Effective Strategies for Insomnia: Stimulus Control Therapy

Disrupted sleep rhythms often increase mood instability.  And, sleep and insomnia are some of the most frequently cited problems of people seeking help for mood disorders. But what works to help you sleep better and more restfully? 

Sleep Medicines Aren’t the Answer

Generally, research has shown that most frequently prescribed medications are not very helpful – they may lengthen sleep times by only about 15 – 20 minutes per night and often reduce deep sleep. The reason people feel they work may have more to do with the fact that they disrupt memory, so we don’t recall the periods of wakefulness at night, than with their effects on sleep.

A Specific Type of Therapy is Helpful

Cognitive Behavior Therapy for insomnia (CBTi) has the most solid evidence for effectiveness in reducing or eliminating insomnia.  In particular, we have recently been hearing more about a form of CBTi called “Stimulus Control Therapy” (SCT).  This system, developed by the late Dr. Richard Bootzin, longtime faculty member of the University of Arizona, focuses on behavioral changes, some of which may seem to represent common sense and some of which may seem counter-intuitive.

The Rules for Healthy Sleep

  1. Use your bed only for sleeping or sex. 

Do not lie in bed trying to drop off to sleep for more than 20 – 30 minutes.  If you don’t fall asleep within 20 minutes of retiring, get up and do something else, until you feel ready to fall asleep. 

The same rule applies to waking up in the middle of the night. Don’t pick up your phone to read, if you can’t fall asleep within 20 minutes or so, get up and do something relaxing (listening to music, for example) until you feel tired.

Never use the bed for reading, watching TV, working on a laptop, etc.

You should only go to bed when you are having sex or when you feel sleepy.

  1. No matter how you feel, get up at the same time every morning.

This is the part of SCT that seems the most counter-intuitive. If you need to shift your sleep cycle by getting to bed earlier, or if you want to begin to establish healthy sleep routines, almost everyone focuses on getting to bed earlier. Eventually, going to bed at the same time each night will become important, but, when you are trying to get a regular sleep schedule established, the key is getting up every day (even if you did not sleep well the night before!) at the same time. 

The reason not to try going to bed at a regular time (initially) is that when you go to bed should depend on sleepiness. If you focus on bedtime initially you will find yourself going to bed when you don’t feel sleepy, and will either spend time in bed worrying about the fact you can’t sleep, or will pick up your phone or do something else you aren’t supposed to do in bed.

Over time, if you get up the same time every morning, you will start feeling sleepy at a regular time every night. And then you will start going to bed every night at the same time.

  1. Learn to distinguish between sleepiness and fatigue.

Fatigue is feeling tired, whether or not you feel sleepy. Many of us think that we need to go to sleep when we feel fatigued, and this confusion is part of the reason it is so hard to establish a regular sleep routine.

Sleepiness, is the feeling that you have to sleep, to recognize that feeling, think about a time when you had trouble keeping your eyes open. 

Fatigue is the feeling you might have after doing a lot of physical work. When you feel fatigued you feel the need to stop being physically active, you feel the need to rest, but you don’t feel the need to sleep.

When you feel sleepy and go to bed, you are much more likely to fall asleep.  If you feel fatigue (low mental or physical energy) and don’t feel sleepy, and go to bed, you are likely to find yourself lying awake, unable to sleep.

  1. Avoid taking long or frequent naps.

One 15- to 30-minute nap in the mid-afternoon can be refreshing, but napping within a few hours of rising, or a few hours before bedtime, can interrupt your sleep and waking rhythm.

That is it. Four rules. If you apply them rigorously you will find that you are sleeping well, and you will also be getting good, restful sleep.

– Nancy


Morin, C., Bootzin, R., Buysse, D., Edinger, J., Espie, C., & Lichstein, K. (2006). Psychological and behavioral treatment of insomnia: Update of the recent evidence (1998-2004). Sleep, 29, 1398-1414.

Morin, C.M., Hauri, P.J., Espie, C.A., Spielman, A.J., Buysse, D.J., & Bootzin, R.R. (1999). Nonpharmacologic treatment of chronic insomnia: An American Academy of Sleep Medicine review. Sleep, 22, 1134-1156.