Stimulus Control Therapy

If you ever feel trepidation at the idea of lying in bed, staring at the ceiling, and waiting hours for sleep to find you, stimulus control therapy is one strategy that can help you retrain your brain to associate your bed with sleep. (1) Trouble falling asleep is one hallmark symptom of insomnia, and about 10 percent of people have this chronic sleep disorder. (1)

As one aspect of insomnia’s gold standard of treatment (cognitive behavioral therapy for insomnia), stimulus control therapy, or SCT, can help you reestablish cues around bedtime and falling asleep to help you drift off more easily. (1) Below, we’ll explain how it works and how you can use these principles to fall asleep faster.

Note: The content on Sleepopolis is meant to be informative in nature, but it shouldn’t be taken as medical advice, and it shouldn’t take the place of medical advice and supervision from a trained professional. If you feel you may be suffering from any sleep disorder or medical condition, please see your healthcare provider immediately.

Long Story Short

• Stimulus control therapy can help you retrain your brain to associate your bed with sleep.
• Trouble falling asleep is one hallmark symptom of insomnia, and about 10 percent of people have this chronic condition.
• To use stimulus control therapy for better sleep, only go to bed when you feel sleepy, get out of bed if you can’t fall asleep, and reserve your bed for sleep and sex only.
• For maximum SCT effectiveness, avoid going to bed too early, watching the clock, and napping.

What Is Stimulus Control? 

A stimulus describes anything that provokes a behavioral response in your body or brain. For example, dim evening light is a stimulus that may make you feel sleepy. On the other hand, scrolling through your smartphone may stimulate you to feel exhilarated, jealous, or distressed. 

Different stimuli around bedtime can help us fall asleep faster or prevent our journey to dreamland, and stimulus control adds some healthy boundaries around what stimuli we connect to bedtime. (2)

Stimulus Control Therapy for Insomnia (SCT)

Since stimuli can affect our ability to fall asleep efficiently, stimulus control therapy can help us set the stage for sleep success. How? “Stimulus control therapy…addresses insomnia by modifying environmental cues and behaviors associated with sleep,” says Joel Frank, PsyD, clinical psychologist and neuropsychologist at Duality Psychological Services. 

The cues around your sleep time lead to behaviors based on how you’ve responded to those stimuli in the past. (3) For example, in a perfect world, when you lie down on your mattress, rest your head on your pillow, pull up the covers, and switch off the light, those stimuli cause the behavioral response of falling asleep. (3) But, with insomnia, some stimuli can lead to behavior or thoughts that activate the nervous system, cause anxiety, or serve as a cue for wakefulness. (4)

After a period of insomnia, your brain may learn to attach negative associations with your bedtime routine, and even trying to fall asleep can trigger stress hormone release, making sleep even more elusive. (1) “Stimulus control therapy can be utilized as a standalone treatment for insomnia, though it is frequently integrated into cognitive-behavioral therapy for insomnia (CBT-I),” says Frank. 

CBT-I is used to treat people with insomnia lasting three months or longer, at least three days each week. (5) (6) CBT-I protocol has been well-studied for years, and is considered very effective as a non-pharmacological (medication-free) treatment for persistent insomnia. Along with SCT, this therapy is designed to help deactivate the nervous system and retrain the brain to respond positively to sleep-related stimuli. (6)

Cognitive Behavioral Therapy for Insomnia (CBT-I)

Other components of CBT-I include: (6)

• Sleep restriction therapy: Sleep restriction therapy limits time in bed to the average number of hours spent sleeping. (7)
• Relaxation training: Relaxation training can help anyone with insomnia reduce anxiety and physical tension, allowing the nervous system to relax and making sleep more likely.
• Cognitive therapy: The therapy component of the protocol addresses negative attitudes and misconceptions about sleep.

The Basics of SCT: How to Use Stimulus Control for Better Sleep

For many people with chronic insomnia, the bed becomes a place for activities like reading or television-watching, as well as planning or worrying about upcoming events. When this happens, bed and the bedtime routine may become psychologically linked with the inability to sleep. (3)

Stimulus control therapy is designed to strengthen associations with the bed as a place to sleep. This can mean adding new habits to your bedtime routine, like taking a warm shower, or avoiding old ones like watching an intense show right before bed. (1)

How to Use Stimulus Control for Better Sleep

Now that you know the basics, we can get into the nitty gritty. For better sleep, you can use the following stimulus control techniques. (3) (8) “Over time, consistently reinforcing these behaviors helps your brain form positive associations with your bed and sleep environment, improving sleep quality and reducing insomnia symptoms,” says Frank.

Go to Bed Only When Sleepy

Many people with insomnia feel sleepy during the day or in the evening, but become “tired but wired” as bedtime approaches. “Going to bed before feeling genuinely sleepy can backfire, leading to prolonged wakefulness, so it’s important to wait until you’re truly ready to sleep,” says Frank. 

“Sleepy” describes the feeling of being unable to stay awake, similar to the feeling of falling asleep on the couch during a movie or while reading a book. (3) (8) It’s also important to know the difference between sleepiness and tiredness. Where feeling tired means you need to rest and relax, feeling sleepy means you’re ready to sleep.

Go to Sleep and Wake up at the Same Time Every Day

To help regulate your circadian rhythm (internal clock) and promote the release of the sleep-promoting hormone melatonin, expose yourself to bright light as soon as possible after you wake up. If you’re going to bed later than usual, set an alarm for your usual wake time to help maintain your sleep schedule and prevent disruption of your body clock. (3) (8)

Get Up If You Can’t Sleep

If you’re unable to sleep after approximately 15 to 20 minutes, get up from bed and wait to feel sleepy in another room. Keep the lights dim and engage in a quiet activity such as reading. (3)

Avoid electronics, which emit stimulating blue light and may keep you awake longer. Return to bed only when you feel ready to sleep. Once in bed, get up again if you don’t fall asleep within ten minutes. Repeat as often as necessary until you sleep. (3) (8)

Use the Bed for Sleep and Sex Only

The more you can keep your bed just for sleep, the better your brain will understand that lying in bed means it’s time to fall asleep. If you spend too much time watching TV, working, studying, or hanging out in bed, you’ll lose that important location cue when it’s time to sleep. (3) (8)

“Making a conscious decision to use the bed solely for sleep and intimacy helps to retrain your brain to associate it with restful activities only,” says Frank. We know this isn’t always possible, but if you must use your bed throughout the day, try setting up other cues, like using one side of the bed for working and the other for sleeping.

Be Patient

Like any sort of stimulus control training, stimulus control therapy for insomnia requires consistency. It takes time to change the associations the brain makes with sleep-related cues, such as showering, preparing clothes for the next day, and turning off the bedroom light. (3) (8)

Things to Avoid during SCT for Better Sleep

Now that you know how to apply better stimuli for sleep, we can tell you which to avoid for your best rest. “During stimulus control therapy (SCT), there are several key habits and behaviors to avoid in order to maximize the therapy’s effectiveness,” says Frank, such as: (8) 

• Go to bed early: If you settle in the sheets before you’re sleepy enough, you’ll take a long time to fall asleep and can start to associate lying in bed with being awake.
• Do anything too stimulating: Playing a loud, intense video game, or fitting in a vigorous workout right before bedtime can keep you too wired to fall asleep when you need to.
• Take on unnecessary stress: Easier said than done, right? You can try meditation or relaxation exercises to de-stress before bed.
• Watch the Clock: Put the clock across the room and cover it if necessary. Once in bed, don’t look at it until the alarm goes off, even if you wake during the night or close to morning.
• Nap: Naps can lower the drive to sleep come bedtime and may further disrupt the circadian rhythm. (9) Even if you didn’t get sufficient sleep the night before, avoid napping to help regulate sleep patterns.

If we’ve just listed your typical nighttime routine (and a few of your favorite things), don’t worry! You can start to wean yourself from these sleep-stealers one at a time, as slowly as you need to.

FAQs

The Last Word From Sleepopolis 

When you find you have trouble sleeping and it’s not getting better, you may benefit from stimulus control therapy. Research says SCT works and you can adopt these new healthy sleep habits anytime! (10) If you feel like you’ve tried everything and still can’t sleep, it’s never a bad idea to get your healthcare provider in the loop. They can recommend other SCT techniques and help you develop a tailored plan for better snoozing.

Sources

1. Jansson-Fröjmark M, Nordenstam L, Alfonsson S, Bohman B, Rozental A, Norell-Clarke A. Stimulus control for insomnia: A systematic review and meta-analysis. Journal of Sleep Research. 2024;33(1):e14002. doi:10.1111/jsr.14002
2. Samuelson MM, Goeke QM. Stimulus Control. In: Vonk J, Shackelford T, eds. Encyclopedia of Animal Cognition and Behavior. Springer International Publishing; 2018:1-5. doi:10.1007/978-3-319-47829-6_1705-1
3. Walker J, Muench A, Perlis ML, Vargas I. Cognitive Behavioral Therapy for Insomnia (CBT-I): A Primer. Klin Spec Psihol. 2022;11(2):123-137. doi:10.17759/cpse.2022110208
4. Yun S, Jo S. Understanding insomnia as systemic disease. Yeungnam Univ J Med. 2021;38(4):267-274. doi:10.12701/yujm.2021.01424
5. Insomnia – What Is Insomnia? | NHLBI, NIH. Accessed September 14, 2023. https://www.nhlbi.nih.gov/health/insomnia
6. Muench A, Vargas I, Grandner MA, et al. We know CBT-I works, now what? Fac Rev. 2022;11. doi:10.12703/r/11-4
7. Maurer LF, Schneider J, Miller CB, Espie CA, Kyle SD. The clinical effects of sleep restriction therapy for insomnia: A meta-analysis of randomised controlled trials. Sleep Medicine Reviews. 2021;58:101493. doi:10.1016/j.smrv.2021.101493
8. Insomnia – Diagnosis | NHLBI, NIH. Accessed September 16, 2023. https://www.nhlbi.nih.gov/health/insomnia/diagnosis
9. Badon SE, Dietch JR, Simpson N, Lyell DJ, Manber R. Daytime napping and nighttime sleep in pregnant individuals with insomnia disorder. Journal of Clinical Sleep Medicine. 19(2):371-377. doi:10.5664/jcsm.10350
10. Verreault MD, Granger É, Neveu X, Delage JP, Bastien CH, Vallières A. The effectiveness of stimulus control in cognitive behavioural therapy for insomnia in adults: A systematic review and network meta-analysis. Journal of Sleep Research. 2024;33(3):e14008. doi:10.1111/jsr.14008

Frank, Joel, PsyD. Personal Interview. August 1, 2024.