GoodSleep

Waking up at 3am and can't get back to sleep

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If you wake at 3am and are not drifting off again, get up, go to another room, and come back to bed when you feel sleepy. In the morning, get up at your usual time.

The NHS counts waking up several times during the night, and waking up early and not being able to get back to sleep, among the symptoms of insomnia when they happen regularly.

When you wake at 3am

  1. Get up and go to another room. Stay up as long as you wish.
  2. Go back to bed only when you feel sleepy. If you still can’t sleep, get up again, as often as you need to during the night.
  3. Don’t time it. These steps set no number of minutes to wait before you get up.
  4. Tomorrow, get up at your usual time and skip the nap. Keep the bed for sleep (and sex).

Where these steps come from

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.

In Bootzin’s 1972 instructions, if you could not fall asleep you got up and went into another room, stayed up as long as you wished, then went back to the bedroom to sleep, and repeated this as often as needed during the night.

Stimulus control, as the AASM guideline lists it: go to bed only when sleepy; get out of bed when unable to sleep; use the bed and bedroom for sleep and sex only; wake up at the same time every morning; and do not nap in the daytime.

The AASM guideline notes that stimulus control may need to be adapted for safety in some people, such as those at high risk for falls, with mobility issues, or using sedative-hypnotics (sleeping pills).

Why not to check the time

Experiments on watching the clock while trying to fall asleep at bedtime suggest it may feed worry and help keep insomnia going:

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.

One simple way to stop checking is to keep clocks and phones out of view. That is our suggestion; the studies above did not test it.

Is waking up in the night normal?

Time spent awake in the night tends to grow with age, even in healthy people:

A 2004 meta-analysis of 65 studies of healthy people aged 5 to 102 found that, in adults, the time taken to fall asleep and the time spent awake after first falling asleep increased with age, while total sleep time and sleep efficiency decreased.

When experts set out what good sleep quality looks like, they counted awakenings longer than 5 minutes:

A National Sleep Foundation expert panel agreed that the time taken to fall asleep, the number of awakenings longer than 5 minutes, the time awake after falling asleep and sleep efficiency are appropriate indicators of good sleep quality.

So it can help to track how long you are awake and how often, not just whether you wake. A week or two in a sleep diary or the private online sleep log shows this: both record how long you were awake after first falling asleep, and the diary also records how many times you woke up.

What can wake you up

The NHS lists the most common causes of insomnia as stress, anxiety or depression; noise; a room that is too hot or cold; an uncomfortable bed; alcohol, caffeine or nicotine; illegal drugs; jet lag; and shift work.

Some of these have their own pages on our sister sites:

If you lie awake with your mind racing about the night itself, see sleep anxiety. If the hard part is falling asleep at the start of the night, see how to fall asleep fast. If bad dreams wake you and you wonder whether something you ate plays a part, see food and nightmares.

The day after a broken night

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

The full set of steps for nights you can't sleep, and what the evidence says, is on what to do when you can't sleep.

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.

When to get help

This site offers self-help information, not medical advice, and can't tell you whether you have a sleep condition. Talk to a doctor or other clinician if:

  • poor sleep has gone on for a long time or is making your days hard to manage;
  • you often feel so sleepy in the day that it's hard to stay awake, especially while driving;
  • you or a bed partner notice loud snoring, choking or pauses in your breathing during sleep;
  • your mood is low, or you feel anxious or on edge most days.

If you are thinking about ending your life or harming yourself

You don't have to go through this alone. If you are in immediate danger, call your emergency number (911 in the US and Canada, 999 in the UK, 112 in the EU). You can also talk to someone now:

  • US:988 Suicide & Crisis Lifeline (call or text)988
  • Canada:988 Suicide Crisis Helpline (call or text)988
  • UK & Ireland:Samaritans116 123
  • Other countries:Find a Helpline (free directory of helplines)findahelpline.com

Sources: NIMH (911, 988), 988.ca (9-8-8, 9-1-1), NHS (999), European Commission (112), Samaritans (116 123, UK and Ireland).

Sources

  1. Edinger JD, Arnedt JT, Bertisch SM, et al. (2021). Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine 17(2):255–262. PMC7853203
  2. Bootzin RR (1972). Stimulus control treatment for insomnia. Proceedings, 80th Annual Convention, American Psychological Association, 1972:395–396. med.upenn.edu (PDF)
  3. NHS (2024). Insomnia. NHS website, page last reviewed 19 March 2024. nhs.uk
  4. Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV (2004). Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep 27(7):1255–1273. PMID 15586779 (we read the abstract; the page says only what it states)
  5. Ohayon M, Wickwire EM, Hirshkowitz M, et al. (2017). National Sleep Foundation’s sleep quality recommendations: first report. Sleep Health 3(1):6–19. PMID 28346153 (we read the abstract; the page says only what it states)
  6. Tang NK, Anne Schmidt D, Harvey AG (2007). Sleeping with the enemy: clock monitoring in the maintenance of insomnia. Journal of Behavior Therapy and Experimental Psychiatry 38(1):40–55. PMID 16793001 (we read the abstract; the page says only what it states)

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