Sleep Restriction

Many subjects with insomnia try to compensate for this by spending more time in bed to provide enough opportunity for sleep, and particularly by staying in bed trying to sleep while this is difficult. This not only induces abnormal circadian rhythms, but also causes frustration.

Sleep restriction assumes that sleep deprivation will lead to deeper and more continuous sleep which, in turn, will reverse the negative conditioning which perpetuates insomnia. Sleep restriction techniques reduce the time in bed in order to increase sleep efficiency.

A sleep–wake diary is kept and the initial time spent in bed should represent the average time asleep or felt to be asleep, but not less than 4.5 h. This is gradually increased as long as the subjective sleep efficiency remains above 80–85% for five nights in every seven. A constant awakening time is adhered to irrespective of the time of going to bed. Fifteen to thirty-minute increments of sleep time are usual and no daytime naps are allowed.

There may be an initial worsening of daytime sleepiness but this gradually improves over a period of months.

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