Insomnia sleep restrictions

Acute Phase Treatment. Hypnotic medications are useful for short-term treatment of insomnia, but they should always be accompanied by behavioral and psychoeducational treatments, including a review of good sleep hygiene practices. It may also include more aggressive measures such as relaxation training, sleep restriction therapy, and stimulus control therapy. 

Spielman AJ, Saskin P, Thorpy MJ. Treatment of chronic insomnia by restriction of time in bed. Sleep 1987 10 45-56. 

SRT has become a standard therapeutic approach, either alone or in combination with other methods, for the management of insomnia. Although it was formally described only 15 years ago, sleep restriction has probably been used as a naturalistic countermeasure to insomnia for much longer. The evidence available, although not very extensive, indicates that SRT is an effective intervention for... 

Wohlgemuth WK, Edinger JD. Sleep restriction therapy. In Lichstein KL, Morin CM, eds. Treatment of Late-Life Insomnia. Sage London, 2000 147-165. 

Friedman L, Bliwise DL, Yesavage JA, Salom SR. A preliminary study comparing sleep restriction and relaxation treatments for insomnia in older adults. J Gerontol 1991 46 Pl-8. 

Riedel BW, Lichstein KL. Strategies for evaluating adherence to sleep restriction treatment for insomnia. Behav Res Ther 2001 39 201-212. 

Morin CM, Kowatch RA, O Shanick G. Sleep restriction for the inpatient treatment of insomnia. Sleep 1990 13 183-186. 

Glovinsky PB, Spielman AJ. Sleep restriction therapy. In Hauri PJ, ed. Case Studies in Insomnia. New York Plenum Press, 1988. 

Some clinicians believe that sleep restriction is an effective form of treatment for chronic insomnia. Evidence from studies varies, and use of sleep restriction in many studies was part of combination therapy, and the specific contribution of sleep restriction toward sleep improvement was unclear. 

A rather different clinical application of the MSLT is the assessment of patients with insomnia. One might expect that, as in the sleep-deprived individuals, patients with insomnia would have a short sleep latency on the MSLT however, in a study by Siedel and Dement (52), only 7% of insomniacs were in the pathological range on MSLT (< 5 min), while 17% were in the gray area (5-10 min), and 41 % had scores >15 min. These data suggest that insomniacs are a heterogeneous population and that many respond abnormally to restricted nocturnal sleep. 

As for most behavioral therapies, the success of SRT is entirely dependent on the patient s compliance with the prescribed sleep window (7,22). Despite the apparent simplicity of this clinical procedure, therapist guidance is often essential to optimize compliance with the clinical recommendations (16). The first hurdle is making it clear to the patient what is expected and why. Indeed, the idea of curtailing even further the sleep of someone who presents with insomnia is somewhat paradoxical. For many patients, it is counterintuitive when sleep quality is unsatisfactory—from their vantage point, time in bed should be increased to obtain more satisfactory sleep. Thus, it is essential to explain the basic principles of sleep homeostasis and the rationale behind SRT, which should help patients better understand why time in bed should be restricted (27). The addition of sleep education is also useful for elderly individuals to explain the nature and extent of sleep changes associated with aging (16,18,22,25). 

Use naps properly. Naps are usually a healthy and stress-relieving practice. But if you have insomnia, avoid naps until you can sleep through the night—no matter how tired you get. If you re not concerned about insomnia, stick to twenty- to forty-five-minute naps in the middle of the day. If your bedtime is 11 p.m., for instance, you should restrict naps to the time between noon and 3 p.m., or you might have trouble falling asleep. 

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