20: LIMIT USE OF THE BED AND THE BEDROOM

The recommendations of this section can be helpful in many ways – especially with not being tired and being anxious at bedtime (Step D1, Section 44) and with early awakening (Step D2, Section 47).

The section has at least three parts [1] how to use the bed, [2] when to use the bed, and [3] who uses the bed. In addition to the bed itself, it can help to clear the larger sleeping area of distractions and non-sleep associations. Some authors call this a “proper sleep environment” or “stimulus control” (Reite, Weissberg and Ruddy, 78-79).

In a series of articles, Bootzin and his colleagues (2010, 2011) have articulated a stimulus control therapy for insomnia, which has goals of

  • Associating the bed and bedroom with sleep
  • Weakening the person’s associations between arousal and the bedroom
  • Developing and maintaining habits of sleeping at consistent times

Their suggestions overlap with the ones presented here and give valuable suggestions on implementation.

 

20a. What to Do in Bed

The general recommendation is only to use the bed for sex and sleep. If a person is doing something else in bed, it could be interfering with his/her ability to fall asleep, both because sleep time becomes poorly defined and because the bed and bedroom become associated with other events. Some possibilities:

  • Reading stimulating material
  • Discussing the day’s events or upcoming activities.
  • Arguing
  • Eating or drinking
  • Watching television programs [especially news and other violence]
  • Working, especially on a computer
  • Talking on the telephone

The same is true of the larger sleep environment. If the patient can be distracted and kept awake by craft projects, they probably shouldn’t be done in the bedroom. If the bedroom door is open, activity in the rest of the house or apartment can interfere with sleep.

20b. When to Go to Bed

The ideal is for a person to get into bed and fall asleep quickly and easily. But falling asleep is not something that a person can make happen through will power. So the best time to go to bed is when the person is sleepy and all interference with sleep is removed (See Bootzin and Perlis, Principle #1, 26-27).

How does a person get into bed and fall asleep at the time he/she wants to? The time one is likely to be sleepy can be influenced by the time he/she gets up in the morning and what happens during the day. If he/she is awake too late, getting up earlier is one control technique.

Given that, having a consistent time for sleeping helps. The time itself leads to a conditioned expectation that getting into bed will be followed by falling asleep. If the person waits to go to bed until he/she is actually sleepy also helps. This also works well in concert with having a consistent time to get up (Section 25).

20c. When to Get Out of Bed

The time that a person awakens in the morning helps to regulate the time that he/she will be sleepy at night (see Section 25).

Getting out of bed immediately after awakening

  • Helps make it clear that the end of sleep has arrived and that the day is starting.
  • Helps maintain the close association between bed and sleep.

20d. Who and What Should Be in the Bed

The presence of others in bed can interfere with the ability to go to sleep.

  • Children typically require attention – rolling over, waking up, etc.
  • Pets also move about, snore, scratch, dream, and lick their masters awake.
  • A partner can engage in activities in bed when you are trying to sleep – reading or working on a laptop at bedtime, snoring, moving about, etc.

 

While it is not inevitable that others will wake a person or keep him/her awake, the possibility should be considered, and if it is happening, handled in some way.