Despite nearly dozing off to sleep on the couch at the end of the night, you find yourself wide awake in bed thinking about the trials and tribulations of your day, as well as what you need to do tomorrow. Adjusting your pillows and switching positions does not help you get into that restful state where you can fall asleep. One hour, then two – you lift up your phone and start doing the mental math of how much sleep you will likely get before your alarm goes off – now you feel annoyed. Another hour goes by, and you are more awake now than you were when you got into bed, and you begin to worry about how much you will be able to function at work the next day. If you could get to sleep in the next 45 minutes, then maybe you will be able to survive the workday. With less than 5 hours left until your alarm, you somehow manage to doze off to sleep, hoping that you don’t face this same ordeal the next night.
For several nights now, you find yourself trying to get to bed even earlier, ensuring your room is dark and cool, and taking melatonin to help you fall asleep. Nonetheless, the subsequent thoughts, distress, and self-soothing behaviors have become a regular occurrence, and you struggle to fall asleep. Not to mention, after one or two hours of sleep, you now wake up only to be tossing and turning for a couple of hours. You think, “All this effort trying to get to sleep. I did everything right, right?” For something that seems straightforward, getting a good night’s sleep seems to require a lot of effort.
While the bed can be a place of comfort and refuge, for others it is mystifying. The previous blog post provided some brief insights into the habits and behaviors that promote sleep, termed sleep hygiene. I want to bring to your attention one recommendation, “Limit your bedroom to sleep and sex,” as this is rooted in one of the foundational principles in psychology: behavior.
Limiting the use of your bed to sleep (and sex) is referred to as stimulus control, which is a strategy used to treat sleep difficulties. It is a type of learning that happens when connections are made by association, called Pavlovian conditioning (or more commonly called classical conditioning). This form of learning was named by the famed physiologist Ivan Pavlov. By accident, he observed that dogs began salivating in response to a bell being rung despite no food being present. He discovered that when he entered the room to feed the dogs, a bell would ring. It turns out that the dogs associated the bell with meat powder. As a result, the dogs began to salivate after the bell rang, even in the absence of the meat powder.
But how does this relate to our bed and sleep? Well, sleep is the intended and desired response to laying in our beds. In fact, there was probably a time when it did not take long after settling into bed for you to readily fall asleep without any effort. However, you may begin to spend your time in bed doing other things like reading, watching TV, scrolling through social media, ruminating, and/or worrying. The more time you spend in bed doing these non-sleep-related activities, the more your bed becomes associated with not sleeping. As a result, it confuses your body, making it unclear whether it should be asleep or awake.
Much like how the dogs associated the bell with the meat powder, resulting in the dogs salivating, people can associate their bed with non-sleep-related behaviors. This results in the bed becoming a place of wakefulness.
To make the bed a cue for sleep, it is necessary to break (or extinguish) the association between your bed and being awake through a process called stimulus control. This approach aims to control or limit the stimulus (i.e., your bed) to when the desired response (i.e., sleep) occurs. In short: stay out of bed until it is difficult to keep your eyes open.
There are several important rules to follow when it comes to stimulus control for sleep difficulties:
- Get into bed when sleepy (i.e., eyes are heavy and difficult to keep open).
- Bed is sued for sleep and sex. No other activities (e.g., reading, watching TV, worrying and/or ruminating).
- If sleep does not occur within 20 minutes, get out of bed. Estimate time as checking the clock is actual discouraged and could exacerbate worry or rumination.
- If after returning to bed and still cannot fall asleep within 20 minutes, again, get out of bed.
- Wake up at the same time every morning, including weekends. Use an alarm that wakes you up at a consistent time even if you slept very little.
- Resist napping as this can affect your ability to fall asleep at bedtime.
Admittedly, stimulus control is not an easy fix for insomnia. However, it is well-known to be an effective intervention for sleep difficulties. Keep in mind that after a couple of weeks of adhering to the six rules of stimulus control, you will likely find that sleep comes quickly as soon as your head hits the pillow.
Dr. Robbie Woods (C. Psych.) is a clinical psychologist at the Centre for Interpersonal Relationships (CFIR). He provides psychological services to adults who are seeking assessments and treatments for a variety of conditions including anxiety (e.g., generalized, social, health, panic), obsessive-compulsive (e.g., body dysmorphia, skin-picking), and depressive disorders (e.g., major depressive, persistent depressive). Moreover, Dr. Woods has a keen interest in treating sleep difficulties, namely insomnia, using a combination of evidence-based cognitive and behavioural interventions as recommended by the Canadian Sleep Society and the American Academy of Sleep Medicine.
Bennett, D. (2020). Cognitive-behavioral therapy for insomnia (CBT-I). In Sleep Medicine and Mental Health: A Guide for Psychiatrists and Other Healthcare Professionals (pp. 47-66). Cham: Springer International Publishing.
