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. 


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