Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.
Stimulus Control | Conditioned Insomnia | Breaking the Cycle | How it Works
Introduction
There are several reasons why people develop sleep problems. Acute insomnia can arise from disturbing or stressful life events, like hospitalization, serious illness, exams, divorce, work, or financial issues.
In most cases, sleep patterns return to normal once issues are resolved; however, sleeplessness can persist due to unhealthy associations developed at the onset of insomnia. What happens is that a person associates the bedroom with feelings of frustration or stress, not restfulness, which preludes a good night’s sleep.
This article looks at how sleeplessness is triggered by certain behaviors and how stimulus control can fix it.
What Is Stimulus Control?
Stimulus control refers to situations where the presence or lack of a stimulus leads to a particular behavior. The stimulus, or the lack thereof, precipitates and triggers a behavior or thought process. To sum it up, the action is controlled by the presence or absence of such a stimulus.[1]
For instance, if a barking dog bites a person, that person may freeze with fear whenever they hear or see a dog barking after the initial incident.
Another example is a young child who goes for regular immunizations and develops a fear of needles. Due to that fear, the child may begin to cry when they enter a doctor’s office.
In these two cases, the child’s cry and the fear of barking dogs are learned behaviors, or conditioned responses, triggered by the person’s experience, i.e., a stimulus.
With time, humans, and even animals, tend to associate particular experiences or objects with certain situations (stimulus), which automatically trigger a specific cognitive response or behavior in them.
Here lies the basic concept of stimulus control. It gives us insight as to why people get addicted to substances or specific behaviors.
Our focus here is the effect of stimulus control on sleep. We’ll be looking at how the presence or lack of stimuli occurring at the onset of insomnia worsens and reinforces sleeping difficulties.
Conditioned Insomnia
Persistent or long-term sleep deprivation can develop due to any number of issues. One common cause is when an association develops, linking a bedtime routine and sleeplessness due to hours spent lying awake in bed.
In the bedroom, turning off the lights, laying on the bed, and trying to sleep have become a stimulus that generates negative emotions like worry, dread, and even outright frustration – actions that further delay sleep and increase wakefulness.
In short, the very act of preparing for bed has become an instant trigger that produces tons of negative emotions.
This scenario is what conditioned insomnia is all about, and it becomes a negative cycle when worry about lack of sleep causes more sleeplessness.[2]
Many people with sleeping difficulties report feeling extremely tired before going to bed; however, the moment their head hits the pillow, their sleepiness disappears. This reaction is a sure sign of the presence of conditioned insomnia.
How to Break the Cycle
Since conditioned insomnia is learned by repeated association, it can also be unlearned and replaced with new responses using stimulus control.
The new association will transform your bedroom and bed into a positive trigger that encourages sleep when you’re sleepy. You can also go back to bed without problems when you wake up in the middle of the night.
Stimulus control treatment or therapy (SCT) is one of many therapies cognitive-behavioral therapists and clinicians use to effectively combat long-term insomnia and restore better sleep patterns.
It retrains the mind and body to associate the bed with only sex and sleep. Thus, the brain gradually shifts from an active state to a calmer state when a person is ready to sleep.
The end goal of stimulus control is to help minimize any negative associations associated with the bedroom and sleep. It’s also a key part of Cognitive Behavioral Therapy for Insomnia (CBT-I), which basically teaches you how to reclaim your sleep.
There are programs accessible online that use the principles of CBT-I, partnering with your doctor to help you overcome your sleeplessness.
How Exactly Does It Work?
Stimulus control uses cognitive and behavior therapy to treat sleeping disorders.
If you suffer from sleep deprivation, the “stimulus” is that thought or behavior that gives you anxiety, activates your nervous system, or prompts wakefulness.
Merely attempting to sleep can trigger the release of stress hormones, like cortisol and adrenaline, making the act of going to sleep more difficult.
If you’re undergoing stimulus control treatment, the program aims to reduce and ultimately remove any negative conditioning and anxiety you might have.
How to Get Sleep Back on Track
1. Use your bedroom for sleep and sex only. No reading, working, watching TV, eating, worrying, or engaging in other activities.
2. Maintain a bedroom environment that decreases stimuli responsible for wakefulness. (e.g., switching off the radio or television and reducing ambient lighting).
3. Keep your bedroom cool.
4. When it’s time for bed, avoid light-emitting screens from smartphones, tablets, eBook readers, laptops, etc.
5. Try going to bed when you’re sleepy.[3]
6. If you’re unable to sleep within 15 to 20 minutes of lying down, leave your room, and only return when you’re feeling sleepy.
7. When you go back and still can’t fall asleep after 20 minutes, leave and restart the process.
8. Avoid taking naps late in the day and naps that are longer than 20 minutes.
9. Ensure you wake up at the same time every morning. Use your alarm if necessary.
Several studies show that stimulus control helps break triggers that control and feed undesired sleep behaviors.[4] These new associations make it possible to overcome insomnia, and get long-term undisrupted and consistent sleep.
How Long Does It Take To See Results?
At first, stimulus control may cause short-term sleep loss. But as therapy continues, the treatment will help regulate your circadian rhythm and restore your body’s natural drive to sleep.
When a natural sleep drive improves, you get to fall asleep a lot faster, especially when you combine your SCT with relaxation and sleep restriction therapies. Sleep should eventually come more easily, and there’s every chance you’ll start feeling sleepy as bedtime approaches.
Conclusion
Stimulus control is just one of the few effective methods used to modify thoughts and habits to promote healthier sleep patterns.[5]
Cognitive Behavioral Therapy for Insomnia (CBT-I) combines a number of therapeutic approaches to give better results, namely relaxation therapy, sleep hygiene education, and sleep restriction therapy.
Lastly, as you start your treatment, it’s advisable to keep a sleep diary. This record will give more insight into your sleep-wake patterns, therefore assisting you and your therapist to monitor your progress.
If you continue to have difficulty sleeping, schedule an appointment to see your doctor as your sleeplessness can be caused by an underlying health condition.
References
- The Noldus Team (2019, June 13). How To Study Human Behavior. https://www.noldus.com/blog/how-to-study-human-behavior
- Lack, L., Scott, H., Micic, G., & Lovato, N. (2017). Intensive Sleep Re-Training: From Bench to Bedside. Brain Sciences, 7(12), 33. MDPI AG. Retrieved from http://dx.doi.org/10.3390/brainsci7040033
- Salmon, L. (2019, August 15). Five ways to tackle insomnia by improving your sleep’ stimulus control’. http://www.irishnews.com/lifestyle/2019/08/15/news/five-ways-to-tackle-insomnia-by-improving-your-sleep-stimulus-control–1680100/
- Baillargeon, L., Demers, M., & Ladouceur, R. (1998). Stimulus-control: nonpharmacologic treatment for insomnia. Canadian family physician Medecin de famille canadien, 44, 73–79. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2277555/
- Sharma, M. P., & Andrade, C. (2012). Behavioral interventions for insomnia: Theory and practice. Indian journal of psychiatry, 54(4), 359–366. https://doi.org/10.4103/0019-5545.104825
