Sleep restriction
Sleep better with less sleep?
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Those who suffer from insomnia should sleep less. Is this really true? We took a closer look at the phenomenon of sleep restriction.
Sleep restrictions as a therapy against sleep disorders
The so-called sleep restriction is a therapy that is particularly aimed at people who suffer from chronic sleep disorders (insomnia) and who therefore sleep too little. The idea: restful sleep does not depend on the length of sleep, but rather on the quality. Therefore, the so-called sleep efficiency should be increased with the sleep restriction – This is the relationship between the time you spend in bed and the time you actually sleep. This works by increasing the sleep pressure, which slowly builds up during the waking phase.
Help with sleep restriction cognitive behavior therapy
Sleep better thanks to little sleep? Sounds paradoxical, but it works. The so-called "therapy of sleep restriction" was launched in 1987 by the American psychologist Art Spielman and is one of the behavioral therapies. Patients with insomnia often lie awake in bed for hours, staring at the ceiling, and become more and more depressed as the time until the morning shrinks. The relationship between bedtime and sleeptime is incorrect. The sleep restrictions are intended to reduce the time spent in bed while awake.
This is how sleep restriction therapy works
Over a few weeks a "sleep diary" records exactly when you go to bed, falls asleep and wakes up again. For example, if you have slept an average of five hours per night, you can only limit the length of stay in bed to these five hours.
To calculate sleep efficiency for sleep restriction, there is even a formula: Sleep duration / bed time x 100. If the result is at least 85 percent, sleep efficiency is good.
For example: You tried to sleep nine hours a night and typically went to bed at 10 p.m. On the other hand, you fell asleep at midnight at the earliest and woke up around five o'clock. For a successful sleep restriction, you would have to reduce your bed time by four hours. However, be careful not to fall below the limit of 4.5 hours of sleep per night – not even if you can actually only sleep three hours. Because that could increase the risk of side effects such as being very tired during the day. You should go through this phase for at least a full week for a successful sleep restriction, even if it is sometimes difficult.
What is the point of such a sleep restriction?
The effect: Especially at the beginning of therapy, tiredness and sleep pressure increase significantly. If the waking therapy works and you have a sleep efficiency of 85 percent, you can stay in bed 15 to 30 minutes longer for the following week. The whole thing is practiced until the individual sleep time is reached.
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Why can a change in the sleep window be effected?
Why the sleep restriction concept works is actually obvious: By the time they go to bed, those affected are so exhausted that they immediately fall into deep sleep due to the high sleep pressure. This means that at some point the bed no longer stands for sleepless nights, but for peaceful sleep. And that is ultimately the goal: the bed should arouse positive feelings by improving sleep efficiency and increasing deep sleep phases.
Summary of sleep restriction
In principle, a sleep restriction should only ever be made in consultation with the doctor. This is how the therapy is carried out:
- Keep a sleep diary for at least two weeks.
- Use the sleep diary to determine the optimal sleep times.
- Calculate sleep efficiency – that is, put the duration of sleep in relation to the respective bedtime.
- Shorten bedtime – but to a maximum of 4.5 hours!
- Strictly adhere to the calculated bedtime for at least a week.
- As soon as you have achieved a sleep efficiency of at least 85 percent, the bed time can be increased by half an hour.
Sleep Restriction Risks
Even if patients benefit from a sleep restriction in the long term and at best can do without medication for better sleep, one must expect various side effects during the time of behavior therapy. These include:
Especially because of the high level of fatigue and the difficulty concentrating Not only does it affect everyday life, it also increases the risk of accidents (e.g. when driving a car). Therefore, it is best to look for a period of time for the sleep restriction in which you can spend a lot of time at home and ideally not have to work.
What else can I do if I have trouble sleeping through the night?
Restricting sleep isn't the only way to get a grip on sleep disorders. Proper sleep hygiene also plays a major role in insomnia. In addition to restricting sleep, the following tips can also improve sleep:
- Basically only go to bed when you are really tired.
- If you have not fallen asleep in bed after 20 minutes at the latest, you should get up again and take up a monotonous activity that does not require much thinking – for example sorting laundry. You do that until you get tired again.
- Set up fixed times when you go to bed and get up again – even on weekends.
- If you have trouble sleeping, you should avoid nap time – because this is one of our fundamentally required sleep time, so it is subtracted from our sleep times during the night.
You can find even more tips on proper sleep hygiene here.
Reading tips: Here we reveal how sleep works best in the heat. We also explain what twitching means before falling asleep and whether 4 hours of sleep is really not enough.
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sources
S3 guideline of the German Society for Sleep Research and Sleep Medicine: Non-restful sleep / sleep disorders (as of 2017)
Stuck, B.A. et al .: Praxis der Schlafmedizin, Springer Verlag, 3rd edition, 2018
Riemann, D.: Non-pharmacological insomnia therapy. Ther Umsch, 71 (11), 687-94, 2014