Stimulus control and sleep restriction

Domain II · Behavioural & cognitive · Richard Bootzin, Arthur Spielman · 1972

What it is

These are two brief behavioural treatments for chronic insomnia. They can be used on their own, which the AASM 2021 guideline conditionally recommends for each, or as the behavioural core of CBT-I. Neither is a full psychotherapy. Each is a short set of instructions that the clinician explains,…

Format

• Indication for SRT in Spielman's chapter: SE below 85% (below 80% in older adults). Also consider people with an early weekday rise and long lie-ins on free days, whose weekly SE can look normal.
• Stage 1: Rationale and prescription (session 1).

Who practises it, and how they are trained or regulated

• Brief SRT in primary care: 4 weekly sessions totalling about 65 minutes (two face-to-face, two by phone), delivered by nurses after half a day of training using a manual, booklet, diaries and SE grids.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Plans that rely on willpower alone. Push for environmental changes.
• Unplanned evening dozing in front of the TV. It often goes unrecorded, so ask specifically.
• Engaging activities such as work email or gaming. These delay sleepiness and can push sleep later.
• Reduced need for sleep, racing thoughts, raised energy. Widen the window and contact the prescriber.
• Patients who drift back into long time in bed once they feel better. Check at a follow-up appointment.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.