Waking up in the middle of the night when you would like to be asleep can be a frustrating experience. People wake up during the night for different reasons. Identifying the cause of your middle-of-the-night wakings is the first step toward a full night of sound sleep.
Why Do I Wake Up in the Middle of the Night?
Many factors cause people to wake up during the night, such as disruptions in the environment, lifestyle factors, health issues, and aging. We explore the possibilities of what might be waking you up at night.
Sleep Environment Factors
Sleep hygiene tips often include the advice to maintain a quiet, dark, cool bedroom, as sensory disturbances can wake a person up during the night. For example:
- Noise: Research suggests that background sounds, such as traffic noises from vehicles on a nearby street, can cause sleep disturbances. Researchers have found that, in addition to waking people up, these sounds can also prompt the release of the stress hormones adrenaline and cortisol, increase heart rate, and affect digestion.
- Light: A study of adults found that even exposure to very dim light during the night can negatively impact sleep. Sources of night time light could include street lights shining in through a window or a night light plugged into a wall outlet. Not only can dim light exposure increase nighttime awakenings, but it can also change how much time a person spends in certain stages of sleep.
- Temperature: Research shows that both skin and room temperature impact sleep. A person experiences the best sleep when their core body temperature cools and skin temperature increases. For that reason, most experts recommend keeping the bedroom between 66 to 70 degrees Fahrenheit and adjusting bedding to regulate skin temperature throughout the night.
In a survey of university students, some respondents identified other environmental factors, like air quality and odors, as causing sleep disturbances.
Multiple lifestyle factors can disrupt a person’s sleep:
- Alcohol: Although alcohol may relax you and even seem to help you fall asleep, studies suggest drinking can reduce your sleep quality. A study of Korean adults found that people who drink excessively obtain less sleep and experience more sleep disruptions. Alcohol also appears to negatively impact sleep for those who do not drink excessively. A study of African-American adults found that drinking alcohol in the four hours before bedtime led to less time spent asleep while in bed.
- Nicotine: Nicotine is a stimulant, and smoking cigarettes can have negative effects for sleep quality. Studies have found that nicotine intake in the four hours before sleep is associated with waking up during the night.
- Caffeine: Caffeine is another substance that could be responsible for sleep troubles. In one study, caffeine disrupted sleep when consumed up to six hours before bedtime.
- Certain Medications: Certain prescription medications, including psychotherapeutic medications, beta blockers, opioids, and stimulants, may interfere with staying asleep.
- Evening Digital Device Usage: Light exposure affects the circadian rhythm, helping the body feel alert during daylight hours and tired at night. Research shows that blue light exposure in particular can impact your sleep schedule. Many studies have demonstrated that digital devices like smartphones and e-readers that emit blue light can disrupt sleep when used near bedtime.
- Lack of Physical Activity: Sleep and exercise are considered mutually beneficial. Although more research is needed, it appears that exercising regularly leads to more and better-quality sleep, while time spent being sedentary increases sleep disruption. Strenuous exercise close to bedtime, can cause sleep disturbances.
When a person awakens during the night despite being in conditions that are good for sleep, they may have insomnia, another sleep disorder, or an underlying health issue.
Although many people think of insomnia as trouble falling asleep, it can also involve waking in the middle of the night or early morning and having difficulty falling back asleep. Insomnia may occur once in a while on a short-term basis. When insomnia happens regularly for more than three months, it is considered chronic insomnia.
Many health issues cause or exacerbate insomnia. People with these conditions often have trouble obtaining adequate sleep:
- Lung disease
- Gastroesophageal reflux disease (GERD)
- Chronic kidney disease
- Fibromyalgia and other chronic pain disorders
- Infectious diseases, such as Lyme disease or human immunodeficiency virus (HIV)
- Diabetes with hypoglycemic events at night
- Mood disorders, like anxiety and depression
Nighttime awakenings associated with a health issue are often due to a symptom of that issue. For example, coughing might wake up a person with a lung disease, while heartburn might wake up a person with GERD. Addressing the underlying health issue or sleep disorder is an important step toward regaining better sleep.
Research shows that as people grow older, they tend to spend less time in deep sleep and more time in light sleep. Since it is easier to wake up from light sleep and more difficult to wake up from deep sleep, spending more time in light sleep might explain why older adults also wake up more during the night. Also, they tend to have circadian rhythm changes that can lead to falling asleep earlier and waking up earlier than they would wish.
Health conditions, medications, lifestyle factors, and sleep disorders such as sleep apnea or restless legs syndrome can further contribute to nighttime awakenings for adults over 60.
If you are currently undergoing hormonal changes, they could be responsible for your nighttime awakenings. Studies have found that people tend to experience a reduction in sleep quality during pregnancy, especially during the third trimester. Menopause is also associated with sleep disturbances.
Tips for Falling Back Asleep After Waking Up
There are multiple research-backed strategies you can try to help yourself fall back asleep after waking up during the night.
Try Deep Breathing
Experts recommend using slow, deep breathing to fall back asleep. This type of breathing may activate the parasympathetic nervous system, which is involved in relaxation and sleep. One such breathing technique is called 4-7-8 method which involves four seconds of inhalation through the nose, hold the breath of seven seconds and then exhale through the mount for eight second.
Try Mindfulness Meditation
According to an analysis of 18 research studies, mindfulness meditation may also help improve sleep quality. Mindfulness meditation involves purposefully focusing on the present moment and paying attention to what occurs from a place of curiosity rather than judgment.
A variety of mindfulness meditation techniques exists, including techniques that incorporate specific breathing patterns. People interested in trying mindfulness meditation can seek out courses or listen to recorded guidance using a smartphone or another device.
Try Relaxation Exercises
Relaxation exercises are meant to promote relaxation and reduce tension, both physically and emotionally. Three relaxation techniques are common:
- Box Breathing: To engage in box breathing, breathe in for four seconds, hold the breath for four seconds, exhale for four seconds, and hold the breath again for four seconds. You may find it helps to imagine working your way around a square box as you breathe. Keep repeating this pattern of inhaling, holding, exhaling, and holding the breath again. If four seconds is not the ideal length of time for you, you can adjust it up or down.
- Guided Imagery: A recording can help guide you as you practice visualizing somewhere peaceful, like a beach. As you visualize the setting, try to imagine what you would be experiencing through all five senses. For example, try to see, hear, smell, taste, and feel the sensations you would if you were in the setting you are imagining.
- Progressive Muscle Relaxation (PMR): This technique involves progressively tensing and then relaxing each muscle in the body. You can start with your feet, then move up to your head one muscle group at a time, or vice-versa. After you tense a muscle, try to keep it contracted for at least five seconds, then slowly release it. Guided recordings are widely available to talk you through progressive muscle relaxation.
Use Soothing Sounds, Music, or ASMR Content
Research shows that listening to music or white noise can help people fall asleep faster and wake up less during the night. Music and white noise likely promote sleep by blocking out background noise or prompting a relaxation response.
Other sounds can also promote sleep through an autonomous sensory meridian response, or ASMR. An ASMR response involves a tingling sensation on the scalp that may trickle down the spine and the rest of the body. This response can be triggered by particular sounds or videos, which often involve whispering, slow movements, personal attention, and crisp sounds. Studies suggest that even when a person does not experience a full ASMR response, watching or listening to ASMR material can still improve mood and reduce pain.
What to Avoid Doing When You Wake Up During the Night
Certain activities are best avoided when you wake up during the night, because they can interfere with your ability to fall back asleep:
- Watching the Clock: Studies suggest that clock-watching, which involves closely monitoring what time it is, can make falling asleep more difficult for people with insomnia. While clock-watching, a person might become frustrated that they have not fallen asleep yet, which can increase stress and make sleep even less likely.
- Looking at Electronics and Turning on Lights: Although you might feel tempted to reach for your smartphone, e-reader, or the lamp on your nightstand after waking up during the night, try to resist. Light exposure stops the production of melatonin, a hormone that promotes sleep.
- Staying in Bed Too Long: If you wake up during the night and cannot fall back asleep, experts recommend getting out of bed after 15 to 30 minutes. To help your brain associate your bed with sleeping rather than with being awake, you want to avoid lying awake in bed for too long. Instead, do something relaxing elsewhere, like meditating or reading a book. Then, come back to bed when you feel tired.
When to See a Doctor
Many of the causes of sleep disruption can be easily remedied through changes to the sleep environment or improved sleep hygiene. However, sometimes waking up at night and being unable to fall back asleep indicates a person has a sleep disorder or underlying health problem. If you continue to experience sleep disruption after improving your sleep habits, talk to your doctor. They can ask questions about your situation and refer you to a sleep specialist, if necessary.
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