Sleep Compression Therapy vs. Sleep Restriction Therapy: Which Therapy Works Best for Insomnia?

Insomnia affects roughly 1 in 10 adults, disrupting sleep and daily functioning, and increasing the risk for depression, anxiety, and other health issues. While Cognitive Behavioural Therapy for Insomnia (CBT-I) is the gold standard treatment, one of its core components – Sleep Restriction Therapy (SRT) – can be tough to stick with due to side effects like fatigue and daytime sleepiness.
This has led clinicians to explore Sleep Compression Therapy (SCT) as a gentler alternative. But until now, no study had directly compared the two. That’s where our new research comes in.

The Study: A Head-to-Head Comparison
We conducted a single-blind randomised controlled trial with 234 adults diagnosed with chronic insomnia. Participants were randomly assigned to receive either SRT or SCT through a structured, therapist-guided 10-week online program. Our goal? To find out whether SCT is non-inferior to SRT in reducing insomnia severity, and to compare side effects, adherence, and overall satisfaction.

What We Found
Both therapies worked well, significantly reducing insomnia symptoms.
However, SCT did not meet the criteria for non-inferiority, as SRT led to faster and slightly greater improvements in insomnia severity.
What SCT had was fewer side effects early in treatment and better adherence, meaning patients were more likely to follow the treatment instructions. Despite these differences, treatment satisfaction and daytime functioning were similar between the two groups.

Clinical Implications
Our findings suggest that Sleep Restriction Therapy should remain the first-line choice for treating insomnia. It works faster and more effectively, though it may come with more side effects.
That said, Sleep Compression Therapy is still a valid option, especially for patients who:

• Struggle with the intensity of SRT
• Have medical or occupational reasons to avoid sleep deprivation (e.g., bipolar disorder, professional drivers)
• Prefer a gentler, more gradual approach

Why This Matters
This is the first large-scale, well-controlled trial to directly compare these two therapies. It fills a critical gap in sleep research and provides clear guidance for clinicians and patients alike.
Both therapies are effective and non-pharmacological, making them excellent alternatives to sleeping pills. The choice between them should be personalised, based on patient needs, preferences, and tolerability.

Looking Ahead
Future research should explore:

• How SCT performs in more diverse or complex patient populations
• Whether certain individuals benefit more from one therapy over the other
• The mechanisms behind how these therapies work—and how to optimise them