Sleep Restriction Therapy (SRT) - Frequently Asked Questions

Sleep Restriction Therapy (SRT) - Frequently Asked Questions

INTRODUCTION:

Sleep Restriction Therapy is a powerful technique from Cognitive Behavioral Therapy for Insomnia (CBT-I). It is a technique to improve your sleep by limiting the amount of time you spend in bed.


In this article, we will address some common questions about Sleep Restriction Therapy (SRT).


Sleep restriction may cause daytime sleepiness until sleep has been regulated.  In general, sleep restriction is safe for most people. However, it is not without a risk.
Consult your healthcare provider if you have the following conditions before proceeding:
  1. History of bipolar disorder
  2. History of epilepsy
  3. Unstable and untreated psychiatric conditions
  4. Individuals who need to maintain optimal vigilance to avoid serious accidents (e.g. air traffic controllers, operators of heavy machinery)
  5. Diagnosed with obstructive sleep apnea
Consult with your physicians before starting sleep restriction if you are unsure.
You can opt out of sleep restriction by choosing the basic program instead of the advanced program.




Q: When does Sleep Restriction Therapy start?

A: Sleep Restriction Therapy (SRT) starts in the second week of the program to train your mind to associate your bed with falling asleep quickly.  


The way this works is that you’re going to keep the wake-up time you set in the first week, but our algorithm will calculate the earliest time for you to go to bed, based on your sleep from the past week. Do not go to bed before your recommended bedtime, and only go to bed after you start getting sleepy.

Initially, your bedtime is probably going to be much later than you expected. The reason for doing this is so that by the time you go to bed, you’re going to be so sleepy that you’ll fall asleep much quicker than before—maybe in just minutes.

If that works well, then the following week, we’ll adjust the bedtime earlier so you can spend more time asleep. Most importantly, during this time period your brain will form a strong association between going to bed and falling asleep quickly, and we’ll slowly adjust your bedtime forward until you’re sleeping your desired number of hours. 

Q: When should I pause Sleep Restriction Therapy (SRT)?

A: Sometimes you might experience inevitable disruptions in the middle of your sleep restriction program. For example, you might fall sick, or you might have upcoming travel plans. 


Our first advice is for you to wait and only start your sleep restriction program when you know you would be able to dedicate at least 2 weeks without any disruptions. But that is not always possible (e.g. if you fall sick in the middle of the program, or if you have to travel due to an emergency).


In that case, we recommend that you pause sleep restriction and return to it afterward. You can pause sleep restriction on the Profile tab, and you can always resume it at a later time. You don't have to restart the program from the beginning, although you can do so if you would like to (refer to the article How do I restart my program?)

It is especially important for you to pause sleep restriction when you're not feeling well. When you're sick, your immune system is already under additional stress and this is when getting adequate amount of sleep is even more important. Remember that safety always comes first. 





If you ever feel that your health is at risk at any point during the program, we recommend pausing sleep restriction and talking to your healthcare provider. 

Q: I wake up multiple times in the middle of the night. Will this help me?

A: Waking up in the middle of the night, also known as mid-sleep awakenings, is normal. Most of us experience mini-awakenings without even noticing them—up to 20 times per hour. When it comes to observable wake-ups, most people have about two or three per night. 


For people with insomnia, the problem is not with waking up in the middle of the night, but rather with falling back to sleep. This is known as middle-of-the-night insomnia or MOTN insomnia. One way to overcome MOTN insomnia is through sleep restriction therapy.


Q: Why Sleep restriction work?

A: Sleep restriction therapy (SRT) has been used in clinical practice for over 30 years. There is plenty of clinical evidence that SRT works.


In fact, a clinical study in 2015 shows that SRT is effective in reducing symptoms of insomnia and decreasing the time it takes to fall asleep, even as a standalone intervention without the other components of cognitive behavioral therapy for insomnia (CBT-I).

Q: Why is SRT so effective, and how does it work?

A: The idea is simple, even if it's counterintuitive. The goal of SRT is to limit the time you spend awake in bed, so that you can shorten the time to fall asleep and replace haphazard and light sleep with deeper and more consolidated sleep.


After your sleep is consolidated, we will gradually increase your time-in-bed while maintaining the same sleep efficiency as before.

Q: What are the ways in which SRT has been shown to help with insomnia?

A. There are 4 ways in which SRT has been shown to help with insomnia:


  1. Builds homeostatic sleep drive: SRT helps to build up sleep drive, or the desire to sleep. This ensures that by the time you go to bed, you're so sleepy that you'll fall quickly into deep, restorative slumber.

  2. Resets circadian rhythm: Patients with insomnia often fall asleep and wake up at inconsistent times. By reducing this inconsistency, your internal biological clock will readjust itself to a more predictable pattern, so it eventually becomes less likely for you to fall asleep during the day or wake up in the middle of the night.

  3. Reduces arousal: SRT is shown to reduce pre-sleep arousal, which are the physical and mental processes that prevent you from falling asleep. Examples of pre-sleep arousal include a rapidly beating heart and racing thoughts.

  4. Reduces negative thought patterns: A study in 2019 shows that SRT alone improves depression, maladaptive thinking, and hyperarousal in postmenopausal women, which resulted in better sleep overall. The same research shows that sleep hygiene does not have the same positive effects as SRT.

Q: What is sleep efficiency?

A:  Sleep efficiency is the percentage of time spent asleep while in bed. For instance, if you spend eight hours in bed per night, and you are asleep for six out of those eight hours, your sleep efficiency score is 6/8 = 75%. Sleep efficiency of 80% or higher is considered healthy. Our goal is to help you reach a sleep efficiency of 85%.


Sleep restriction is a proven and effective way to increase your sleep efficiency score. By narrowing your sleep window, your mind produces enough sleep pressure for you to fall asleep quickly when you go to bed, and stay asleep throughout the night.


We will be adjusting your sleep window on a weekly basis by taking into account your sleep efficiency score over the past week, so remember to continue to record your sleep daily for our recommendation to be accurate.


Q: Can you explain the goal of sleep restriction?

A: The goal of sleep restriction is twofold. 


  • First, we want you to focus on building up your sleep pressure to the point that you will be able to fall asleep quickly when you finally go to bed. This means you might have to stay up until a much later time before going to bed. 

  • Second, we want to help you reset your circadian rhythm. In order to do that, we need you to wake up at the same time everyday, even during the weekends. We also need you to avoid napping, because napping before your bedtime will disrupt your circadian rhythm and will release the sleep pressure that you worked so hard to build up.  


Q: Is sleep restriction a challenging part of the program, and how does it work to improve sleep?

Sleep restriction is one of the most effective parts of the program, but also the most difficult part. 


You might find it counterintuitive that you have to try to stay awake in order to get better sleep, but this is fundamental psychology at work. You’re so sleepy by the time you hit the pillow that you immediately fall into a deep, restorative sleep. In time, your mind starts forming a strong, permanent association between your bed and quickly falling into a restorative sleep. This association will benefit your sleep for the rest of your life.


We know this is hard, and we’re not going to sugarcoat that. But we want you to know that you’re not alone. Hundreds of thousands of people have survived sleep restriction and have successfully overcome their sleep problems permanently. We’re confident that this will help you too. 


At times it might seem impossible to carry on, but remember that things often get worse before they get better, so stay strong and persevere.


The first two weeks are always the hardest, so if you can stick with us for just two weeks, then the hardest part will be over.
We look forward to celebrating your success with you at the end of the program!













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