If you can't sleep, stop fighting it. The NHS and the American Academy of Sleep Medicine (AASM) suggest getting up after about 20 minutes, doing something quiet in low light, and going back to bed when you feel sleepy. Here is what to do when you can't sleep, what to avoid, and when to see a doctor.
Lying in bed trying harder rarely works. The NHS says to try not to force sleep. If you are comfortable and resting, you may drift off naturally. But if you are still awake after around 20 minutes, get up and sit somewhere comfortable, do something relaxing, and go back to bed when you feel sleepy. The AASM gives the same advice and adds that the activity should be quiet, without a lot of light, and not on electronics. Mayo Clinic also suggests doing something calming in dim light.
Why get up at all? The National Heart, Lung, and Blood Institute (NHLBI) describes an approach called stimulus control, part of cognitive behavioral therapy for insomnia (CBT-I). It helps you link being in bed with being asleep. It involves going to bed only when sleepy, getting out of bed if you cannot sleep, and using your bed only for sleep and sex.
Do not time the 20 minutes with a clock. A rough guess is fine. Watching the minutes tick by tends to make you more alert.
Read a paper book or magazine under a dim lamp.
Do some gentle stretches or easy yoga.
Listen to quiet music or a calm audiobook at low volume.
Try slow breathing: in through your nose and out through your mouth, counting to 5 each way.
Write down whatever is going round in your head, then close the notebook.
Do a boring, low-light task, such as folding laundry.
Keep the lights low and skip anything exciting. When you yawn or your eyes feel heavy, go back to bed.
Do not watch the clock. The NHS suggests keeping clocks out of view and placing your phone face down.
Do not pick up your phone. The AASM says it is especially important not to get on electronics. More in this guide to blue light and sleep.
Do not reach for caffeine, alcohol or nicotine. The NHS suggests avoiding alcohol, tea and coffee for at least 6 hours before bed.
Do not sleep in the next morning. The NHS advises sticking to your regular hours after a bad night instead of sleeping in.
Do not take long daytime naps. The NHS insomnia advice is to avoid napping during the day. Mayo Clinic suggests keeping any naps short and early.
Do not start a sleep aid without advice. The NHS says pharmacy sleep aids cannot cure insomnia and should only be used for a short time. NHLBI notes that research has not proven melatonin to be an effective treatment for insomnia. Check with your doctor or pharmacist first.
A rough night is a good prompt to check your habits. The NHS and AASM both suggest:
Get up at the same time every day, even after a bad night and on weekends.
Only go to bed when you feel sleepy.
Relax for at least an hour before bed, for example with a bath or a book.
Keep your bedroom dark, quiet and comfortable.
Exercise regularly during the day, not right before bed.
For a full list, see this sleep hygiene checklist. If your problem is waking in the small hours rather than falling asleep, this guide to waking up at night covers that.
The NHS calls insomnia short-term if it lasts less than 3 months and long-term if it lasts 3 months or longer. It suggests seeing a doctor if:
changing your sleeping habits has not helped
you have had trouble sleeping for months
your insomnia is affecting your daily life in a way that makes it hard to cope
Also talk to a doctor if you snore loudly or your breathing stops and starts in your sleep, or if you feel sleepy while driving. The NHS says not to drive when you feel sleepy.
Help works. NHLBI says CBT-I is usually recommended as the first treatment for long-term insomnia and can be very effective. It is a 6 to 8 week plan that can be done in person, by phone or online.
This is general information, not medical advice. Talk to your doctor or pharmacist about your own situation.
Not for long. If you are still awake after about 20 minutes, get up, do something quiet in dim light, and return when you feel sleepy.
Use the same approach. Keep the lights low, avoid your phone, and if you are wide awake after about 20 minutes, get up for a quiet activity until you feel sleepy again.
Talk to your doctor or pharmacist first. NHLBI says research has not proven melatonin to be an effective treatment for insomnia, and it can have side effects such as daytime sleepiness and headaches.
Usually not. Mayo Clinic says occasional sleepless nights are normal. If you often have trouble sleeping, contact a health care provider.
Sleepward: Bedtime Routine has white, pink and brown noise with a sleep timer you can start before lights out, and a private Brain Dump for writing down what is on your mind earlier in the evening. It does not score or grade your sleep and it is not a medical device, so it is no substitute for talking to a doctor about insomnia. It is free to download with optional Pro purchases.
Get Sleepward free on the App Store
How to fall asleep faster and sleep better (NHS Every Mind Matters)
Healthy Sleep Habits (Sleep Education, American Academy of Sleep Medicine)
Insomnia: Treatment (National Heart, Lung, and Blood Institute, NIH)