The effect of single‐component sleep restriction therapy on depressive symptoms: A systematic review and meta‐analysis
Open accessAbstract
Summary: Sleep restriction therapy is a behavioural component within cognitive behavioural therapy for insomnia and is an effective standalone treatment for insomnia, but its effect on depressive symptoms remains unclear. This review aimed to synthesise and evaluate the impact of single‐component sleep restriction therapy on depressive symptoms relative to a control intervention. We searched electronic databases and sleep‐related journals for randomised controlled trials and uncontrolled clinical trials, published from 1 January 1986 until 19 August 2023, that delivered sleep restriction therapy to adults with insomnia. Random‐effects meta‐analysis of standardised mean differences and Cochrane risk of bias assessment were performed on randomised controlled trials, while uncontrolled clinical trials were discussed narratively. The meta‐analysis was pre‐registered on PROSPERO (ID: CRD42020191803). We identified seven randomised controlled trials (N = 1102) and two uncontrolled clinical trials (N = 22). Findings suggest that sleep restriction therapy is associated with a medium effect for improvement in depressive symptoms at post‐treatment (Nc = 6, g = −0.45 [95% confidence interval = −0.70 to −0.21], p < 0.001) and a small effect at follow‐up (Nc = 4, g = −0.31 [95% confidence interval = −0.45 to −0.16], p < 0.001). Five of the seven included randomised controlled trials were judged to have a high risk of bias. Standalone sleep restriction therapy appears to be efficacious for improving depressive symptoms at post‐treatment and follow‐up. However, conclusions are tentative due to the small number of trials and because none of the trials was performed in a population with clinically defined depression. Large‐scale trials are needed to test the effect of sleep restriction therapy in patients experiencing depression and insomnia. Findings also highlight the need to improve the standardisation and reporting of sleep restriction therapy procedures, and to design studies with more rigorous control arms to reduce potential bias.
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Altered default mode network-salience network coupling and limbic-prefrontal hyperconnectivity are implicated during periods of sleep anticipation and rumination.
“Recent neuroimaging studies also implicate altered default mode network (DMN)-salience network coupling and limbic-prefrontal hyperconnectivity during periods of sleep anticipation and rumination [34,35].”
From Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice. (2026) · cites this paper as [34]
The Discussion’s “Broader considerations” section discusses rumination and intrusive thoughts during nighttime wakefulness, but does not report neuroimaging findings. Searches for default mode–salience network coupling, limbic–prefrontal hyperconnectivity, and sleep anticipation found no passage addressing those claims in our copy (page unavailable). (LLM, conf=0.75)
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“…in adult humans enhances serotonin, norepinephrine, and BDNF levels, promoting neuroplasticity, suppressing hyperactive default mode network, and improving mood without negatively impacting brain development (Krause et al., 2017; Massa et al., 2011; Sochal et al., 2024; Tse et al., 2024).”
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
Longitudinal cardiorespiratory wearable sleep staging in the home
Davidson, S. M., Carter, J. F., Stanyer, E. C., Sharman, R. L., Román, C., Kyle, S. D., & Tarassenko, L. (2026) · Frontiers in Neuroscience · doi:10.3389/fnins.2026.1693860 · Cited by 1 · see citing works
Self-citationBouthillier, J. L., Ivers, H., & Morin, C. M. (2025) · Journal of Sleep Research · doi:10.1111/jsr.70043 · Cited by 1 · see citing works
“Although ISR is not a first-line treatment, it could be an alternative treatment option for patients who do not respond to standard CBT-I, sleep restriction alone (Tse et al. 2024) or other treatment modalities such as third-wave psychotherapies.”
Looman, M. I., Schoenmakers, T. M., Kamphuis, J. H., Blanken, T. F., & Lancee, J. (2025) · SLEEP · doi:10.1093/sleep/zsaf360 · Cited by 1 · see citing works
Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice.
Song, S., Irfan, M., Tahir, Z., Garrison, K. A., & Ziskind, S. (2026) · Current Sleep Medicine Reports · doi:10.1007/s40675-026-00370-2
New European guidelines for the accreditation of sleep medicine centres and more!
Riemann, D. W. (2024) · Journal of Sleep Research · doi:10.1111/jsr.14408
“Tse et al. (2024) from Oxford investigated whether single-component sleep restriction therapy may have a significant effect on depressive symptoms also, besides the well-known effects on sleep parameters in patients suffering from insomnia.”
La santé du sommeil comme marqueur et cible d’intervention dans les troubles psychiatriques
Coelho, J., Samalin, L., Yrondi, A., Iftimovici, A., Philip, P., & Micoulaud‐Franchi, J. (2025) · médecine/sciences · doi:10.1051/medsci/2025065
- Authors
- Tse, K. Y. K., Maurer, L. F., Espie, C. A., & Kyle, S. D.
- Affiliations
- University of Oxford (GB)
- Mementor Leipzig Germany
- Corresponding author
- Kyle, Simon David
- Venue
- Journal of Sleep Research
- Publisher
- Wiley
- Published
- 2024-02-28
- Volume
- 33
- Issue
- 6
- Pages
- e14180-e14180
- ISSN
- 0962-1105 (ISSN-L)
- 1365-2869
- PMC
- PMC11596993
- OpenAlex
- W4392291126
- Cited by
- 12
- References
- 88
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 4
- FWCI
- 0.89
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Sleep Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- National Institute for Health and Care Research (NIHR203316, NIHR131789, 16/84/01)
- 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
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- sleep restriction therapy, depressive symptoms, insomnia, cognitive behavioral therapy for insomnia, depression, treatment efficacy, risk of bias
- MeSH terms
- Depression, Humans, Sleep Initiation and Maintenance Disorders, Sleep Deprivation, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic
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