Getting Out Of Bed When You Cannot Sleep

The standard advice for a long stretch of lying awake is to get up. It seems perverse, and it follows directly from how associations are formed.

The bed acquires whatever happens in it

Repeated pairing of a place with a state creates an association. A bed used almost exclusively for sleep becomes a cue for sleepiness, and the effect is noticeable on entering it.

The same mechanism works in reverse. A bed that regularly hosts long periods of frustrated wakefulness becomes a cue for alertness.

This develops over weeks rather than a single night, which is why occasional bad nights do not cause it and a difficult month can.

Frustration is the active ingredient

Lying awake calmly is not the problem. What builds the unhelpful association is the effort of trying to sleep, along with the tension and clock-watching that come with it.

Trying is itself counterproductive, because sleep cannot be produced by effort. Increasing effort raises arousal, which moves the state further from sleep.

Getting up interrupts the cycle. It removes the person from the situation in which the trying is happening.

What to do once up

The aim is a quiet, dimly lit activity that occupies attention without demanding much: reading, listening to something undemanding, or a simple manual task.

Bright light and screens work against the purpose, as does anything that generates decisions or emotional engagement.

Returning to bed happens when sleepiness appears, not when a certain amount of time has passed. Going back while still alert reproduces the original situation.

Watching the clock makes it worse

Checking the time converts wakefulness into arithmetic about how little sleep remains. That calculation is reliably activating.

It also makes the night feel longer than it was, because remembered awake periods are weighted heavily and the sleep between them is not remembered at all.

Turning the clock away removes the input. There is nothing useful to be done with the information at that hour.

The limits of this approach

This is one element of a structured approach to insomnia that also involves how time in bed is scheduled. Used alone it helps some people and not others.

Where sleeplessness has persisted for months, is affecting daytime function, or is accompanied by low mood or anxiety, it warrants a proper assessment.

Sleep problems can also arise from pain, breathing disorders, medication and other conditions. A doctor is the right place to sort out which applies.