An excerpt from Sleep Reimagined: The Fast Track to a Revitalized Life.
Stimulus control is highly useful in treating insomnia and can be considered a partner to sleep restriction because it helps maximize sleep efficiency by limiting disturbances. Stimulus control is based on the concept of conditioning and association. Its goal is to reassociate the bed or bedroom with sleep, so as to alleviate the anxiety linked to sleep. To this end, one must begin the process of only associating the bed with sleeping and relaxation. The bed must only be used for sleeping or sex. It is not a place where one works; pays the bills; or watches Netflix, Apple TV, or the like. This may be difficult for those who live in a small living space where a room is multipurposed but, even in such a setting, the bed can be partitioned and set off from other work-related tasks. The goal is to create a strong link between the bed and sleep and to sever anything that diminishes such a connection between the two. The goal for you is to sleep when you see a bed. We must forge that strong link.
If you do everything in bed, then nothing is sacred in bed. And sleep is golden. So limit, or ideally do away with, any menial tasks that you’ve been doing in bed. The less you do in bed outside of sleep, the more you will come to associate your bed with sleep automatically, which can be extremely helpful to the brain when you’re finally lying down at the end of a long day.
As you’ll remember, you should also keep any sensory stimuli or environmental factors outside the bedroom. Minimize light, noise, or any other distraction from the outside. Sometimes this is impossible, like if a roommate is talking to someone too loudly while you’re trying to sleep. Talk to them and explain that they’re affecting your sleep. If they appreciate their own sleep, they’ll understand. With regard to light, a recent study showed that individuals who slept with a television or light on were more likely to gain weight and develop obesity. Researchers determined that being exposed to light at night may affect levels of melatonin, leading to changes in circadian rhythms and weight gain from altered eating habits. Yet another recent study revealed that exposure to a moderate amount of light while sleeping with the eyes closed increased resistance and altered glucose metabolism. Furthermore, this exposure to light also increased sympathetic activity, as observed by an increased heart rate and elevation of cortisol. All of this is to say that one’s environment during sleep is especially important. Do all that you can to minimize it and bathe yourself in that cocoon state.
The idea of a buffer zone and relaxation time can also help you set boundaries about when you might start reducing stimuli and light. Both the buffer zone and scheduled relaxation time are intended to lull and transition you from the hectic schedule of the day to the peaceful slumber of night. As I’ve mentioned before, for most, sleep is not a light switch that you can turn off or on at a moment’s notice. It is a gradual process, and so the techniques you use to prepare for sleep must be taken seriously. A buffer zone creates that transitional time before sleep when you can progressively unwind. No work-related activities or strenuous physical activities should be performed at this time. The idea is to relax. Listening to music, reading a book, or practicing yoga are activities that are conducive to such an idea. Music and reading can even extend to the bed, as long as the duration is short. Music should be relaxing and, ideally, soothing, conjuring pleasant images. Reading in bed should last no more than 15 minutes and should consist of novels that take you to a fictional domain and distract you from life stressors. However, stay away from tablets and stick to a traditional paper format, even if the tablet light is dim and doesn’t emit blue light. Taking a warm bath is actually a great idea, too, not only because it relaxes the muscles but because the temperature gradient one experiences entering and leaving the tub cools the body significantly and leads to better sleep. A cool temperature is optimal for sleep, whereas a warm or hot one is not.
Some people tend to worry a lot when they go to bed. Often, an insomniac lies in bed and ruminates about the problems they have faced or, more often, will face in the future. The anxiety this fosters further contributes to insomnia. We want to avoid this; after all, it runs counter to this rest time that we’re trying to establish before bed. A great way to combat worrying and preserve your established relaxation time is to create a designated time to worry. This may not sound so pleasant, but it is a great way to separate chaos from the peaceful promise of sleep. You can schedule this time earlier in the day, perhaps after dinner. If the time of day is too early, however, you may have forgotten what you wrote down and may have a propensity to ruminate again once you retire to sleep. It is better to write these problems down on a piece of paper (and paper is better in this regard that an electronic tablet or phone because it does not use the blue light that is detrimental to sleep) and stop ruminating about them while going to sleep. You just need a receptacle for these thoughts that intrude into your sleep. Recognizing that they exist and compartmentalizing them is one way to simultaneously broach and address them to deter them from intruding into sleep. These thoughts need not be problematic, either. Some people simply worry about getting up in time to make lunch for work or decide what to wear the following day. The solution to these issues is fairly easy: Address these issues before you go to sleep. That is, fix the lunch and lay out your clothes, so you don’t have to worry about it the following day. Preparation and routine are key to good sleep. The less that you have to worry about, the more restful your sleep will be.
Relaxation techniques, such as deep breathing exercises (particularly the 4-7-8 model, which we’ll discuss in the next session), mindfulness, guided imagery, and others are also instrumental in combating insomnia. The idea is to distract your mind from sleep and focus on things over which you have control. Insomnia is fostered by a lack of control, and the idea is to regain control over that which one can potentially control. You may not have a choice about when you fall asleep, but you can control those ideas that can allow for a peaceful slumber. For example, using the technique of guided imagery, you can imagine an ideal situation in which you may have participated, such as a glorious vacation in Santorini, and allow that thought to pervade your consciousness. This not only allows you to think about something other than sleep, but it also predisposes you to positive thoughts that will allow you to relax. Each individual has their own way of relaxing, so the ideas above may not apply to everyone. But, in general, certain activities should be avoided before going to bed, such as work-related activities, finance, physical exercise, and family matters that may contribute to arguments. Of course, some of this is unavoidable, such as when a big project at work is looming, but this allows for an opportunity to plan these tasks beforehand so as to not allow them to pervade into your buffer time. Remember: The more you address any issues that may be contributing to poor sleep before you go to bed, the more you have control over the situation, which, ironically, will allow you to relinquish control to sleep. You must have control in order to give up control and let go.
Pedram Navab is a neurologist and author of Sleep Reimagined: The Fast Track to a Revitalized Life.
