Can Stimulus Control Therapy for Insomnia Do More Harm Than Good?

If you've explored cognitive behavioural therapy for insomnia (CBT-I), you've probably come across stimulus control therapy. One of its central recommendations is that if you've been awake in bed for around 15 to 20 minutes, you should get up, leave the bedroom, and only return once you feel sleepy again. The aim is to strengthen the association between bed and sleep, rather than bed and wakefulness. It's a logical idea, and for some people it can be very helpful.

However, early in my career I began to notice that it wasn't helping everyone. Many of my clients disliked the advice immediately. Some would ask me, "Do you get out of bed if you can't sleep?" If I'm honest, the answer was no. That question stayed with me. Why were we asking people who were already exhausted, anxious, and overwhelmed to repeatedly leave the warmth and comfort of their bed in the middle of the night?

Over time, another pattern became clear. Getting out of bed often reduced anxiety in the short term, but it didn't change the person's relationship with that anxiety. In many cases it simply became another way of escaping uncomfortable thoughts, feelings, and wakefulness. When they returned to bed, the anxiety returned with them.

I found myself agreeing with the principle. We don't want people spending hours fighting for sleep. But I began questioning whether leaving the bed was always the best solution. What if the real skill was learning how to stay in bed differently? Learning to rest, even when sleep isn't happening. Learning to notice racing thoughts, frustration, or fear without treating them as emergencies.

When I began introducing this gentler approach, many clients described an immediate sense of relief. Relief that they no longer had to "perform" the night correctly. Relief that wakefulness didn't automatically mean they had to get up. As the pressure eased, so too did the anxiety, allowing the nervous system to settle naturally. Ironically, this often made sleep more likely.

This doesn't mean stimulus control is wrong. Like any therapeutic tool, it has its place, and for some people it can be very effective. But after working with thousands of people with chronic insomnia, I've come to believe that rigid rules rarely suit every individual. Lasting recovery often begins not by escaping wakefulness, but by changing our relationship with it.

Sometimes the most important question isn't, "How do I get away from being awake?" It's, "How can I be with this moment a little more gently?"