Treatment of chronic insomnia by restriction of time in bed.
Level 4 - case-series / case-control
Uncontrolled before-and-after clinical intervention study (case series) with no control group.
What was done
Thirty-five patients with chronic insomnia (mean age 46 years, mean insomnia history 15.4 years) completed an 8-week sleep restriction therapy protocol. Treatment started with marked restriction of time in bed, followed by gradual extension contingent on improved sleep efficiency. Sleep parameters and subjective insomnia were measured at post-treatment (8 weeks) and at a follow-up assessment averaging 36 weeks in 23 participants.
What was found
At 8 weeks, patients reported a statistically significant increase in total sleep time (p < 0.05) and improvements in sleep latency, total wake time, sleep efficiency, and subjective insomnia severity (all p < 0.0001). All sleep improvements remained statistically significant at the 36-week follow-up in the 23 evaluated patients. Absolute baseline, post-treatment, and follow-up values were not reported in the abstract.
Why it matters
This study introduced and provided early clinical evidence for sleep restriction therapy, demonstrating that limiting time in bed can improve sleep continuity in chronic insomnia.
Limits
The study lacked a control group, making it impossible to rule out placebo effects or spontaneous fluctuation. Sample size was small (n = 35), and attrition at the 36-week follow-up was 34% (12/35 lost). The abstract also notes that treatment compliance was difficult for some patients.
Cited by
- context In the original publication describing sleep restriction therapy, the intervention was called restriction of time in bed rather than sleep restriction therapy.