# PWR-049 — Sleep initiation: learner worksheet Release: Revision 7T · Full Tutorial Edition Estimated time: Estimated 11 min reading; practical time is provider-set Difficulty: Intermediate Equipment: Common household or practice equipment — A seven-night sleep diary with bedtime, estimated sleep onset, awakenings, final wake and out-of-bed time.; A provider-agreed wake time and written stimulus-control plan.; A dim, safe place outside the bed for a quiet activity.; A low-stimulation activity such as a familiar paper book or calm audio; no clock-facing contest. Space: Room-scale practice space Automated structural checklist: 10 of 10 structural checks present Evidence quality/context: G4; Detailed research depth Automated method-quality band: Comprehensive Method-rating basis: Structure coverage, instruction/check specificity, alternative distinctness, source troubleshooting, comparison depth and whether purpose/check fields are authored rather than derived. Editorial review: Pending manual editorial sign off ## Before you begin - [ ] I read the tutorial authority and stop conditions. - [ ] I have the required equipment/space or a declared accessible alternative. ## Canonical source context Sleep initiation can improve with structured insomnia treatment; it is not an on-command superpower. This lesson teaches the stimulus-control part of cognitive behavioural therapy for insomnia (CBT-I): track the pattern, keep a provider-agreed wake time, go to bed when sleepy, leave the bed when unable to sleep and return only when sleepy again. A clinician controls any sleep-window restriction and screens other causes. Target outcome: The learner follows the provider-agreed bedtime response for seven nights and records sleep-onset latency, adherence, next-day function and adverse effects. ### Authority and setup conditions - A sleep clinician or other qualified provider screens for sleep apnoea, mania, seizures, parasomnias, medication effects, shift work and other conditions that change the plan. - Do not reduce time in bed or change medicine without the provider. - Make the route from bed to the quiet place safe and accessible at night. - If drowsy driving or dangerous sleepiness is present, address transport and work safety before sleep practice. ### Required or supplied materials - A seven-night sleep diary with bedtime, estimated sleep onset, awakenings, final wake and out-of-bed time. - A provider-agreed wake time and written stimulus-control plan. - A dim, safe place outside the bed for a quiet activity. - A low-stimulation activity such as a familiar paper book or calm audio; no clock-facing contest. ## 1. Complete the baseline diary For at least seven nights, estimate lights-out time, sleep onset, awakenings, final wake, out-of-bed time and next-day function. Why: A pattern across nights is more useful than one difficult night or a wearable score. Success check: All nights remain in the diary, including poor estimates. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “All nights remain in the diary, including poor estimates.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 2. Anchor the wake time Rise at the provider-agreed time every day, within the agreed tolerance, and record deviations. Why: A stable wake anchor supports a regular sleep opportunity and makes the plan testable. Success check: Out-of-bed time is recorded rather than inferred from device data. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “Out-of-bed time is recorded rather than inferred from device data.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 3. Enter bed when sleepy Use the bed for sleep and sexual activity; begin the sleep attempt when you notice genuine sleepiness, not only frustration or a preferred clock time. Why: Stimulus control aims to reconnect bed with sleeping rather than prolonged wakefulness. Success check: The learner can name the sleepy cue used that night. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “The learner can name the sleepy cue used that night.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 4. Remove the clock contest Turn the clock face away and do not repeatedly calculate lost sleep. Estimate timing once in the morning diary. Why: Clock watching increases effort and makes estimates falsely precise. Success check: No repeated clock checks occur during the sleep attempt. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “No repeated clock checks occur during the sleep attempt.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 5. Leave when clearly awake If you are unable to sleep and becoming alert or frustrated, follow the provider’s cue-based rule: leave the bed safely rather than waiting for an exact minute. Why: Remaining awake and distressed in bed strengthens the wrong association. Success check: The learner moves to the prepared safe place without starting stimulating work. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “The learner moves to the prepared safe place without starting stimulating work.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 6. Use a quiet dim activity Choose the prepared calm activity under low light. Avoid work, news, gaming, bright screens, meals or exercise unless the provider plan says otherwise. Why: The aim is to wait for sleepiness, not reward or punish wakefulness. Success check: A quiet activity is ready and the light remains low. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “A quiet activity is ready and the light remains low.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 7. Return only when sleepy Go back to bed when sleepiness returns. Repeat the leave-and-return sequence if alert wakefulness returns. Why: Repeating the same contingency teaches the bed–sleep link over time. Success check: Each return is triggered by sleepiness, not a forced deadline. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “Each return is triggered by sleepiness, not a forced deadline.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## 8. Review function and safety In the morning, record estimates, adherence, mood, falls risk, driving sleepiness and next-day function; review weekly with the provider. Why: A shorter sleep-onset estimate is not a success if daytime safety or health worsens. Success check: The diary contains both night and daytime outcomes. Accessible alternative: Ask the qualified provider to adapt positioning, cue modality, pace, interface or rest while preserving this step’s declared check: “The diary contains both night and daytime outcomes.” If an adaptation changes the measured task or configuration, record it as a different configuration rather than an equivalent attempt. Alternative relationship: Conditional equivalence requires target and configuration check Learner notes: ________________________________________________________________________________ Completed: [ ] ## Reflection What changed? ________________________________________________________________________________ What remains difficult? ________________________________________________________________________________ What will I repeat, adapt, ask for help with, or stop? ________________________________________________________________________________ --- Completion of this worksheet demonstrates tutorial participation only. It does not establish capability, qualification, safety clearance, diagnosis, treatment or independent validation.