Don't Lie Awake in Bed at Night

This is it. In 30 days of lessons to improve your sleep, this is the one you print out and hang above your desk. This is the one you e-mail to your family and share among your social networks. This is the lesson that, once mastered, will guarantee you sleep better for the rest of your life. It is simple, common sense, and the heart of it all: Don't lie awake in bed at night. Learn how insomnia can improve by avoiding time spent lying awake in bed at night.

Insomnia Worsens With Time Spent Awake in Bed

Insomnia is difficulty falling or staying asleep or an adequate amount of sleep that is not refreshing, in the absence of another sleep disorder. It is characterized by feeling "tired but wired," a sense of fatigue or exhaustion with an inability to sleep, especially during daytime naps. It may run in families. It may be provoked by periods of stress, but it may simmer beneath the surface for years, waiting to raise its ugly head. Once begun, changes may occur that perpetuate the effects. No matter how it manifests, it nearly always includes lying awake in bed at night.

What happens when an insomniac lies awake at night in bed? This is time that is not spent sleeping, which is a source of endless aggravation. Inevitably, sleep becomes a focus of attention and a source of tension. Questions flood a racing mind: "Why can't I sleep? What is wrong with me? Why can't I turn off my mind?" Anxiety inevitably builds as concerns turn to the effects on the next day. When sleep is pursued, it becomes a struggle. Sleep is evasive, fleeting in pursuit. You cannot strive to sleep. You have to give up the struggle.

Control Your Insomnia by Limiting Time Spent Awake in Bed

If you cannot fall asleep within 15 to 20 minutes, you should leave your bed. This is called stimulus control. Move to another place where you can recline and engage in relaxing activities while waiting for sleepiness to come. These activities should not be stimulating or rewarding. Avoid computers and television, and instead choose to read a boring book or an old magazine. You may choose to stretch or breathe slowly, allowing any tension to dissipate. Only when you feel drowsy or sleepy—your eyelids getting heavy, lingering in closure—only then do you return to bed. You must only go to your bed when you feel sleepy and periods of wakefulness must be truncated.

What happens if we stay in bed while awake? We learn to associate our beds with wakefulness and perhaps even tension or anxiety. Those with insomnia must break a negative association with the bed: "That is the awful place where I struggle to sleep." Pavlov was famous for his dogs. He would ring a bell while feeding them, the food initially prompting salivation. In time, a bell alone, without food, would lead to salivation. This is a conditioned response. Similarly, those with insomnia may develop a negative association with the bed. This must be extinguished and in its place, it is necessary to re-establish the relationship of bed with sleep.

Too Much Time in Bed Worsens Insomnia

Many people with insomnia will try to get as much sleep as they can manage. If difficulty falling or staying asleep starts to erode away the total amount of sleep a person gets, it is natural to extend the opportunity to sleep. Why not go to bed early or sleep in to catch up? If you spend hours awake in the night, it makes sense to try to balance this out by spending more time in bed. Unfortunately, this is the opposite of what should be done. Going to bed early will lead to more time spent awake before falling asleep as you will diminish your desire for sleep and disrupt your circadian rhythm. By staying in bed longer into the morning, you will spend some of this time sleeping, which will make it harder to fall asleep the next night for the same reasons. Sleep consolidation works by harnessing your ability to sleep, and lying awake in bed at night undermines it.

For those with insomnia, the cure you seek is entirely within your grasp: Don't lie awake in bed at night. There can be hurdles to mastering this simple advice, however. It is sometimes necessary to incorporate additional lessons to facilitate the change, including the management of thoughts, behaviors, attitudes, and emotions linked to sleep. It can be especially helpful to have a guide in this journey, such as a sleep doctor or a trained cognitive behavioral therapist who specializes in insomnia. You have the ability to reclaim your sleep; we can help.