Stimulus control

Stimulus control is a more involved way to try to improve sleep. People with chronic insomnia may, over time, develop an unhealthy connection with their bedroom. Instead of linking the bedroom with peacefulness and a good night’s sleep, it's linked with stress and a poor night’s sleep. This can be very upsetting.

In these situations, stimulus control might be a good strategy. Stimulus control can:

• break the bad links
• reset healthy connections between sleep and the bedroom
• improve circadian rhythms
• help people who wake up at night settle and get back to sleep faster

1. Only go to bed when you feel sleepy.
2. Only use your bed for sleep and intimacy. Don’t do anything else in bed.
3. If you can’t fall sleep within 20 minutes, try relaxation exercises in bed or in a chair in your bedroom. If you feel sleepy after the relaxation, try to go to sleep again.
4. If you don't fall asleep, leave your bedroom. Go to another place in your home (keep the lights low) and do a calming activity like a crossword puzzle, jigsaw puzzle, or more relaxation. Go back to bed only when you feel sleepy.
5. Repeat step 4 during the night whenever you need to.
6. Set an alarm and get up at the same time every morning, even if you didn’t have a good sleep.
7. Don’t take daytime naps.

Sleep restriction

Sleep restriction is another more involved strategy to improve sleep. People who don’t sleep well might think staying in bed longer will help them get enough sleep. This usually doesn’t work. If you wake up often at night, think about sleep restriction. Over time, it can help change many short periods of sleep into one long period of unbroken sleep.

Research shows that sleep restriction can help improve sleep, but it can sometimes cause side effects like headaches, sleepiness, and low energy. If you decide to try sleep restriction, ask your healthcare provider about driving or operating machinery during that time.

1. Use sleep diaries to find your average hours of sleep per night. Add 30 minutes to that time. This is how long you need to stay in bed.


2. Set your alarm for the time you need to wake up. Decide your bedtime based on how long you need to stay in bed. For example, if you need to get up at 6 a.m. and your diary shows you need to stay in bed for 6 hours and 30 minutes (6 hours of average sleep plus 30 minutes), then you need to go to bed at 11:30 p.m.

   Don’t ever set your time in bed for less than 5 hours and 30 minutes.

3. Keep sleep diaries to find your sleep efficiency. Sleep efficiency is a way to measure the quality of your sleep. It helps you know when you can slowly start to go to bed earlier.
   
   
   How to calculate your sleep efficiency

   Take the actual time you’re asleep (in hours) and divide that by the total time you’re in bed (in hours). Multiply this number by 100.

   For example, if you were asleep for 6 hours and were in bed for 10 hours, your sleep efficiency would be:

   6 divided by 10 = 6 ÷ 10 = 0.6

   0.6 multiplied by 100 = 0.6 x 100 = 60%

4. When your sleep efficiency is at least 85 to 90%, you can go to bed 15 to 30 minutes earlier. Once your sleep efficiency reaches 85 to 90% again, you can go to bed another 15 to 30 minutes earlier, and so on.​​​​​