Sleep restriction therapy is a behavioural technique used to treat chronic insomnia. It works by limiting the total time spent in bed to align with actual sleep time. It’s not about restricting actual sleep time but is about restricting the time spent in bed. This cuts out time spent in bed tossing and turning. The next step is to gradually increase the time spent in bed.

Mild sleep deprivation builds up natural sleep pressure, reduces nighttime waking, and rewires the brain to associate the bed with deep sleep.

Here is a helpful example from Stanford Medicine. Imagine someone who goes to bed at 23:00pm and gets out of bed at 8:00am. They are spending nine hours in bed but only sleeping for an average of six hours each night. During the first stage of sleep restriction therapy, their time in bed may be reduced to match the amount of time they actually sleep, for example from 12:00am to 6:00am.

Over the following week, this increased sleep pressure often helps reduce the amount of time spent awake during the night and improves sleep quality. The amount of time spent in bed then remains the same for at least a week before any adjustments are made.

These adjustments are based on sleep efficiency, which measures the percentage of time spent asleep compared with the total time spent in bed. If sleep efficiency is 85% or higher, time in bed may be gradually increased. If it falls below 80%, time in bed may be reduced further or kept the same.

Sleep restriction therapy is tailored to each individual and should be guided by a qualified healthcare professional. The process continues until a person is consistently getting enough sleep to function well during the day.
Another option is to take time to stop and notice the things around you that fill you with the feeling of gratitude. When you’re out and about stop and smell the roses and notice the things that surround you that you appreciate. Maybe it’s the sunshine, a cool breeze, your favourite restaurant, or pretty flowers. Whatever is, take a moment to notice it and say thank you, aloud or in your head for it.

The simple the practice is the better. It’s also important to have a practice that you can easily incorporate into your life, so that it’s harder to forget. For example, you could pair your gratitude practice with a daily routine like brushing your teeth.

Sleep restriction can be highly effective for people with insomnia, and there is a substantial body of research that supports its usage. In fact, it is a core component of Cognitive Behavioural Therapy for Insomnia (CBT-I). By limiting the time spent in bed to match the amount of time actually spent asleep, sleep restriction helps build natural sleep drive. Over time, this can help people fall asleep more quickly, spend less time awake during the night, and achieve a better quality of sleep.

• Temporary daytime fatigue: You may feel more tired than usual during the first one to two weeks as your body adjusts to the new sleep schedule.
• Gradual expansion of sleep time: As sleep efficiency improves, the amount of time you are allowed to spend in bed is slowly increased.
• Consistent sleep tracking: Keeping a sleep diary and maintaining regular sleep and wake times are key to achieving the best results from sleep restriction therapy.

Sleep restriction therapy typically takes between two and eight weeks of consistent practice to produce noticeable improvements. While the exact timeline varies from person to person, many people find that their sleep becomes deeper before the total number of hours slept begins to increase. Patience and consistency are key because changes happen overtime.

Weeks 1 to 2:

You track sleep in a diary and cut your time in bed to match your actual sleep time. This first phase often feels difficult and daytime sleepiness increases.

Weeks 3 to 5:

Sleep efficiency gradually begins to improve. You wake up in the night less often.

Weeks 6 to 8:

Your sleep window widens by 15 to 30 minutes at a time as your body learns to sleep solidly through the night.

Some important things to note are that the first two weeks are usually the most difficult and can cause immense daytime fatigue. You may also feel irritable or sad while going through this phase. It is also important to never let your time in bed drop below 5.5 hours.

Sleep restriction therapy is not appropriate for everyone. It may be unsafe for people with untreated sleep apnoea, bipolar disorder, seizure disorders, or those whose jobs involve driving or operating heavy machinery, where excessive daytime sleepiness could pose a safety risk.

Sleep restriction therapy should also ideally be carried out under the supervision of a trained healthcare professional or as part of a structured CBT-I programme, rather than being attempted alone.

In the short term, sleep deprivation can lead to slower reaction times, poor concentration, memory lapses, irritability, and significant mood changes. It can also increase the risk of accidents, particularly when driving or operating machinery.

Over the long term, chronic sleep deprivation has been linked to a range of serious health concerns, including high blood pressure, heart disease, an increased risk of type 2 diabetes, a weakened immune system, and poorer mental health.

If any of these symptoms sound familiar, it is important to speak with your GP. They can help identify the cause of your sleep difficulties, discuss appropriate treatment options, and determine whether approaches such as sleep restriction therapy may be suitable and safe for you.

Sleep restriction isn't recommended without professional support for people with bipolar disorder (sleep loss can trigger mania), epilepsy, or untreated sleep apnoea, or for people who drive or work with machinery.