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Adult sleep-restriction therapy plan

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Sleep restriction therapy: a week-by-week plan.

One of the core behavioural techniques of CBT-I. Compress your time in bed to match your actual sleep, then expand it back as efficiency climbs. Single page, no app needed.

What this is: the core behavioural arm of CBT-I, the first-line treatment for chronic insomnia per the AASM and NICE. It feels worse before it feels better — short sleep in the first week is the mechanism. Plan on at least 4 weeks, adjusting each week, or don’t start.

Step 1 — Baseline (do this BEFORE day 1)

Average sleep time

From a 7-day sleep diary, average the actual hours slept (NOT time in bed). With insomnia, the hours asleep are often well short of the hours in bed.

Avg sleep: ____ h ____ min

Prescribed time in bed

Average sleep + 30 min (never below 5h total). This is your window for week 1. Set your wake time first (consistency is non-negotiable), then count backwards.

Wake: ____ : ____
Bed: ____ : ____
Window: ____ h ____ min

Step 2 — Week 1 log

Day	Bed time	Wake time	Sleep efficiency
M	____	06:30	____ %
T	____	06:30	____ %
W	____	06:30	____ %
T	____	06:30	____ %
F	____	06:30	____ %
S	____	06:30	____ %
S	____	06:30	____ %

Sleep efficiency = (hours actually asleep ÷ hours in bed) × 100. Estimate it from your morning diary entry. A rough estimate is fine — the trend matters. Skip the tracker during the plan: wearables often miss time spent lying awake.

Step 3 — Weekly adjustment rule

Average efficiency (week)	Adjustment for next week	Why
≥ 90%	Move bedtime 15 min earlier. Wake time stays.	Sleep is consolidated. Add capacity.
85-89%	No change. Repeat the same window.	System is converging. Hold.
< 85%	Move bedtime 15 min later, but never below 5 hours in bed.	Window still too wide. Need more sleep pressure.

Non-negotiable rules

1. No naps. Anywhere. Even 5 min counts.
2. Wake time fixed every day, including weekends.
3. Out of bed within 20 min if not asleep — read in dim light, return when sleepy.
4. Bed only for sleep + sex. No phone, no TV, no work.
5. No clock-watching. Turn it away.

When to stop / call a clinician

Daytime sleepiness so severe you can’t drive safely.
Mood swings, mania symptoms, or active suicidal thoughts.
4 weeks in, efficiency still < 80%.
Witnessed apnea / gasping during sleep — get a sleep study before continuing.
Pregnancy — modified protocol needed, see a CBT-I therapist.

What “working” looks like: in a meta-analysis of CBT-I trials (Trauer et al., Annals of Internal Medicine, 2015), people fell asleep about 19 minutes faster and spent about 26 minutes less awake at night. Total sleep changed little at first. The gains seemed to hold at later follow-ups.

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