Rosén Ann, Cassel Maria, Stjernberg Johanna, Stenfalk Joel, Blom Kerstin, Tamm Sandra, Åkerstedt Torbjörn, Carlsson Rickard, Jernelöv Susanna
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Sweden.
Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden; Stress Research Institute, Department of Psychology, Stockholm University, 10691 Stockholm, Sweden.
Sleep Med Rev. 2025 Oct;83:102150. doi: 10.1016/j.smrv.2025.102150. Epub 2025 Aug 9.
Cognitive behavioural therapy for insomnia includes methods to adjust bedtimes and risetimes. The most well-known is sleep restriction therapy, but alternatives like sleep compression therapy and bedtime regularization also exist. Instructions and terminology vary. This scoping review uses "time-in-bed manipulation therapy" to encompass all such interventions, aiming to synthesize information on their implementation in adult populations, focusing on different instructions found in the literature. We searched five electronic databases. Two independent reviewers screened full-text papers, followed by data extraction. Both quantitative (e.g., instruction frequencies) and qualitative (e.g., analysis of content) syntheses were conducted. Of 7474 citations and 500 full-text papers, 52 studies met inclusion criteria, covering 60 therapies. Most interventions were termed sleep restriction therapy, but other names, such as sleep compression and bedtime restriction, were also used. Nine different methods for calculating the initial sleep window were identified, with further variation in other instructions. About half of the studies were randomized controlled trials. This review provides a comprehensive overview of time-in-bed manipulation therapies, aiding researchers and clinicians in selecting appropriate approaches. It highlights the need for clearer reporting, increased direct comparisons, and suggests a new model, The Restriction and Flexibility Model, describing key dimensions of these interventions.
失眠的认知行为疗法包括调整就寝时间和起床时间的方法。最著名的是睡眠限制疗法，但也存在如睡眠压缩疗法和就寝时间规律化等其他方法。指导说明和术语各不相同。本范围综述使用“卧床时间操纵疗法”来涵盖所有此类干预措施，旨在综合关于其在成年人群中实施情况的信息，重点关注文献中发现的不同指导说明。我们检索了五个电子数据库。两名独立评审员筛选全文论文，随后进行数据提取。进行了定量（如指导频率）和定性（如内容分析）综合分析。在7474条引文和500篇全文论文中，52项研究符合纳入标准，涵盖60种疗法。大多数干预措施被称为睡眠限制疗法，但也使用了其他名称，如睡眠压缩和就寝时间限制。确定了九种计算初始睡眠窗口的不同方法，其他指导说明也存在进一步差异。约一半的研究是随机对照试验。本综述全面概述了卧床时间操纵疗法，有助于研究人员和临床医生选择合适的方法。它强调了更清晰报告、增加直接比较的必要性，并提出了一个新模型，即限制与灵活性模型，描述了这些干预措施的关键维度。
