If you can't fall asleep, get out of bed

Why trying to lie in bed longer backfires

Key points in 30 seconds

1. The brain remembers places and states as pairs. When nights of tossing and turning wide awake in bed keep repeating, the bed gets learned as "the place where your mind becomes sharp the moment you lie down."
2. So treatment goes the opposite way. It's not about lying in bed longer but about rebuilding the link between bed and sleep.
3. The first rule is to use the bed only for sleep. If you haven't fallen asleep after 15–20 minutes of lying down, get out of bed. Go back when you feel sleepy again.
4. The second rule is to actually cut down the time you spend lying in bed. The idea is to pack thin, spread-out sleep into a shorter, deeper block.
5. However, you shouldn't decide how much to cut on your own. Daytime sleepiness can become dangerous, so there's a lower limit, and the amount is set after looking at a 1–2 week sleep diary.

What we often hear

• "I went to bed an hour early to get to sleep early, and it came even less."
• "I lie there for two or three hours before I finally drop off."
• "I sleep fine at other people's places, just not in my own bed."
• "The harder I try to sleep, the further away it seems to run."

Lying in bed longer is making insomnia worse

Tonight I'm definitely going to bed early. So you lie down an hour earlier than usual.

But your eyes are wide open, you toss this way and that, and when you check the clock, an hour has already passed. The more you think "I have to sleep, I have to sleep," the further sleep runs away. You hold out for two or three hours before you finally drop off, and the next day you make the same resolution: tonight I'll go to bed even earlier.

This is the most common effort people with insomnia make: lying in bed longer.

And it's also the very first habit insomnia treatment corrects.

Your bed is being learned as "the place where sleep doesn't come"

Our brain remembers places and states as pairs. Like how sitting at the dinner table makes you hungry, and sitting at your desk makes you think about work.

But when nights of tossing and turning in bed keep repeating for months, the brain learns this about the bed: this is the place where your mind becomes sharp the moment you lie down.

Some people say they actually sleep well at other people's homes or on the sofa, but not in their own bed. That's a sign this learning has taken place.

So treatment goes the opposite way. It's not about staying in bed longer but about rebuilding the link between bed and sleep. The bed retraining I'll describe now makes up the two pillars of the treatment called cognitive behavioral therapy for insomnia (CBT-I).

Pillar one: the bed is only for sleep

The rules are simple.

Lie down in bed only when you're sleepy. Don't do anything in bed except sleep. That includes your phone, TV, and worrying about work. And if you haven't fallen asleep after 15–20 minutes of lying down, get out of bed.

Do something boring in the living room, and go back to bed when you feel sleepy again. Repeat as many times as needed.

No matter what time you fell asleep at night, keep the same wake-up time every morning.

The key is to get rid of the time you spend lying awake in bed, holding out. The first few days you may be more tired from going back and forth. As you get through those few days, the brain learns again: the bed is the place where you fall asleep the moment you lie down.

Pillar two: actually cut down the time you lie in bed

Here's a useful number: the time you actually slept divided by the time you lay in bed. Put simply, the share of your time in bed that you really spent sleeping.

If you lay in bed for eight hours and slept for five, this figure is in the 60s (percent).

If this figure is below 85%, we cut the time in bed itself down to close to the time you actually sleep. The idea is to compress sleep and raise its density. Once thin, spread-out sleep packs into short, deep sleep, we then extend time in bed again, little by little.

This part you shouldn't decide on your own

There's a condition that always comes with the cutting-down method.

Cutting down too hard on your own can make daytime sleepiness dangerous. So time in bed is not to be cut below a certain level, roughly the five-hour range, and the amount to cut is set based on a 1–2 week sleep diary.

You can use the general direction at home. But how much and how fast are things to decide together.

How we use this in our clinic

First, we look for the cause and the pattern. With a 1–2 week sleep diary, you write down when you lay down, when you fell asleep, how many times you woke up, and when you got up, so we can see the actual shape of your sleep. Along with this, blood tests, brain wave (EEG) tests and body composition tests, plus abdominal and pulse diagnosis, help us look at the bodily reasons your alertness won't switch off. If snoring or sleep apnea is suspected, pointing you to a facility that can do a sleep study (polysomnography) comes before retraining.

Next, we retrain while switching off alertness. We work on tension built up during the day with acupuncture and pharmacopuncture, and restore your disrupted rhythm with herbal medicine matched to your test results, while designing the bed retraining above together, at an intensity that fits your life. Treatment that switches off the body's alertness and training that fixes what the bed has learned need to go together; that makes the road shorter than doing either one alone. The order in which we look at insomnia is laid out in our insomnia care page.

Then we check with numbers. We look together at whether the figure from your sleep diary, recorded before treatment, goes up. By the records, not by feel. We don't treat without evidence.

If you're taking sleeping pills

Don't stop on your own. Stopping suddenly can make insomnia worse, so any adjustment should be decided in consultation with whoever prescribed them.

Retraining can start even while you're taking medication. Cutting down is covered separately.

You can start tonight

A bed where you fall asleep as soon as you lie down. A night when you pull up the covers without calculating whether you'll be able to sleep tonight.

What we aim for is a bed that's on sleep's side again.

The pace and intensity of retraining vary from person to person, depending on the state of your sleep and your living situation. But what you can start tonight is the same for everyone: if sleep won't come, don't hold out. Get up.

If you're still wide awake 20 minutes after lying down, try doing the opposite tonight. And if those nights have been repeating for weeks, bring your diary in. We'll set the amount and pace with you.

For questions or appointments, message us in English through the messenger at the bottom right of the page, or call +82-53-716-1175.

The story of insomnia where you wake up during the night being its own kind is in the director's column Waking up during the night is insomnia too, and how what to look at changes depending on when you wake up is in Waking at 3 a.m. and waking at 5 a.m. are not the same.