Introduction

People with chronic insomnia often go to bed sleepy. However, the moment their head hits the pillow, the brain begins to go into hyperdrive mode, and they end up wide awake.

There’s a saying that people with insomnia actually can sleep. It’s just that they can sleep anywhere except their own bed.

I often hear from my own patients that they would find it very difficult to fall asleep. After rolling around in bed for hours, they may move to the couch or the guest bedroom and find themselves falling asleep quite quickly, thereafter.

But why does this happen?

Bedtime associations and learning principles

The reason that people with insomnia find their bed to be a particularly activating spot is because their brain has been conditioned to associate the bed with wakefulness. This is one of the causes of insomnia.

This learning principle can occur in many contexts. A famous example is of Ivan Pavlov and his dogs. The idea is that Pavlov ran the bell whenever he fed the dogs. And over time, the dogs began to learn that the bell meant that food was near – i.e., an association between ringing of the bell and food. Consequently, the dogs began to salivate just by hearing the ringing of the bell.

These types of learning principles can happen for humans too. If a person spends a lot of time in bed awake, worrying and ruminating, then they will begin to associate their bed with wakefulness. This is called conditioned arousal.

This also explains why sometimes people sleep much better when they travel. By removing themselves from the bedroom environment and context of their conditioned arousal, the association weakens and they are able to fall asleep easier.

How do I start sleeping in my own bed again?

There is an evidence-based strategy to treat conditioned arousal, which is known as stimulus control (Bootzin et al., 2016). This is a strategy that works by making sure that the bed is only for sleep and restoring the association between the bed and sleep. The rules are as follow.

1. Go to bed only when sleepy. Set a normal bedtime, but if you find that you are not sleepy at that time, then don’t go to bed until you are sleepy. For some, they may get worried because they may not get sleepy until late into the night, but facing this anxiety is important to freeing yourself from insomnia.

2. Get out of bed to do something pleasant (e.g., reading a book) if sleep is not coming. If you find that your brain is going into overdrive the moment your head hits the pillow, or if sleep hasn’t come after 20 minutes, get out of bed.

3. Only go back to bed if feeling sleepy. If you find that you go back to bed and sleep is not coming again, repeat the cycle by getting out of bed.

4. Wake up at a consistent time every morning. No matter how little sleep you get, try to stick to a consistent rise time. This will be important to break the cycle and build sufficient sleep pressure to return to a schedule the next night.

5. Use the bed only for sleep. Using the bed only for sleep is helpful to further reinforce to our brain that the bed is only for sleeping.

Although these are tough recommendations to follow, they can be very effective in breaking down the association between bed and wakefulness.

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Best wishes,

P