Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.
Getting enough sleep (>7 hours) is essential for optimal physical and mental health. [1,2]
While most people think of insomnia as an inability to fall asleep, maintenance insomnia involves difficulty staying asleep or early morning waking, which is more common in older adults because of age-related changes in the circadian rhythm. 
Keep reading to learn about five strategies to overcome maintenance insomnia and get back to sleep.
1) Don’t Try to Sleep
Trying not to sleep may sound counterintuitive as getting to sleep is precisely the goal.
Hormones, such as melatonin and cortisol, are produced by the hypothalamic-pituitary-adrenal (HPA) axis, which regulates sleep and reactions to stress. 
Those who experience maintenance insomnia have an imbalance in the production of these hormones, which is further exacerbated by additional stress that’s linked to difficulty sleeping.
Alternately, remaining awake in bed, when you should be sleeping, leads to the body associating the bedroom with wakefulness. The longer you lay in bed, night after night, the stronger this association becomes.
2) The 20-Minute Rule
The first goal is to associate the bedroom and bed with sleep and restfulness; lying there stressed about an inability to sleep has an opposite effect on your body. If you haven’t fallen back asleep after 20 perceived minutes, it’s time to take a break.
Start by removing yourself from the bedroom. Get up, go to another room, preferably with little to no light exposure, and do a quiet activity.
Quiet activities that allow you to remain passively awake, and don’t involve digital devices, are best. Work on a puzzle, draw, or read a book. Once drowsiness sets in, return to the bedroom prepared to sleep.
It’s important to differentiate between drowsy and tired, meaning your eyes become heavy, your start to yawn, and it becomes increasingly difficult to remain awake. It’s at this point that you should head back to bed to try and sleep.
3) Manage Unhealthy Thoughts
Cognitive distortions include racing thoughts, black-and-white thinking, magnification of problems, and negative thinking. They have the power to disrupt sleep by increasing anxiety and preventing relaxation, which is the first phase of sleep.
Thankfully there are strategies to help redirect unhealthy thoughts and ease your mind into a state of relaxation. Here are two of the more popular methods:
- Distract your Mind
The stillness of the night is the ideal environment for thoughts and worries to play out in the theater of your mind.
In this instance, distraction is vital. Instead of ruminating, interject another topic to distract yourself. It can be anything, the more mundane the better as emotionally charged topics should be avoided.
If this tactic doesn’t work, up the ante and visualize a stop sign to prevent the thought from taking over your mind. Some people find it beneficial to vocalize the word stop.
- Jot it Down
If you cannot stop ruminating at night, pull out a notebook and jot down pressing thoughts, and slam the book closed. The next day, set aside time to review what was written, and come up with a plan of action, which can consist of bullet points and lists. Taking control of worries and stressors is an empowering feeling, helping to deconstruct magnified thoughts and fears.
4) Relaxation Techniques
Progressive Muscle Relaxation
Progressive muscle relaxation is used for various conditions, including anxiety, pain management, insomnia, and other sleep disorders. [5,6,7]
First described nearly 100 years ago, progressive muscle relaxation was based on a concept called neuromuscular hypertension, which ascribes negative psychological states to excessive muscle tension. 
Progressive muscle relaxation aims to disrupt that process.
The technique has been modified over the years, and while the reason this technique works remains poorly understood, it has proven to be beneficial for a variety of conditions. 
One recent study found that progressive muscle relaxation was able to decrease anxiety and improve sleep quality for COVID-19 patients during isolation. 
Calming visualization is the last strategy aimed to relax the body and distract you from trying to sleep. It alleviates worry, rumination, or other intrusive thoughts by transporting one to a new, calmer location within the mind. Here are three quick steps to get started:
- Prepare the environment for sleep
- Close your eyes and envision a calming location, like a beach, river, or forest
- Visualize the appearance of a location with as much detail as possible, like waves crashing to the shore and sand stretching on for miles
- Try to engage all the senses
5) Grab a Snack
Caloric deficits, due to prolonged dieting or poorly timed intermittent fasting, negatively affect your ability to fall asleep and stay asleep. [11,12,13]
Go grab a snack. There are several sleep-inducing snack options. Carbohydrates are a good option as studies show that they regulate the circadian cycle. Here are some snack options with their benefit:
- Bananas are a natural relaxant
- Cherries and kiwi stimulate the natural production of melatonin
- Oatmeal contains tryptophan, which helps the body relax
Waking up and struggling to get back to sleep or waking too early can be stressful and frustrating. Utilize these techniques to tackle maintenance insomnia and get back to sleep. For those who continue to struggle to get back to sleep, a healthcare professional may be able to help.
- Consensus Conference Panel, Watson, N. F., Badr, M. S., Belenky, G., Bliwise, D. L., Buxton, O. M., Buysse, D., Dinges, D. F., Gangwisch, J., Grandner, M. A., Kushida, C., Malhotra, R. K., Martin, J. L., Patel, S. R., Quan, S. F., Tasali, E., Non-Participating Observers, Twery, M., Croft, J. B., Maher, E., … Heald, J. L. (2015). Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 11(6), 591–592. https://doi.org/10.5664/jcsm.4758
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- Patel, D., Steinberg, J., & Patel, P. (2018). Insomnia in the Elderly: A Review. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 14(6), 1017–1024. https://doi.org/10.5664/jcsm.7172
- Hirotsu, C., Tufik, S., & Andersen, M. L. (2015). Interactions between sleep, stress, and metabolism: From physiological to pathological conditions. Sleep science (Sao Paulo, Brazil), 8(3), 143–152. https://doi.org/10.1016/j.slsci.2015.09.002
- Valiente López, M., van Selms, M. K. A., Van Der Zaag, J., Hamburger, H. L., & Lobbezoo, F. (2015). Do sleep hygiene measures and progressive muscle relaxation influence sleep bruxism? Report of a randomised controlled trial. Journal of oral rehabilitation, 42(4), 259-265.
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- Ost L. G. (1987). Applied relaxation: description of a coping technique and review of controlled studies. Behaviour research and therapy, 25(5), 397–409. https://doi.org/10.1016/0005-7967(87)90017-9
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- Safi S. Z. (2015). A Fresh Look at the Potential Mechanisms of Progressive Muscle Relaxation Therapy on Depression in Female Patients With Multiple Sclerosis. Iranian journal of psychiatry and behavioral sciences, 9(1), e340. https://doi.org/10.17795/ijpbs340
- Xiao, C. X., Lin, Y. J., Lin, R. Q., Liu, A. N., Zhong, G. Q., & Lan, C. F. (2020). Effects of progressive muscle relaxation training on negative emotions and sleep quality in COVID-19 patients: A clinical observational study. Medicine, 99(47), e23185. https://doi.org/10.1097/MD.0000000000023185
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