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Understanding CBT-I: Using Your Bed Only for Sleep

Do you ever feel sleepy on the couch but then are wide awake when you go to bed? When you spend a lot of time in bed awake and frustrated, your body may start to link bed with being awake and frustrated. Chronic insomnia develops as a result of this negative association.

Cognitive behavioral therapy for insomnia (CBT-I) has a tool to tackle this problem. It’s called stimulus control. This is a simple series of tasks to help your body connect your bed as a place for sleep. Stimulus control is done by consistently following a set of rules. Go to bed only when you feel sleepy. Use the bedroom only for sleep (and sex).                                                                                                                                                

How It Works

  1. If you’ve been awake in bed for more than 20 minutes or so, leave the bedroom. (Do not watch the clock. Guess the time in your head.)

  2. Do a calming activity. This may include listening to music, reading, or meditation. Do not do things that may wake you up. These include eating, using the computer, doing work, talking on the phone, or watching an exciting TV show.

  3. Return to bed when you feel sleepy.

  4. Leave the bed if you do not sleep for another 20 minutes or so. (Do not watch the clock. Guess the time in your head.)

  5. Wake up at the same time each morning, no matter how much sleep you received.

  6. Do not take naps during the day.

You must follow these rules consistently for 2 to 4 weeks to see an effect. As you start to change your behavior, you may feel more tired during the day. Over time, your body will adapt so that you will fall asleep quicker and stay asleep longer. By following these rules, you can help retrain your mind and body for sleep.

What to Do When You Can’t Sleep

When you leave your bedroom because you can’t sleep, do an activity that doesn’t wake you up too much. You want to change your focus from your difficulties sleeping to something relaxing. But don’t give yourself a reason to stay awake.

Do try:

  • Writing your thoughts down in a journal

  • Playing solitaire

  • Reading a calming book or light magazine

  • Looking at catalogs

  • Making a grocery list

  • Writing a list of fun things to do on weekends

  • Knitting or crocheting

  • Meditating or praying

  • Doing gentle muscle stretches

  • Listening to calming music

  • Folding laundry

Try to avoid:

  • Eating

  • Showering

  • Exercising

  • Worrying

  • Doing work

  • Using the computer

Morning Tips

While your body is changing its pattern, you may feel more tired in the morning. There are activities you can do to help you feel more awake. These include:

  • Making your bed

  • Opening all curtains or window blinds to let in light

  • Taking a hot bath or shower

  • Going for a walk or run

  • Doing laundry

  • Going grocery shopping

  • Doing errands

  • Cleaning

  • Talking to someone on the phone

  • Going to the gym

  • Making your lunch or dinner for later

  • Organizing tabletops and countertops  

Stick with It

When you make a change to your sleep habits, it can take a while for you to feel better. You may feel more tired at first. CBT-I methods take time to work. Be patient and keep using the methods your sleep therapist gives you.

Working with CBT-I

The tools of CBT-I are often used together. Stimulus control is often done along with other therapies. These can include sleep efficiency training, sleep hygiene, and cognitive therapy. Your health care provider can tell you more about these tools and which can work best for you.

Author: StayWell Custom Communications
Last Annual Review Date: 7/17/2014
Copyright © The StayWell Company, LLC. except where otherwise noted.
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