Module 8 · Sleep & recovery · Strong evidence

When you can’t sleep

Lying in bed trying harder makes it worse. What sleep specialists suggest instead.

7 min read · Level: Practising · Free — no account needed to read

The idea

Lying in bed trying harder to sleep usually makes it worse. Sleep can’t be forced, and the effort and frustration keep the mind alert. Over time, the bed itself can become linked with being awake and anxious.

Sleep specialists often suggest a technique called stimulus control. If you have been awake in bed for what feels like around twenty minutes, get up, go to another dim room and do something calm — read, listen to quiet music — until you feel sleepy, then return. Keep the same wake time in the morning, however the night went. Avoid napping to make up.

This is part of cognitive behavioural therapy for insomnia (CBT-I), which major guidelines recommend as the first treatment for long-term insomnia. CBT-I also includes other steps best done with a trained professional or a structured programme. If sleeplessness lasts for weeks, it is worth talking to a doctor.

Why it works

Knowing what to do when you can’t sleep stops a bad night turning into a pattern — and points you to the most effective help if it does.

A real example

The situation

Since a stressful move, Oksana lies awake for hours most nights, checking the time and growing more anxious.

What happened

She follows stimulus control: she turns the clock away, and after about twenty minutes awake she gets up and reads on the sofa until she feels sleepy. She keeps her 7am wake time. After two weeks she is falling asleep faster, and bed feels like a place for sleep again.

The takeaway

Getting up, rather than trying harder, helped her brain relink bed with sleep.

Use this when you are…

• you lie awake for long periods
• you dread going to bed
• you check the time repeatedly at night

Common mistakes

• Staying in bed for hours, trying harder to sleep.
• Sleeping in or napping to make up, which makes the next night harder.
• Using screens when you get up. Choose something calm and dim.

What the evidence says

Strong evidence: Many good-quality studies, usually including randomised trials and reviews that pool them, point the same way. Guidelines tend to recommend it.

Stimulus control is a well-supported part of CBT for insomnia, which guidelines such as those from the American College of Physicians recommend as first-line treatment for chronic insomnia. Some parts of CBT-I are best done with professional guidance.

Where this comes from: Sleep and circadian research; American Academy of Sleep Medicine (AASM).

Fields that study this: Sleep science, Clinical psychology.

Try it now: Plan for a sleepless night

1. Choose where you will go if you can’t sleep — a dim room with a comfortable seat.
2. Choose a calm activity to have ready there, like a book.
3. Decide your wake time, and keep it whatever happens.

Practise with a guided technique

• If you can’t sleep, get up — (As needed · Strong evidence)
• Body scan — (8–10 min · Moderate evidence)
• Slow breathing — (2–5 min · Moderate evidence)

Questions to think about

• What do you usually do when you can’t sleep?
• What calm activity could you keep ready for those nights?

Try this today

Prepare a calm “can’t sleep” spot and activity before bed tonight.

Afterwards, ask yourself

On a night you couldn’t sleep, what happened when you got up instead of trying harder?

Words in this lesson

• Stimulus control — A sleep technique: if you can’t sleep, get up and do something calm until sleepy, so your bed becomes linked with sleep rather than being awake.
• CBT for insomnia (CBT-I) — A structured programme for long-term sleep problems, recommended by major guidelines as the first treatment for chronic insomnia.