The problem with the 20 minute rule
People with chronic insomnia have often heard the advice to get out of bed if you can’t fall asleep within 20 minutes.
Inherently, this is not a bad idea. The recommendation comes from an evidence-based treatment for insomnia, known as stimulus control. The components of stimulus control are meant to break the association between the bed and wakefulness (known as conditioned arousal). That is, to make sure that when you get into bed, you don’t become wide awake and restore the association between the bed and sleep.
These recommendations include going to bed only when sleepy, not taking naps, getting out of bed the same time every night, and getting out of bed if sleep does not come within 20 minutes or so. Therefore, stimulus control effectively targets the causes of insomnia.
But sometimes, following this recommendation perfectly can be problematic. This is especially true when you wake up feeling very hyperaroused (i.e., feeling very anxious, in a fight-or-flight state) and sleep is unlikely to come within the next 20 minutes.
Below, I discuss why giving yourself 20 minutes to fall back asleep doesn’t always work.
More time to worry when we are in bed
When we give ourselves more time to try to sleep when we are not sleepy, this is a simple formula for time in bed spent worrying. We may ruminate about why we woke up again, be frustrated about the fact that we couldn’t stay asleep, and think about all the things we have to do in the daytime. These thoughts and feelings can add to the conditioned arousal that we are trying to break.
Importantly, thinking about the 20-minute period puts added pressure on our need to fall asleep within that time frame.
“I need to fall asleep now or I have to get out of bed”, “I only have 20 minutes to do this”. These thoughts create distress and may cause the person to ‘white-knuckle’ getting back to sleep. Unsurprisingly, this generates even more anxiety about sleep, making sleep get further away.
Not building additional pressure for sleep
When we stay in bed, we are not building a lot of pressure for sleep. Our sleep pressure is what makes us sleepy and provides us the deep restorative sleep that we need.
Getting out of bed when we know is sleep is unlikely to come can help to give us a head-start in getting back to sleep by building up sleep pressure.
Moreover, by getting out of bed quickly, we can avoid the distress of lying in bed, which can further mask our sleep drive because we are so anxious about getting back to sleep. By releasing our need to sleep, we may be able to notice our feelings of sleepiness quicker.
It’s a less enjoyable experience
Assuming you were going to be awake for the next hour no matter what, what would you rather be doing? Lying in bed in distress and hoping for sleep that will never come? Or getting out of bed and enjoying an episode of Friends or getting back to the Hitchhiker’s Guide to the Galaxy that you started but put aside for the past 6 months?
In addition to breaking the conditioned arousal and increasing pressure to sleep, accepting that we are getting out of bed makes for a much more pleasant experience. In such a way, being awake in the middle of the night becomes a much less scary experience and may even become somewhat fun (okay, fun might be a bit of a stretch).
How do I decide to get up or stay in bed then?
Truthfully, you know yourself best. And most people can get a sense of whether they are truly sleepy and know that sleep will come back or not. If you believe that sleep is likely to come and you are feeling sleepy, then definitely stay in bed!
However, if you know that you just woke up feeling very alert and there’s a good chance that sleep is unlikely to come (and it’s more of a wish at this point), then perhaps it’s time to cut our losses and get out of bed.
It’s tough at first, but try to change your perspective from “Ugh, I can’t handle not getting sleep again. I don’t want to go outside. It’s just going to make me feel terrible. Maybe there’s a chance that I can fall asleep” to “Yes, there may be a small chance that I do fall asleep. But the most likely thing that is going to happen is that I’ll stay in bed feeling stressed out for a few hours. This is a nice chance for me to catch up on a show that I’ve been too busy for. Once I’m sleepy, I’ll back to bed then. It’ll be more enjoyable, and I know it’s good for my future sleep”.
I hope this post was helpful in learning more about using stimulus control in the nighttime!
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Best wishes,
P
Simply Mental Health 