The evidence base of sleep restriction therapy for treating insomnia disorder - 06/09/14

Doi : 10.1016/j.smrv.2014.01.006

Christopher B. Miller ^a,^b,^⁎ , Colin A. Espie ^c, Dana R. Epstein ^d,^e, Leah Friedman ^f,^g, Charles M. Morin ^h, Wilfred R. Pigeon ^i,^j, Arthur J. Spielman ^k,^l, Simon D. Kyle ^m
^a Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, Sydney Medical School, University of Sydney, Australia
^b Institute of Neuroscience & Psychology, University of Glasgow, UK
^c Nuffield Department of Clinical Neurosciences and Sleep & Circadian Neuroscience Institute, University of Oxford, UK
^d Phoenix Veterans Affairs Health Care System, USA
^e Arizona State University College of Nursing and Health Innovation, USA
^f Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, USA
^g Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
^h Université Laval, Québec City, Québec, Canada
ⁱ Sleep & Neurophysiology Research Lab, University of Rochester Medical Center, USA
^j Center of Excellence for Suicide Prevention, U.S. Department of Veterans Affairs, USA
^k Cognitive Neuroscience Doctoral Program, The City College of the City University of New York, USA
^l Weill Cornell Medical College, Center for Sleep Medicine, NY, USA
^m School of Psychological Sciences, University of Manchester, UK

^∗Corresponding author. Woolcock Institute of Medical Research, Sydney Medical School, University of Sydney, PO Box M77, Missenden Road, Sydney, NSW 2050, Australia. Tel.: +61 (2) 9114 0451; fax: +61 (2) 9114 0014.

Summary

Sleep restriction therapy is routinely used within cognitive behavioral therapy to treat chronic insomnia. However, the efficacy for sleep restriction therapy as a standalone intervention has yet to be comprehensively reviewed. This review evaluates the evidence for the use of sleep restriction therapy in the treatment of chronic insomnia. The literature was searched using web-based databases, finding 1344 studies. Twenty-one were accessed in full (1323 were deemed irrelevant to this review). Nine were considered relevant and evaluated in relation to study design using a standardized study checklist and levels of evidence. Four trials met adequate methodological strength to examine the efficacy of therapy for chronic insomnia. Weighted effect sizes for self-reported sleep diary measures of sleep onset latency, wake time after sleep onset, and sleep efficiency were moderate-to-large after therapy. Total sleep time indicated a small improvement. Standalone sleep restriction therapy is efficacious for the treatment of chronic insomnia for sleep diary continuity variables. Studies are insufficient to evaluate the full impact on objective sleep variables. Measures of daytime functioning in response to therapy are lacking. Variability in the sleep restriction therapy implementation methods precludes any strong conclusions regarding the true impact of therapy. A future research agenda is outlined.

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Keywords : Insomnia, Sleep, Cognitive behavioral therapy, Treatment, Psychological intervention, Sleep restriction therapy, Evidence base, Review