The evidence base of sleep restriction therapy for treating insomnia disorder

Miller, Christopher B.; Espie, Colin A.; Epstein, Dana R.; Friedman, Leah; Morin, Charles M.; Pigeon, Wilfred R.; Spielman, Arthur J.; Kyle, Simon D.

doi:10.1016/j.smrv.2014.01.006

Cited by 192Sleep and related disordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesObstructive Sleep Apnea Research

The evidence base of sleep restriction therapy for treating insomnia disorder

Miller, Christopher B., Espie, Colin A., Epstein, Dana R., Friedman, Leah, Morin, Charles M., Pigeon, Wilfred R., Spielman, Arthur J., Kyle, Simon D.·2014·Sleep Medicine Reviews

DOI 10.1016/j.smrv.2014.01.006

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Abstract

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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Sleep restriction has been identified as an effective stand-alone treatment for insomnia.
“sleep restriction has been identified as an effective stand-alone treatment for insomnia [24]”
From Cognitive behavioral therapy for insomnia in patients with mental disorders and comorbid insomnia: A systematic review and meta-analysis (2022) · cites this paper as [24]
Bedtime restriction addresses the homeostatic process and represents the single most effective treatment component of CBT-I.
“Bedtime restriction addresses the homeostatic process and represents the single most effective treatment component of CBT-I [23].”
From <i>Become your own SLEEPexpert</i>: design, implementation, and preliminary evaluation of a pragmatic behavioral treatment program for insomnia in inpatient psychiatric care (2020) · cites this paper as [23]

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S3-Leitlinie Nicht erholsamer Schlaf/Schlafstörungen
Riemann, D. W., Baum, E., Cohrs, S., Crönlein, T., Hajak, G., Hertenstein, E., Klose, P., Langhorst, J., Mayer, G., Nissen, C., et al. (2017) · Somnologie - Schlafforschung und Schlafmedizin · doi:10.1007/s11818-016-0097-x · Cited by 339 · see citing works
“[98] untersuchten ein spezifisches Element der KVT-I metaanalytisch, nämlich die Bettzeitrestriktion.”
Background
The assessment and management of insomnia: an update
Krystal, A. D., Prather, A. A., & Ashbrook, L. H. (2019) · World Psychiatry · doi:10.1002/wps.20674 · Cited by 256 · see citing works
The European Academy for Cognitive Behavioural Therapy for Insomnia: An initiative of the European Insomnia Network to promote implementation and dissemination of treatment
Baglioni, C., Altena, E., Bjorvatn, B., Blom, K., Bothelius, K., Devoto, A., Espie, C. A., Frase, L., Gavriloff, D., Tuuliki, H., et al. (2020) · Journal of Sleep Research · doi:10.1111/jsr.12967 · Cited by 259 · see citing works
“…14 meta-analyses (GeigerBrown et al., 2015; Ho et al., 2015; Irwin, Cole, & Nicassio, 2006; Johnson et al., 2016; Koffel, Koffel, & Gehrman, 2015; Miller et al., 2014; Montgomery & Dennis, 2004; Morin, Culbert, & Schwartz, 1994; Murtagh & Greenwood, 1995; Okajima, Komada, & Inoue, 2011;…”
Self-citation
The effectiveness of behavioural and cognitive behavioural therapies for insomnia on depressive and fatigue symptoms: a systematic review and network meta-analysis
Ballesio, A., Aquino, M. R. J. V., Feige, B., Johann, A. F., Kyle, S. D., Spiegelhalder, K., Lombardo, C., Rücker, G., Riemann, D., & Baglioni, C. (2018) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2017.01.006 · Cited by 172 · see citing works
Mobile phone-delivered cognitive behavioral therapy for insomnia: a randomized waitlist controlled trial
Horsch, C. H., Lancee, J., Griffioen-Both, F., Spruit, S., Fitrianie, S., Neerincx, M. A., Beun, R. J., & Brinkman, W.-P. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.6524 · Cited by 164 · see citing works
“Modified Sleep Restriction Sleep restriction is seen as the most effective exercise [23,24], and therefore was the main focus of the app.”
Gender differences in obstructive sleep apnoea, insomnia and restless legs syndrome in adults – What do we know? A clinical update
Theorell‐Haglöw, J., Miller, C. B., Bartlett, D. J., Yee, B. J., Openshaw, H. D., & Grunstein, R. R. (2017) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2017.03.003 · Cited by 161 · see citing works
Self-citation
Comparative effectiveness and safety of pharmacological and non-pharmacological interventions for insomnia: an overview of reviews
Rios, P. D. L., Cardoso, R., Morra, D. E., Nincic, V., Goodarzi, Z., Farah, B., Harricharan, S., Morin, C. M., Leech, J. A., Straus, S. E., et al. (2019) · Systematic Reviews · doi:10.1186/s13643-019-1163-9 · Cited by 141 · see citing works
Self-citation
Treating insomnia improves depression, maladaptive thinking, and hyperarousal in postmenopausal women: comparing cognitive-behavioral therapy for insomnia (CBTI), sleep restriction therapy, and sleep hygiene education
Kalmbach, D. A., Cheng, P., Arnedt, J. T., Anderson, J. R., Roth, T. G., Fellman-Couture, C., Williams, R. A., & Drake, C. L. (2018) · Sleep Medicine · doi:10.1016/j.sleep.2018.11.019 · Cited by 133 · see citing works
The Variability of Sleep Among Elite Athletes
Nédélec, M., Aloulou, A., Duforez, F., Meyer, T., & Dupont, G. (2018) · Sports Medicine - Open · doi:10.1186/s40798-018-0151-2 · Cited by 133 · see citing works
Cognitive Behavioral Therapy for Insomnia (CBT-i) in School-Aged Children and Adolescents
Dewald‐Kaufmann, J., de Bruin, E. J., & Michael, G. (2019) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2019.02.002 · Cited by 129 · see citing works
Association of Subjective Quality and Quantity of Sleep with Quality of Life among a General Population
Matsui, K., Yoshiike, T., Nagao, K., Utsumi, T., Tsuru, A., Otsuki, R., Ayabe, N., Hazumi, M., Suzuki, M., Saitoh, K., et al. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182312835 · Cited by 114 · see citing works
“Sleep restriction therapy is part of a package of cognitive behavioral therapy for insomnia (CBT-I) [41,42], but it has been suggested to be effective against insomnia symptoms when used alone [43].”
Background
Group vs. Individual Treatment for Acute Insomnia: A Pilot Study Evaluating a “One-Shot” Treatment Strategy
Boullin, P., Ellwood, C., & Ellis, J. G. (2016) · Brain Sciences · doi:10.3390/brainsci7010001 · Cited by 108 · see citing works
“[26] 2014 The evidence base of sleep restriction therapy for treating insomnia disorder”
Background
Cognitive Behavioral Therapy for Insomnia (CBT-I): A Primer
Walker, J., Muench, A., Perlis, M. L., & Vargas, I. (2022) · Clinical Psychology and Special Education · doi:10.17759/cpse.2022110208 · Cited by 106 · see citing works
Towards standardisation and improved understanding of sleep restriction therapy for insomnia disorder: A systematic examination of CBT-I trial content
Kyle, S. D., Aquino, M. R. J., Miller, C. B., Henry, A. L., Crawford, M., Espie, C. A., & Spielman, A. J. (2015) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2015.02.003 · Cited by 103 · see citing works
Self-citation
Treating chronic insomnia in postmenopausal women: a randomized clinical trial comparing cognitive-behavioral therapy for insomnia, sleep restriction therapy, and sleep hygiene education
Drake, C. L., Kalmbach, D. A., Arnedt, J. T., Cheng, P., Tonnu, C. V., Cuamatzi-Castelan, A. S., & Fellman-Couture, C. (2018) · SLEEP · doi:10.1093/sleep/zsy217 · Cited by 103 · see citing works
The clinical effects of sleep restriction therapy for insomnia: A meta-analysis of randomised controlled trials
Maurer, L., Schneider, J., Miller, C. B., Espie, C. A., & Kyle, S. D. (2021) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2021.101493 · Cited by 101 · see citing works
Self-citation
How does sleep restriction therapy for insomnia work? A systematic review of mechanistic evidence and the introduction of the Triple-R model
Maurer, L., Espie, C. A., & Kyle, S. D. (2018) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2018.07.005 · Cited by 99 · see citing works
Self-citation
We know CBT-I works, now what?
Muench, A., Vargas, I., Grandner, M. A., Ellis, J. G., Posner, D. A., Bastien, C., Drummond, S. P. A., & Perlis, M. L. (2022) · Faculty Reviews · doi:10.12703/r/11-4 · Cited by 91 · see citing works
Comparing the Effects of Mindfulness-Based Cognitive Therapy and Sleep Psycho-Education with Exercise on Chronic Insomnia: A Randomised Controlled Trial
Wong, S. Y. S., Zhang, D., Chi-kwan, C. L., Yip, B. H. K., Chan, D. C.-C., Ling, Y.-M., Lo, C. S. L., Woo, D. M.-S., Sun, Y., Ma, H., et al. (2017) · Psychotherapy and Psychosomatics · doi:10.1159/000470847 · Cited by 76 · see citing works
The Berlin Treatment Algorithm: recommendations for tailored innovative therapeutic strategies for multiple sclerosis-related fatigue
Veauthier, C., Hasselmann, H., Gold, S. M., & Paul, F. (2016) · EPMA Journal · doi:10.1186/s13167-016-0073-3 · Cited by 71 · see citing works
“Sleep restriction is an easy and very efficacious therapy against sleep-onset insomnia [174].”
Background
To Drug or Not to Drug: A Qualitative Study of Patients’ Decision-Making Processes for Managing Insomnia
Cheung, J. M. Y., Bartlett, D. J., Armour, C. L., Laba, T., & Saini, B. (2016) · Behavioral Sleep Medicine · doi:10.1080/15402002.2016.1163702 · Cited by 66 · see citing works
“This can potentially limit the transferability of findings in clinical settings implementing SRT, which is known to produce mild sleep deprivation in the induction phase of treatment (Miller et al., 2014).”
Background
The effect of cognitive and behavioral therapy for insomnia on week-to-week changes in sleepiness and sleep parameters in patients with comorbid insomnia and sleep apnea: a randomized controlled trial
Sweetman, A., McEvoy, R. D., Smith, S., Catcheside, P. G., Antic, N. A., Chai-Coetzer, C. L., Douglas, J., O’Grady, A., Dunn, N., Robinson, J., et al. (2020) · Sleep · doi:10.1093/sleep/zsaa002 · Cited by 62 · see citing works
Sham treatment effects in manual therapy trials on back pain patients: a systematic review and pairwise meta-analysis
Lavazza, C., Galli, M., Abenavoli, A., & Maggiani, A. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-045106 · Cited by 66 · see citing works
Isolating the role of time in bed restriction in the treatment of insomnia: a randomised, controlled, dismantling trial comparing sleep restriction therapy with time in bed regularisation.
Maurer, L., Espie, C., Omlin, X., Reid, M. J., Sharman, R., Gavriloff, D., Emsley, R., & Kyle, S. (2020) · Sleep · doi:10.1093/sleep/zsaa096 · Cited by 47 · see citing works
Self-citation
Improving daytime functioning, work performance, and quality of life in postmenopausal women with insomnia: comparing cognitive behavioral therapy for insomnia, sleep restriction therapy, and sleep hygiene education
Kalmbach, D. A., Cheng, P., Arnedt, J. T., Cuamatzi-Castelan, A., Atkinson, R. L., Fellman-Couture, C., Roehrs, T., & Drake, C. L. (2019) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.7882 · Cited by 58 · see citing works
Group cognitive behavioural therapy for insomnia: Effects on sleep and depressive symptomatology in a sample with comorbidity
Norell‐Clarke, A., Jansson‐Fröjmark, M., Tillfors, M., Holländare, F., & Engström, I. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.09.005 · Cited by 56 · see citing works
“First, all the included techniques were evidence-based regarding sleep, on their own or combined (Carney & Waters, 2006; Miller et al., 2014; Morgenthaler et al., 2006).”
Method
Adapted CBT to stabilize sleep on psychiatric wards: a transdiagnostic treatment approach
Sheaves, B., Isham, L., Bradley, J., Espie, C., Barrera, A., Waite, F., Harvey, A. G., Attard, C., & Freeman, D. (2018) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465817000789 · Cited by 55 · see citing works
“sleep restriction, SR) are widely regarded as one of the most powerful ingredients of CBT for insomnia (Miller et al., 2014).”
BackgroundInfluential
The effect of sleep restriction therapy for insomnia on sleep pressure and arousal: a randomized controlled mechanistic trial
Maurer, L., Espie, C. A., Omlin, X., Emsley, R., & Kyle, S. D. (2021) · SLEEP · doi:10.1093/sleep/zsab223 · Cited by 56 · see citing works
Self-citation
Insomnia and cognitive behavioural therapy—how to assess your patient and why it should be a standard part of care
Anderson, K. N. (2018) · Journal of Thoracic Disease · doi:10.21037/jtd.2018.01.35 · Cited by 53 · see citing works
Effects of cognitive behavioral therapy for insomnia on subjective and objective measures of sleep and cognition
Perrault, A. A., Pomares, F. B., Smith, D., Cross, N. E., Gong, K., Maltezos, A., McCarthy, M., Madigan, E., Tarelli, L., McGrath, J. J., et al. (2022) · Sleep Medicine · doi:10.1016/j.sleep.2022.05.010 · Cited by 50 · see citing works
The cognitive treatment components and therapies of cognitive behavioral therapy for insomnia: A systematic review
Jansson‐Fröjmark, M., & Norell‐Clarke, A. (2018) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2018.05.001 · Cited by 49 · see citing works
The CHD8/CHD7/Kismet family links blood-brain barrier glia and serotonin to ASD-associated sleep defects
Coll-Tané, M., Gong, N. N., Belfer, S. J., van Renssen, L. V., Kurtz‐Nelson, E. C., Szuperák, M., Eidhof, I., van Reijmersdal, B., Terwindt, I., Durkin, J., et al. (2021) · Science Advances · doi:10.1126/sciadv.abe2626 · Cited by 47 · see citing works
Dispensing good sleep health behaviours not pills – a cluster‐randomized controlled trial to test the feasibility and efficacy of pharmacist‐provided brief behavioural treatment for insomnia
Fuller, J. M., WONG, K. K. H., Hoyos, C. M., Krass, I., & Saini, B. (2015) · Journal of Sleep Research · doi:10.1111/jsr.12328 · Cited by 45 · see citing works
“However, the implementation variability across studies made a true impact assessment difficult (Miller et al., 2014).”
Background
Comparison of subjectively and objectively assessed sleep problems in breast cancer patients starting neoadjuvant chemotherapy
Kreutz, C., Müller, J. H., Schmidt, M. E., & Steindorf, K. (2020) · Supportive Care in Cancer · doi:10.1007/s00520-020-05580-0 · Cited by 41 · see citing works
“65%) is typically considered as normal sleep efficiency (cut-off, 85% [39]).”
Background
Conversational Agent for Healthy Lifestyle Behavior Change: Web-Based Feasibility Study
Dhinagaran, D. A., Sathish, T., Soong, A., Theng, Y. L., Best, J. D., & Car, L. T. (2021) · JMIR Formative Research · doi:10.2196/27956 · Cited by 39 · see citing works
“The collated advice was then compartmentalized into themes, which translated into the topic of focus for each interaction between conversational agent and user (Multimedia Appendix 1 [8,26,27,29-53]).”
Background
<i>Become your own SLEEPexpert</i>: design, implementation, and preliminary evaluation of a pragmatic behavioral treatment program for insomnia in inpatient psychiatric care
Schneider, C. L., Hertenstein, E., Fehér, K., Maier, J. G., Cantisani, A., Moggi, F., Berger, T., & Nissen, C. (2020) · SLEEP Advances · doi:10.1093/sleepadvances/zpaa005 · Cited by 37 · see citing works
“Current guidelines identify cognitive behavioral therapy for insomnia (CBT-I) as first-line treatment, usually composed of education, relaxation, behavioral change, and cognitive components [6].”
BackgroundInfluential
Etiology and Pathophysiology of Insomnia
Perlis, M. L., Ellis, J. G., Kloss, J. D., & Riemann, D. W. (2016) · Elsevier eBooks · doi:10.1016/b978-0-323-24288-2.00082-9 · Cited by 35 · see citing works
A Cognitive Behavioral Model Proposing That Clinical Burnout May Maintain Itself
Almén, N. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18073446 · Cited by 36 · see citing works
“Sleep restriction is an effective intervention for insomnia [132].”
Background
A randomized controlled trial comparing guided internet-based multi-component treatment and internet-based guided sleep restriction treatment to care as usual in insomnia
Krieger, T., Urech, A., Duss, S. B., Blättler, L. T., Schmitt, W. J., Gast, H., Bassetti, C. L., & Berger, T. (2019) · Sleep Medicine · doi:10.1016/j.sleep.2019.01.045 · Cited by 33 · see citing works
Cognitive behavioural therapy for insomnia for patients with co-morbid generalized anxiety disorder: an open trial on clinical outcomes and putative mechanisms
Jansson‐Fröjmark, M., & Jacobson, K. (2021) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465821000023 · Cited by 32 · see citing works
“Based on a relatively solid evidence base for sleep restriction (Miller et al., 2014), it is likely that restricting time in bed was one important component for reducing insomnia symptoms in this trial.”
Background
Objective sleep disturbance is associated with poor response to cognitive and behavioral treatments for insomnia in postmenopausal women
Kalmbach, D. A., Cheng, P., Roth, T. G., Sagong, C., & Drake, C. L. (2020) · Sleep Medicine · doi:10.1016/j.sleep.2020.04.024 · Cited by 32 · see citing works
“Sleep restriction therapy (SRT)was the second active treatment in this RCT and is considered an effective standalone behavioral treatment for insomnia [31].”
Physiological Markers of Arousal Change with Psychological Treatment for Insomnia: A Preliminary Investigation
Miller, C. B., Kyle, S. D., Gordon, C. J., Espie, C. A., Grunstein, R. R., Mullins, A. E., Postnova, S., & Bartlett, D. J. (2015) · PLoS ONE · doi:10.1371/journal.pone.0145317 · Cited by 31 · see citing works
“These findings support the efficacy of SRT, as previously found in controlled and uncontrolled trials [31, 32].”
ResultSelf-citation
Social and Circadian Rhythm Dysregulation and Suicide: A Systematic Review and Meta-Analysis
Walsh, R., Maddox, M. A., Smith, L., Liu, R. T., & Alloy, L. B. (2024) · Neuroscience and Biobehavioral Reviews · doi:10.1016/j.neubiorev.2024.105560 · Cited by 28 · see citing works
The Development of Sleep Medicine: A Historical Sketch
Schulz, H., & Salzarulo, P. (2016) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.5946 · Cited by 30 · see citing works
“41 Methods which are used in behavior therapy of sleep disorders include sleep restriction, 42 cognitive therapies, rules for sleep hygiene, or a combination thereof, 43 called cognitive behavior therapy (CBT).”
Does total sleep time substantially increase after cognitive behavioral therapy for insomnia?
Scott, H., Cheung, J. M. Y., Muench, A., Ivers, H., Grandner, M. A., Lack, L. C., Morin, C. M., & Perlis, M. L. (2022) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.10004 · Cited by 30 · see citing works
“Accordingly, the current study was undertaken to evaluate, using archival data from one of the few long-term studies of CBT-I, 9,15,16 the percentage of participants who met and/or appreciably exceeded baseline TST at posttreatment, and 3, 6, 12, and 24 months after CBT-I.”
InfluentialSelf-citation
Cognitive Behavioral Therapy for Insomnia and Acute Insomnia
Ellis, J. G. (2019) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2019.01.007 · Cited by 28 · see citing works
An Integrated Sleep and Reward Processing Model of Major Depressive Disorder
Boland, E. M., Goldschmied, J., Wakschal, E. S., Nusslock, R., & Gehrman, P. (2020) · Behavior Therapy · doi:10.1016/j.beth.2019.12.005 · Cited by 29 · see citing works
Symptom-specific effects of cognitive therapy and behavior therapy for insomnia: A network intervention analysis.
Blanken, T. F., Jansson‐Fröjmark, M., Sunnhed, R., & Lancee, J. (2021) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000625 · Cited by 29 · see citing works
An Update on Assessment, Therapeutic Management, and Patents on Insomnia
Porwal, A., Yadav, Y. C., Pathak, K., & Yadav, R. (2021) · BioMed Research International · doi:10.1155/2021/6068952 · Cited by 29 · see citing works
Stimulus control for insomnia: A systematic review and meta‐analysis
Jansson‐Fröjmark, M., Nordenstam, L., Alfonsson, S., Bohman, B., Rozental, A., & Norell‐Clarke, A. (2024) · Journal of Sleep Research · doi:10.1111/jsr.14002 · Cited by 28 · see citing works
“The items are in line with recommendations from the Centre for Reviews and Dissemination for systematic reviews (Akers et al., 2009) and with previous trial assessment approaches in the area of insomnia disorder (Miller et al., 2014; Morin et al., 2006).”
Method
Methodologies for optimizing behavioral interventions: introduction to special section
Riley, W. T., & Rivera, D. E. (2014) · Translational Behavioral Medicine · doi:10.1007/s13142-014-0281-0 · Cited by 28 · see citing works
“For example, sleep restriction is one of the least acceptable components of behavioral treatments for insomnia but it is also one of the most effective components [8].”
Cognitive-Behavioral Therapy for Chronic Insomnia
Hood, H. K., Rogojanski, J., & Moss, T. G. (2014) · Current Treatment Options in Neurology · doi:10.1007/s11940-014-0321-6 · Cited by 27 · see citing works
Insomnia (primary) in older people: non-drug treatments.
Alessi, C., & Vitiello, M. V. (2015) · PubMed Central · Cited by 26 · see citing works
“Thinking About Thinking” in Insomnia Disorder: The Effect of Cognitive-Behavioral Therapy for Insomnia on Sleep-Related Metacognition
Galbiati, A., Sforza, M., Scarpellino, A., Salibba, A., Leitner, C., D’Este, G., Mombelli, S., Ferini‐Strambi, L., & Castronovo, V. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.705112 · Cited by 25 · see citing works
Insomnia among cancer caregivers: A proposal for tailored cognitive behavioral therapy.
Shaffer, K. M., Garland, S. N., Mao, J. J. J., & Applebaum, A. J. (2018) · Journal of Psychotherapy Integration · doi:10.1037/int0000105 · Cited by 24 · see citing works
“This technique matches the presenting caregivers’ time spent in bed to their current sleep ability, and is effective as both a stand-alone and component of treatment (Harvey et al., 2002; Miller et al., 2014).”
The Effectiveness of Digital Insomnia Treatment with Adjunctive Wearable Technology: A Pilot Randomized Controlled Trial
Aji, M., Glozier, N., Bartlett, D. J., Grunstein, R. R., Calvo, R. A., Marshall, N. S., White, D. P., & Gordon, C. J. (2021) · Behavioral Sleep Medicine · doi:10.1080/15402002.2021.1967157 · Cited by 24 · see citing works
“Inclusion criteria were aged 18 years to 65 years, literate in English, score of ≥ 15 on the Insomnia Severity Index (ISI) (Bastien et al., 2001; Morin et al., 2011), and a global score of >5 on the Pittsburgh sleep quality index (PSQI) (Buysse et al., 1989).”
BackgroundMethod
Novel Treatment Based on Acceptance and Commitment Therapy Versus Cognitive Behavioral Therapy for Insomnia: A Randomized Comparative Effectiveness Trial in Women Veterans
Martin, J. L., Carlson, G. C., Kelly, M. R., Song, Y., Mitchell, M. N., Josephson, K. R., McGowan, S. K., Culver, N. C., Kay, M. A., Erickson, A. J., et al. (2023) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000836 · Cited by 23 · see citing works
A Drosophila model of sleep restriction therapy for insomnia
Belfer, S. J., Bashaw, A. G., Perlis, M. L., & Kayser, M. S. (2019) · Molecular Psychiatry · doi:10.1038/s41380-019-0376-6 · Cited by 23 · see citing works
A feasibility study of a mobile app to treat insomnia
Aji, M., Glozier, N., Bartlett, D. J., Peters, D., Calvo, R. A., Zheng, Y., Grunstein, R. R., & Gordon, C. J. (2020) · Translational Behavioral Medicine · doi:10.1093/tbm/ibaa019 · Cited by 22 · see citing works
An Actigraphy-Based Validation Study of the Sleep Disorder Inventory in the Nursing Home
Hjetland, G. J., Nordhus, I. H., Pallesen, S., Cummings, J. L., Tractenberg, R. E., Thun, E., Kolberg, E., & Flo, E. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00173 · Cited by 22 · see citing works
“(25) defined disturbed sleep as having <85% SE, in each participants’ individual rest interval (based on light, activity, and event marker information in the actogram, indicating bedtime and wake time), which is a common cut-off for defining disturbed sleep (55, 56), albeit in normal populations.”
Background
Evidenced-Based Review and Evaluation of Clinical Significance: Nonpharmacological and Pharmacological Treatment of Insomnia in the Elderly
Flaxer, J. M., Heyer, A., & Francois, D. (2020) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2020.10.011 · Cited by 22 · see citing works
Comparing the Effects of Single‐ and Multiple‐Component Therapies for Insomnia on Sleep Outcomes
Sidani, S., Epstein, D. R., Fox, M. T., & Collins, L. J. (2019) · Worldviews on Evidence-Based Nursing · doi:10.1111/wvn.12367 · Cited by 21 · see citing works
“These results support the effectiveness of SRT as a single component therapy, as also documented by Miller et al. (2014).”
ResultSelf-citation
Impact of chronic sleep restriction on sleep continuity, sleep structure, and neurobehavioral performance
Xin, Q., Yuan, R. K., Zitting, K., Wang, W., Purcell, S., Vujović, N., Ronda, J. M., Quan, S. F., Williams, J. S., Buxton, O. M., et al. (2022) · SLEEP · doi:10.1093/sleep/zsac046 · Cited by 22 · see citing works
Follow-Up Analyses From a Wait-List Controlled Trial of Occupational Therapist–Delivered Cognitive–Behavioral Therapy for Insomnia Among Veterans With Chronic Insomnia
Eakman, A. M., Schmid, A. A., Rolle, N. R., Kinney, A. R., & Henry, K. L. (2022) · American Journal of Occupational Therapy · doi:10.5014/ajot.2022.045682 · Cited by 19 · see citing works
“I for the treatment of chronic insomnia (Miller et al., 2014; van der Zweerde et al., 2019; van Straten et al., 2018).”
Psychological Interventions for Late-Life Insomnia: Current and Emerging Science
Dzierzewski, J. M., Griffin, S. C., Ravyts, S. G., & Rybarczyk, B. D. (2018) · Current Sleep Medicine Reports · doi:10.1007/s40675-018-0129-0 · Cited by 19 · see citing works
Paradoxical intention for insomnia: A systematic review and meta‐analysis
Jansson‐Fröjmark, M., Alfonsson, S., Bohman, B., Rozental, A., & Norell‐Clarke, A. (2022) · Journal of Sleep Research · doi:10.1111/jsr.13464 · Cited by 18 · see citing works
“The items are consistent with the recommendations of the Centre for Reviews and Dissemination for systematic reviews (Akers et al., 2009) and with previous study assessment approaches in the area of insomnia disorder (Miller et al., 2014; Morin et al., 2006).”
BackgroundMethod
Dysfunctional beliefs and attitudes about sleep (DBAS) mediate outcomes in dCBT-I on psychological distress, fatigue, and insomnia severity
Faaland, P. M., Vedaa, Ø., Langsrud, K., Sivertsen, B., Lydersen, S., Saksvik, S. B., Vestergaard, C. L., Kjørstad, K., Vethe, D., Ritterband, L. M., et al. (2023) · Sleep Medicine · doi:10.1016/j.sleep.2023.07.018 · Cited by 18 · see citing works
Implementing the Integrated Strategy for the Cultural Adaptation of Evidence-Based Interventions: An Illustration
Sidani, S., Ibrahim, S., Lok, J., Fan, L., & Fox, M. T. (2018) · Canadian Journal of Nursing Research · doi:10.1177/0844562118774493 · Cited by 18 · see citing works
The effectiveness of stimulus control in cognitive behavioural therapy for insomnia in adults: A systematic review and network meta‐analysis
Verreault, M. D., Granger, É., Neveu, X., Delage, J. P., Bastien, C., & Vallières, A. (2023) · Journal of Sleep Research · doi:10.1111/jsr.14008 · Cited by 18 · see citing works
“Among the main components of CBT-I, a few studies evaluated SRT and cognitive therapy effectiveness when used alone, or their mechanisms of action (Harvey et al., 2014; Kyle et al., 2015; Maurer & Kyle, 2022; Miller et al., 2014; Riemann et al., 2022; Spielman et al., 1987; Vallières et al., 2013).”
Background
The Effects of Objective Push-Type Sleep Feedback on Habitual Sleep Behavior and Momentary Symptoms in Daily Life: mHealth Intervention Trial Using a Health Care Internet of Things System
Takeuchi, H., Suwa, K., Kishi, A., Nakamura, T., Yoshiuchi, K., & Yamamoto, Y. (2022) · JMIR mhealth and uhealth · doi:10.2196/39150 · Cited by 17 · see citing works
“In the treatment of patients with insomnia, sleep restriction therapy, which induces mild sleep deprivation to build homeostatic sleep pressure, is used, and existing mHealth studies incorporating sleep restriction therapy demonstrate a significant improvement in insomnia severity and sleep efficacy [35,64,65].”
Background
Daytime sleepiness, driving performance, reaction time and inhibitory control during sleep restriction therapy for Chronic Insomnia Disorder
Whittall, H., Pillion, M., & Gradisar, M. (2017) · Sleep Medicine · doi:10.1016/j.sleep.2017.10.007 · Cited by 16 · see citing works
Effects of Educational Counseling as Solitary Therapy for Chronic Primary Tinnitus and Related Problems
Liu, Y., Chen, Z., Li, G., Lai, D., Liu, P., & Zheng, Y. (2018) · BioMed Research International · doi:10.1155/2018/6032525 · Cited by 16 · see citing works
“Subjective sleep quality, indicated by sleep onset latency, awakening time after sleep onset, and sleep efficiency, improved after sleep restriction, and the effect size was moderate to large [39].”
Background
The Impact of Cognitive Behavioral Therapy for Insomnia on Sleep Log and Actigraphy Outcomes in People with Multiple Sclerosis: A Secondary Analysis
Williams-Cooke, C., LeSuer, L., Drerup, M. L., & Siengsukon, C. F. (2021) · Nature and Science of Sleep · doi:10.2147/nss.s324879 · Cited by 16 · see citing works
Intraindividual variability in sleep schedule: effects of an internet-based cognitive-behavioral therapy for insomnia program and its relation with symptom remission
Shaffer, K. M., Hedeker, D., Morin, C. M., Ingersoll, K. S., Thorndike, F. P., & Ritterband, L. M. (2020) · SLEEP · doi:10.1093/sleep/zsaa115 · Cited by 15 · see citing works
Self-citation
Opening the curtains for better sleep in psychotic disorders - considerations for improving sleep treatment
Barrett, E. A., Aminoff, S. R., Simonsen, C., & Romm, K. L. (2020) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2020.152207 · Cited by 15 · see citing works
Treatment feasibility of a digital tool for brief self‐help behavioural therapy for insomnia ( FastAsleep )
Jernelöv, S., Forsell, E., Westman, H., Dufva, Y. E., Lindefors, N., Kaldo, V., & Kraepelien, M. (2022) · Journal of Sleep Research · doi:10.1111/jsr.13759 · Cited by 14 · see citing works
“Several studies suggest that sleep restriction and stimulus control are core therapeutic methods in CBT-i, and even effective as standalone interventions (Bootzin & Epstein, 2011; Edinger et al., 2021; Harvey et al., 2002; Kaldo et al., 2015; Miller et al., 2014; Morin, 2011; Morin et al., 1994, 2006, 2015), and they…”
Background
Patients’ experiences of motivation, change, and challenges in group treatment for insomnia in primary care: a focus group study
Sandlund, C., Kane, K., Ekstedt, M., & Westman, J. (2018) · BMC Family Practice · doi:10.1186/s12875-018-0798-2 · Cited by 14 · see citing works
“However, one study has explored patients’ experiences of long-term treatment with hypnotic drugs [15]; another, patients’ experiences of mindfulness-based group treatment for insomnia [16]; and a third, patients’ experiences of sleep restriction therapy, one technique included in CBT-I [17].”
MethodInfluential
The effect of single‐component sleep restriction therapy on depressive symptoms: A systematic review and meta‐analysis
Tse, K. Y. K., Maurer, L. F., Espie, C. A., & Kyle, S. D. (2024) · Journal of Sleep Research · doi:10.1111/jsr.14180 · Cited by 12 · see citing works
Self-citation
Risk of excessive sleepiness in sleep restriction therapy and cognitive behavioral therapy for insomnia: a randomized controlled trial
Cheng, P., Kalmbach, D. A., Fellman-Couture, C., Arnedt, J. T., Cuamatzi-Castelan, A. S., & Drake, C. L. (2020) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.8164 · Cited by 13 · see citing works
“Restriction of time in bed (TIB) with the aim of consolidating sleep (ie, sleep restriction) is a core component of cognitive behavioral therapy for insomnia (CBT-I), and has efficacy as a single-component therapy.(1) As a stand-alone treatment, sleep restriction therapy (SRT) putatively leverages the homeostatic slee…”
BackgroundMethod
The Integration of Sleep Research Into Eating Disorders Research: Recommendations and Best Practices
Irish, L. A., Bottera, A. R., Manasse, S. M., Christensen, K. A., & Schaefer, L. M. (2024) · International Journal of Eating Disorders · doi:10.1002/eat.24241 · Cited by 14 · see citing works
Cognitive and behavioural therapy for insomnia in the treatment of adolescent insomnia: A systematic review and meta‐analysis of randomised controlled trials
Galgut, Y., Hoyos, C. M., Kempler, L., Aji, M., Grunstein, R. R., Gordon, C. J., & Bartlett, D. J. (2024) · Journal of Sleep Research · doi:10.1111/jsr.14442 · Cited by 13 · see citing works
“In adults, SRT is an effective standalone treatment for insomnia with post-treatment effect sizes noted as large as multicomponent CBTi when compared with a con-trol group (Maurer et al., 2021; Miller et al., 2014).”
Treating insomnia in Swiss primary care practices: A survey study based on case vignettes
Linder, S., Duss, S. B., Dvořák, C., Merlo, C., Essig, S., Tal, K., Giovane, C. D., Syrogiannouli, L., Heinzer, R. C., Nissen, C., et al. (2020) · Journal of Sleep Research · doi:10.1111/jsr.13169 · Cited by 13 · see citing works
“Sleep restriction has been found effective also when used alone (Krieger et al., 2019; Miller et al., 2014).”
Background
The translational genetics of ADHD and related phenotypes in model organisms
Cabana‐Domínguez, J., Antón-Galindo, E., Fernàndez‐Castillo, N., Singgih, E. L., O’Leary, A., Norton, W., Strekalova, T. V., Schenck, A., Reif, A., Lesch, K., et al. (2022) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2022.104949 · Cited by 13 · see citing works
“Sleep restriction therapy (SRT) is widely used as a part of cognitive behavior therapy for insomnia (CBT-I) and performing SRT alone is sufficient to confer most CBT-I benefits (Miller et al., 2014).”
Background
Healthy Nutrition, Physical Activity, and Sleep Hygiene to Promote Cardiometabolic Health of Airline Pilots: A Narrative Review
Wilson, D., Driller, M. W., Johnston, B., & Gill, N. (2023) · Journal of Lifestyle Medicine · doi:10.15280/jlm.2023.13.1.1 · Cited by 16 · see citing works
“Sleep restriction therapy has demonstrated moderate-to-large effect sizes for reducing night waking and enhancing sleep latency and efficiency, however the impact on daytime sleepiness is inconclusive and this strategy may not be appropriate for airline pilots due to regular changes in rosters [82].”
Background
Cognitive Behavioral Therapy for Insomnia: A Promising Treatment for Insomnia, Pain, and Depression in Patients With IBD
Salwen‐Deremer, J. K., Siegel, C. A., & Smith, M. T. (2020) · Crohn s & Colitis 360 · doi:10.1093/crocol/otaa052 · Cited by 15 · see citing works
Trialling a microbiome-targeted dietary intervention in children with ADHD—the rationale and a non-randomised feasibility study
Lawrence, K., Myrissa, K., Toribio-Mateas, M. A., Minini, L., & Gregory, A. M. (2022) · Pilot and Feasibility Studies · doi:10.1186/s40814-022-01058-4 · Cited by 12 · see citing works
“The actigraphy measures of sleep showed a consistent pattern for small improvements in sleep quality, with a reduction in total sleep duration; by improving sleep quality it can be consolidated [109].”
Background
The comparison of brief, online mindfulness and relaxation interventions to reduce stress and improve sleep-related outcomes in college students
Pickett, S. M., Kozak, A. T., Lanni, D. J., Warnke, A. S., Gaillard, P., & Jarrett, N. L. (2022) · Journal of American College Health · doi:10.1080/07448481.2022.2066979 · Cited by 13 · see citing works
Personalised app-based relapse prevention of depressive and anxiety disorders in remitted adolescents and young adults: a protocol of the StayFine RCT
Robberegt, S. J., Kooiman, B., Albers, C. J., Nauta, M. H., Bockting, C., & Stikkelbroek, Y. A. J. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-058560 · Cited by 12 · see citing works
Primary care treatment of insomnia: study protocol for a pragmatic, multicentre, randomised controlled trial comparing nurse-delivered sleep restriction therapy to sleep hygiene (the HABIT trial)
Kyle, S. D., Madigan, C. D., Begum, N., Abel, L., Armstrong, S., Aveyard, P. N., Bower, P., Ogburn, E., Siriwardena, A. N., Yu, L., et al. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-036248 · Cited by 12 · see citing works
Self-citation
Sleep and Cognition in People with Autism Spectrum Condition: A Systematic Literature Review
Shaw, A., Do, T., Harrison, L. K., Marczak, M., Dimitriou, D., & Joyce, A. (2021) · Review Journal of Autism and Developmental Disorders · doi:10.1007/s40489-021-00266-7
A Comprehensive Review of Lemborexant to Treat Insomnia
Fuller, M. C., Carlson, S. F., Grant, C., Berry, V., Ivancich, M. S., Cornett, E. M., Kaye, A. M., Viswanath, O., Urits, I., Shekoohi, S., et al. (2025) · Psychopharmacology Bulletin · doi:10.64719/pb.4483 · Cited by 11 · see citing works
Treating comorbid insomnia in patients enrolled in therapist-assisted transdiagnostic internet-delivered cognitive behaviour therapy for anxiety and depression: A randomized controlled trial
Edmonds, M., Peynenburg, V. A., Kaldo, V., Jernelöv, S., Titov, N., Dear, B. F., & Hadjistavropoulos, H. D. (2024) · Internet Interventions · doi:10.1016/j.invent.2024.100729 · Cited by 10 · see citing works
“The goal of sleep restriction is to increase sleep efficiency by creating a new “ sleep window ” (i.e., amount of time spent in bed) and then gradually titrating the amount of time in bed contingent upon increased sleep efficiency (Miller et al., 2014).”
Background
A randomised controlled dismantling trial of sleep restriction therapies for chronic insomnia disorder in middle childhood: effects on sleep and anxiety, and possible contraindications
Cain, N., Richardson, C. E., Bartel, K., Whittall, H., Reeks, J., & Gradisar, M. (2022) · Journal of Sleep Research · doi:10.1111/jsr.13658 · Cited by 11 · see citing works
“Due to the lack of evidence informing sleep restriction therapies in children, for both sleep and bedtime restriction therapy there was no lower limit of restriction specified (some adult protocols specify no <5 h TIB) (Miller et al., 2014).”
Background

The clinical effects of sleep restriction therapy for insomnia: A meta-analysis of randomised controlled trials
Maurer, L., Schneider, J., Miller, C. B., Espie, C. A., & Kyle, S. D. (2021) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2021.101493 · Cited by 101 · see citing works
Self-citation
The Effects of Sleep Restriction-Emphasized Cognitive Behavioral Therapy for Insomnia on Sleep with Chronic Insomniacs: A Preliminary Study
Choi, S. J., & Kim, K. S. (2010) · Journal of Korean Sleep Research Society · doi:10.13078/jksrs.10009 · Cited by 2 · see citing works
The Effect of Single‐Component Sleep Restriction Therapy for Insomnia in Adults: A Meta‐Analysis of Randomised Controlled Trials
Wei, J., Yang, F., Li, C., Xiaofang, D., & Liu, Y. (2025) · Journal of Sleep Research · doi:10.1111/jsr.70200 · Cited by 1 · see citing works
How does sleep restriction therapy for insomnia work? A systematic review of mechanistic evidence and the introduction of the Triple-R model
Maurer, L., Espie, C. A., & Kyle, S. D. (2018) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2018.07.005 · Cited by 99 · see citing works
Self-citation
Sleep restriction therapy : experimental studies
Miller, C. B. (2014) · Enlighten: Theses (The University of Glasgow)
Self-citation

Authors: Miller, C. B., Espie, C. A., Epstein, D. R., Friedman, L., Morin, C. M., Pigeon, W. R., Spielman, A. J., & Kyle, S. D.
Affiliations: The University of Sydney (AU)
University of Oxford (GB)
Phoenix VA Health Care System (US)
VA Palo Alto Health Care System (US)
Université Laval (CA)
United States Department of Veterans Affairs (US)
City College of New York (US)
University of Manchester (GB)
Corresponding author: Miller, Christopher B.
ORCID: Miller, Christopher B.
Espie, Colin A.
Epstein, Dana R.
Morin, Charles M.
Pigeon, Wilfred R.
Kyle, Simon D.
Venue: Sleep Medicine Reviews
Publisher: Elsevier BV
Published: 2014-10
Volume: 18
Issue: 5
Pages: 415-424
ISSN: 1087-0792 (ISSN-L)
DOI: 10.1016/j.smrv.2014.01.006
OpenAlex: W2165118243
Cited by: 192
References: 80
Citations by year: 2026: 11 · 2025: 10 · 2024: 10 · 2023: 22 · 2022: 27 · 2021: 24 · 2020: 21 · 2019: 14 · 2018: 17 · 2017: 13 · 2016: 10 · 2015: 9 · 2014: 3
FWCI: 1.58
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Sleep Medicine Reviews (publishedVersion)
PubMed (publishedVersion)
Research Explorer (The University of Manchester) (publishedVersion)
Funders: National Health and Medical Research Council (NHMRC, Australia) Centre for Integrated Research and Understanding of Sleep (CIRUS) (571421)
Sackler Institute of Psychobiological Research (University of Glasgow Sleep Centre, Scotland, UK)
Chief Scientist Office (Scotland, UK) (CZG/2/503)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
Keywords: sleep restriction therapy, chronic insomnia, insomnia, sleep diary, sleep latency, wake after sleep onset, sleep efficiency, total sleep time, treatment efficacy, cognitive behavioral therapy
MeSH terms: Humans, Sleep Initiation and Maintenance Disorders, Sleep Deprivation, Cognitive Behavioral Therapy, Treatment Outcome

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The evidence base of sleep restriction therapy for treating insomnia disorder

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