Can't Sleep? What to Do Now

What to do when you can't sleep: the 20-minute rule

Get out of bed when you can't sleep, keep the light low, and come back only when you feel sleepy. This is called stimulus control. The 2021 AASM guideline for chronic insomnia suggests it and lists its instructions: go to bed only when sleepy, get out of bed when unable to sleep, use the bed only for sleep and sex, wake at the same time every morning, and skip daytime naps ^[11].

1. Get up. Guess the time rather than checking it.
2. Change rooms. A chair in another room, with one soft lamp on.
3. Pick something dull. A paper book, folding laundry, quiet music. No phone, no email, no TV series.
4. Return when sleepy. Heavy eyelids and yawning are the signal, whatever time it is.
5. Repeat if needed. Some nights take two or three rounds. Get up at your usual time anyway.

If you have been lying in bed for hours and still can't sleep, you have not missed your chance: get up now and start at step 1.

The guideline adds that the rule may need changes for people at high risk of falls, with mobility problems, or taking sleeping pills ^[11]. If getting up at night is unsafe for you, keep the path lit and ask your doctor how to adapt it.

Where "20 minutes" comes from (and why it is a guess)

The number comes from patient guides, and the clinical guideline itself does not set one. The AASM's page for patients says: "If you are not asleep after about 20 minutes, then you are to get out of bed to do something else relaxing" ^[1]. Another AASM page puts it as "about 15 to 20 minutes for most people", counted from when you begin to get frustrated ^[12]. The 2021 guideline only says to get out of bed when you are unable to sleep ^[11].

The signal is frustration, not the clock.

How well does the rule work? A 2024 meta-analysis pooled 11 trials, most of them from 1978 to 1998. Against no treatment, stimulus control gave small to large gains in time to fall asleep and total sleep (g = 0.38 to 0.85). Against other active treatments the differences were negligible (g = 0.06 to 0.30), and the authors call for more robust studies ^[13].

What to do when you wake up in the middle of the night

It is 3 a.m., the phone is right there, and you want to know how long you have left. Leave it. Waking up at night is normal, and counting the missed minutes adds stress that can delay sleep ^[3]. If you wake up already anxious and it carries into the day, see morning anxiety.

• If you need the bathroom or the room is too warm, deal with it quickly and quietly, then lie back down ^[3].
• If you keep checking the time, turn the clock around. In a sleep clinic sample of 1,078 patients, those who watched the clock more often had more severe insomnia. That study shows a link, not that clock-watching causes insomnia ^[14].
• If pain keeps you awake, follow your doctor's plan for nighttime pain first.
• If you are still awake after about 20 minutes, get up and follow the rule above.

In the morning, get up at your usual time.

When your mind won't stop: worries, lists and pictures

Spend 5 minutes writing tomorrow's tasks on paper, then give your mind one calm picture. In a lab study of 57 healthy young adults, those who wrote a specific to-do list at bedtime fell asleep faster than those who wrote about tasks they had finished, and the more specific the list, the faster they fell asleep ^[6].

Worry gets a similar treatment in an older trial. Students with insomnia who wrote down their worries along with a possible next step had less mental arousal before sleep than those who only wrote worries ^[15]. That trial had 33 students and did not measure how fast they fell asleep. For worries that also follow you through the day, see how to stop overthinking.

For the picture, choose one quiet scene and fill in details: the light, the sounds, the temperature. In 41 people with insomnia, imagery cut the time to fall asleep, and general distraction did not ^[7]. If you feel spaced out or panicky rather than busy-minded, 5-4-3-2-1 grounding may suit you better. If you would rather breathe than picture a scene, breathing exercises for sleep has a dim night timer.

Should you stay up if you can't sleep?

Stay up only until you feel sleepy, and do it out of bed. NHS inform says it is better to stay up until you are ready to sleep than to go to bed early and worry about not sleeping ^[16].

Pulling an all-nighter on purpose does not fix the next night. The NHS advice after a bad night is the opposite of catching up: keep your usual hours, don't sleep in, and don't nap ^[5]. You may feel worse the next day, and that extra sleep pressure helps the following night ^[3]. Do not drive if you feel very sleepy.

Why won't my body let me sleep?

Often there is no single cause you can find in one night, and that is all right. The NHS lists the most common causes of insomnia: stress, anxiety or depression, noise, a room that is too hot or cold, an uncomfortable bed, alcohol, caffeine or nicotine, jet lag and shift work ^[5].

• If you had a drink to relax, expect lighter sleep. Alcohol can make it easier to fall asleep but makes waking up during the night more likely ^[9].
• If coffee or tea was your afternoon habit, the NHS advises none in the 6 hours before bed ^[5].
• If someone says you snore or gasp in your sleep, mention it to a doctor. Breathing that stops and restarts during sleep is sleep apnea ^[17].
• If your legs have a strong urge to move when you rest at night, that is the main sign of restless legs syndrome ^[18].
• If worry is the loudest thing, go back to the section on lists and pictures.

Signs that need a doctor are listed at the end of the page.

What's checked and what's only advice

The get-up rule has the best evidence of the common tips; the clock, the list and the warm drink have much less.

Frequently asked questions