Tuesday, November 6, 2018

Fives Ways to Improve Your Sleep: #3 Stimulus Control Therapy

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Five Ways to Improve Your Sleep: #3 Stimulus Control Therapy

What Is It? 

Stimulus Control Therapy (SCT) helps us develop connections between sleep and things in our surroundings [1]. 

With strong connections, these things can help control sleepiness. They prime our brain to get in sleepiness ‘mode’. Thus, by repeatedly pairing sleep with things around us, we can turn those things into triggers for better sleep.

How Does It Work?

Developing these triggers requires us to make a strong connection between sleep/sleepiness and the things in our surroundings—like our bed!
To make that strong  connection requires two things [2,3]:

  1. Only sleep around/with the surroundings that you’ve chosen to connect with sleep (don’t sleep without a bed, ritual, etc.)  
  2. When awake, limit your time with/around your chosen sleep settings. Even if it’s bedtime but unable to sleep, a quiet break and return can help reset your brain to ‘this place is sleep time'.

How Can I Practice It?

If you wish to connect things in your surroundings with sleep, you have be strict in your pairings. Thus, the most important thing you can do is be strict about when, where, and how you sleep.

Here are some examples:

If you wish to turn your bed into a 'sleep trigger', you must only spend time in your bed when sleeping (the exception being intimacy) [3]. That means that you do not read, relax, or watch TV from your bed. And if you are having trouble falling asleep, you will take a brief, quiet break in another room, rather than lying awake in your bed. It also means that you do not sleep outside of a bed. You will also avoid sleeping at a desk, on the couch, or other places. 

You can turn times into a 'sleep trigger' as well. If you practice going to bed at the same time every night, your body will connect that time with sleepiness. Our bodies are fantastically attuned to a 24-hour cycle, and sleeping at regular times makes use of that cycle. 

You can also connect darkness to sleepiness. Our brains tend to wake up around bright lights, and it tends to settle down when the lights go down [4]. You can put that natural connection to use! 1-2 hours before bedtime, turn off all overhead lighting in your home. Use lamps and low-setting floor lighting. Repeat this for at least two weeks, and you will train your mind to associate those reduced lights with sleepiness. (If you want to make that connection even stronger, try the opposite in the mornings--turn on overhead lights when you get ready in the morning, to connect bright lights with wake up time!).

How Can This Help Insomnia?

Sleep requires us to switch from ‘alert mode’ to ‘rest mode’. However, it’s pretty risky for us to rest during times where we should be alert (like driving, work, exercise, socializing, etc.). Thus, on average, our brain avoids being ready for rest.

However, when we make connections between sleeping and things/places we use for sleep, we can signal our brain that it’s ‘okay’ to sleep. And with strong connections, our minds will start to settle and prepare for sleep before we get under the covers—not after [5].

How Long Does It Take To Work?

Like most treatments for insomnia, the answer is: it depends. 

EVERYONE is different. Some people respond to Stimulus Control Therapy right away, while others will take several weeks to see improvement.  But most people WILL improve! [6]

The highlights of this tool is that it can be self-administered and the benefits grow with time [7]. Even if it isn’t a magic fix, making stronger connections between sleep and a ’sleep setting’ will improve a person’s sleep. Whether their insomnia is complex and treatment resistant, or it's just a case of poor sleep, stimulus control therapy improves sleep quality. It helps users enter rest mode, and they will fall asleep faster and stay asleep longer.


The following studies form the basis of the claims made here! Check them out if you wish to know more about the science of Stimulus Control Therapy.

  1. Bootzin, R. R., & Perlis, M. L. (2011). Stimulus control therapy. In Behavioral Treatments for Sleep Disorders (pp. 21-30). 
  2. Turner, R. M., & Ascher, L. M. (1979). Controlled comparison of progressive relaxation, stimulus control, and paradoxical intention therapies for insomnia. Journal of Consulting and Clinical Psychology, 47(3), 500. 
  3. Bootzin, R. R., Smith, L. J., Franzen, P. L., & Shapiro, S. L. (2016). 24 Stimulus Control Therapy. Diagnosis and Treatment, 268. 
  4. Mishima, K., Okawa, M., Hishikawa, Y., Hozumi, S., Hori, H., & Takahashi, K. (1994). Morning bright light therapy for sleep and behavior disorders in elderly patients with dementia. Acta Psychiatrica Scandinavica, 89(1), 1-7. 
  5. Bootzin R.R., Epstein D., Wood J.M. (1991) Stimulus Control Instructions. In: Hauri P.J. (eds) Case Studies in Insomnia. Critical Issues in Psychiatry (An Educational Series for Residents and Clinicians). Springer, Boston, MA 
  6. Ho, F. Y. Y., Chung, K. F., Yeung, W. F., Ng, T. H., Kwan, K. S., Yung, K. P., & Cheng, S. K. (2015). Self-help cognitive-behavioral therapy for insomnia: a meta-analysis of randomized controlled trials. Sleep medicine reviews, 19, 17-28. 
  7. Zachariae, R., Lyby, M. S., Ritterband, L. M., & O'Toole, M. S. (2016). Efficacy of internet-delivered cognitive-behavioral therapy for insomnia–a systematic review and meta-analysis of randomized controlled trials. Sleep medicine reviews, 30, 1-10. 

NOTE: Vecteezy.com contributed the raw vectors that I used to make the graphics you see here. Check them out, if you are interested in vector design. 

Wednesday, August 8, 2018

Five Ways to Improve Your Sleep: #2 Exercise

Five Ways to Improve Your Sleep: #2 Exercise

Exercise and Sleep?

Physical exercise can help improve several sleep problems, including more restful sleep and reducing sleep onset (6,7). At just 30 minutes every other day, studies show that physical exercise can improve sleep quality (8,9).

Pooh always fit in his Stoutness Exercises (Source: Winnie the Pooh and the Honey Tree)

Why Does Exercise Help Sleep?

Exercise improves our sleep because of the relationship between sleep and our physical and mental states (10,11). How well we sleep is connected to our situations, our personal tendencies, and our emotional well-being. For instance, our sleep is affected by situational stress, how we respond to stress, our levels of anxiety and/or depression, excessive rumination and obsessive thinking (when the mind won’t stop running!), and even being preoccupied with the issue of sleep itself. 

Thankfully, exercise can help reduce the severity of such issues (11,12). Exercise promotes healing effects for negative stress and upsetting emotional states, and it helps to balance our physical states as well. Accordingly, it can help alleviate problems that disrupt sleep wellness, in addition to reducing the power such problems have over our sleep. Furthermore, it can help us achieve better relaxation and calmness as we get into bed.

How to Use Exercise for Better Sleep

Even with as little as 30 minutes of exercise 3x per week, studies show that physical exercise improves sleep quality (8). This benefit applies to both cardiovascular exercise (running, biking, walking) and resistance based exercise (weight lifting, yoga, Pilates) (9). 
If you are already exercising but are still struggling with sleep, there may be some changes that could improve your results. For example, it may be worth exploring additional exercise or more difficult routines, as it’s possible that more exercise will provide more benefits; research shows that increasing the difficulty and frequency of exercise can provide proportionally greater improvements to sleep (13). Another potential change may be the time you exercise; some research shows that it’s more effective to exercise in the late afternoon or evening (2).

Remember: Do What Works and is Safe for YOU!

However, what’s most important is that you find a routine and pattern that works for you and is safe for you to partake in (2). And while exercise is shown to improve sleep to some degree for anyone, it also matters that it comes in the right form and time for you. Moreover, when exploring major changes in your activity level or exercise routine, it can be helpful to consult with a physician. Remember, this is for the benefit of YOUR sleep and YOUR health! 

Thank you for reading today, and keep an eye out for the next entry in the series: Behavioral Training. (And if you missed the first, check out Sleep Hygiene here!)


  • 6. Yang, P. Y., Ho, K. H., Chen, H. C., & Chien, M. Y. (2012). Exercise training improves sleep quality in middle-aged and older adults with sleep problems: a systematic review. Journal of physiotherapy58(3), 157-163.
  • 7. Montgomery, P., & Dennis, J. A. (2002). Physical exercise for sleep problems in adults aged 60+. The Cochrane Library.
  • 8. Reid, K. J., Baron, K. G., Lu, B., Naylor, E., Wolfe, L., & Zee, P. C. (2010). Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Sleep medicine11(9), 934-940.
  • 9. Kovacevic, A., Mavros, Y., Heisz, J. J., & Singh, M. A. F. (2017). The effect of resistance exercise on sleep: A systematic review of randomized controlled trials. Sleep medicine reviews.
  • 10. Yao, K. W., Yu, S., Cheng, S. P., & Chen, I. J. (2008). Relationships between personal, depression and social network factors and sleep quality in community-dwelling older adults. Journal of Nursing Research16(2), 131-139.
  • 11. Brand, S., Gerber, M., Beck, J., Hatzinger, M., PĆ¼hse, U., & Holsboer-Trachsler, E. (2010). High exercise levels are related to favorable sleep patterns and psychological functioning in adolescents: a comparison of athletes and controls. Journal of Adolescent Health46(2), 133-141.
  • 12. Fox, K. R. (1999). The influence of physical activity on mental well-being. Public health nutrition2(3a), 411-418.
  • 13. Kovacevic, A., Mavros, Y., Heisz, J. J., & Singh, M. A. F. (2017). The effect of resistance exercise on sleep: A systematic review of randomized controlled trials. Sleep medicine reviews.
  • 14. Stepanski, E. J., & Wyatt, J. K. (2003). Use of sleep hygiene in the treatment of insomnia. Sleep medicine reviews7(3), 215-225.

Sunday, August 5, 2018

Five Ways to Improve Your Sleep: #1 Good Sleep Hygiene

Celebrate the Sleep News!
If you follow my page on Facebook, then you've seen the announcements for a new sleep series for this site. And this week, they are rolling out! Hurray!
The theme this month is sleep: sleep problems, sleep disorders, and sleep treatments. Why? Because, I've realized just how pervasive the problem is--sleep questions are the most common topic of the messages I receive.

I've also seen an unfortunate shortage of explanatory resources. Many sites give loads of information on sleep, without citing where that information comes from, or why it works. And for those that do cite, it's often written for medical professionals. Apparently, they don't see a need for a format that provides simplified explanations with research to support them.

So this week, I'm releasing the first phase of my project: a resource that gives simple explanations for sleep treatments. Every entry will have written explanations and a handy graphic. I'll briefly explain what the treatment is, how and why it works, and how it should be practiced.

Of course, these are explanations, not recommendations. Remember, my goal is to share and spread medical research; I am not giving out medical advice. However, I hope these explanations can help you make informed personal decisions and arm you with knowledge when you meet with your personal physician.

Now, without further ado:

Five Ways to Improve Your Sleep: #1: Good Sleep Hygiene 

What is Sleep Hygiene?

Sleep Hygiene is a list of behaviors that are associated with better sleep (1). In addition to shortening the amount of time it takes to fall asleep (sleep latency), the behaviors can also help improve the quality of your sleep (2&3).

In the short term, they help create appropriate sleepiness the day/next day that they are practiced; in the long term, they help condition (train) better alertness during wake times and more restful sleep at sleep times (4).

Why the Name?

You may be used to hearing the word 'hygiene' in reference to sanitation. However, it actually refers to any behaviors/conditions that help people to maintain good health. Thus, the listed behaviors have all been linked to better sleep health. 

Why Does it Work?

Going from 'awake' to 'resting' is a transition that requires physical and chemical changes in our brain. That transition is initiated by a series of bodily and external/situational signals. 

While some people are sensitive enough to simple signals (such as fatigue or darkness), others are less sensitive to common signals; furthermore, some people require more salient signals to trigger sleep. Such people are more prone to sleep problems, including insomnia. 

However, practicing good sleep hygiene can provide more signals for initiating sleep, and it can also make existing signals more salient (2).

How to Do it: 

Review the recommended list of behaviors (see above) and consider integrating them into your daily routine. If you are not currently practicing a large number of these behaviors, it may be helpful to gradually adjust your routine. 

Some changes may require discussion with your personal physician, particularly those that may affect existing conditions or health problems. 

Consistency works best, because the proscribed behaviors affect short term and long term factors for sleep wellness. Sleep hygiene helps give your body sleep signals, and it also conditions your brain to recognize more signals as 'sleep time'. Furthermore, it conditions your brain to be alert during appropriate times. 

For sleep hygiene's conditioning to work, it requires regular practice and exposure to the routine. Thankfully, even just being aware of sleep hygiene can improve our ability to practice healthier sleep behaviors (5).


  1.   Mastin, D. F., Bryson, J., & Corwyn, R. (2006). Assessment of sleep hygiene using the Sleep Hygiene Index. Journal of behavioral medicine, 29(3), 223-227.
  2.   Stepanski, E. J., & Wyatt, J. K. (2003). Use of sleep hygiene in the treatment of insomnia. Sleep medicine reviews, 7(3), 215-225.
  3.   Irish, L. A., Kline, C. E., Gunn, H. E., Buysse, D. J., & Hall, M. H. (2015). The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep medicine reviews, 22, 23-36.
  4.   Guilleminault, C., & Brooks, S. N. (2001). Excessive daytime sleepiness: a challenge for the practising neurologist. Brain, 124(8), 1482-1491.
  5.   Brown, F. C., Buboltz Jr, W. C., & Soper, B. (2002). Relationship of sleep hygiene awareness, sleep hygiene practices, and sleep quality in university students. Behavioral medicine, 28(1), 33-38.

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About The BedRiddenHead

I want to be happy. And this site is about that chance. How to strive to thrive in the body I've got and maybe turn my experiences into something worthwhile.

This site aims to help educate and reach out to people all over that struggle with pain or illness. To try and make something helpful. I work as a medical research writer, my background is in neuropsychology and biology, and I want to share what I learn in a way that is easy to understand. I am not a doctor. I'm definitely not your doctor. I am just some lady who wants to make someone's (anyone's) life a little bit better. Whether you have endometriosis, a chronic injury, a struggling friend, or just want to learn something new, I hope to make a place that has what you are looking for.

Thank you for stopping by, I wish you strength in your health and happiness.