What is stimulus control? When is it used?
Stimulus control, when applied to sleep, are a set of instructions designed to try to ensure an association between being in bed and feeling sleepy or ready for sleep. The intention of stimulus control is to break the association of being awake or alert in bed. Stimulus control instructions are based on the psychologicial principle of conditioning, which results in a particular pattern of behaviour in the presence of a given stimulus and a different behaviour when that stimulus isn’t present.
How does conditioning relate to sleep?
Conditioning is very important to good sleep. If people are sleeping well, just thinking about bed or sleep, can generate feelings of being sleepy and positive sensations. However, if people are having trouble with sleep, thoughts about sleep, or getting in to bed can become associated with feelings of anxiety, uncertainty or heightened alertness that are not conducive to sleep. This association develops through reinforcement, with these feelings occurring in the presence of a given stimulus, for example having trouble sleeping and being awake in bed.
Many people describe features of conditioning with negative feelings around sleep. Examples that I hear commonly are:
- Feeling tired throughout the day, and nodding off watching television sitting on the couch in the evening, but on getting in to bed feeling more alert and not sleepy at all.
- Thinking about sleep and feeling anxious or worried
What are the stimulus control instructions?
Step 1: Become aware of your state of mind. If you notice that you are tossing and turning and sleep is not happening, pause to recognize your state of mind. This might happen at the beginning of the night or if you happen to wake up in the middle of the night. Prolonged periods of being awake in bed usually lead to tossing and turning, becoming frustrated, or worrying about not sleeping. These reactions make it more difficult to fall asleep. Also when you lie in bed awake trying to sleep, wanting and hoping to go back to sleep, you are training (conditioning) yourself to be awake in bed.
Step 2: Get out of sleep mode. Once you are aware that sleep is not likely to come soon, you need to acknowledge this state of wakefulness, get out of bed, and go to another room. Getting out of bed when you are unable to sleep is often not easy. Your bed is comfortable, you might want to at least get some rest, and you might be hopeful that your continued efforts to sleep will make it happen. However, keep in mind that sleep naturally emerges when the body and the mind are calm and content. Therefore, the activities that you choose to do when you are out of bed should promote that state of mind. Things that are soothing and pleasant usually work well. If you find that getting out of bed is too difficult or if there are physical limitation for getting out of bed at night, you can also choose to sit up in bed. This means getting yourself into an upright position so that your intention is to engage in a soothing activity rather than trying to sleep. If you are using a light to read, a dim light will have less of an alerting effect.
Step 3: Return to bed or a sleeping position only when sleepy. Whatever activity you choose, it is best to return to a sleeping position when you become aware that you are sleepy. When you become aware of a sensation that the mind and body are feeling relaxed and sleepy, you are more likely to fall asleep faster. Be aware of trying to make sleep to happen as this is likely to just lead to being alert and awake.
You can download a copy of the stimulus control instructions here.
Frequently Asked Questions
How long should I wait before getting out of bed or sitting up? Generally speaking, when you are aware that you feel wide awake and that sleep is a long way away you should get out of bed. Most people become aware of their non-sleepy state of mind fairly quickly (in less than 15 minutes).
Can I still do other activities in bed? While in bed, you should avoid doing things that you do when you are awake. Activities such as watching T.V., eating, studying, or talking on the phone should not be done while you are in bed. If you frequently use your bed for activities other than sleep, you are unintentionally training yourself to stay awake in bed. If you avoid these activities while in bed, your bed will eventually become a place where it is easy to go to sleep and stay asleep.
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