If you fall asleep fine but find yourself wide awake at 3:00 or 4:00 in the morning, you may have what’s called sleep maintenance insomnia. It’s troublesome and frustrating, but there are tips to help you deal with this annoying and stressful sleep disturbance.
First, it’s important to recognize that you’re experiencing a sleep disorder, and a very common one. Insomnia in some form affects up to 40% of Americans each year, and it can take many different forms.
The American Academy of Sleep Medicine has defined 11 specific types of insomnia. Yours could have an underlying medical cause. It could be due to poor sleep hygiene (the habits surrounding and supporting, or undermining, your sleep). Your undesired wakefulness may also be worsened by stress, anxiety, medications, or diet.
No matter what its cause, insomnia is probably compromising the quality of your sleep, which in turn has a negative effect on your health and well-being. This can be either a short-term problem or a chronic one.
For the purposes of this article, you are likely having either difficulty falling asleep (onset insomnia) or trouble staying asleep (maintenance insomnia). (Some people have both.)
- Difficulty falling asleep, or onset insomnia, is what it sounds like: you simply can’t get to sleep. You may feel alert and awake when you know you need to be drowsy. Perhaps worries and anxieties keep your mind so busy that you can’t relax. Maybe noises or bright light outside your window are drawing your attention. Whatever the cause, you can’t fall asleep easily, or at all.
- Difficulty staying asleep, maintenance insomnia, is different. You may fall asleep when you want to, but you awaken in the middle of the night or too early in the morning. Once awake, you feel totally alert. If you’re anxious, your racing thoughts may begin at this point, keeping you from going back to sleep.
What causes maintenance insomnia (trouble staying asleep)?
Sleep maintenance insomnia can sometimes have underlying medical causes, including:
- Chronic pain
- Hormonal fluctuations due to menopause or menstruation
- Indigestion, acid reflux, or other gastrointestinal issues
- Low blood sugar
Or you could be waking up because of environmental triggers like:
- Sounds outside or in your bedroom (hint: if you keep your smartphone, computer, or tablet in the room, chimes and notifications may be waking you up)
- Temperature — you could be overheating; try lowering your thermostat, turning on the A/C or a fan, using lighter blankets, or wearing fewer clothes
Your middle-of-the-night awakenings could even be caused by another sleep disorder; for example:
However, for the majority of insomniacs, those 3:00 A.M. awakenings are caused by periods stress and anxiety. If you can learn to manage your stress and reduce your anxiety, you may stop experiencing these periods of wakefulness — or at least have an easier time going back to sleep.
Why 3:00 A.M.?
Insomniacs in every time zone and culture experience this dreaded form of early morning restlessness from time to time. Theories abound as to why 3:00 a.m. is such a universal time for people to wake up and have trouble going back to sleep.
It’s possible that sleep cycles may have something to do with it; at 3:00 you may be entering a lighter phase of sleep, which makes disruptions and awakenings more likely.
Some researchers speculate that during times of stress, excess adrenaline may flood our systems, disrupting the body’s normal self-repair process.
Other people believe the universality of 3:00 a.m. awakenings harkens back to Neanderthal self-preservation habits.
Whatever the reason: it’s frustrating and disruptive to wake up when you want to be asleep. The good news is, there are ways you can combat it.
Tips for how to deal with 3 a.m. insomnia
If you have maintenance insomnia, you need to find ways to minimize the risk of awakenings. You’ll also benefit from techniques to help usher yourself back to sleep. The following may be helpful.
Before you go to bed:
- Exercising moderately on a daily basis, preferably in the early morning or early afternoon, has been shown to improve sleep in people with insomnia. If it helps you to relax and shed stress, light stretching or yoga before bed can also set you up for a better night’s sleep.
- Don’t nap in the day. If you’re not sleeping well at night, the temptation is to make up for what missed by sleeping during the day. However, napping too much on a regular basis may disrupt your sleep schedule. If you experience maintenance insomnia regularly, experiment with eliminating your naps, and take note of whether this makes a difference.
- Avoid stimulants and alcohol. Don’t drink, eat, or take caffeine after early afternoon. Stay away from smoking, vaping, and drinking alcohol within a couple hours of bed, too. These behaviors have been associated with fragmented sleep and middle-of-the-night awakenings, and some have been proven to interfere with REM sleep. Caffeine and alcohol are also dehydrating, which can disrupt your sleep cycle and wake you up feeling thirsty.
- Avoid diuretics. Within a few hours of bedtime, limit liquids to avoid nighttime awakenings to urinate. Take particular care to avoid consuming diuretic foods, drinks, and medications, which stimulate the kidneys and cause you to use the bathroom more often. Examples of diuretic foods include coffee, caffeinated soft drinks, some herbal teas, asparagus, and watermelon.
- Keep your room sleep-friendly. Darken your bedroom, keeping out all light, including the blinking or glowing lights from digital devices. Turn your alarm clock to the wall if seeing the time makes you feel anxious. Block out distracting sounds with white noise machines, fans, or earplugs. Keep the temperature cool, between 65 and 67 degrees.
After you awaken:
- If you’re anxious, try a breathing exercise to calm your mind and cue your body to relax. Many peoplelike “equal breathing” exercises. Inhale a deep breath and hold it for a count of four, then release it for a count of four. If it helps, you can add a meditation phrase. For example, “Inhale, breath; exhale, rest.” You can try a variety of different breathing techniques, including alternate nostril breathing (what it sounds like; press one nostril closed, then another) and progressive relaxation (where you focus on and relax one body part at a time).
- Use guided visualization. Close your eyes and use your imagination to place yourself somewhere calm and soothing. Perhaps you love the sound of a waterfall in the forest. Maybe you like to envision your troubles as leaves floating down a river, away from you. You can have a vision ready for stressful moments, or you can plug in earbuds and listen to an audio track, gentle music, or a book on tape. The key is to stop your mind from dwelling on your anxiety about being awake. Refocus on relaxing thoughts.
- Stop trying; leave your bed. Insomniacs sometimes associate their beds with the frustration of trying and failing to sleep. If you can’t fall back to sleep within 20 minutes, it’s best to get up and leave your bed altogether. Sit in a chair, lie on the floor, or go to your living room couch. Keep the lights dim and engage in a relaxing, distracting activity that occupies your mind (like knitting, watching a bad movie, or reading). When you feel drowsy again, you can return to your bed to try sleeping.
When to see a doctor or sleep specialist for your Insomnia
If your insomnia is chronic or recurring and is preventing you from feeling rested and healthy, tell your doctor.
Seeing your physician or getting a referral to a sleep specialist can help you to determine if your insomnia has an underlying physical or psychological cause like sleep apnea, restless leg syndrome, depression, or some other health condition.
If your insomnia has no clear physical cause, a referral to a psychotherapist may be able to help with understanding and managing depression or anxiety. A therapist can also teach you cognitive behavioral therapy techniques to combat racing thoughts and worries that might be keeping you up at night.
Treating your insomnia is possible with the right help. The first step is to see a professional so you can better understand what’s causing it.