Dr. R. Bootzin pioneered the use of Stimulus Control instructions as a behavioural treatment for insomnia in 1972. Treatment involves the use of six instructions with logical ties to good sleep. The first thing people are required to do is to attempt to sleep only when they are sleepy. Frustration is often the byproduct of unsuccessful attempts of the completion of any task. Sleep is not exempt from this rule. This instruction not only avoids undue associations of attempting to sleep with frustration and concomitant arousal, but it also sensitizes people to the internal physiological cues of sleepiness. People employ such experiences as head nods and droopy eyes to signal bedtime.
Decreased arousal levels are associated with the bed and bedroom by restricting the activities therein to sleep only. According to the second instruction, all arousing activities such as discussions and financial arrangements must be conducted outside of the sleep environment.
The third requirement forces people to get out of bed if they are unable to sleep. This also reduces the association of the bed with increased arousal due to the frustration of not sleeping. People are told to leave the bedroom and to engage in relatively unstimulating tasks and not to return to bed until they feel sleepy again. This is a difficult instruction to comply with since it seems counter productive and many insomniacs have developed a pervasive pattern of remaining in bed at all costs.
Rule four requires people to repeat the process of leaving the bedroom when unable to fall asleep and returning only when feeling sleepy as often as necessary throughout the night.
The fifth instruction is to get up at the same time every morning regardless of the quality of sleep during the night. Many insomniacs try to make up for a poor night of sleep by sleeping later in the morning. Sleeping late makes the situation worse by increasing sleep onset latency the following night. The last, and sixth rule instructs people to avoid all napping.
These last two rules help to regulate the body’s sleep rhythm and deprive people of sleep. Sleep deprivation decreases sleep onset latency the following night and strengthens the association of sleep to the sleep environment.