Waking up during the night is a common issue that affects people of all ages. According to studies, around 30-35% of adults experience some form of sleep maintenance insomnia, which involves difficulty staying asleep through the night. There are many potential causes for nighttime awakenings including stress, underlying health conditions, medication side effects, sleep disorders, environmental factors, and more. Understanding the root cause of your own night waking can help you and your doctor find solutions to achieve better quality, uninterrupted sleep.
Common Causes of Nighttime Awakenings
Stress and Anxiety
Stress, worry, and anxiety are some of the most prevalent triggers for middle of the night waking. Racing thoughts and rumination keep your mind overactive during a time when it should be at rest. The body’s fight-or-flight response may also become activated, releasing stress hormones that disrupt sleep. Try relaxation techniques before bed, keep a worry journal, and speak to a therapist if anxiety is significantly impacting your sleep.
Underlying Health Issues
Many health problems can interfere with getting a full night’s sleep. Conditions like asthma, allergies, acid reflux, arthritis, cancer, dementia, diabetes, heart disease, hyperthyroidism, restless leg syndrome, and more are associated with nighttime awakenings. Treat any underlying conditions appropriately to resolve symptoms keeping you awake.
Medication Side Effects
Some prescription drugs are stimulants or have side effects that make it hard to sleep through the night. Medications that commonly disrupt sleep include steroids, alpha-blockers, beta-blockers, ADHD medications, antidepressants, diuretics, and others. Check with your doctor if you suspect your night wakings may be linked to a medication you take. Adjusting the timing or dosage could help.
Poor Sleep Hygiene
Improper sleep habits and an unstable sleep environment also promote nighttime awakenings. Examples of poor sleep hygiene include inconsistent bedtimes, exposure to blue light before bed, exercising close to bedtime, and use of electronic devices in bed. Optimal temperature, darkness, quietness and comfort are also important sleep environment factors. Focus on good sleep hygiene and setting up an ideal sleep space.
Sleep Disorders
Many sleep disorders like insomnia, sleep apnea, restless leg syndrome and nighttime GERD directly cause multiple nightly awakenings. Other conditions like narcolepsy can involve a disrupted sleep cycle with frequent transitions out of REM sleep. Diagnosing and properly treating any existing sleep disorder will be key to sleeping through the night.
Aging
As we age, our sleep patterns and sleep architecture change. Older adults are more prone to nighttime awakenings due to a decreasing percentage of restorative deep NREM sleep and increased bathroom trips. Implementing good sleep habits can help minimize age-related night waking.
Disrupted Circadian Rhythm
When your body’s internal clock is thrown off its normal cycle, you may struggle to sleep soundly at night. Jet lag, shift work, inconsistent bedtimes, exposure to bright light before bed and lack of natural light during the day can all contribute to a disrupted circadian rhythm and impaired nighttime sleep. Focus on regulating your schedule, diet, light exposure and bedtime habits.
Alcohol
While alcohol may help induce sleep at first, it actually fragments sleep through the second half of the night. As alcohol is metabolized, it can cause awakenings due to its dehydrating and stimulatory effects. Limit alcohol intake in the evenings if you want to sleep undisturbed.
Diagnosing the Cause
Since there are many possible explanations for nighttime waking, take time to reflect on your symptoms and pinpoint any lifestyle factors or health issues that could be involved. Keeping a sleep diary for 1-2 weeks can provide helpful insights. Be sure to track details like:
- What time you go to bed
- Approximate times you wake up
- Total estimated sleep time
- Number of night wakings
- How long you are awake each time
- Reasons for waking up (bathroom, thirst, stress, pain, etc.)
- Food and fluid intake before bed
- Alcohol and medication use before bed
- Feelings of anxiety, pain, discomfort before bed
- Level of fatigue and sleepiness the following day
Looking for patterns around what times you wake up, associated factors, and next-day consequences can help identify potential causes to discuss with your physician.
Your doctor will also want to rule out any underlying health issues or sleep disorders. They may order blood work to check for conditions like anemia or thyroid problems. A sleep study can help diagnose issues like sleep apnea. A referral to a sleep specialist or psychologist may be recommended as well.
Medical Treatment Options
If an underlying health condition or sleep disorder is contributing to disrupted sleep, the most effective way to sleep through the night is to properly treat the problem:
Medications
Medications may be prescribed to help treat insomnia, sleep apnea, restless leg syndrome, heartburn, pain, anxiety and other issues that could be waking you up.
CPAP
If you have sleep apnea, using a CPAP machine at night provides continuous airflow to keep your airway open, reducing awakenings.
Supplements and Hormones
Your doctor may suggest supplements like melatonin, magnesium, calcium, iron or B vitamins if a deficiency is suspected. Hormone replacement like thyroid medication or testosterone can also help regulate sleep.
Integrative Therapies
Alternative therapies like hypnosis, acupuncture, cognitive behavioral therapy (CBT) and mindfulness meditation can help when sleep disruptions are anxiety-related.
Lifestyle Changes
Making healthy lifestyle changes like losing weight, eating well, exercising more, and quitting smoking and drinking can all improve sleep troubles related to underlying health issues.
Non-Medical and Lifestyle Strategies
Along with any medical treatments, putting consistent effort into improving your daily habits and nighttime routine makes a significant difference in minimizing awakenings.
Sleep Hygiene
Follow basic sleep hygiene principles like:
- Limiting daytime naps to 30 minutes
- Exercising early and not right before bed
- Having a wind-down period before bedtime
- Establishing a regular sleep schedule
- Making sure your bedroom is dark, quiet, and cool
- Avoiding electronic devices in bed
- Limiting caffeine, alcohol and heavy meals before bed
Relaxation Techniques
Using relaxation techniques like deep breathing, progressive muscle relaxation, visualization, meditation or light yoga can reduce anxiety and make it easier to fall back asleep after a night waking.
Cognitive Therapy
Cognitive therapy exercises can help limit worry and repetitive thoughts that interfere with sleep. Strategies include thought stopping, positive imagery, gratitude journaling and challenging irrational beliefs.
Sleep Restriction
Restricting time spent in bed to only actual sleep time and gradually increasing can improve sleep consolidation. However, speak to your doctor first before attempting sleep restriction.
Sleep Environment
Optimize your sleep environment by keeping it cool (around 65°F), dark, quiet and comfortable. Consider a white noise machine, blackout curtains, and an adequate mattress and pillow to support restful sleep.
Nighttime Routine
Having a consistent, relaxing pre-bed routine like taking a bath, listening to calming music, journaling, or light yoga can prepare your mind and body for continuous sleep.
Tips to Fall Back Asleep
Despite your best efforts, you will likely still wake up occasionally during the night. When this happens, stay calm and try these methods to fall back asleep quickly:
- Avoid checking the time or reaching for electronic devices when you wake up. This can trigger anxiety and make it harder to fall back asleep.
- Use the bathroom if needed, as a full bladder can prevent sleep. Avoid overhydrating before bed.
- Do a quiet activity like meditating, breathing exercises, or reading a book until sleepy again.
- Keep eyes open if you wake up earlier than desired. Closing them sends a sleep signal to the brain.
- Consider getting out of bed temporarily if unable to fall back asleep after 20 minutes. Only return when drowsy.
When to See a Doctor
If disturbed sleep and frequent night awakenings continue regularly despite your best efforts, consult your doctor or a sleep specialist. They can screen for underlying causes and provide tailored treatment recommendations. Seek medical advice if:
- You wake up gasping or snoring
- Night awakenings leave you fatigued during the day
- Underlying health issues could be involved
- You have persistent anxiety, pain or discomfort at night
- You wake up at the same times each night
- Poor sleep occurs nightly for over a month
Sleep Medications
Sleep aids either help initiate sleep or help you stay asleep. Here are some of the most common medications used for sleep:
| Medication | Details |
|---|---|
| Zolpidem (Ambien) | May help initiate sleep but can cause dependence and complex sleep behaviors like sleep walking. |
| Eszopiclone (Lunesta) | Helps initiate sleep and stay asleep. Potential for dependence and side effects like drowsiness the next day. |
| Zaleplon (Sonata) | Very short acting, used for sleep onset. Not helpful for night waking. |
| Ramelteon (Rozerem) | Mimics melatonin. May help initiate sleep with less risk of dependence. |
| Melatonin | Natural hormone supplement used to help regulate sleep cycle. Very minimal side effects. |
| Temazepam (Restoril) | Benzodiazepine that treats insomnia, good for sleep maintenance. Risk of dependence. |
All sleep medications should be used cautiously under a doctor’s supervision due to risks like daytime drowsiness, confusion, sleepwalking and dependence. Changes in dose or timing may be needed if nighttime dosing causes awakenings later. Non-medication approaches should be tried first.
When to See a Sleep Specialist
If you are regularly having trouble sleeping through the night and cause is unclear, consulting a sleep specialist can help uncover any underlying sleep disorders or other factors contributing to disrupted sleep. A specialist may recommend:
- An overnight sleep study to analyze sleep stages, breathing, and limb movements
- Bloodwork to check hormone levels
- Genetic testing related to circadian rhythms
- MRI to identify potential neurological causes
- Cognitive behavioral therapy for insomnia (CBT-I)
- Detailed sleep history and lifestyle review
Based on results, they can diagnose sleep disorders like sleep apnea or restless leg syndrome. They can also design a tailored sleep improvement plan which may include both medical and behavioral recommendations for achieving deep, uninterrupted sleep.
Conclusion
Nighttime awakenings can occur periodically in anyone but become problematic if they occur frequently and impact daytime function. Pay attention to your own symptoms and sleep patterns to identify potential lifestyle, health, or environmental factors contributing to the issue. Keeping a consistent sleep schedule, limiting alcohol, reducing evening stress, and creating an optimal sleep environment can go a long way towards improving sleep maintenance. But don’t hesitate to seek medical advice if night wakings remain frequent after trying these methods. Treating any underlying health or sleep issues, whether through lifestyle changes, therapy, medication or other interventions, can get you back to sleeping soundly through the night.