In this lesson, you will learn about using stimulus control to help you associate your bed with sleep. You can train your brain to fall asleep at a certain time and place. This is called Stimulus Control.

Stimulus control therapy was created for people with insomnia. The process of stimulus control helps to strengthen cues that promote sleep and to weaken cues that promote wakefulness. These concepts work for those who can’t sleep due to other reasons (like pain), too.

Why Stimulus Control?

Can you relate to the following situation? You go to bed and you lay awake, feeling frustrated and worried that you won’t get enough sleep. You end up worrying for several hours until you finally fall asleep.

This may be because your brain has associated worrying and frustration with bedtime. These feelings aren’t exactly relaxing. Unfortunately, your bed is no longer a safe, restful place. When you get into bed, your brain easily transitions into worry-mode due to these reinforced neural pathways.

Stimulus control trains you to sleep when you go to bed. It takes repetition and commitment, but it is possible! When you get into bed, your brain will be cued to fall asleep rather than worry.

Stimulus Control Process

There are several instructions for ensuring that your bed serves as a cue to sleep.

First, only lay in your bed when you are feeling sleepy. Don’t use your bed for any other activities. For example, don’t eat, study, read, or watch television in bed. The only exception is for sexual activity. Further, don’t sleep anywhere other than your bed (e.g., the couch).

Next, if you can’t sleep, get up. Don’t lay in bed awake for longer than 10-20 minutes. This doesn’t need to be a precise amount of time (to avoid overthinking this). However, if you feel you’ve been awake in bed for a while without sleeping, get up.

If you need to get up, go to another room. Avoid getting up and watching tv or scrolling through your phone. The bright screens can make it more difficult to sleep. You can read a book or practice some relaxation techniques. Do something that doesn’t stimulate you too much. Once you feel sleepy again, return to your room to try to sleep.

Repeat this process if necessary. Never lay in bed awake for too long.

Then, try to get up at the same time each day. Even if you didn’t sleep as much as you think you should have. Make sure that this wake-time stays consistent. It will train your circadian rhythm to make you sleepy at the same time every day.

Finally, don’t nap during the day. It will make it more difficult to sleep at night.

How does this work?

Making sure you’re only in bed when you’re sleepy can help you to identify your body’s cues for sleepiness. Often, people go to bed aiming to get a certain number of hours of sleep. They go to bed when they’re not necessarily sleepy. This allows time for your day’s worries to creep in. Further, when you live with chronic pain, this can turn into you lying in bed awake in pain, feeling awful.

When you go to bed worrying (and in pain), night after night, you begin to naturally become anxious at bedtime. Unfortunately, this causes your brain to form an association between worrying, negative emotions, and bedtime. You’re less primed to fall asleep at night (even if you’re tired).

Stimulus control allows you to disconnect that association. By only going to bed when you’re sleepy and not using the bed for any other purpose, you reform the association between the bed and sleep. This process can take time. However, once your brain adjusts, you will have a more natural sleep-wake cycle that you can incorporate into your routine.

Additionally, avoiding napping during the day can help make you feel sleepier at night. As mentioned in the first lesson, adenosine builds up in your brain during the day. The level of adenosine creates a drive to sleep. If you nap, this adenosine is cleared out. It reduces your drive to sleep at night.

There are even more behaviours you can try during the day that promote sleep at night. In the next lesson, we will discuss some of the simple actions you can take to improve your sleep.

Reflect

Take some time to reflect on what you’ve just learned about stimulus control. Have you ever tried this method of reassociating your bed with sleep? If so, was it successful? Do you practice any of these rules outside of a strict stimulus control process? How can you try this in your routine?

Take the next quiz to proceed.

References

Bootzin, R.R. & Perlis, M.L. (2011). Stimulus Control Therapy. In M. Perlis, M. Aloia & B. Kuhn (Eds.), Behavioral Treatments for Sleep Disorders (pp. 21-30). Elsevier. doi: 10.1016/B978-0-12-381522-4.00002-X

Calgary Headache Assessment and Management Program. (2018, July 9). Stimulus Control. Alberta Health Services. https://myhealth.alberta.ca/Learning/sleep-strategies/strategies-to-improve-sleep/stimulus-control

Drug and Alcohol Services South Australia. (2017). Insomnia Management Kit: Stimulus Control Therapy. Government of South Australia: Health. https://www.sahealth.sa.gov.au/wps/wcm/connect/9e2651804033fd8c99b0bbd30eb2c8cd/6+-+Stimulus+Control+Therapy+2017.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-9e2651804033fd8c99b0bbd30eb2c8cd-niQ21kj

Morin, C.M., Bootzin, R.R., Buysse, D.J., et al. (2006). Psychological and Behavioral Treatment of Insomnia: Update of the Recent Evidence (1998-2004). Sleep, 29(11), 1398 – 1414. doi: 10.1093/sleep/29.11.1398