Can't sleep? What to do right now

Why getting out of bed helps

The idea is to make your bed a place where you sleep, not a place where you lie awake, scroll or worry. The author of the 1972 paper that set out these steps put it this way:

Bootzin’s 1972 paper set out to separate the bedroom at bedtime from everything but sleep: if a person wished to watch TV or to worry, he would have to do it somewhere other than the bedroom.

So if your mind is busy, the busy part happens on the sofa. If you are not asleep, you are not in bed. When sleepiness comes back, you return to bed and give it another go.

Is there a 20-minute rule?

You may have read that you should get up after 20 minutes. The guideline and the original paper don't give a number. What a footnote in the paper says about one of its instructions is worth knowing:

Neither the AASM guideline nor Richard Bootzin’s 1972 stimulus control paper gives a set number of minutes before you get out of bed. A footnote in the 1972 paper calls one of its instructions vague and says any attempt to be more specific would have produced clock-watching.

Watching the time has its own cost. In experiments on clock-watching:

In the first of two experiments, good and poor sleepers asked to watch a clock while trying to fall asleep reported more worry before sleep and took longer to fall asleep than those asked not to. In the second, people with insomnia asked to watch a clock reported more worry and a longer time to fall asleep than on their own baseline night, and overestimated that time more than people asked to watch a digit display instead. The authors suggest clock-watching may fuel worry before sleep and help keep insomnia going.

So turn the clock away and put your phone out of reach. Get up when you notice you are awake and not getting sleepier, without timing it.

How well does it work?

The AASM guideline makes a conditional recommendation for stimulus control used on its own as a treatment for chronic insomnia disorder in adults.

A 2024 meta-analysis of 11 studies, most of them published between 1978 and 1998, found that stimulus control led to small to large improvements in the time taken to fall asleep and in total sleep time compared with passive comparison conditions, and negligible differences compared with other active treatments. Its authors say more robust studies are needed.

A 2024 network meta-analysis of 23 studies, generally of poor quality, found stimulus control effective compared with control conditions, and found that not all of its instructions seem essential.

That 1972 paper reported a single person:

Bootzin’s 1972 paper was a single case study of a 25-year-old man who had found it hard to fall asleep for four or five years, and the paper itself says the result may have been due to factors other than stimulus control.

Stimulus control is usually one part of a fuller programme. The American Academy of Sleep Medicine’s 2021 guideline strongly recommends multicomponent cognitive behavioral therapy for insomnia (CBT-I) for chronic insomnia in adults. Another part of that programme, sleep restriction, is explained in how sleep restriction therapy works.

Tomorrow morning

The NHS advises not sleeping in after a bad night’s sleep, and sticking to your regular sleeping hours instead.

A short note of how the night went makes the next step easier to judge. Our online sleep log keeps your nights on your own device and shows how much of your time in bed you spent asleep; the printable sleep diary does the same on paper.

If it's a different kind of night

• You fall asleep fine but wake in the small hours: waking up at 3am.
• The worry is about sleep itself, and bedtime has started to feel like a test: sleep anxiety.
• You want something to try in bed before getting up: how to fall asleep fast, with each method's evidence.

The NHS advises seeing a GP if changing your sleeping habits has not helped, you have had trouble sleeping for months, or your sleep problem is affecting your daily life in a way that makes it hard to cope.