Sleep hygiene and stimulus control counseling are a vital part of the treatment of insomnia.
Sleep Hygiene Counseling
Sleep hygiene refers to actions you can take that will tend to improve and maintain good sleep.
- Keep a regular sleep schedule. A time for bed and a time to wake up. A regular wake-up time in the morning is most important.
- Sleep only as long as needed to feel rested and refreshed the next day but not more. This is usually 7 to 8 hours for adults. In other words, Don’t “eat” more sleep than you need today!
- Don’t try to force sleep.
- Exercise regularly for at least 20-30 minutes 5 times a week. However, don’t exercise 4-5 hours before bedtime. Don’t do it close to your bedtime.
- Eat a healthy non-heavy dinner. Don’t eat too late at night or right before bedtime.
- Don’t drink alcohol near your bedtime ( late afternoon and evening)
- Don’t use caffeine and caffeinated beverages (or other stimulants) after lunch or 4-6h before your bedtime.
- Don’t smoke tobacco (or take other forms of nicotine) 4-6h before your bedtime
- Avoid mentally or emotionally challenging activities around bedtime.
- Do not let the sun go down while you are still angry. That is, deal with concerns or worries before bedtime.
It’s worth noting that some of the recommendations of sleep hygiene tend to overlap with stimulus control, and that shouldn’t be a cause for worry.
Stimulus Control Counseling
Stimulus control is a term used to describe situations in which a behavior is triggered by the presence or absence of some stimulus. That is, the stimulus (or absence of it) comes before the behavior and leads to the behavior. In other words, the stimulus (or lack of it) controls the behavior. In our case, Insomnia is the behavior. There are certain stimuli (or lack of them) that occur before the difficulty with sleep and that reinforce and worsen insomnia. Stimulus control counseling refers to actions that you can take that will decrease the stimuli that control insomnia (the behavior). Stimulus control counseling for insomnia is based on the premise that insomnia is a conditioned response to temporal (bedtime) and environmental (bed/bedroom) cues that are usually associated with sleep. Accordingly, the main objective of stimulus control therapy is to train the patient to “re-associate the bed and bedroom with rapid sleep onset by curtailing sleep-incompatible activities (overt and covert) that serve as cues for staying awake and by enforcing a consistent sleep-wake schedule.”
- Use the bed only for sleep and sex! Don’t watch TV, eat, read, or worry in bed.
- Adjust the bedroom environment to decrease stimuli (eg, reduce ambient light, turn off the television or radio). I use thick blinds to keep my bedroom very dark to keep lights from neighbors coming in.
- Keep a cool temperature in the bedroom.
- Don’t use light-emitting screens like smartphones, laptops, tablets, ebook readers, etc before bedtime
- Go to bed only when you are sleepy.
- Don’t stay in bed for more than 20 minutes if you can’t fall asleep in that time frame. Leave the room and come back to bed only when you are sleepy. If you still can’t sleep after 20 minutes, get up and repeat the process.
- Don’t take naps, especially if they are longer than 20-30 minutes or occur late in the day.
- Wake up at the same time every day. Use an alarm if you need it.
Why do the above things? People with insomnia often associate their bed and bedroom with the fear of not sleeping and with other arousing events instead of associating it with an expectation to fall asleep and enjoy sleep. That worry about not being able to sleep actually feeds insomnia. By doing the above things, we break the stimuli that are controlling and feeding these undesired behaviors.
References
Am Fam Physician. 2015 Dec 15;92(12):1058-1064. Nonpharmacologic Management of Chronic Insomnia. http://www.aafp.org/afp/2015/1215/p1058.html
Ann Indian Acad Neurol. 2010 Apr-Jun; 13(2): 94–102. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924526/