National Sleep Foundation

Chapter 2: Insomnia

Insomnia Treatment: Cognitive Behavioral Therapy—Stimulus Control Therapy

The premise of stimulus control therapy is that insomnia is a conditioned arousal response to bedtime and to cues associated with the sleep environment. The primary objective is to recreate the natural association of bedtime and the bedroom with rapid sleep and not being awake.

Stimulus control therapy is one of the most effective techniques for insomnia management when used consistently.1, 2
Typical stimulus control therapy instructions include:

  1. Go to bed only when you are sleepy.
  2. Use the bed and the bedroom only for sleeping and having sex.
  3. If you are unable to fall asleep within about 15-20 minutes, get out of bed and go to another room until you feel sleepy again. (Repeat as necessary.) It is important to keep in mind that clock-watching can also perpetuate insomnia, so it is often best to estimate the time one has been awake or to assume, after the person is frustrated and awake, that it is time to leave the bed.
  4. Maintain a regular waking time, even on weekends, regardless of the quality of the previous night’s sleep;
  5. Avoid daytime napping.

References

  1. Bootzin RR, Epstein D, Wood JM. Stimulus control instructions. In: Hauri P, ed. Case Studies in Insomnia. New York, NY: Plenum Press; 1991:19-28.
  2. Espie CA, Inglis SJ, Tessier S, Harvey L. The clinical effectiveness of cognitive behavior therapy for chronic insomnia: Implementation and evaluation of a sleep clinic in general medical practice. Behav Res Ther. 2001;39:45-60.