What is sleep restriction therapy and when is it used?

• A. A CBT-I technique that confines time in bed to increase sleep efficiency; used for chronic insomnia.
• B. A method to increase time in bed to treat hypersomnia.
• C. A technique to restrict naps; used for circadian rhythm disorders.
• D. A pharmacologic approach to extend sleep duration.

Answer: (A)

Sleep restriction therapy is a behavioral component of cognitive behavioral therapy for insomnia (CBT-I) that aims to increase sleep efficiency by limiting time spent in bed to roughly the amount of time actually spent asleep. By reducing the opportunity to be awake in bed, it decreases conditioned arousal and wakefulness-at-bedtime, helping to consolidate sleep. As sleep efficiency improves (more of the time in bed spent asleep), the time in bed is gradually increased in small steps, with the goal of preserving efficient, continuous sleep. This approach is used for chronic insomnia because it directly targets the disordered sleep relationship and sleep continuity, rather than simply adding time or relying on medications.

Increasing time in bed would typically worsen sleep efficiency and is not used for insomnia; that approach is more aligned with addressing hypersomnia, not the problem of long periods of wakefulness in bed. Restricting naps or focusing on circadian rhythm issues falls outside the primary aim of sleep restriction therapy, which centers on the homeostatic sleep drive and bed-sleep timing within CBT-I. And it’s a behavioral technique, not a pharmacologic one, so it’s not about drugs to extend sleep duration.