In insomnia, people have high anxiety about being unable to sleep. Moreover, they often spend a lot of their time in bed awake and feeling distressed. Over time, their brain begins to make an association between the bed and wakefulness (known as conditioned arousal). If you have ever had the experience of going to bed sleepy, and then feeling wide awake the moment your head hits the pillow, then you understand the experience of conditioned arousal.
Getting out of bed when you cannot sleep
This conditioned arousal is why insomnia therapists ask patients to leave the bed when they are not able to sleep. By limiting the amount of time we spend in bed awake, and spending more of that time in bed asleep, we give our brains the chance to start associating the bed with sleep again.
This is called stimulus control where patients get out of bed to do something quiet (like reading or doing a crossword puzzle) and then go back to bed when they feel the sleepiness come back on.
Can I stay in bed when I am awake?
Stimulus control can be a very powerful technique. However, there is research to suggest that you don’t necessarily have to get out of bed to break the association between the bed and wakefulness.
Ultimately, the idea is to ensure that the bed is seen as a place of relaxation rather than stress. You don’t have to get out of bed to do that. You can also do this through a clinical technique called countercontrol.
Countercontrol means doing all the same things as in stimulus control except changing your position in bed (for example, lying on the other side of the bed instead of your usual side). Again, you would do something quiet and enjoyable until sleepiness comes back – at which point you can go back to sleep.
When should I stay in bed?
Here are a few situations where countercontrol may be more helpful than stimulus control.
1. When safety is an issue – If you are at risk of falling, or pregnant, or there are other reasons why it might be unsafe to get out of bed at night, then staying in bed would be recommended.
2. When there’s too much anxiety about getting out of bed – We should not let perfect get in the way of good. If the idea of getting of bed is a terribly frightening idea and you can’t see yourself doing that at least right now, then countercontrol may be a better fit.
3. When environmental factors don’t allow for stimulus control – If you are living in a studio apartment, or have lots of roommates, then getting out of bed may be challenging. In this case, counter control may be more appropriate.
4. When you are struggling with just sleep anxiety – If most of your fears are about sleep, then doing something light and enjoyable in bed may be more appropriate.
5. If your difficulty is staying asleep at night – there’s some research to suggest that countercontrol may be particularly helpful if the insomnia challenge is waking up a lot at night.
When should I get out of bed?
1. When your difficult is falling asleep at night – Research suggests that stimulus control is very effective for treating sleep onset difficulties and helping folks fall asleep when they first get to bed at night.
2. When you are dealing with more generalized worries – if you are more of a worrier in general (rather than about sleep in particular), then getting out of bed may be helpful so that you are not constantly worrying about the next day in bed.
3. When you have a place that works well for stimulus control – if your living arrangements allows you to leave the bedroom and you have a nice place to sit and do something enjoyable, then stimulus control may be a better fit.
4. When you notice that you just can’t relax if you are in bed – In cases where you try to relax and enjoy your time in bed, but find that you are just an anxious wreck, then I encourage you to get out of bed. Listen to your inner wisdom as to what might be more helpful!
5. When you want to rip off the band-aid – stimulus control is one of the most effective strategies in treatment of insomnia. It’s hard to do, but I think of it like ripping off a bandaid. If you can do it, the true healing can really start to happen.
Best wishes,
P
Simply mental health 