Reading time: 8 minutes
What’s inside?:
- The birth of Sleep Medicine… and Arthur Spielman’s radical idea
- So… what exactly is Sleep Restriction Therapy?
- How It Works
- Modern Uses of Sleep Restriction Therapy
- The Challenges of Sleep Restriction Therapy
- The Role of a Sleep Therapist
- The Payoff
Are you a restless sleeper?
Do you lie there… staring at the ceiling… counting sheep until the early hours?
Well, you’re not alone.
Insomnia and sleep disturbances are way more common than you might think. But here’s a little-known secret in the world of sleep science that could change everything for you: Sleep Restriction Therapy (SRT).
Yep, it’s a thing, and it might just be the game-changer you’ve been looking for… although it doesn’t come easy. In fact, it is torture.
So, where did Sleep Restriction Therapy come from, and how did it become a go-to treatment for insomnia?
Let’s take a quick stroll down memory lane to find out.
The birth of Sleep Medicine
Sleep medicine didn’t really start making waves until the mid-20th century. Before that, if you had trouble sleeping, people just shrugged it off as a side effect of something else—stress, anxiety or whatever else was going on in your life. But the 1960s and 70s brought a change in perspective. Researchers began to see sleep problems as issues that deserved their own attention.
During this time, Cognitive Behavioural Therapy (CBT) was gaining popularity for treating all sorts of mental health issues. And soon enough, someone had the bright idea to apply CBT principles to sleep problems.
Enter Dr Arthur Spielman.
Arthur Spielman’s radical idea
Dr. Spielman, a psychologist with a keen interest in insomnia, came up with an idea that was both brilliant and, let’s be honest, a bit counterintuitive.
What if, instead of trying to get people to spend more time in bed, we actually made them spend less time there?
Sounds a bit off-kilter, right?
But Spielman’s hypothesis was that by limiting the time you’re allowed in bed, you could actually improve the quality of sleep. Less time in bed means less time lying awake, which could lead to better, more restful sleep.
This idea became a cornerstone of Cognitive Behavioural Therapy for Insomnia (CBT-I), a broader treatment approach that includes sleep hygiene, stimulus control, cognitive restructuring and… you guessed it… Sleep Restriction Therapy.
So… what exactly is Sleep Restriction Therapy?
Alright, now we know where SRT came from, let’s break down how it works.
At its heart, Sleep Restriction Therapy is all about matching the time you spend in bed to the actual time you’re sleeping. For instance, if you’re only catching about five hours of Zs each night but spending eight hours in bed, SRT would have you cut your time in bed down to just five hours. The idea here is to create a mild sleep deprivation, which makes you sleepier the next night and helps you fall asleep faster.
Over time, as your sleep efficiency (the percentage of time spent asleep while in bed) improves, you gradually increase your time in bed.
The goal?
To eventually get a full, restful night’s sleep without spending unnecessary hours awake.
How It Works
Here’s a quick step-by-step guide to how Sleep Restriction Therapy usually goes down:
- Keep a Sleep Diary: First things first, you’ll need to keep a sleep diary for about a week or two. This helps establish how much time you’re actually spending asleep each night. If you have wearable sleep tracker… this could be a little more reliable than a pen & paper.
- Calculate Your Sleep Efficiency: Next, you’ll figure out your sleep efficiency. This is just a fancy way of saying, “How much of your time in bed are you actually sleeping?” If you sleep five hours but spend eight hours in bed, your sleep efficiency is around 62.5%.
- Set Your Bedtime and Wake Time: Based on your sleep diary, you’ll set a bedtime and wake time that limits your time in bed to your average sleep time. For example, if you’re sleeping five hours, you might start going to bed at midnight and getting up at 5am. Note… that’s GETTING UP at 5am… not hitting the snooze button at 5am.
- Gradually Increase Time in Bed: As your sleep efficiency improves (once it hits around 85%), you’ll slowly start increasing your time in bed by 15 to 30 minutes at a time until you’re getting a full night’s sleep.
- Maintenance: Once you’ve reached your ideal sleep time, the focus shifts to keeping these healthy sleep habits going strong.
Now, there’s no point in trying to sugarcoat it… SRT can be tough, especially at the start.
Sleep deprivation is, after all, a recognised form of torture.
You’ll likely feel more tired as you adjust. But, so long as you and your medical adviser agree it is a safe option for you… there’s evidence the rewards can be more than worth it.
Why Sleep Restriction Therapy Works
So, what’s the deal? Why does restricting sleep actually help you sleep better in the long run? Let’s dig into the science behind SRT.
Building Up Sleep Pressure
One of the key concepts here is sleep pressure, also known as homeostatic sleep drive. This is your body’s way of making sure you eventually crash into a deep sleep after being awake for a long time. Think of it like a balloon filling up with air throughout the day. It needs to release that pressure at night.
By restricting your time in bed, you’re increasing that sleep pressure. This makes it easier to fall asleep quickly and stay asleep, as your body is more ‘desperate’ for rest.
Syncing with Your Circadian Rhythm
Another big factor is your circadian rhythm… your body’s internal clock that tells you when it’s time to sleep and when it’s time to wake up. By sticking to a consistent bedtime and wake time, you’re reinforcing this natural rhythm, which can help you sleep more consistently.
Breaking the Insomnia Cycle
Insomnia often creates a nasty cycle: you struggle to sleep, so you spend more time in bed, which leads to more time lying awake, which only makes your anxiety about sleep worse. SRT helps break this cycle by retraining your body to associate bed with sleep, not stress or frustration.
Modern Uses of Sleep Restriction Therapy
So, where does Sleep Restriction Therapy fit into today’s sleep medicine landscape? Let’s take a look at how it’s being used.
Treating Insomnia
The number one use for Sleep Restriction Therapy is in treating insomnia, whether it’s primary insomnia (where sleep problems are the main issue) or secondary insomnia (where sleep issues are caused by another condition, like anxiety or chronic pain). Studies suggest SRT can be a solid solution for many folks struggling to get the rest they need.
A Key Part of CBT-I
As we touched on earlier, SRT is often a key component of Cognitive Behavioural Therapy for Insomnia (CBT-I), which is considered the gold standard for treating chronic insomnia. Here’s a quick rundown of what CBT-I usually includes:
- Sleep Hygiene: Teaching people about habits and environmental tweaks that can improve sleep… like avoiding that late-afternoon cup of coffee or creating a cozy sleep space.
- Stimulus Control: Helping people break the habit of using the bed for anything other than sleep or nuptuals… or a little pre-sleep reading… or pre-nuptuals reading, if that floats your boat.
- Cognitive Restructuring: Addressing and changing those unhelpful beliefs and thoughts about sleep, like thinking, “I’ll never be able to sleep without medication.”
- Sleep Restriction Therapy: The part we’ve been talking about… cutting down time in bed to improve sleep efficiency.
Beyond Insomnia: Other Sleep Disorders
While SRT is mostly used for insomnia, it’s also been explored as a treatment for other sleep disorders. For example, some studies have looked at its use in treating circadian rhythm sleep disorders, like delayed sleep phase disorder (where you can’t fall asleep or wake up at ‘normal’ times) and shift work disorder (where irregular work hours mess with your sleep).
The Challenges of Sleep Restriction Therapy
As promising as SRT is, it’s not without its challenges. Here are a few things to keep in mind if you’re considering this approach.
Sticking With It
One of the toughest parts of SRT is just sticking with it. Deliberately restricting sleep can be pretty uncomfortable, especially in the early days when you might feel extra tired and cranky. Staying motivated and remembering the long-term benefits is key.
Handling Sleep Deprivation
Since SRT involves reducing your sleep, it can lead to symptoms of sleep deprivation at first. This might include increased daytime sleepiness, irritability, difficulty focusing and even a temporary dip in your mood. It’s important to be aware of these potential side effects and manage them as best as you can.
Everyone’s Different
Not everyone will respond to SRT in the same way. Factors like your age, overall health, and the severity of your sleep issues can all play a role in how well this therapy works for you. Older adults, for instance, might need more gradual adjustments to their sleep schedule, while those with certain health conditions might need to take extra precautions.
The Role of a Sleep Therapist
Given the challenges of SRT, it’s probably a good idea to work with a trained sleep therapist or psychologist, especially if you’re dealing with complex or severe sleep problems. A professional can help tailor the therapy to your specific needs, monitor your progress and make adjustments as needed.
The Payoff: Success Stories and Research on SRT
Despite the challenges, many people have found success with Sleep Restriction Therapy. Research backs it up too, showing that SRT could significantly improve sleep quality and reduce the symptoms of insomnia.
So, for some, Sleep Restriction Therapy has been a powerful tool in the fight against insomnia. While it’s not an easy fix and requires professional guidance and personal commitment, the rewards can be life-changing… better sleep, better mood, and better overall health.
If you’re tired of being tired… SRT might just be worth a shot.
Cheers,
Alan
P.S. I have taken to creating various bits on sleep and sleep apnea. If you would enjoy hearing more and find out where else you can find stuff like this, you can get my weekly Triple Whammy email, which has 3 short topics each week. Some written or recorded by me and others I’ve found out there in the strange world we live in.
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