II. Category
- Cognitive Behavioral Therapy for Insomnia technique
III. Indications: Insomnia
- Difficulty initiating sleep or difficulty maintaining sleep
- Patient wakes up later to compensate for sleep loss
- Prolonged periods of lying in bed awake
IV. Contraindications
- Epilepsy
- Bipolar Disorder
- Parasomnias such as Sleep Walking
- Untreated Obstructive Sleep Apnea
V. Goal
- Time asleep should approach time in bed (with a Sleep Efficiency >90%)
VI. Precautions
- Should be performed under the guidance of a provider trained in Cognitive Behavioral Therapy for Insomnia (CBT-I)
- Typically patient is seen for an initial assessment to determine whether they are appropriate for CBT-I
- May also be performed via web-based CBT (as effective as in-person or group therapy)
VII. Protocol
- Follow Sleep Hygiene guidelines
- Step 1: Determine total sleep time (TST)
- Log the total time asleep for at least one week
- Consider monitoring with Actigraphy (accelerometer worn by patient records movement)
- Calculate an average duration of time asleep per night (TST)
- Example
- Patient goes to bed at 10 pm and awakens at 6 am, a time in bed (TIB) of 8 hours
- Total sleep time (TST) however averages 5 hours
- Step 2: Determine new sleep schedule
- Determine a consistent wake up time (and maintain 7 days per week)
- Establish a new bedtime that is on average allows for only the total sleep time (TST) that was calculated in step 1
- Do not limit sleep to less than 4.5 hours per night
- Example:
- New bedtime: 1 am
- Constant awakening time: 6 am
- Step 3: Initiate new sleep schedule
- Monitor with log (and consider Actigraphy) nightly
- If prolonged awakening occurs (>15-20 minutes)
- See Sleep Stimulus Control technique
- Step 4: Review log on a weekly basis
- Re-evaluate Sleep Efficiency weekly (100 * TST / TIB)
- Where TST is total sleep time
- Where TIB is time in bed
- Adjust bedtime based on weekly log results
- Sleep Efficiency >90%
- INCREASE time in bed by 15-20 minutes/night
- New bedtime is 15-20 minutes EARLIER (with same awakening time)
- Sleep Efficiency <80%
- DECREASE time in bed by 15-20 minutes/night
- New bedtime is 15-20 minutes LATER (with same awakening time)
- Sleep Efficiency >90%
- Re-evaluate Sleep Efficiency weekly (100 * TST / TIB)
- Step 5: Repeat cycle for 8 weeks
- Monitor with log (and consider Actigraphy) nightly
- If prolonged awakening occurs (>15-20 minutes), practice Sleep Stimulus Control technique
- Continue cycles of nightly logging followed by weekly Sleep Efficiency calculation and adjusted bedtime
VIII. Resources
- Clinician CME to learn CBT-I Techniques
IX. References
- Perlis (2005) Cognitive Behavioral Treatment of Insomnia
- Maness (2015) Am Fam Physician 92(12): 1058-64 [PubMed]
- Morin (2015) Ann Intern Med 163(3): 236-7 [PubMed]
- Trauer (2015) Ann Intern Med 163(3): 191-204 [PubMed]
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Related Studies
Definition (MSH) | A progressive advance or delay of bedtime until the desired bedtime is achieved. |
Concepts | Therapeutic or Preventive Procedure (T061) |
MSH | D055865 |
English | Sleep Phase Chronotherapy, Chronotherapies, Sleep Phase, Chronotherapy, Sleep Phase, Sleep Phase Chronotherapies |
Spanish | Cronoterapia de la Fase del Sueño |
French | Chronothérapie sur les phases de sommeil, Chronothérapie par resynchronisation des phases de sommeil |
Italian | Cronoterapia della fase del sonno |
Russian | ХРОНОТЕРАПИЯ ФАЗАМИ СНА, KHRONOTERAPIIA FAZAMI SNA, PRAVIL'NOGO VREMENI OTKHODA KO SNU OPREDELENIE, ПРАВИЛЬНОГО ВРЕМЕНИ ОТХОДА КО СНУ ОПРЕДЕЛЕНИЕ |
German | Schlafphasen-Chronotherapie |
Portuguese | Cronoterapia de Fase do Sono |
Swedish | Sleep Phase Chronotherapy |
Czech | posun spánkové fáze - chronoterapie, nástup spánku - chronoterapie, čas spánku - chronoterapie |
Polish | Chronoterapia fazy snu, Chronoterapia przyspieszonej fazy snu |
Japanese | 睡眠相時間療法, 時間療法-睡眠相 |
Norwegian | Søvnfasekronoterapi |
Ontology: Sleep restriction therapy (C2584987)
Concepts | Therapeutic or Preventive Procedure (T061) |
SnomedCT | 440089000 |
English | Sleep restriction therapy, Sleep restriction therapy (regime/therapy) |
Spanish | terapia de restricción del sueño (régimen/tratamiento), terapia de restricción del sueño |