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Sleep restriction therapy for chronic insomnia (conducted over multiple visits)

Sleep restriction therapy for chronic insomnia (conducted over multiple visits)
Step 1: Patient maintains a daily sleep diary for 1 to 2 weeks. Average total sleep time and sleep efficiency are computed from the information on the sleep diary*.
Step 2:

If sleep efficiency is below 85%, the time in bed window (ie, elapsed time from bedtime to rise time) is set to equal the number of hours of sleep based on the sleep diary with a consistent bedtime and rise time each day.

The patient is instructed not to nap during the day.

The patient continues to keep a sleep diary until the next visit.
Step 3: Average total sleep time and sleep efficiency are computed from the information on the sleep diary, and one of the following steps is taken:
  • If sleep efficiency is >90% and the patient does not feel sufficiently rested, the time in bed window is increased, typically by 15 minutes.
  • If sleep efficiency is between 85 to 90%, the sleep schedule is maintained.
  • If sleep efficiency is <85% and the patient does not feel sleepy, the time in bed window is shortened by 15 minutes.
The patient continues to keep a sleep diary until the next visit.
Step 4: Step 3 is repeated until sleep quality is satisfactory (refer to step 3A above) and the patient feels sufficiently rested during the day.
* Sleep efficiency is the time asleep divided by time in bed x 100.
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