can have advantages, it is important that solutions have the appropriate risk mitigations in place. Without a clinician present to monitor care, sleep restriction may pose risks to health for some people — particularly for those who have certain medical or mental health conditions or who work in certain occupations. 

With the new era of accessible and engaging digital mental health care, there is support to help all employees sleep better, feel happier, and consequently improve your company’s bottom line. With the help of sleep restriction, Sleepio helps participants fall asleep 54% faster, spend 62% less time awake at night, and have 45% better functioning the next day. To learn more about Sleepio and how it can help your employees back to good mental health, listen to Sally’s story.

 

Disclaimer: In accordance with FDA’s Current Enforcement Discretion Policy for Digital Health Devices for Psychiatric Disorders, for patients aged 18 years and older, who are followed by and diagnosed with Insomnia Disorder or Generalized Anxiety Disorder by a medical provider, Sleepio and Daylight can be made available as an adjunct to their usual medical care for Insomnia Disorder or Generalized Anxiety Disorder, respectively. Sleepio and Daylight do not replace the care of a medical provider or the patient’s medication. Sleepio and Daylight have not been cleared by the U.S. Food and Drug Administration (FDA) for these indications. Users are directed to not make any changes to their prescribed medication or other type of medical treatment without seeking professional medical advice.

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