Sleep Buddy: Stimulus Control Therapy

Negative Associations

Back in lesson 3 on Insomnia we learned about negative associations and how they can be changed into positive associations.  I gave you the example of someone you don’t like and how by learning about their situation, your negative emotions associated with them could be dispelled.

If you have been experiencing insomnia for a long time, you will have built up negative associations with your bed and your sleep.  How could you not?  Sleep has let you down again and again.  You get frustrated and angry not being able to sleep, especially after you have tried so hard to sleep better.  Your bed may be a place of dread for you, somewhere that you endure the night, unpleasant, uncomfortable, wasteful. 

Other than acknowledging this pain and discomfort, I am not going to dwell much on this aspect of your sleep.  It is helpful to acknowledge whatever negative emotions you have associated with sleep.  I encourage you to take a pen and paper, or word processor, and write out how you feel about sleep and your bed.  Be as vivid and as livid as you can.  Doing this will help you to let go of the negative associations you have pent up inside of you and will help you be successful with this aspect of CBTi.   By expressing your emotions, your brain no longer has to draw them to your attention and it will be easier to move on.  When you experience something negative in your life, you can become better or bitter and I want you to become better and writing out your negative emotions helps you become better.

I will have an emotion venting form on my website, sleeptohealthy.com that you can use if you decided to take advantage of this extra step which is not formally part of the CBTi curriculum. 

Bed Buddy:

Bed buddy or Stimulus Control Therapy is about 2 things.  It is about how you feel about and think about your bed and how you feel about and think about your sleep.  Right now I bet that your relationship with your bed and your sleep is not very good. 

The types of words that you would use to describe your sleep and your bed are not the type of words that you would use to describe a good friend or a buddy.  So let’s just say that for now you don’t have a bed buddy, you have a bed antagonist.  Your bed and your sleep seem to be antagonizing you rather than helping you feel and function as you want to be.  What we want to do in this lesson is to turn your antagonist into your buddy, slowly but surely.

Beliefs – actions – outcomes: 

Lets go back to our basics that we learned in Lesson 4, about CBTi, which is beliefs lead to actions lead to outcomes.  Incorrect beliefs lead to wrong actions lead to undesirable outcomes.

Let’s say that you get into bed and you just can’t fall asleep.  Your thought might be – “if I’m not getting to sleep.  I should lay here and make myself get to sleep”.  The action that follows is to stay in bed no matter what.  The result is that you take the pleasant experience of falling asleep that good sleepers look forward to and enjoy, and turn it into your antagonist, an event to fight with.  You have changed your association with sleep from buddy to antagonist.

Or how about when you wake up in the middle of the night and can’t get back to sleep.  You lay in your bed flipping and flopping, you mind racing and worrying, waiting impatiently for sleep to return.  You invent things to do to get you to sleep like counting sheep or counting backwards from 1,000 by 3s.  Your bed, that should be a place of comfort and relaxation becomes a bed of thorns, antagonizing you and stopping you from getting to sleep.  You have turned your bed buddy into an antagonist.  You don’t think of your bed as a wonder place of refuge, but as a place of torment.  I might be exaggerating, but I don’t think by much.

What happens over time is those associations become deeply engrained, like a wagon travelling through a muddy road and leaving deep ruts.  After the wagon has travelled the road many times, the ruts become so deep that the wagon couldn’t go down a different route if it wanted to.  It couldn’t get out of the ruts.  You have developed a similar pattern in your brain.  You have such deep negative associations with your bed and your sleep that you cannot go to bed without having negative thoughts and feeling rise quickly to the surface.  Getting out of those ruts and getting onto the smooth path running beside your ruts is going to take some heavy lifting, but it is possible.

Sleep Buddy:  When you want to make a new friend, you can’t force it.  You need to let it happen naturally.  In fact, you have probably tried to force someone to like you or had someone try to force you  to like them.  It just doesn’t work, does it?  Sleep is similar.  You can’t force it.  But believe me, sleep wants to be your buddy if you would just back off and let sleep be itself and not what you are trying to force it to be.

So let’s start with bedtime.  If you have someone you would like to be friends with, when would you approach them or try to get together with them.  Would you pick a random time and force them to meet you at a time that is inconvenient to them?  Or would you wait until they seemed to be in the mood for getting together and socializing? 

When you climb into bed and you can’t get to sleep, that is a sign that your sleep buddy is probably not ready to engage with you just now.  In other words, your sleep drive is not strong enough.  So back off, and wait until they seem to be in the mood for sleep.  The funny thing is that you know this, you have just forgotten.  Have you ever experienced when a friend puts an object or event before your needs.  Perhaps they are getting you some food, but what your really need is companionship.  They haven’t read your body language or haven’t listened and understood what you said.

In the same way, you are likely putting your digital clock ahead of your sleep buddy’s need to get into the mood for sleep.  Stop looking at the stupid clock and start paying attention to your lifelong sleep buddy.  I recommend covering all your clocks about an hour before your expected bedtime and listen to your body rather than clock watching.  Otherwise your sleep buddy is not going to be very cooperative because they don’t like being forced into sleep.

Go to bed when sleepy: 

So the first sleep buddy rule is don’t go to sleep until you are sleepy.  Once I say it that way, it sounds obvious, but most of us don’t do this. 

I consider Michael Schwartz a Sleep Buddy genius, so we are going to hear a lot from Michael today.  He refers to Sleep Buddy by it’s proper CBTi nomenclature which is Sleep Restriction Therapy.  Michael has a wonderful approach your relationship with your sleep, a great balance between being firm with the expectations while being gentle and non-technical on the implementation.  So here is Michael Schwartz on going to bed only when sleepy <Michael audio clip – about going to bed when sleepy only.>

By going to bed only when sleepy, you are reinforcing to yourself that your bed is where you sleep and where sleep comes easily.  You are also disengaging your natural sleep rhythms from artificial rhythms dictated by technology and society.  Your body and mind have a natural tempo of sleep and wakefulness.  Trying to force yourself on this is like trying to dance the tango when your partner is trying to jive.  It just doesn’t work.  Figure out what your sleep buddy’s mood is and adapt to that.  It reminds me of that saying “If mamma ain’t happy, than nobody’s happy”.  If your sleep buddy isn’t happy, then you are not going to be happy.  So find the dance that you both enjoy, and then dance the night away.

If not sleeping or sleepy, get out of bed. 

So if you know that you shouldn’t got to bed unless you are sleepy, then the corollary to this is also true: If you find yourself in bed and not sleepy, get the heck out of bed.  In fact, don’t stay in bed if you are not sleeping.  This is the 2^nd sleep buddy rule.  If you are in bed and not sleepy, then get out of bed until you are sleepy and then try again. 

Some nights this will feel like a yo-yo, where you are constantly getting out of bed, returning to bed, realizing your are not getting to sleep, getting back out of bed and so on all through the night.  The point is that you want to train your mind that bed is for sleeping and not for worrying, solving tomorrow’s problems or fretting about yesterday’s experiences.  It is just for sleeping. 

You want your mind to associate your bed with peaceful sleep, not restless tossing and turning. 

The rule normally given is to give yourself about 15 to 20 minutes to get to sleep.  If it is not happening, then get out of bed.  This creates a real paradox or catch-22:

<arcade sound> If you can’t sleep for 15-20 minutes, then get out of bed.

< arcade sound > Don’t think about sleep or clock watch – so don’t track the time or think about whether you are sleeping or not.

Michael Schwartz has developed a ingenious way to resolve this issue as he will explain:

<Michael – audio clip – 12 rules for getting out of bed>

Me getting to sleep:

In my case, I have found two ideas that work well at getting my mind off sleep and onto something else so I can drift off to sleep when I go to bed either at the beginning of the night or after awakening in the middle of the night.

The first is that I walk myself through a 5 step thought process.  I first try to recall memories from the day that make me smile.  If I can’t find any, then it prods me make sure I do something enjoyable the next day.  Then I think of any good deeds I did such as helping someone, even giving the dog a walk.  3^rd I think of things that I am grateful for, even if it is for my next breath.  Sometimes this list can go on for a long time.  Next, I think of things that I am looking forward to tomorrow and imagine how they might turn out and what I could do to make the unfold the way I hope.   5^th I think of any obstacles I might experience tomorrow and what I might do to accept them if they are beyond my control or mitigate them if I do have some control.  Usually I fall asleep around step 1 or 2.  If I make it past step 5, I should probably get out of bed and try again!

Another approach I use is to find all the words I can think of starting with a letter helps me to drift off to sleep, for instance trying to think of all the words starting with the letter B such as Buddy, Backhand and Bleak.  It works for me because I find it fascinating to see all the different directions this exercise leads me, and I wonder why I thought of a particularly unusual word such as Budapest.  I stop thinking about getting to sleep and before I know it, if I am sleepy and not anxious, I fall asleep.  I choose a different letter each night.

As an example of how my personal reaction to these ideas is the key, not the idea itself, I told my alphabet idea to a friend.  They had a horrible time of it and found it made them frustrated, not relaxed.  So no single idea will work for everybody, or even most people.  You just need to find what helps you relax, feel engaged and get your mind off of sleep.

When deciding to get out of bed, in addition to Michael’s suggestion about seeing if my mind’s eye engages easily, I just let my eyelids relax.  If they pop open when relaxed, it is a pretty good

Ruts:

Remember the ruts we talked about earlier – how your chronic insomnia has created a deep path of behaviors and beliefs that make it difficult to do anything other than continue down your path of insomnia?  Getting out of bed when you are not sleeping is the heavy lifting of moving your cart over to the smoother roadway.  The cart will continue to drift into the ruts and your job is to keep lifting it out over and over again.  You will feel like giving up.  It will seem like it is making things worse, and for a while it likely will make things worse.  And not just for 1 night.  But eventually you will be riding down the smooth roadway more frequently and your sleep journey will become a pleasure, not a burden. 

Spoiler Alert:

Here’s a spoiler alert – Towards the end of this lesson I will introduce you to a method that Michael Schwartz has developed that can speed the whole process up.  But first we have finish up our Sleep Buddy, or Stimulus Control Therapy for Insomnia, concept.

Getting out of bed when you really want to get to sleep is hard to do.  You always think that if you just give it a little more time then sleep will come.  But it can be a long wait and there can be a lot of damage done to your relationship with your sleep buddy.  Just as you would respect the boundaries of a good friend, you should respect how sleep is feeling and reacting to your advances of forcing sleep. 

I would like to give you a tip that can make getting out of bed easier.  It is the 5 second rule.  The instant you realize that you should get out of bed, start counting down from 5.  5, 4, 3, 2, 1, 0.  Before you reach 0, start the motions of getting out of bed.  Start swinging your legs over to the side.  Or start pulling the covers off.  Or sit up in bed.  Whatever you usually first motions are when you get out of bed normally, start to do them.  You will find that the inertia of starting the motion will carry on and before you know it you will be out of bed and doing all the things Michael described earlier.  I will have a link to the 5 second rule on my website, sleeptohealthy.com, if you want to learn more about this effective technique.

What to do when out of bed: 

The other issue getting out of bed raises is: What do you do when you get out of bed?  What you do is almost as important as the act of getting yourself out of bed in the 1^st place. 

I’m going to let Mr. Schwartz explain his 12 step process.  This audio is taken from Michael’s podcast called Sleep on Q, that’s with the letter Q.  I will have a link to his podcast in the show notes.  His podcast is especially helpful if you want to buckle down and really tackle your Sleep Buddy aspect of CBTi.  < Michael audio – 12 steps process of what to do when awake in bed>

Remember that CBTi is designed to help people who have firmly entrenched chronic insomnia.  At some point, you may no longer judge your self as suffering from insomnia.  Insomnia is not like the way Alcoholic’s Anonymous  defines alcoholism, that is it a disease that you carry for life.  Insomnia is a temporary condition that you have developed from decisions, beliefs and actions that interfered with you sleeping well.  Once you have corrected these and you are sleeping well given your life’s circumstances, then you don’t need to adhere so rigidly to the CBTi elements. 

As an example, like every other human on the planet, I still have wakeful nights.  Sometimes I choose to get out of bed and follow Michael’s advice, especially if I notice that I have fallen into a pattern of wakeful nights.  But sometimes, I am laying awake quite peaceful but just not sleeping.  I am not feeling anxious and if don’t have a monkey mind.  In these situations I may choose to stay in bed, think my peaceful thoughts or perhaps meditate or play a mind game and let sleep naturally return.  CBTi does not restrict you to a ridged sleep routine for life.  Rather, it is liberating where you can choose when to sleep in or not, when to stay up late socializing or not, and so on.  You will recognize when your lifestyle choices are leading down the insomnia ruts and you can easily move your cart over to the smooth roadway that you know is nearby. 

Waking up at a consistent time.

The 3^rd sleep buddy rule is to end your relationship with your sleep buddy at the same time every day.  In other words, make your wake time consistent. 

So far, you may have the impression that your relationship with your Sleep Buddy is all 1 sided.  Your sleep buddy seems to make all the rules and get their own way.  They decide when you initiate the relationship and what you can and can’t do.  That’s not fair.  Well now its time to assert your own boundaries.  You get to decide when the sleep dance ends each morning.

By getting up at the same time every day, regardless of how horrible or wonderful your sleep was, you are establishing a healthy sleep rhythm and letting your sleep buddy know that they can’t push you around.  You have your own boundaries in the relationship. 

In the case of sleep, absence indeed makes the heart grow fonder.  You need to have a nice long separation from sleep for sleep to want to get together with you again the next night. 

As we learned in lesson 1 about the sleep drive, the sleep drive slowly builds up all day long when you are awake.  If you sleep in, then there is less time for the sleep drive to build up and you will likely have more trouble getting to sleep the following night.  If you sleep in, you have less time for your sleep drive to build, you will not be sleepy at bedtime and you won’t have a deep sleep.

Also your awake time is the most important aspect of establishing the start of your circadian rhythm.   If you don’t make this consistent, say within ½ hr day to day, perhaps within 1 hour on weekends, then it is like giving your system jet lag.  The signals get confused and your body and mind get out of sync and your sleep signals get confused.  The cascade of events that allow you go from wakefulness to sleep get weak and uncoordinated and you don’t get to sleep as easily.  

So set your alarm in the morning and stick to your wake up time.  You can use the 5 second rule that you use to get out of bed in the middle of the night to get out of bed in the morning.  Also remind yourself that your priority is to sleep better tonight, not repair your broken sleep from last night. It’s too late for that. You know repairing last night’s sleep doesn’t work, so don’t even try.

You will want to set your normal wake up time to whatever time you normally have to get up in the morning – for most people this is the time you get up to go to work.  You do not want to deviate by more than 30 minutes for most days and 1 hour on weekends.  

Again, Michael Schwartz has some great advice on getting up in the morning <Michael audio clip – get up and start the day>

Light alarm clock:

In the winter, many of us wake up in the dark.  This is a problem because one of the strongest triggers to kick start your circadian rhythm is bright light.  In addition, being awoken in the morning by an unpleasant sounding alarm clock is a jolt to the system and not a natural way to wakeup.  Ideally, you would be gently woken at a time when you are sleeping lightly or experiencing an awakening as discussed in previous lessons.

There is a way to do this.  It is called a light alarm clock.  This is an alarm clock that turns on a light rather than sounding an irritating alarm.  I have put a link to the light alarm clock that I use on my website sleeptohealthy.com along with some tips that I use to make it most effective.  The alarm  also has an audible alarm so if you don’t wake to the light, you still won’t sleep in.  I don’t want to go into details here so I will have some tips on how to use this device successfully on my website.  The other alternative is to get a smart lightbulb that you can program to come on around your wake time.  It is not essential for CBTi, but has been a game changer for myself and other members of my family that I have gifted this too.

Sleep Buddy is Jealous

A Personality trait of your sleep buddy that you should be aware of is that they are jealous.  Your buddy does not like sharing your sleeping space with others.  Your buddy does not like it when you bring work into their space.  They don’t like it when you have intense discussions right when you are going to have an intimate time with your sleep buddy.  So don’t do anything in your sleep space that would be offensive to your sleep Buddy.  Nothing stressful or distracting.  Don’t call it your bedroom, call it your sleep room.  You don’t call your living room your couch room do you? 

The one exception is that your sleep buddy wants you to have great relationships to others you care about.  So the bedroom can be shared with your partner and sex is OK.  Just not other stressful or disturbing activities and relationships.  Just sleep and sex in the sleep room.

To help you, I have made a list of rules and a list of doe’s and don’ts for creating a great relationship with your sleep buddy on my website, sleeptohealthy.com.  Good luck at turning your sleep antagonist into your sleep buddy.

Sleep on Cue:

You may have been wondering what the tip is for shortening this whole painful process from Michael Schwartz.  I have emphasized over and over again that you can’t force sleep, you can’t make sleep happen when you want.  What if there is an exception to this rule? Well there is.  It is called Sleep on Cue, cue spelled c-u-e. 

When you want to learn a skill such as shooting a basketball, you can grab a basketball and practice as much as you want until you learn the skill.  With sleep, you may have lost the skill to fall asleep quickly and effortlessly, but you only get one chance a night.  And even then, that practice session may not go so well.  Sleep on Cue is an amazing method that lets you practice getting to sleep many times in a short space of time. 

Since this method may not interest all listeners and isn’t part of the CBTi curriculum, I am going to let Michael explain it at the end of this episode.  So if you are interested, Michael will explain everything in about 2 minutes.  I will also have links and an explanation on my website sleeptohealthy.com.  In scientific terms, Sleep on Cue is called Intensive Sleep Retraining, a term that might have you running for the hills if it wasn’t going to potentially save you a lot of grief. 

Wrap-Up

So that is it for Sleep Buddy.  I want to remind you that if you want to do some of your own research on this CBTi or Cognitive Behavioral Therapy for Insomnia element, in CBTi terminology, Sleep Buddy is called Stimulus Control Therapy.  I don’t like that term because it doesn’t mean much to most people.

Next lesson we will be covering Sleep Myths – Unlearning Everything You Thought you Knew about Sleep.  This is the 3^rd of the 5 CBTi elements.  The first 2 elements have focused on behavior changes, new physical actions you can take to improve your sleep.  Sleep is a function of the brain and the mind, so the next 3 lessons will focus on changing how you think about sleep.

Did you think you could force yourself to sleep if you just tried hard enough?  Wrong.  Did you think that you think that sleeping pills creates sleep?  Wrong.  Did you think that if you had the right combination of things to do and products to take at the right time that it would make you sleep?  Wrong.  We are going to look at these myths and many more to tell you what works and what doesn’t and why.  You will never be mislead by false advertising or unrealistic claims again. 

<Dr. Daniel Erichsen – sound snippet from next lesson>

Assignment:

This lesson, like the other lessons, comes with an assignment.  You can find the assignments at sleeptohealthy.com.  In fact, sign up for our email newsletter on sleeptohealthy.com and receive the assignments as soon as the lesson is released.  Knowing the assignment ahead of time helps you to focus on what’s important during the lesson.

I’m sure you can guess what today’s assignment is.  Your assignment, should you decide to accept it, is to create a great relationship with your Sleep Buddy by following the advice in this lesson.

All the instructions are at my sleeptohealthy.com website.  Go there and work the plan.  It’s as simple as that.

Well that’s it for Lesson 6.  It would be great to hear from you & how this course is helping or frustrating you or if you have any questions.  Just use any of the easy to use contact methods sleeptohealthy.com

As mentioned throughout this course, executing CBTi is hard.  In fact, the majority of people will either not be able to implement CBTi well by themselves or will take much longer time, months rather than weeks, to get it working the way it should.  The reason is that it is as much psychological as it is practical.  Life is complex and situations vary drastically.  My job is to give training in CBTi and to give you all the tools and advice I know of to allow you to be successful at CBTi, ideally on your own.  But a podcast cannot be responsive to your individual needs.

If you are one of the lucky few who can do it yourself quickly, then congratulations.  If you are in the majority, then you may appreciate some help along the way. 

I would like to leave this message from Michael Schwartz <Michael audio – “Tip Jar” consulting offer>

Disclaimer

And here is the disclaimer spoken in one breath….

This podcast is not a substitute for advice from a qualified healthcare professional.  The sole purpose of this podcast is to educate and entertain.  As we do not know your particulars, we cannot and do not provide professional or medical advice or services.  We strongly encourage you to consult a healthcare professional before incorporating any ideas in this podcast.  Listeners who use the information in this podcast do so at their own risk.

Intensive Sleep Retraining (ISR) and Sleep on Cue App

I want to say 2 things to introduce this to you.

First is that I have used this method personally and it did everything it claimed to do.  I have put my Sleep on Cue graph and a few comments about my experience on the website.

Secondly, is that this is an astounding use of a cell phone to replace a complex, expensive, inconvenient experience with a simple, convenient, economical alternative.  The Sleep on Cue app that Michael developed would cost you thousands of dollars to do in a sleep lab if you could ever find a sleep lab that was willing to do it for you.  For me, Michael has created a smart phone miracle for sleep.  Here is Michael to explain it all to you.

<Michael – Explain App & background – from previous podcast episode>

Outro:

By structuring this as a course on curing insomnia, it keeps you focused on the core skills you need to improve your sleep. You don’t need tons of sleep trivia and people’s opinions about sleep.  You just need to know proven instructions on what you can do today, to sleep better tonight, so you can feel and function better tomorrow. This allows you to repeat lessons as it’s hard to absorb all the knowledge the first time through, and the information will make more sense after you have the context of the whole course.

You, like most people, will likely benefit from repeated listening.  The lessons will be updated based on student feedback. So the next time you listen to the same lesson, it may be improved since last time.  And that’s about it. Thanks for joining my in my sleep class.

I look forward to seeing you again on the next episode of the sleep to healthy podcast. See you then..