Why stimulus control works
After enough bad nights, the bed itself can start to cue alertness. Some people feel sleepy on the couch and wide awake the moment they lie down. Others sleep better in a hotel than at home. Stimulus control is a set of rules for teaching the bed to mean sleep again.
The rules
Richard Bootzin described them in 1972. The version most programs use today looks like this.
- Go to bed only when you’re sleepy. Sleepy means your eyes are heavy and your head nods, not just tired or worn out.
- Use the bed only for sleep and sex. No phone, TV, work, or worrying in bed. Reading in bed is a gray area, and many programs ask you to move it elsewhere at first.
- If you can’t sleep, get up. When you’ve been awake for what feels like a while, go to another room and do something quiet in dim light. Come back when you’re sleepy. Repeat as often as you need to.
- Get up at the same time every day, however the night went, weekends included.
- Avoid naps. If you’re too sleepy to drive or work safely without one, keep it short and early in the afternoon.
Why they help
Every night spent lying awake in bed pairs the bed with frustration and effort. The rules break that pairing. Each time you get up instead of lying there, the bed is kept for sleep. Over a few weeks, the aim is for lying down to bring on sleepiness again.
The fixed wake time and fewer naps help in a second way. They let sleep drive build through the day, so you’re sleepier by night.
What “a while” means
The rule used to say 15 or 20 minutes. Checking the clock to measure that wakes most people up, so many programs now say to go by feel. If you notice you’re frustrated, wide awake, or planning tomorrow, that’s the time to get up.
What to do once you’re up
Something calm that you don’t mind stopping. A book or magazine, a puzzle, folding laundry, or listening to something quiet. Keep the lights low. Avoid work, bright screens, and anything you’d have trouble putting down. Getting up doesn’t have to mean sitting in the dark, bored.
The first weeks
Expect some nights with several trips out of bed. That’s the rules working, not failing. It’s also why the sleep window and stimulus control are often used together. A shorter time in bed means sleep comes faster, so there are fewer trips.
Safety
Getting up in the dark can lead to falls, especially for older adults or anyone unsteady at night. Use a night light, keep a clear path, and sit down to wait if you need to. If you care for someone at night, adapt the rules with your clinician.
The diary’s “Last night I…” questions follow four of these rules. Didn’t come up is the right answer when there was no reason to get up, for example when you fell asleep quickly.
References
- Bootzin, R. R. (1972). Stimulus control treatment for insomnia. Proceedings of the 80th Annual Convention of the American Psychological Association, 7, 395–396.
- Edinger, J. D., Arnedt, J. T., Bertisch, S. M., Carney, C. E., Harrington, J. J., Lichstein, K. L., Sateia, M. J., Troxel, W. M., Zhou, E. S., Kazmi, U., Heald, J. L., & Martin, J. L. (2021). Behavioral and psychological treatments for chronic insomnia disorder in adults: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 17(2), 255–262. doi.org/10.5664/jcsm.8986
- Perlis, M. L., Jungquist, C., Smith, M. T., & Posner, D. (2005). Cognitive behavioral treatment of insomnia: A session-by-session guide. Springer.
Helpful links
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