CBT-I Sleep Restriction Worksheet: Sleep Diary, Sleep-Efficiency Calculation & Time-in-Bed Titration

What it helps with

• Finding a client's true time asleep from a diary-derived baseline rather than an aspirational time in bed.
• Calculating sleep efficiency (time asleep divided by time in bed) from nightly diary data.
• Applying the sleep-efficiency titration rule consistently, session by session, instead of eyeballing the diary.
• Pairing stimulus control instructions with the titration schedule as standing rules rather than optional advice.

How clinicians use it

• Run the baseline week before prescribing any window. Restricting from an estimated rather than a diary-derived time-asleep figure is the most common implementation error.
• Set the wake time first, always. It anchors the whole schedule and should be chosen for what the client can actually sustain seven days a week, including weekends.
• Re-titrate on the diary data, not on the client's subjective report of "better" or "worse". Subjective sleep quality and diary-derived efficiency diverge often enough in the first fortnight that titrating on feeling alone will misfire.
• Screen for shift work, untreated sleep apnoea, bipolar disorder, seizure history and safety-critical daytime driving or machine operation before prescribing restriction. Each is a modification or a contraindication, not a footnote.
• Expect and normalise increased daytime sleepiness in week one to two. This is the mechanism working, not a treatment failure, provided the daytime-function check stays within safe bounds.
• For ADHD or autistic clients, adapt the format rather than the protocol: a fixed wake-time alarm and a same-time nightly reminder to complete the diary supports clients who find open-ended time tracking hard to start, a short-hand diary (tick boxes and single numbers) reduces the load of nightly free-text logging, and reviewing the titration table together in session removes the demand for independent weekly arithmetic.
• Pairs with `soothing-rhythm-breathing` or `the-regulate-skill-breathwork` for pre-sleep physiological arousal, and with `worry-postponement-worksheet` where cognitive rumination is the presenting maintenance factor.

Clinical Implementation Guide

1. Run the 7-night baseline diary before prescribing any sleep window.
2. Calculate mean sleep efficiency from 5-7 nights before each titration review.
3. Apply the decision rule consistently: extend at 90% or higher, hold between 85% and 89%, reduce below 85%, with a 5-5.5 hour floor.

What the worksheet looks like

Clinical cautions

Do not prescribe sleep restriction to clients with untreated obstructive sleep apnoea, uncontrolled seizure disorder, bipolar disorder (restriction can precipitate a manic episode), or active safety-critical responsibilities (driving for work, operating machinery, sole caregiving for a dependant with no backup) without first addressing those risks directly, adjusting the floor upward, or deferring to a sleep medicine specialist. Screen for obstructive sleep apnoea (loud snoring, witnessed apnoea, morning headaches, marked daytime sleepiness disproportionate to reported sleep loss) before beginning, since CBT-I is not a treatment for a primary breathing-related sleep disorder. This worksheet is a clinical template for use by qualified practitioners within a formulation-led treatment plan. It does not diagnose any condition, does not constitute psychological treatment in itself, and is not a substitute for individual face-to-face therapy, for medical or sleep-specialist assessment, or for emergency crisis support.

References

1. Spielman, A. J., Saskin, P., & Thorpy, M. J. (1987). Treatment of chronic insomnia by restriction of time in bed. Sleep, 10(1), 45-56.
2. Bootzin, R. R. (1972). Stimulus control treatment for insomnia. Proceedings of the American Psychological Association, 7, 395-396.
3. Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., & Denberg, T. D. (2016). Management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 165(2), 125-133.
4. Morin, C. M., & Espie, C. A. (2003). Insomnia: A clinical guide to assessment and treatment. Kluwer Academic/Plenum Publishers.
5. Edinger, J. D., & Carney, C. E. (2014). Overcoming insomnia: A cognitive-behavioral therapy approach, therapist guide (2nd ed.). Oxford University Press.

Part of

Cognitive Behavioral Therapy (CBT) Foundations

Related worksheets

• Worry Postponement Worksheet
• Pacing and Symptom Diary
• Soothing Rhythm Breathing
• My Sleep Window: CBT-I Client Worksheet

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