What to Do When You Can't Fall Asleep

It is 2am. You have been awake a while. The question you are asking has a clear, evidence-based answer, and it is probably not the one you want.

Get up.

The technique has a name: stimulus control. It is one of the components of CBT-I, and the AASM's 2021 guideline conditionally recommends it as a single-component therapy for chronic insomnia in adults.1

The rule: when you have been awake in bed for a while and you are frustrated rather than sleepy, leave the bed. Go to another room. Do something quiet and undemanding in low light. Return when you feel sleepy — not when you feel you have been up long enough, and not when you decide you ought to try again.

Why it works

It sounds too simple to matter. It works because the association between your bed and sleep is learned, and learning runs in both directions.2

For most of your life, bed meant sleep. Then came a stretch of lying there awake — tense, checking the time, doing arithmetic about how many hours are left. Once that becomes the prevailing pattern, the bed stops cueing sleep and starts cueing alertness.

At that point, walking into the bedroom is enough to wake you slightly. People describe falling asleep on the sofa and becoming wide awake the moment they get into bed. That is not a quirk; it is conditioning doing exactly what conditioning does.

Stimulus control reverses it by breaking the pairing. If you are awake, you are not in bed. The bed is for sleep, so the bed goes back to meaning sleep.

What not to do instead

The worst response is the most natural one: stay put and keep trying. The harder you try, the more alert and tense you become. That is hyperarousal, named among the factors that perpetuate chronic insomnia — and deliberately attempting to fall asleep is a reliable way to produce it.2

Do not check the clock. It turns the night into a countdown, which never helps. It is also why the rule here uses frustration as the trigger rather than a number of minutes.

Do not compensate tomorrow. Going to bed an hour earlier to make up the loss, or sleeping in to catch up, is the most common way one rough night becomes a run of them. It spends the sleep pressure you need the next night, which makes another night of lying awake more likely.

The first few nights are harder

Getting out of bed at 2am feels like giving up on sleep, and in the short term you may get less of it.

But the mechanism is not about tonight. It is about re-establishing what the bed means, so that you sleep better in the nights that follow instead of repeating this one. Lying there feels more restful in the moment, and that is precisely what keeps the problem going.

Where this sits in treatment

Stimulus control works best as part of multicomponent CBT-I, which is the only treatment carrying a strong recommendation in the AASM's 2021 guideline. On its own it drops to a conditional recommendation.1

Pairing it with sleep restriction is particularly effective. When the sleep window is narrow and sleep pressure is high, you fall asleep quickly on returning to bed. Run stimulus control without it and you can end up out of bed for long stretches.