Sleep Restriction for Fibromyalgia: Why Less Sleep Time Can Mean Better Sleep Quality

If you’re living with fibromyalgia, you’re likely all too familiar with the cruel irony of chronic fatigue paired with poor sleep quality. Despite feeling exhausted, you may find yourself lying awake for hours, tossing and turning, or waking frequently throughout the night. This sleep disruption doesn’t just leave you tired—it can worsen fibromyalgia symptoms, creating a vicious cycle that feels impossible to break.

One of the tools I learned about when I attended an NHS pain management programme was sleep restriction therapy. While the name might sound counterintuitive (restricting sleep when you’re already sleep-deprived sounds dreadful, right?!), this technique can actually help rebuild healthy sleep patterns and improve overall sleep quality.

It’s important to note that I am not a medical professional and that at the time I underwent sleep restriction for the first time, I was under the care of a professional multi disciplinary pain management team. Please consult an appropriate medical professional if you are interested in following a sleep restriction programme.

What Is Sleep Restriction Therapy?

Sleep restriction therapy is a component of cognitive behavioural therapy for insomnia (CBT-I) that involves temporarily limiting the amount of time you spend in bed to match the actual amount of sleep you’re getting. The goal isn’t to deprive you of sleep permanently, but rather to consolidate your sleep into a more efficient, restorative period.

Think of it this way: if you’re spending 9 hours in bed but only sleeping for 5 of those hours, you’re essentially training your brain to associate your bed with wakefulness and frustration rather than sleep. Sleep restriction therapy helps break this association by ensuring that most of the time you spend in bed is actually spent sleeping.

The Science Behind Sleep Restriction

The effectiveness of sleep restriction therapy is rooted in our understanding of sleep drive and circadian rhythms. When we spend excessive time in bed while not sleeping, we weaken what sleep researchers call “sleep drive”—the biological pressure that builds up during wakefulness and makes us feel sleepy.

By restricting time in bed, we accomplish several things:

Improved Sleep Efficiency: Sleep efficiency is calculated as the percentage of time in bed that you’re actually asleep. By matching your time in bed more closely to your actual sleep time, you improve this ratio, leading to more consolidated sleep.

Strengthened Sleep-Wake Cycle: Consistent sleep and wake times help regulate your circadian rhythm, your body’s internal clock that governs when you feel alert and when you feel sleepy.

Reduced Sleep Anxiety: When you fall asleep more quickly and sleep more soundly, you develop more positive associations with your bed and bedtime, reducing the anxiety that often surrounds sleep in people with chronic sleep problems.

For people with fibromyalgia specifically, research suggests that sleep restriction therapy can be particularly beneficial because fibromyalgia symptoms are closely linked to sleep disturbances. Poor sleep can increase pain sensitivity, worsen fatigue, and contribute to mood problems—all core symptoms of fibromyalgia.

How to Calculate Your Sleep Restriction Window

Before starting sleep restriction therapy, you’ll need to track your current sleep patterns for about one to two weeks. Keep a sleep diary that includes:

• What time you go to bed
• How long it takes you to fall asleep
• How many times you wake up during the night and for how long
• What time you wake up in the morning
• What time you get out of bed
• How many hours you actually slept (total sleep time)

Once you have this baseline data, calculate your average total sleep time. This becomes your initial sleep window.

Here’s how it works:

1. Calculate Average Sleep Time: Add up all your total sleep times and divide by the number of nights tracked. For example, if over 7 nights you slept 5, 4, 6, 4, 5, 3, and 5 hours, your average is 4.6 hours.
2. Set Your Sleep Window: Your initial sleep restriction window should be your average sleep time, but no less than 5 hours (going below 5 hours can be counterproductive and potentially unsafe).
3. Choose Your Wake Time: Pick a consistent wake time that works with your schedule and stick to it every day, including weekends.
4. Calculate Bedtime: Subtract your sleep window from your wake time. If you need to wake up at 7 AM and your sleep window is 5 hours, your bedtime would be 2 AM.

Important Safety Note: Sleep restriction should not reduce your time in bed to less than 5 hours, and people with certain medical conditions, those who drive regularly for work, or those taking certain medications should consult with a healthcare provider before starting this therapy.

How Sleep Restriction Can Help Fibromyalgia Symptoms

Sleep restriction therapy can benefit people with fibromyalgia in several interconnected ways:

Pain Management: Quality sleep is crucial for pain processing and pain threshold. When you achieve more consolidated, deeper sleep, your body’s natural pain-fighting mechanisms work more effectively. Many people with fibromyalgia report reduced pain intensity after improving their sleep quality.

Reduced Fatigue: While you might feel more tired initially during sleep restriction, most people experience less daytime fatigue once their sleep becomes more efficient. This happens because you’re getting more restorative deep sleep, even if the total amount is initially less.

Improved Mood: Sleep disturbances are closely linked to depression and anxiety, which are common comorbidities with fibromyalgia. Better sleep can lead to improved emotional regulation and reduced symptoms of depression and anxiety.

Enhanced Cognitive Function: “Fibro fog”—the cognitive difficulties associated with fibromyalgia—often improves with better sleep quality. Consolidated sleep allows your brain to complete important maintenance functions that support memory, attention, and executive function.

Better Sleep Architecture: Sleep restriction can help normalize sleep stages, ensuring you get adequate amounts of deep sleep and REM sleep, both crucial for physical and mental restoration.

Timeline: How Long to Follow Sleep Restriction

Sleep restriction therapy is typically implemented in phases:

Week 1-2: Initial Restriction Phase During the first week or two, you’ll likely feel more tired as your body adjusts to the restricted sleep window. This is normal and expected. The key is to stick to your schedule consistently, even on weekends.

Week 3-4: Monitoring and Adjustment After about two weeks, evaluate your progress. If your sleep efficiency (time asleep divided by time in bed) has improved to 85% or higher, you can gradually increase your sleep window by 15-30 minutes earlier bedtime.

Week 5-8: Gradual Expansion Continue to monitor your sleep efficiency weekly. Each time you maintain 85% or higher efficiency for a week, you can add another 15-30 minutes to your sleep window. If efficiency drops below 85%, return to the previous schedule for another week.

Month 3 and Beyond: Maintenance Most people reach their optimal sleep window within 6-8 weeks. Once you’ve found a schedule that gives you good sleep efficiency and adequate sleep duration (usually 7-8 hours for most adults), maintain this schedule consistently.

The entire process typically takes 2-3 months to complete, though some people may need longer. The key is patience and consistency—the benefits often aren’t immediately apparent but build over time.

Important Considerations and Tips for Success

Consistency is Key: The most crucial element of sleep restriction therapy is maintaining your sleep and wake times every single day, including weekends. This consistency helps strengthen your circadian rhythm.

Manage Daytime Sleepiness: During the initial phase, avoid napping if possible. If you must nap, limit it to 20 minutes and don’t nap after 3 PM. Engage in bright light exposure in the morning and stay active during the day to help maintain alertness.

Create a Buffer Zone: Don’t go to bed until you feel genuinely sleepy. If your calculated bedtime is 1 AM but you’re not sleepy, engage in quiet, relaxing activities outside the bedroom until sleepiness kicks in.

Optimize Your Sleep Environment: Make sure your bedroom is cool, dark, and quiet. Consider blackout curtains, a white noise machine, or earplugs if needed.

Be Patient with the Process: The first few weeks can be challenging, and you might feel worse before you feel better. This is normal and typically temporary. Most people start noticing improvements in sleep quality after 2-3 weeks.

Monitor Your Symptoms: Keep track of not just your sleep but also your fibromyalgia symptoms, mood, and energy levels. This can help you see the broader benefits as your sleep improves.

Manage Your Diary: It might be helpful to reduce any commitments as far as possible in the early days of following the plan to give your body time to adjust to the new regime. If possible choose a time to start when you’re less busy.

My Own Experience with Sleep Restriction Therapy

My specific sleep issue was that I could fall asleep no problem, but I was not able to stay asleep. I would typically wake up at around 1am and could sometimes still be awake at 5 am, unable to fall asleep again. Even if I did manage to fall back asleep, I would generally wake up every hour or so and so by the time morning came around, I’d feel as if I hadn’t slept at all, or had a terrible hangover.

On the Pain Management course, the sleep module was tailored very much to those who had issues falling asleep. When I mentioned my specific sleep issue, the psychologist who was part of the team running the course, told me about Sleep Restriction Therapy and the following week came to me with more specific information. I talked it over with her on a one to one basis and decided to give it a try.

The early days were really hard as I struggled with getting up so early when I still felt tired. I was still waking up at around 1am, and would usually remain awake until 3am or so. By following the calculation above, my alarm was set for 4.30am and it was horrendous to drag myself out of bed at that time having had so little sleep. I had cleared my calendar so that I didn’t have to drive any where or have any commitments for the first two weeks and that helped me feel more relaxed about the whole thing.

After about a week, the 1am waking had almost stopped. I was still waking up at 3am or so but would generally fall back into a light asleep until the alarm went off. By the second week, I was waking up 2 or 3 times a night but for no more than a quarter of hour at a time. Over the next few weeks, I was able to make the alarm time later and later as my sleep efficiency edged towards 85%. This remained relatively stable for several months. But I am now at the point where my sleep is worsening again. I am planning to restart the programme over the next few weeks as soon as I have a suitable gap in my diary to be able to follow the recommendations. I would say Sleep Restriction has helped my to improve my sleep although I am not sure that I could have managed the early weeks if I had had to drive anywhere or work as I felt so ill. Sadly, even though my sleep did improve, I did not notice any impact on my pain levels.

In conclusion

Sleep restriction therapy offers hope for people with fibromyalgia who have struggled with sleep issues. While it requires commitment and patience, the potential benefits—reduced pain, improved energy, better mood, and enhanced quality of life—make it a valuable tool in managing fibromyalgia symptoms. Remember that everyone’s experience is different, and what works for one person may need to be modified for another. The key is to approach it systematically, be consistent with your efforts, and give your body time to adapt to healthier sleep patterns.

Further Information

I found this PDF file from NHS Berkshire Healthcare extremely useful:

Click to access gsh-11_v1_sleeprestrictionworkbook_final.pdf