When people have experienced poor sleep for quite some time, the bed and poor sleep have been paired again and again. A kind of automatic learning, called ‘classical conditioning’, sets in. The bedroom becomes associated with being awake, alert, frustrated and/or worried, rather than with feeling relaxed and sleepy. This is conditioned insomnia. The bed becomes a trigger for feeling alert instead if a cue for feeling sleepy. The event that caused the poor sleep in the first place (stress, illness, jet lag, small children, depression) may have long gone, but the poor sleep remains.
People experiencing conditioned insomnia often describe that they can sense increasing unease as bedtime approaches, or that while they can happily doze on the couch in the evening, that they then feel alert when they go to bed. In short, these people can sleep as long as they are not in their bed, or are not trying to sleep. Very frustrating! In treatment for Insomnia we want to work towards the bedroom triggering feelings of sleepiness and relaxation, not worry and tension.
Many people who suffer from this type of insomnia may rely excessively on aids such as caffeine, alcohol or pills to help them cope with poor sleep. Unfortunately, these crutches can prolong insomnia in the long term.
The good news is that it is possible to make the bed and bedroom become a positive trigger for sleep, meaning that when you go to bed or wake up during the night you can expect to fall asleep more easily.
To achieve this it is important to:
1. Use the bed only for sleeping
Avoid doing what you do when you are awake while in bed. Keep your bedroom only for sleep or sexual intimacy. Do not use for activities such as eating, TV, smoking, talking on the phone, working, worrying, or arguing.
2. Go to bed only when sleepy
Go to bed at night only when you feel sleepy, not because of the time on the clock. Going to bed before you are sleepy or drowsy is likely to result in a longer period of wakefulness in bed.
3. Get up out of bed when you can’t sleep (this is called ‘stimulus control’).
Long periods of being awake in bed usually lead to tossing and turning, becoming frustrated, or worrying about not sleeping. When you lie in bed awake for long periods, you are unintentionally training yourself to be awake in bed. If after going to bed and turning out the light, if you do not fall asleep in a reasonably short period of time (approx 30 minutes) and you are feeling alert, fed-up, frustrated, worried, and/or tense, – get out of bed, go to another room and do something to help you wind down. When you feel sleepy again, go back to bed and give yourself another chance to fall asleep.