Waking Up in the Middle of the Night

What Causes Waking Up in the Middle of the Night?

Most people wake up once or twice during the night. Reasons this might happen include drinking caffeine or alcohol late in the day, a poor sleep environment, a sleep disorder, or another health condition.

When you can’t get back to sleep quickly, you won’t get enough quality sleep to keep you refreshed and healthy. It’s important to figure out what’s waking you up so you can treat the problem and get some rest.

In general, adults need about 7 to 9 hours of sleep a night for best health and well-being. That’s divided into periods of light, deep, and rapid eye movement (REM) sleep, when you dream. You cycle through these stages several times each night. Most of your deep sleep happens early in the night. Toward morning, you’re mainly in REM and lighter sleep, when it’s easier for something to wake you up.

Physical Causes

Many health conditions have symptoms that can seem worse at night, such as:

  • Pain, especially from arthritis, heart failure, sickle cell anemia, or cancer. Tell your doctor if you hurt too much to stay asleep. They might need to change your medication.
  • Breathing trouble from asthma, bronchitis, or another lung disease.
  • Digestive problems, especially pain and cough from acid reflux or symptoms of irritable bowel syndrome.
  • Hormones. Women often wake up at night when levels change around their periods or during menopause. Hot flashes and night sweats also disrupt sleep.
  • Brain and nerve diseases, including Alzheimer’s and Parkinson’s.
  • Peeing a lot, possibly because you drank a lot of fluids during the day or because of a health condition like diabetes, heart disease, or bladder inflammation.

Medications to treat these conditions can also affect your sleep, including beta-blockers, antidepressants, ADHD drugs, decongestants, and breathing treatments that have steroids.

If health issues often interrupt your sleep, let your doctor know. It may mean you need to start treatment or change what you’ve been doing to get your symptoms under control.

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Psychological Causes

Stress is one of the main reasons people wake up in the night. It makes your sleep lighter and keeps you from getting deep and REM sleep.

Other mental health problems can also cause sleep problems, including:

  • Anxiety disorders such as post-traumatic stress disorder (PTSD)
  • Bipolar disorder
  • Depression
  • Schizophrenia

If a mental health condition is keeping you awake, get help from your doctor or a mental health professional.

Your Sleep Habits

Some of the things you do every day can keep you from sleeping well at night.

  • Your sleep schedule. Changing when you go to bed and wake up makes it hard to keep your internal clock set.
  • Electronics. The light from your phone and computer can wake up your brain.
  • Alcohol. A drink before bed may make you fall asleep quickly, but you’ll wake up in the night as it wears off. And it doesn’t let you get to the deep or REM sleep stages.
  • Caffeine. It’s a stimulant that can take 8 hours to wear off.
  • Smoking. Nicotine is another stimulant that can make you sleep less soundly. Many smokers wake up too early as their bodies start to crave a cigarette.

Your Sleep Environment

Things around you like light, pets, or the temperature can make it hard to stay asleep as you move between sleep stages. Experts suggest that you:

  • Put dark shades on windows or wear an eye mask to block light.
  • Use earplugs, a fan, or a white noise machine to cover sounds.
  • Keep the temperature on the cool side, between 60 and 70 degrees.

Sleep Rhythm Disturbances

Your body has a natural cycle of sleepiness and alertness. Your hormones and daylight control it. When that gets thrown off, you have trouble sleeping. Causes include:

  • Age. Your body’s sleep rhythms change as you get older. You get tired earlier in the evening and wake up earlier in the morning. You also spend more time in lighter stages and less time in deep and REM stages.
  • Jet lag
  • Working nights or rotating shifts

There’s not much you can do about some of these issues. Focus on the things you can control, like your daytime and nighttime habits and any health conditions that need treatment.

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Sleep Disorders

Other types of sleep problems can affect your ability to stay asleep, such as:

  • Sleep apnea. If you snore loudly and often, you may have obstructive sleep apnea. Tissues in your mouth and throat close off your airway, which stops your breathing many times a night. Your brain wakes you enough that you can breathe again, and you may wake up completely. One of the most effective treatments is to sleep with a breathing machine that keeps your airway open.
  • Restless legs syndrome. This causes a tingling or prickling feeling that makes you want to stretch or move your legs. It can be worse at night.
  • Periodic limb movement disorder (PLMD). Many people with restless legs also have this condition. Your arms and legs jerk and wake you up.
  • Night terrors. These are episodes of screaming, thrashing, or acting scared while you sleep. They’re most common in children, but adults can have them, too.

Tips to Help You Sleep Through the Night

Try some of these sleep hygiene practices to help you get more rest:

  • Don’t use tobacco. Stay away from caffeine and alcohol later in the day.
  • Go outdoors for at least 15 minutes each day to set your internal clock.
  • Get regular exercise. Work out at least 5 hours before bed.
  • Stick to a sleep schedule. Try to go to sleep and wake up at the same time every day.
  • Don’t nap, especially later in the day.
  • Follow a relaxing bedtime routine. Take a warm bath, listen to soft music, or read a book.
  • Shut off electronic screens. Don’t use devices that have screens in the hour before bed.
  • Don’t use your bed for anything other than sleeping or sex.
  • Keep the room quiet, dark, and cool.
  • Don’t just lie there. If you wake up and can’t get back to sleep after 15 or 20 minutes, get out of bed and do something calming until you feel drowsy again. Resist the urge to grab your phone while you try to get back to sleep.
WebMD Medical Reference Reviewed by Neha Pathak, MD on February 21, 2020

Sources

SOURCES:

National Sleep Foundation: “Surprising Reasons You’re Not Staying Asleep,” “How to Wake Up Less Frequently at Night,” “Interrupted Sleep: What Happens to Your Body,” “Nocturia or Frequent Urination at Night,” “Design a Sleep-Friendly Bedroom,” “How to Manage Noise Pollution.”

Harvard Women’s Health Watch: “Too early to get up, too late to get back to sleep.”

American Academy of Sleep Medicine: “Sleep and Growing Older,” “Insomnia – Symptoms & Causes.”

National Heart, Lung and Blood Institute: “Your Guide to Healthy Sleep.”

National Institute of Neurological Disorders and Stroke: “Brain Basics: Understanding Sleep.”

Harvard Men’s Health Watch: “Insomnia: Restoring restful sleep.”

Medscape: “Management of Chronic Sleep-Maintenance Insomnia.”

Mayo Clinic: “Insomnia: How do I stay asleep?” “Sleep terrors (night terrors).”

American Urological Association: “What is Nocturia?”

Nemours/KidsHealth: “Night Terrors.”

Office on Women’s Health: “Insomnia.”

National Heart, Lung, and Blood Institute: “Insomnia.”

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