Sleep Handout - Bed Restriction Therapy

JULY 2021
BED RESTRICTION THERAPY
The Sleep Equation Broken Sleep

Sleep occurs when tiredness Broken sleep is very disruptive and often stressful. It can involve long periods
(sleep drive) is greater than the
mental activation caused by all of wakefulness throughout the night, giving you plenty of opportunity to toss
those problems and troubles on and turn, worry, ruminate and mentally list all of the stuff you will be too tired
your mind. That activation results to deal with in the morning.
in psychological arousal which
makes it harder to fall asleep.
Perhaps the biggest problem with broken sleep is that is become habitual, as
Sleep Drive > Arousal = Asleep your body seems to get used to waking up at the same time throughout the
Sleep Drive < Arousal = Awake night. Your body then associates your bed with a place to worry, rather than a
place to sleep. This tanks your sleep efficiency.
Sleep drive refers to the biological
processes that make us feel
sleepy, and involves adenosine, Consider the following example:
melatonin and our circadian
rhythm. There are steps we can Sam goes to bed at 10:00pm and takes about an hour to fall asleep (sleep
take to increase our sleep drive, latency). He sleeps for an hour and then wakes up. He feels wide awake and
such as practicing light hygiene,
undertaking exercise, reducing tosses and turns for 90 minutes. He falls back to sleep for two hours and then
caffeine and sticking to a regular wakes again. This continues until early morning when he wakes about 7:30am
bed and wake time. and lays there thinking about how tired he will be today until he finally rolls out of
bed at 8:00am. Sound familiar?
Our arousal is how mentally awake
we are. Stress, anxiety and 1hr 2hr 1hr 1hr
activity keep us alert and thinking.
This alertness is counter-
productive at bed time. If our
arousal exceeds our sleep drive, 10pm 12am 2am 4am 6am 8am
then we won’t get to sleep.
Sleep Efficiency Calculation
Steps need to be taken that are Time Asleep = Actual number of hours slept = 5 hr
deliberate and intentional before
you get in to bed and optimise Time in Bed = Actual number of hours in bed = 10pm - 8am = 10hrs.
sleep. Spending too much time Sleep Efficiency = Time Asleep divided by Time in Bed = 5/10= 50%
awake in bed can increase our
alertness and we worry more. This
series of worksheets will help you
to learn strategies for overcoming
insomnia.
So increase your sleep drive
and reduce your arousal if you SLEEP LATENCY SLEEP INERTIA SLEEP EFFICIENCY
want to sleep.
The amount of time The amount of time A measure of the
taken to get to sleep. taken to feel fully percentage of time that
awake. you are asleep whilst in
bed.
THEPSYCHCOLLECTIVE.COM BED RESTRICTION THHERAPY
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Decreasing Broken Sleep
Reducing night time awakenings involves a technique called Bed Restriction Therapy (BRT). The aim of BRT is to consolidate
the amount of sleep you usually get into a shorter period of time to increase your sleep efficiency. BRT is helpful if you have
frequent and long night awakenings and a sleep efficiency score less than 80%. This means that for the total amount of
time you are in bed, we want you sleeping for almost all of it. Hence, we reduce the amount time you are in bed.
Before you get started, you should know that BRT can be pretty hard. You will probably hate us at first (that's okay, we can
handle it), but we also know how effective this can be so you can thank us once you stop hating us. BRT will likely cause
increase disruption to your sleep for the first week, so pick the timing of when you can start and get support from members
of your household before you begin. No pain, no gain.You may wish to consider doing this under the supervision of a health
professional, especially if you are taking any sleep medications.
Identify Your Current Sleep Patterns
Start by using our Sleep Diary Card to record your sleep patterns for a week.
Look for patterns in sleep latency and awakenings and look for inconsistencies in bed and wake time.
Set Your Sleep Plan
BRT is about getting you to sleep in a solid chunk, so you need to calculate the timing of that chunk.
Review your sleep diary to determine what is your usual amount of total sleep during the night.
BRT needs to be consistent every day. Choose a wake up time that you can stick to for 7 days a week.
Work backwards to calculate your total time of sleep from your wake up time, and add half an hour for sleep latency
(the time it would take you to fall asleep).
Example: Sam normally gets 5 hours of sleep. He actually needs to be up by 7:00am each day, which means he
needs to be asleep by 2:00am to get five hours. Add in the 30 minute sleep latency and his time to bed is 1:30am.
10pm 12am 2am 4am 6am 8am

Now calculate your sleep plan.
Duration of sleep: ___________
Wake up time: ____________
Time to bed: ___________. (remember to add 30 minutes for sleep latency)
If that new bed time sounds scary, remember that it is only for a few weeks, and ideally you actually won't be missing out on
any sleep. In fact, we hope that by the time you finally do go to bed, you'll feel extra sleepy and fall asleep faster than usual.
Using Your Extra Wake Time
Now that you will be going to bed later than usual, you will have more time to kill. You need to make a plan on how you will
spend this time, ideally doing something with low lights, no screens and that is really boring so your mind is calm when you
get to bed. This is definitely a good opportunity to do some Clear Your Head Before Bed worksheets.
List what activities you could do in your extra time.
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_______________________________________________________________________________________________________________
Getting More Sleep
You will know if the BRT is working when your Sleep Efficiency stays above 80%. Once you are sleeping solidly, move your
Time To Bed forward by half an hour for 4 days. If you keep sleeping solidly, then move it forward again in 30 minute at a
time until you are either getting 8 hours of sleep a night or your Sleep Efficiency starts to suffer by going to bed too early.
Check out our website for more resources, handouts and videos
Scan the QR code for the Youtube clip for this handout

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JULY 2021

BED RESTRICTION THERAPY

The Sleep Equation Broken Sleep

10pm 12am 2am 4am 6am 8am

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