Can't fall asleep or stay asleep? Why it happens, and a plan that works

When you can't fall asleep and can't stay asleep, you most likely have insomnia of both kinds at once, and it's very common: the two usually share the same engine, a body and mind that stay alert at night, plus habits (long time in bed, clock-watching, catch-up lie-ins) that keep the problem going after its first cause has gone. The best-tested fix isn't a pill or a tea. It's CBT for insomnia (CBT-I): one wake-up time, time in bed matched to the sleep you get, getting up when you can't sleep, and a set place for worry, held for 4 to 8 weeks.

Below: how to tell what you have, why falling asleep and staying asleep go wrong together, causes to rule out, what to do tonight, a 4-week plan with clock times, what to expect, and when to see a doctor.

Falling asleep, staying asleep, or both?

Sleep doctors split insomnia into three patterns. Most people with long-running insomnia have more than one.

Insomnia as a condition (insomnia disorder) means one or more of these at least 3 nights a week, for at least 3 months, despite having time to sleep, and it affects your day: tiredness, poor focus, low mood, irritability, mistakes (International Classification of Sleep Disorders, 3rd edition). Shorter spells, from a few nights to a few weeks, usually follow stress, illness or a change, and often settle on their own.

Insomnia is common. In a widely cited review of population studies, about a third of adults reported at least one insomnia symptom, and roughly 6 to 10% met the criteria for an insomnia disorder (Ohayon, 2002).

Why can't I fall asleep or stay asleep?

A model sleep researchers use, from Arthur Spielman (1987), explains it in three parts, and it's useful because it tells you what to change.

• What makes you prone. Some people are lighter sleepers, worry more, or have a body clock that runs late. You can't change this much, and you don't need to.
• What set it off. A stressful job, a loss, an illness, a new baby, a move, menopause, pain. This is usually where it starts.
• What keeps it going. The habits we form to cope: going to bed early, lying in, napping, lying awake for hours "resting", watching the clock, a drink to wind down, cancelling plans after bad nights. These feel like help. They're why insomnia carries on long after the trigger has passed.

The third part is where CBT-I works. Two mechanisms explain why falling asleep and staying asleep usually go wrong together:

• Thin sleep pressure. Sleep pressure, the drive to sleep, builds the longer you're awake. Spend 9 hours in bed to get 6 hours of sleep and it's spread too thin: you take longer to drop off and wake more in the night.
• A bed that means wakefulness. After weeks of lying awake, the bed itself becomes a cue for alertness. Many people with insomnia fall asleep on the sofa and wake up the moment they get into bed. The same thing happens at 3 a.m.

On top sits the worry: "If I don't sleep tonight, tomorrow will be a disaster." That worry raises alertness, which makes sleep less likely, which feeds the worry.

Rule these out first

Some causes need their own treatment. Check this list before you start.

Even when one of these is part of it, insomnia often becomes its own problem. Treating both works better than treating either alone.

What to do tonight

1. Go to bed only when you're sleepy, meaning eyelids heavy and head nodding, not just tired. Until then, stay up in low light doing something calm.
2. Turn the clock to the wall and put your phone outside the room or out of reach.
3. If you're awake for what feels like 20 minutes, at the start or in the night, get up. Go to another room with a lamp, do something quiet (a paper book, a puzzle, folding laundry), and go back when sleepy. Repeat as needed.
4. Get up at your set time tomorrow, however the night went. No lie-in.
5. No nap tomorrow, or 20 minutes before 3 p.m. at most.

Our guides go deeper on each part: what to do when you can't fall asleep, and how to stop waking up at night.

The plan: CBT for insomnia, step by step

CBT-I is the first treatment recommended for chronic insomnia by the American College of Physicians (2016) and by the American Academy of Sleep Medicine (Edinger and colleagues, 2021), ahead of sleeping pills, because its effects tend to last after treatment ends. Its main parts:

1. A sleep diary

Each morning, write roughly when you went to bed, how long it took to fall asleep, how long you were awake in the night, when you woke, and when you got up. Estimates are fine; don't watch the clock to fill it in. A week of this gives you your average sleep and your sleep efficiency (sleep time divided by time in bed).

2. A fixed wake-up time

Pick the time you need to get up and keep it 7 days a week. It's the anchor for everything else.

3. A sleep window that matches your sleep

Set time in bed to your average sleep, plus up to 30 minutes, but never less than about 5.5 to 6 hours. Count back from the wake-up time to get your earliest bedtime. Each week, if you're asleep for 85% or more of the time in bed, add 15 minutes by going to bed earlier. If below 80%, take 15 minutes off. Our sleep restriction guide covers the rules and safety.

4. Bed is for sleep

The stimulus control rules: bed only for sleep and sex, go to bed only when sleepy, get up after about 20 minutes awake, same wake-up time, no naps. See our stimulus control guide.

5. Calming the mind

A 15-minute worry time in the early evening, writing down concerns and a next step for each. A wind-down hour before bed with low light. Slow breathing or muscle relaxation in bed. Our guide on when your brain won't shut off has more.

6. Changing the thoughts about sleep

Notice beliefs like "I need 8 hours or I can't function" or "one bad night ruins my week". Test them against your diary: most people find they cope better on short nights than they predicted. Less fear of a bad night means less arousal at bedtime.

A worked example

Someone goes to bed at 10 p.m. and gets up at 7 a.m. (9 hours in bed). It takes about an hour to fall asleep and they're awake about 1.5 hours in the night. Their diary shows about 6 hours of sleep: 67% efficiency.

In week 2 they stay up until 12:30 in dim light, go to bed only if sleepy, and get up if awake for 20 minutes. If you want your own numbers rather than this example, the free 2-minute sleep quiz works out your sleep efficiency and a starting window from your answers.

What to expect, week by week

• Week 1: no change, just the diary. Many people find their sleep is better or worse than they thought.
• Weeks 2–3: the hardest part. You'll feel sleepier in the day as sleep pressure builds. Don't drive or use machines when drowsy. Falling asleep usually gets quicker first, then night wakings get shorter.
• Weeks 4–6: sleep starts to feel more solid. The window widens.
• Weeks 6–8: most of the gains are in. Keep the wake-up time and the get-up rule; they're your defence against a relapse after a stressful week.

In trials, CBT-I typically shortens the time to fall asleep and the time awake at night by a meaningful amount, and the gains hold up months later. Results vary person to person; some need a clinician to adjust the plan.

What about sleeping pills, melatonin and supplements?

• Prescription sleeping pills can help in the short term. Guidelines advise CBT-I first, and pills, if used, at the lowest dose for the shortest time, with a doctor. Don't stop a prescribed medicine abruptly.
• Melatonin mainly shifts the timing of your body clock. The American Academy of Sleep Medicine's medicines guideline (Sateia and colleagues, 2017) suggests against it as a treatment for insomnia in adults, as its effect on sleep is small. It's more useful for a late body clock or jet lag.
• Over-the-counter sleep aids (most contain antihistamines like diphenhydramine) are also suggested against in that guideline. They can cause next-day grogginess and, in older adults, confusion.
• Alcohol helps you fall asleep and breaks up the second half of the night. It makes the "can't stay asleep" side worse.

Mistakes that keep both problems going

• Going to bed early to "get a head start" on sleep
• Lying in or napping long after a bad night
• Lying awake in bed for hours
• Checking the clock or phone at night
• Trying hard to sleep. Sleep comes when you stop chasing it.
• Changing your whole life around sleep: cancelling plans, avoiding exercise
• Giving up on CBT-I in week 2, which is when it feels worst

When to see a doctor

• It's gone on 3 or more nights a week for 3 months, or it's hurting your work, driving, mood or relationships.
• Signs of sleep apnea: loud snoring, gasping, someone has seen you stop breathing, or you nod off in the day.
• Low mood, loss of interest, or anxiety most days. If you have thoughts of harming yourself, call or text 988 in the US, any hour.
• Pain, breathing problems, reflux, or bladder trouble that wakes you.
• You're pregnant, have epilepsy, bipolar disorder, or a job where sleepiness is dangerous: do sleep restriction only with a clinician.

A doctor can refer you for CBT-I with a trained therapist or recommend a digital CBT-I program. Ask specifically for "CBT for insomnia"; it's a defined treatment, not general advice.

Frequently asked questions

Why can't I fall asleep or stay asleep anymore?

Usually a trigger (stress, illness, a change in life or hormones) started it, and coping habits such as long time in bed, lie-ins and lying awake have kept it going. Rule out causes like sleep apnea, then work on the habits with CBT-I.

What is it called when you can't fall asleep or stay asleep?

Insomnia. Trouble falling asleep is sleep-onset insomnia, trouble staying asleep is sleep-maintenance insomnia, and having both is common. When it happens 3 nights a week for 3 months with daytime effects, it's called chronic insomnia disorder.

How long does it take to fix insomnia?

CBT-I usually takes 4 to 8 weeks. Falling asleep often improves first, within 2 to 3 weeks; night waking usually follows.

Can you fix insomnia without medication?

For many people, yes. CBT-I is the first treatment guidelines recommend, ahead of medication, and its benefits tend to last after it ends.

Is it bad to lie in bed awake if I'm resting?

Now and then, no. Night after night, yes: it teaches your brain that bed is a place for being awake. Get up after about 20 minutes and come back when sleepy.

Should I stay up later if I can't sleep?

If you're in bed much longer than you sleep, yes: a later bedtime that matches your actual sleep makes sleep deeper and more solid. Keep the wake-up time fixed and widen the window as sleep improves.

Start this week

Start the sleep diary tonight. Choose one wake-up time and keep it every day. Go to bed only when sleepy, get up after about 20 minutes awake, and turn the clock away. After 7 nights, work out your window as in the example. For your starting numbers in 2 minutes, take the free sleep quiz. Related: why you wake up every 2 hours, waking up too early, and all our sleep guides.

Sources: American Academy of Sleep Medicine, International Classification of Sleep Disorders, 3rd edition, 2014. Ohayon MM, Epidemiology of insomnia: what we know and what we still need to learn, Sleep Medicine Reviews, 2002. Spielman AJ, Caruso LS, Glovinsky PB, A behavioral perspective on insomnia treatment, Psychiatric Clinics of North America, 1987. Qaseem A et al., Management of chronic insomnia disorder in adults, American College of Physicians, Annals of Internal Medicine, 2016. Edinger JD et al., Behavioral and psychological treatments for chronic insomnia disorder in adults, AASM, Journal of Clinical Sleep Medicine, 2021. Sateia MJ et al., Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults, AASM, Journal of Clinical Sleep Medicine, 2017. Harvey AG, A cognitive model of insomnia, Behaviour Research and Therapy, 2002. Riemann D et al., European guideline for the diagnosis and treatment of insomnia, Journal of Sleep Research, 2017. 988 Suicide and Crisis Lifeline, 988lifeline.org. This guide is education, not medical advice.