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Chronic Insomnia / Insomnia Disorder

Stimulus Control Therapy

Stimulus control therapy strengthens the association between being in bed and being asleep, particularly for patients with difficulties falling asleep at the start of the night.1

A core component of stimulus control therapy is to get out of bed if not asleep after about 15 minutes and to return to bed and try to fall asleep when feeling sleepy. Stimulus control therapy is not appropriate for patients with an isolated complaint of early morning awakening insomnia (i.e. without any difficulties falling asleep at the start of the night).

Some patients find it difficult to follow this ‘15-minute’ rule. It is important to emphasise to the patient that the goal is to improve their sleep efficiency and reduce the learned insomnia habit (i.e. spending more time in bed than is necessary, in the hopes of acquiring/catching up on lost sleep, and thereby resulting in more time spent awake, rather than asleep, in bed, which can result in further frustration, worry and concern while awake during the night) thus producing a more permanent improvement in sleep.

The patient should be encouraged to get out of bed at the same time each morning, regardless of how they slept the night before. This may result in some sleep loss on the first few nights of therapy among patients who have had insomnia for a long time. However, the patient should be re-assured that this initial sleep loss will help to increase their feelings of sleepiness (pressure to fall asleep) on subsequent nights, and help them to fall asleep quicker and return to sleep quicker throughout the night.

The patient is encouraged to invest some attention and effort in this therapy over the relatively short time (2-4 weeks) of therapy to obtain a more permanent improvement in sleep and reduction of aversive daytime symptoms (e.g. fatigue, mild depression, irritability, cognitive impairments).

Table. Components of Stimulus Control Therapy

Instruct the patient to:

  1. Use the bedroom only for sleep and intimacy
  2. Get out of bed at the same time each morning (even if eventual sleep onset was quite late, and even on weekends)
  3. Go to bed only when feeling sleepy
  4. If not asleep after about 15 minutes get out of bed, when feeling sleepy again return to bed and try to fall asleep
  5. If not asleep after about 15 minutes, repeat Step 4 and continue this as many times as necessary. (This ‘15-minute’ rule should be used only as an approximate ‘rule of thumb’, to avoid clock-watching behaviour that can exacerbate anxiety about sleep.)
  6. Avoid daytime naps

AHI - Apnoea-Hypopnoea Index
BBTi - Brief Behavioural Therapy for Insomnia
BMI - Body Mass Index (kg/m2)
BQ - Berlin Questionnaire
CBTi - Cognitive Behavioural Therapy for Insomnia
CELL - Coblation Endoscopic Lingual Lightening
COPD - Chronic Obstructive Pulmonary Disease
CVA - Cerebrovascular Accident
CPAP - Continuous Positive Airway Pressure
CSA - Central Sleep Apnoea
DASS - Depression Anxiety Stress Scale
DBAS - Dysfunctional Beliefs and Attitudes about Sleep
DBP - Diastolic Blood Pressure
DIMS - Difficulties Initiating and/or Maintaining Sleep
DISE - Drug-Induced Sleep Endoscopy
DISS - Daytime Insomnia Symptom Scale
ENT - Ear Nose and Throat
ESS - Epworth Sleepiness Scale
FOSQ - Functional Outcomes of Sleep Questionnaire
FSH - Follicle-Stimulating Hormone
FTP - Friedman Tong Position
GP - General Practitioner
HANDI - RACGP Handbook of Non-Drug Interventions
HGNS - Hypoglossal Herve Htimulation
ISI - Insomnia Severity Index
K10 - Kessler Psychological Distress Scale
MAD - Mandibular Advancement Device
MAS - Mandibular Advancement Rplint
MBS - Medicare Benefits Schedule
MMA - Maxillomandibular Advancement Surgery
MRA - Mandibular Repositioning Appliance
ODI - Oxygenation Desaturation Index
OSA - Obstructive Sleep Apnoea
PLMD - Periodic Limb Movement Disorder
PT - Positional Therapy
PTSD - Post-Traumatic Stress Disorder
PSG - Polysomnography
QSQ - Quebec Sleep Questionnaire
REM - Rapid Eye Movement
RFTB - Radiofrequency Thermotherapy of the Tongue Base
SBP - Systolic Blood Pressure
SCI - Sleep Condition Indicator
SE - Sleep Efficiency
SF36 - Short-Form (36) Health Survey
SMILE - Submucosal Minimally Invasive Lingual Excision
SNRIs - Serotonin-Norepinephrine Reuptake Inhibitors
SOL - Sleep Onset Latency
SSRI - Selective Serotonin Reuptake Inhibitors
TFTs - Thyroid Function Tests
TIB - Time In Bed
TORS - Transoral Robotic Surgery
TST - Total Sleep Time
UPPP - Uvulopalatopharyngoplasty
WASO - Wake After Sleep Onset

Quick links


  1. Winkelman JW. Overview of the treatment of insomnia in adults. In UpToDate, Benca R (ed). Waltham, MA: UpToDate 2020