Stimulus Control Treatment for Insomnia

Robert is a 45 year old gentleman who comes home from work at 6 pm. He eats dinner, watches a television show, pays bills and does some house chores. Around 8 pm gets on his computer to check emails including work emails and tries to do some work for the next day so he can be “on top of things” when he gets to his office the next morning. He shuts everything off around 10:30 pm when his wife tells him “enough”.

By 11 pm, he is in bed but he cannot shut his eyes and goes to sleep because he is thinking about all the emails and work. He is wired up. Robert suffered from insomnia so he got only 5 hours of sleep and felt tired the next day.

Robert is suffering from psychophysiological insomnia. There is nothing “psycho” about it. His evening and night time habits are not conducive to a good night sleep. He does not need a sleeping pill. Instead, he needs to work on his pre-bedtime sleep habits. He saw a sleep medicine doctor who trained him on a non-medication therapy called stimulus control therapy. This therapy works by re-associating the bed and bedtime with sleep and relaxation (instead of mental stimulation). It re-establishes good pre-bedtime rituals. This therapy was pioneered by Dr Bootzin in 1972.

Stimulus control therapy helped Robert get a good night sleep. Its tenant is to remove any mental stimulation before or during bedtime. Robert worked on making sure he gets to wind down before his bedtime. After watching, television, he would turn it off about 9 pm and instead he reads, listens to soft music and talks to his wife. He goes to bed in a calm state. He exercises in the morning, which also helped him.

Stimulus control therapy instructions:

  1. Go to bed when you are sleepy.
  2. If you cannot fall asleep after 20 minutes or you wake up and have a difficult time falling back to sleep, leave your bed and go to another room. Do something relaxing such as listening to soft music or reading.
  3. Return to your bed only when you are sleepy.
  4. Do not watch the clock.
  5. Use the bed only for sleep and intimacy.
  6. The bed is not for doing homework, eating, watching TV or surfing the internet. These activities will condition an arousal response to the bedroom. Instead, you want to condition yourself to think “bed=sleep”.
  7. Keep a routine wake time, no matter when you fell asleep at night. This helps establish a regular circadian body rhythm.
  8. Avoid napping.