Sleep Restriction Therapy

Sleep Restriction Therapy (SRT) is a non-drug method for addressing insomnia, and has had success with many problem sleepers.  Like an exercise or diet program it requires dedication by the patient who may find it easy to fall away from the program. But if SRT is incorporated into a insomniac’s life, it can work.

Although it might sound counterintuitive, forcing your available sleep time into a fixed window can help you beat insomnia.  That’s the idea behind sleep restriction therapy.  The sleeper sets a bedtime and wake-up time and sticks to those times closely.  The total time in bed is probably shorter than what the sleeper had been doing.  The time allocated for bed is determined from an estimate of how long the patient has actually been sleeping at night.  If the patient routinely spends 8 hours in bed every night but sleeps a total of 6 hours over that period, the initial time for bed allocated under SRT is 6 hours. The patient is forbidden to go to bed early or get up late, and forbidden from taking naps during the daytime.

This regimen forces the patient’s sleep into a window.  If the patient continues to have bedtime periods of waking, the time allocated for sleep is further reduced.  The goal is to have the patient sleeping the entire time he or she is in bed.

Once this goal is achieved, if the patient feels sleepy during the day, the time allocated for bed can be slowly increased, maybe by 15 minutes at a time.  After enough iterations, an equilibrium is achieved that the patient can keep going indefinitely.  There is no significant daytime sleepiness and no excess time spent in bed.

All treatments have side effects, and even a non-drug regimen like SRT produces patient complaints that could be considered side effects.  A Scottish trial found most patients experienced fatigue, excessive daytime sleepiness, and headache.  It makes complete sense that insomniacs in a sleep restriction trial experience daytime sleepiness and fatigue.  In a sense the SRT produces these effects on purpose.  If successful, the daytime sleepiness disappears after a while.

What kind of medical practitioner conducts sleep restriction therapy? Probably not your family doctor, who is more likely to address insomnia with sleeping pills.  A psychologist or psychiatrist is more apt to endorse this type of treatment.  But you don’t really absolutely need an external practitioner.  With self-discipline, you can set up and execute a SRT regimen on your own.  It’s not rocket science.  Some people need coaching, though, to stick to the plan. And that’s where a psychologist can be helpful.

Successful use of sleep restriction therapy can retrain the insomniac into sleeping right in a few weeks.  A closely controlled trial at the University of Glasgow found patients benefitted both immediately after a 4-week training regimen and several months later.

Depression and sleep restriction therapy

Insomnia and hypersomnia are both common symptoms of depression, even mild depression. Doctors who suspect depression ask patients about their sleeping patterns. Depressed people with insomnia frequently get to sleep in a normal period of time (no unusual sleep latency) but wake after a few hours and pretty much are up for the morning at around 5 am.

Sleep restriction therapy can actually be a short-term treatment for depression. Don't let people sleep as much as they want to, and the depression subsides. It doesn't work for everyone, and it's hardly a long-term cure, but sleep restriction can play a part in overall depression management. Indeed, staying up past one's normal bedtime can often produce a feeling of euphoria.

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