[Ellen N]

I know when I wake up in the middle of the night and can’t sleep I should get out of bed. But I don’t want to! It’s cold and dark and I would rather toss and turn. Any advice?

[Glynis]

I smiled when I read your post. I have a similar except that it is summer where I live and I only have air-conditioning in my bedroom. So if I have to get up in the night, I have to leave a nice cool room and go into the stinking hot house!
I chose to do the same thing as you (stay in bed) when I woke up in the early hours one night last week and couldn’t go back to sleep.
Maybe you could leave a lamp on and have a blanket ready for you to use if you have to get up at night.

[delv-x]

To many who are doing CBT-i, this is often the mystery question and often thinking about stimulus control perpetuates further sleep troubles. You may want to try something like this if you are dealing with sleep maintenance.

When you wake up, deal with anything you need to such as a sip of water or bathroom break. Head back to bed and rest. Often if you are sufficiently sleepy, you will fall back asleep. If it’s been what you think has been half an hour and sleep does not appear to be on the horizon, then it is better to get out of bed for a little while and do something relaxing like read.

The purpose of stimulus control is to break the association between wakefulness and the bed if that’s actually become a problem. SC is powerful to break the association however, to many, get scared that the association is severely broken especially if they have sleep anxiety. What is reassuring is that we’ve evolved through millions of years of evolution. You may have bouts of sleep maintenance troubles but staying in bed and resting if you are relaxed IS better than thinking about getting out of bed.

Get out of bed if you are anxious, alert, awake, been in bed for a bit and feel like sleep is not going to happen.

[jazzcat22]

I am just the opposite in that SC was my favorite part of CBTI! I kind of envy those of you who would prefer to stay in bed. It makes it harder for you to adhere to CBTI, but it also means that you are at least somewhat comfortable and relaxed in bed. The bed became such a stressor to me that once I had a panic attack (first one in 65 years!) walking back to the bedroom. Lying next to my husband while he sleeps is nice for about 5 minutes, but boring after that. I love mindfulness. I meditate during the day. I can do a little at night, but with what I do during the day, not a big impetus to do more, especially for hours. I truly would rather get up and read or listen to a podcast or do yoga than lie in bed. I have mostly made my peace with still-remaining challenges of falling and staying asleep, so it’s not that I need to practice more acceptance. I accept that I get bored in bed and that it just isn’t pleasing or productive for me to spend more than 5.5 hours in bed…and even less if I’m not sleeping. My problem is more that I often don’t even give myself 20 minutes before getting up to go into the sunroom and read.

But for you, Ellen, it sounds like you don’t have anxiety in bed. Possibly you can combine CBTI, like with the sleep window and other principles, with ACT, lying in bed not sleeping. But for me, I never would have made any progress without the SC because I would hate being in bed for longer than about 10 or 15 minutes without sleeping!

[Martin Reed]

Let me ask you this, Ellen — when you are in bed wide awake, tossing and turning, is that pleasant? If not, then getting out of bed might be a more appealing (and more constructive) alternative!

Sometimes it can be helpful to expect to be out of bed at night and to plan for this — you could leave the heat on in the living room and keep a little nest ready and waiting for you; maybe a book on a side table, a pile of cushions and blankets, perhaps a thermos with a warm drink, too?

Thank you to everyone who contributed to this topic — lots of excellent support and guidance here!

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