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 but not less than 6 hours, 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 restriction therapy is also sometimes referred to as "time in bed restriction" or "sleep efficiency training."

¶ Sleep efficiency is the time asleep divided by time in bed × 100.

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