Can’t sleep? When to get out of bed

Key takeaways

• Yes, get up if you’re awake and frustrated. Behavioral sleep guidance says to leave the bed once you’ve been awake for roughly 15 to 20 minutes, and to go back only when you feel sleepy.

• “20 minutes” is a rule of thumb. Sources give figures between 15 and 30 minutes, and the AASM guideline gives none.

• Keep it quiet and dull while you’re up. Stick to calming activities. Eating, work, phone calls, and exciting shows can wake you up.

• The evidence is real but modest. The American Academy of Sleep Medicine (AASM) rates its support for stimulus control as low-certainty, even though older reviews found it among the most effective single techniques.

• If it happens most nights for months, talk to a doctor. Chronic insomnia has treatments, and the first-line one is a structured program called CBT-I.

The short answer

If you’ve been lying awake for around 20 minutes and you’re getting frustrated, get out of bed. Go to another room if you can, do something calm, and return to bed when you feel sleepy. If you’re still awake after another 20 minutes or so, repeat it.

That advice comes from a technique called stimulus control, part of cognitive behavioral therapy for insomnia (CBT-I). The number is a rule of thumb, and the evidence behind it is modest.

Where the “20 minutes” rule comes from

Stimulus control is built on a simple idea. In people with insomnia, the bed can become linked to lying awake and trying hard to sleep. A 2022 primer on CBT-I says other behaviors in bed “strengthen the association between one’s bed and wakefulness,” and that stimulus control aims to restore the bed as a cue for sleep. The Veterans Health Library puts it plainly. Staying in bed awake and frustrated can lead your body to link the bed with being awake and frustrated instead of being a place to sleep.

Those two sources describe a theory of how the habit forms. The rule is aimed at people with ongoing insomnia, though many people use it on an occasional bad night.

The full instruction set is short. The AASM’s 2021 guideline lists five instructions.

• Go to bed only when you’re sleepy.

• Get out of bed when you’re unable to sleep.

• Use the bed only for sleep and sex.

• Wake at the same time every morning.

• Avoid napping in the daytime.

The National Heart, Lung, and Blood Institute describes the same approach, saying it helps you have a regular sleep-wake cycle so you can link being in bed with being asleep, and includes getting out of bed if you cannot sleep.

How long is too long to lie there?

Sources disagree here.

• About 20 minutes. The Veterans Health Library says to leave the bed after being awake “for more than 20 minutes or so” and again after another 20 or so if sleep doesn’t come.

• 15 to 20 minutes. The 2022 CBT-I primer gives the instruction as getting out of bed if unable to sleep within 15 to 20 minutes.

• 15 to 30 minutes. A 2018 review of behavioral strategies says people are told to get up if they can’t fall asleep or get back to sleep after 15 to 30 minutes, and its sleep hygiene table uses 30.

• No number at all. The AASM guideline’s wording is “get out of bed when unable to sleep,” and it doesn’t set a number of minutes.

So 15 to 30 minutes is the working range, and a therapist can adjust it. None of these sources offers evidence that one cutoff beats another. All of them aim to cut down the time you spend awake and frustrated in bed.

What to do once you’re up

The Veterans Health Library gives the most detail, and the other CBT-I sources match its main points.

• Move to another room if you can. That separates the bed from the awake time.

• Do something calming. Its examples are listening to music, reading, or meditation.

• Skip anything that wakes you up. It names eating, using the computer, doing work, talking on the phone, and watching an exciting TV show.

• Don’t watch the clock. It says to guess the time in your head. Our post on why you wake up at 3am covers clock-watching in more depth.

• Go back when you feel sleepy. Go by how you feel, whatever the clock says.

Two more tips. A lamp is an easier choice than the overhead light. And your phone is the hardest item on the list to use calmly, because it hands you email, news, and messages, and a screen can keep your mind busy. Our post on whether blue light from your phone keeps you awake looks at the light itself. Stimulation is a separate problem.

What not to do

• Don’t lie there waiting it out. Staying in bed awake and frustrated is the habit stimulus control is meant to break.

• Don’t sleep in or nap to make up for it. The VA page says to wake at the same time each morning and avoid daytime naps. If you need a nap anyway, our post on the ideal nap length covers how short to keep it.

How strong is the evidence?

Better than a folk remedy, though the evidence is modest.

The old reviews were encouraging. A 1994 meta-analysis by Charles Morin and colleagues looked at 59 studies with 2,102 patients and found stimulus control and sleep restriction to be the most effective single therapy procedures, while sleep hygiene education was not effective used alone. A 2006 update covering 37 studies and 2,246 people listed stimulus control among five treatments that met criteria for empirically supported psychological treatment for insomnia.

The newer, stricter look is more cautious. The AASM’s 2021 systematic review found eight randomized trials of stimulus control alone. In diary data from four studies, sleep latency was 10.48 minutes lower after treatment, but the 95% confidence interval ran from 24.68 minutes lower to 3.72 minutes higher. Wake time after sleep onset, from three studies, was 18.98 minutes lower, with an interval from 41.78 minutes lower to 3.83 minutes higher. Neither met the review’s threshold for clinical significance, and the authors rated the evidence for those two outcomes low in quality because of imprecision and risk of bias. Remission was the exception. One trial reported a 19% higher remission rate, which the review counted as clinically significant. The guideline’s recommendation for stimulus control as a single treatment is conditional, worded “we suggest.”

Stimulus control is rarely used alone. In its 2016 guideline, the American College of Physicians recommends CBT-I as the first treatment for chronic insomnia disorder in adults, with a strong recommendation and moderate-quality evidence. A 2006 meta-analysis of 23 trials of behavioral interventions found moderate to large effects on self-reported sleep. That analysis was about behavioral treatment in general and not stimulus control specifically.

When it happens every night

An occasional bad night is common, and the advice above is for those. A pattern is a different matter.

The NHLBI describes chronic insomnia as occurring 3 or more nights a week, lasting more than three months, and not fully explained by another health problem. Other sources use different cutoffs, and MedlinePlus says chronic insomnia lasts a month or longer, so the exact line is less important than the pattern. If sleeplessness is regular, is affecting your days, or has gone on for weeks, it’s worth raising with a doctor, who can look for other causes and talk through options.

The NHS treatment page tells people to see a GP if changing their sleeping habits hasn’t helped or if they’ve had trouble sleeping for months. The NHLBI calls CBT-I a 6- to 8-week treatment plan and says it is usually recommended as the first treatment option for long-term insomnia. CBT-I is a package. Stimulus control is one piece, and sleep restriction, which limits the time you spend in bed, is another. Sleep restriction isn’t right for everyone, including people who drive or operate machinery for work, so a trained provider is the safer route for the stricter parts. This post can’t tell you whether what you have is insomnia, and the rule above isn’t a substitute for an assessment.

Caffeine can also keep you awake. Our post on how late you can drink coffee covers cutoffs.

Frequently asked questions

Should you get out of bed if you can’t sleep?

According to CBT-I guidance, yes, once you’ve been awake for roughly 15 to 20 minutes and feel frustrated. Do something calm elsewhere and go back when you feel sleepy. Sources differ on the exact number of minutes, so treat 20 as a starting point.

How long should you lie in bed before getting up?

Sources give figures between 15 and 30 minutes, and the Veterans Health Library says “20 minutes or so.” The VA also advises against watching the clock, so a rough sense of how long it’s been is enough.

What should I do when I get out of bed?

Pick something calming, like reading, quiet music, or meditation, ideally in another room with the lights kept low. The VA lists eating, working, using a computer, phone calls, and exciting TV shows as things that can wake you up, so skip those.

What if I can’t get back to sleep after getting up?

Come back to bed only when you feel sleepy. If you’re still awake after another 20 minutes or so, get up again. Keep your wake-up time the same the next morning, and avoid napping.

Is lying in bed awake bad for you?

The worry in CBT-I is the habit. Lying awake in bed over and over can link the bed with being awake, according to the VA. If it’s frequent, a doctor can help.

How many nights of poor sleep counts as insomnia?

Definitions vary. The NHLBI says chronic insomnia happens 3 or more nights a week for more than three months, and MedlinePlus says a month or longer. Only a health professional can tell you whether you have insomnia.