Can't get a good night's sleep? You're not alone. In surveys of what would improve people's lives, a good night's sleep frequently comes near the top of the list.
Poor sleep results in worse cognitive performance, including degraded memory, attention, performance and alertness. And in the long term insomnia is also associated with anxiety and depression. And people's sleep gets worse as they get older. After 65 years old, between 12% and 40% of people have insomnia.
All sorts of methods have been tried to combat poor sleep, from drugs through psychological remedies to more outlandish treatments.
The problem with drugs is that they have side-effects and are often addictive. The problem with the more outlandish treatments is that although they tend not to have side-effects, we don't know if they have any effect at all. Psychological remedies, though, combine the best of both worlds: studies show they work without side-effects.
Stimulus Control Therapy
Professor Richard R. Bootzin has been researching sleep disorders for many years at the University of Arizona Sleep Research Lab. Writing in the Annual Review of Clinical Psychology, he describes the different psychological approaches that have been used to treat insomnia (Bootzin & Epstein, 2011).
Of these the most successful single intervention is called Stimulus Control Therapy (Morin et al., 2006). You'll be happy to hear it consists of six very straightforward steps. If you follow these it should improve your sleep. After the list I'll explain the thinking behind them. First, here are their six steps:
1. Lie down to go to sleep only when you are sleepy.2. Do not use your bed for anything except sleep; that is, do not read, watch television, eat, or worry in bed. Sexual activity is the only exception to this rule. On such occasions, the instructions are to be followed afterwards, when you intend to go to sleep.
3. If you find yourself unable to fall asleep, get up and go into another room. Stay up as long as you wish and then return to the bedroom to sleep. Although we do not want you to watch the clock, we want you to get out of bed if you do not fall asleep immediately. Remember the goal is to associate your bed with falling asleep quickly! If you are in bed more than about 10 minutes without falling asleep and have not gotten up, you are not following this instruction.
4. If you still cannot fall asleep, repeat step 3. Do this as often as is necessary throughout the night.
5. Set your alarm and get up at the same time every morning irrespective of how much sleep you got during the night. This will help your body acquire a consistent sleep rhythm.
6. Do not nap during the day.
Why it works
This method is based on the idea that we are like Pavlov's drooling dog. We attach certain stimuli in the environment to certain thoughts and behaviours. Famously Pavlov's dogs would start drooling when a bell rang, because they associated hearing the bell with getting food. Eventually the dogs would drool at the sound of the bell even when they didn't get any food. Replace the bell with a bed and food with sleep and conceptually you're there.
If we learn to do all kinds of things in bed that aren't sleep, then when we do want to use it for sleep, it's harder because of those other associations.
This is just as true of thoughts as it is of actions. It's important to avoid watching TV in bed, but it's also important to avoid lying in bed worrying about not being able to get to sleep. Because then you learn to associate bed with worry. Worse, you suffer anticipatory anxiety: anxiety about the anxiety you'll feel when you are trying to get to sleep.
So, this therapy works by strengthening the association between bed and sleep and weakening the association between bed and everything else (apart from sex!).
Other treatments supported by the research are progressive muscle relaxation, which is exactly what it sounds like, and paradoxical intention. This latter technique involves stopping people trying so hard to get to sleep. The paradox being that when people stop trying so hard, they find it easier to fall asleep.
All this assumes you don't live next door to a late night drummer and you're not downing a double espresso before hitting the sack, but those sorts of things are pretty obvious. Everything else being equal, though, Stimulus Control Therapy seems the easiest for most people to implement.
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