Treating Insomnia With Stimulus Control Conditioning

Insomnia can be difficult to deal with, and not everyone wants to take sleeping pills, so what are the other options? Difficulty falling or staying asleep can be overcome with behavioral treatment options, including something called stimulus control therapy. What is stimulus control therapy? How does it relate to general guidelines to improve sleep habits called sleep hygiene and to psychological conditioning?

A woman in bed looking at her phone

To answer these questions, let’s review an excerpt from UpToDate—a trusted electronic medical reference used by healthcare providers and patients alike. Then, read on for additional information about what all of this means for you.

  • You should spend no more than 20 minutes lying in bed trying to fall asleep.
  • If you cannot fall asleep within 20 minutes, get up, go to another room and read or find another relaxing activity until you feel sleepy again. Activities such as eating, balancing your checkbook, doing housework, watching TV, or studying for a test, which "reward" you for staying awake, should be avoided.
  • When you start to feel sleepy, you can return to bed. If you cannot fall asleep in another 20 minutes, repeat the process.
  • Set an alarm clock and get up at the same time every day, including weekends.
  • Do not take a nap during the day.

"You may not sleep much on the first night. However, sleep is more likely on succeeding nights because naps are not allowed."

This passage highlights several important concepts related to healthy sleep. First, you cannot underestimate the importance of your sleep environment. Your bedroom is meant to be a space of quiet repose. If you have difficulty sleeping, you should take a close look at where you are trying to sleep. Distractions and disruptions should be cleared out, from your television to your pets. If your bed partner has a sleep disorder and is disrupting your ability to sleep, this should be addressed as well.

The Role of Conditioning in Insomnia

One problem that occurs in chronic insomnia relates to a psychological concept called "conditioning," which the first few points above are trying to address. Conditioning is perhaps most familiar in the story of Pavlov’s dogs. Ivan Pavlov, a scientist, repeatedly fed his dogs while ringing a bell. In time, the dogs’ mouths automatically salivated in the expectation of food at the sound of the bell, even if they were not fed. This became known as a Pavlovian response. In the same vein, if you repeatedly toss and turn in your bed for hours on end, your body will eventually learn to associate your bed with stress and being awake. As a result, your bedroom will actually cause you to stay awake.

By limiting the amount of time that you allow yourself to be in bed awake, this cycle is broken. If you cannot fall asleep within 20 minutes, you leave the bed. You go to another place where you can engage in various "sleep rituals," activities that are likely to make you sleepy such as reading or praying. As described above, it is important not to engage in stimulating activities that may make it difficult for you to fall asleep. You may also wish to limit your exposure to light from screens as this could affect your circadian rhythm.

Once you again feel sleepy, you return to your bed. The hope is that the period of relaxation and the extra time awake will prompt you to fall asleep more easily. Moreover, you will break the association of your bed with not being able to sleep.

A Word From Verywell

Beyond this behavioral change, it is also important to follow other guidelines to improve your sleep habits. You should go to bed and wake up at the same every day, allowing your body to learn when to expect to be awake and asleep. By eliminating naps during the day, you will also consolidate your sleep to the nighttime. This can be furthered with a treatment called sleep restriction.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. UpToDate. Stimulus control instructions for chronic insomnia.

  2. Bottary R, Seo J, Daffre C, et al. Fear extinction memory is negatively associated with REM sleep in insomnia disorderSleep. 2020;43(7):zsaa007. doi:10.1093/sleep/zsaa007

  3. McGowan SK, Behar E. A preliminary investigation of stimulus control training for worry: effects on anxiety and insomniaBehav Modif. 2013;37(1):90-112. doi:10.1177/0145445512455661

Additional Reading

By Brandon Peters, MD
Brandon Peters, MD, is a board-certified neurologist and sleep medicine specialist.