The Quick Answer
Sleep specialists suggest the 20-minute rule: if you are not asleep after about 20 minutes (going by how it feels, not the clock), get out of bed and do something relaxing until you feel sleepy, then return. A five-minute to-do list helped people fall asleep faster in one study. If it happens three nights a week for three months, that's chronic insomnia, and CBT-I is the first-line treatment.
In this article
It is the middle of the night, and you have been lying in bed for what feels like hours. First, you are far from alone. The American Academy of Sleep Medicine reports that 30% to 35% of adults have brief symptoms of insomnia. Second, sleep specialists describe a well-studied step that may sound surprising: getting out of bed. Here is what that means, what else helps, and when it is worth talking with a provider.
Key takeaways
- The 20-minute rule: if you are not asleep after about 20 minutes, sleep specialists suggest leaving bed for something relaxing and returning when you feel sleepy.
- Go by how long it feels, not the clock. The AASM guidance says to leave after you perceive about 20 minutes awake, rather than watching the time.
- A five-minute to-do list helped 57 young adults fall asleep about nine minutes faster in one sleep-lab study.
- You cannot force tiredness, but daytime habits such as exercise, morning light, and caffeine timing can help.
- If it happens three nights a week for three months, talk with a provider. CBT-I is the first-line treatment for chronic insomnia.
Why lying awake in bed can make it harder
Most people need about 10 to 20 minutes to fall asleep. Cleveland Clinic's behavioral sleep specialist adds that this is only an average. It becomes a problem only if it keeps you from enough sleep or causes stress.
Lying in bed awake for a long time can also make the next night harder. The AASM's clinical guideline explains that long stretches awake in bed can link the bed with wakefulness, frustration and worry. The AASM's patient guide describes how people begin to dread bedtime, expecting to toss and turn for hours.
The 20-minute rule
The step sleep specialists describe is called stimulus control. It is one part of cognitive behavioral therapy for insomnia, or CBT-I. The AASM guideline lists its instructions. They include going to bed only when sleepy, keeping a regular schedule, skipping naps and using the bed only for sleep. If you cannot fall asleep within 20 minutes, the instruction is to get out of bed. You do something relaxing until you feel drowsy, then return to bed, and repeat as needed.
The guideline adds that the 20 minutes is perceived time. People are advised to leave bed once they sense about 20 minutes have passed, rather than watching the clock. The AASM patient guide also suggests doing something else relaxing after about 20 minutes. Cleveland Clinic's CBT-I page describes the same idea as the 15- to 20-minute rule and suggests planning ahead for what you will do after you get up.
When your mind will not slow down
Racing thoughts are a common reason for lying awake. In a 2018 sleep-lab study, 57 healthy adults aged 18 to 30 spent five minutes writing before bed. Those who wrote a to-do list fell asleep significantly faster than those who wrote about tasks they had completed. The difference was about nine minutes, and more specific lists went with faster sleep.
The researchers noted that they studied healthy young adults, so it is not known whether the results apply to people with insomnia. Relaxation therapy also has support. The AASM 2021 guideline gives a conditional recommendation for it as a single therapy for chronic insomnia. Cleveland Clinic's specialists suggest a relaxing routine such as a bath, reading or meditation.
How can you make yourself tired?
You cannot force tiredness, but a few things build the drive to sleep and steady your body clock. Sleep pressure depends on how long you have been awake and on the time of day. The table below shows what studies found for daytime habits.
| Habit | What studies found | Note |
|---|---|---|
| Regular exercise | Small-to-medium benefit for time to fall asleep in a meta-analysis of 66 studies | Kredlow 2015 |
| Warm bath or shower, 1 to 2 hours before bed | About 10 minutes shorter time to fall asleep in a review of 17 studies | Haghayegh 2019 |
| Bedtime to-do list | About 9 minutes faster in a lab study of 57 healthy young adults | Scullin 2018 |
| Caffeine timing | 400 mg six hours before bed cut total sleep by more than an hour | Drake 2013 |
| Naps | Avoiding naps is part of the AASM stimulus-control instructions | AASM guideline |
| Consistent wake time and morning light | Suggested by Cleveland Clinic's sleep specialists | No trial of its own |
Cleveland Clinic's specialist also suggests not getting into bed until you are actually sleepy, which fits the stimulus-control instructions.
Why can't I get comfortable?
If the problem is getting comfortable, several things can play a part. Cleveland Clinic notes that being too hot can disrupt sleep and that 60 to 67 °F (15 to 19 °C) is the range it suggests for the bedroom. A behavioral sleep specialist there also notes that restless legs syndrome can affect how long it takes to fall asleep. The Sleep Foundation notes that people in pain or discomfort often have difficulty getting deep sleep. If discomfort keeps returning, a healthcare provider can help find the cause.
When lying awake is more than a rough night
Occasional bad nights are common. The AASM describes chronic insomnia as occurring at least three times a week for at least three months, and it estimates that about 10% of adults have it. In that case, the American College of Physicians recommends CBT-I as the initial treatment, and the AASM guideline gives it a strong recommendation. CBT-I typically takes four to eight sessions.
Cleveland Clinic notes that stress is one of the main causes of insomnia. If worries or low mood are keeping you awake, a provider can help with that as well.
Good to know
If you often lie awake, feel very sleepy in the day, snore loudly or notice leg discomfort at night, a healthcare provider can help look for causes. Many medicines can affect sleep, and Cleveland Clinic suggests telling your provider if you notice sleep changes after starting one, rather than stopping it on your own. If you are pregnant, nursing, take prescription medicines or have a health condition, it is a good idea to check with your provider before trying anything new.
If you would like to try one thing tonight
If you would like to try one thing tonight, the best-supported step is the 20-minute rule, with a consistent wake time the next morning. Choosing in advance where you will go and what you will do can make it easier to follow through. If the same pattern continues for weeks, a provider trained in CBT-I can guide the rest.
The short version
Sleep specialists suggest that when you have been awake about 20 minutes, you leave bed for something relaxing and return when you feel sleepy. A short to-do list before bed and steady daytime habits may help too. If lying awake happens three nights a week for three months, CBT-I is the first-line treatment, and a provider can help you find it.
Frequently asked questions
What should I do if I have been lying in bed for hours and can't sleep?
Sleep specialists suggest getting out of bed once you perceive about 20 minutes awake, doing something relaxing in low light, and returning when you feel sleepy. You can repeat this as needed. Keeping a consistent wake time the next morning is part of the same approach.
Is it okay to stay in bed and rest if I can't sleep?
We did not find studies that compare staying in bed with getting up on an occasional bad night. The AASM's guidance for chronic insomnia suggests leaving bed after about 20 minutes so the bed stays linked with sleep. It advises going by how long it feels rather than watching the clock.
How can I make myself tired at night?
You cannot force tiredness. Sleep pressure builds with time awake, and regular exercise, morning light, avoiding late naps and keeping caffeine early may help. A five-minute to-do list before bed helped healthy young adults fall asleep about nine minutes faster in one study.
Why can't I get comfortable to sleep?
Temperature, pain and restless legs can all play a part. Cleveland Clinic suggests a bedroom at 60 to 67 °F, and it notes that restless legs syndrome can affect how long it takes to fall asleep. If discomfort returns often, a healthcare provider can help find the cause.
How long should it take to fall asleep?
Most people fall asleep in about 10 to 20 minutes, according to Cleveland Clinic's sleep specialist. It is an average, and it varies from person to person. It becomes a concern mainly when it keeps you from enough sleep or causes stress.
When should I see a doctor about not being able to sleep?
Chronic insomnia means trouble sleeping at least three times a week for at least three months, with daytime effects. Talk with a provider sooner if you feel very sleepy in the day, snore loudly or have leg discomfort at night. CBT-I is the first-line treatment for chronic insomnia.
References
- Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008;4(5):487–504. (Stimulus-control instructions, Table 11.) Link
- American Academy of Sleep Medicine. Cognitive behavioral therapy. Sleep Education patient guide. Link
- Cleveland Clinic. Cognitive behavioral therapy for insomnia (CBT-I): what it is. Updated February 2026. Link
- American Academy of Sleep Medicine. New guideline supports behavioral, psychological treatments for insomnia. December 2020. Link
- AJMC. New AASM guidelines support behavioral, psychological treatments for insomnia. (Summary of Edinger et al., J Clin Sleep Med. 2021;17(2):255–262.) Link
- Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;165(2):125–133. DOI 10.7326/M15-2175. Link
- Cleveland Clinic. How long should it take to fall asleep? January 28, 2026. Link
- Cleveland Clinic Newsroom. How long should it take you to fall asleep. June 22, 2026. Link
- Cleveland Clinic. Here's how to get more deep sleep and REM sleep. May 9, 2025. Link
- American Academy of Sleep Medicine. Insomnia Awareness Day facts and stats. Sleep Education. Link
- Scullin MK, Krueger ML, Ballard HK, Pruett N, Bliwise DL. The effects of bedtime writing on difficulty falling asleep: a polysomnographic study comparing to-do lists and completed activity lists. J Exp Psychol Gen. 2018;147(1):139–146. DOI 10.1037/xge0000374. Link
- Denworth L. The connection between writing and sleep. Psychology Today. January 2018 (average difference in minutes). Link
- HealthDay. To-do list before bedtime prompts better sleep. 2018 (study limitations noted by the author). Link
- Zisapel N. New perspectives on the role of melatonin in human sleep, circadian rhythms and their regulation. Br J Pharmacol. 2018;175(16):3190–3199. PMC6057895. Link
- Kredlow MA, Capozzoli MC, Hearon BA, Calkins AW, Otto MW. The effects of physical activity on sleep: a meta-analytic review. J Behav Med. 2015;38(3):427–449. PMID 25596964; DOI 10.1007/s10865-015-9617-6. Link
- Haghayegh S, Khoshnevis S, Smolensky MH, Diller KR, Castriotta RJ. Before-bedtime passive body heating by warm shower or bath to improve sleep: a systematic review and meta-analysis. Sleep Med Rev. 2019;46:124–135. PMID 31102877; DOI 10.1016/j.smrv.2019.04.008. Link
- Drake C, Roehrs T, Shambroom J, Roth T. Caffeine effects on sleep taken 0, 3, or 6 hours before going to bed. J Clin Sleep Med. 2013;9(11):1195–1200. PMID 24235903; DOI 10.5664/jcsm.3170. Link
- Sleep Foundation. How to get more deep sleep: tips for a restful night. Updated March 12, 2026. Link
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