What to do when you can't sleep

Step 1. Stay in bed and lower your arousal

The first goal is to calm your body, not to fall asleep. Lie still in the dark and slow your breathing. Use whichever pattern you know best: a few physiological sighs, 4-7-8 breathing or box breathing. Two to five minutes is enough.

If your body feels tense, add a quick round of progressive muscle relaxation, tensing and releasing your hands, shoulders and face.

Keep your eyes closed and your position still. Small, constant adjustments to the pillow and blanket keep your body in an active mode. Pick a comfortable position, commit to it for a few minutes, and let the breathing do the work.

Step 2. Give your mind a neutral job

Once your breathing has slowed, thoughts often rush back in. Do not fight them; replace them. Pick a calm, slightly absorbing task, such as walking through a familiar street in your mind or picturing unrelated objects one after another, like in the cognitive shuffle.

A study by Harvey and Payne in 2002 found that people who used calm imagery when unwanted thoughts appeared before sleep fell asleep sooner than people given general distraction. Choosing what to think about works better than trying to think about nothing.

If the same worry keeps returning, tell yourself you will deal with it in the morning, and if needed, keep a notepad by the bed to jot one line in the dark.

Step 3. If you are still wide awake, get up for a while

If you have been lying awake for what feels like a long time, perhaps around twenty minutes, and you feel alert or frustrated, get out of bed. Staying put while getting angrier teaches your brain that bed is a place for struggling.

• Go to another room and keep the lights dim.
• Do something quiet and dull: read a paper book, fold laundry, listen to calm audio.
• Avoid work, email, news and social media.
• Go back to bed when your eyes feel heavy.

This is a core part of the stimulus control approach used in structured sleep programs. It can feel like the opposite of what you should do, but it protects your bed as a place for sleep.

Do not watch the clock while you are up either. Trust your body to tell you when it is ready. Heavy eyes, yawning and losing your place in a page are the signals to head back.

What not to do at 2 AM

• Do not check the clock repeatedly. Calculating hours left builds pressure. Turn the clock away.
• Do not start scrolling. Bright screens and new information wake you further.
• Do not raid the fridge for a big meal or reach for caffeine.
• Do not use alcohol to get back to sleep; it tends to fragment the rest of the night.
• Do not sleep in for hours. Keep your wake time steady so tomorrow night is easier.

If you are lying awake most nights, or the nights are affecting your days, talk to a clinician. Persistent sleeplessness is common and responds to structured help.