Why You’re Waking up During the night and how to go Back to Sleep!
Written by Benjamin Semmens, Registered Nutritionist (BHSc)
Believe it or not, waking up in the middle of the night is extremely common! In fact, it’s completely normal to wake up around 7 to even 15 times during the night. However, when waking up becomes more frequent and for longer periods this can have some serious consequences on your health.
When you awaken suddenly, you may just roll over and fall back asleep and not even realise these mini awakenings occur! The reason why is that there is a time between sleep and wakefulness known as the hypnogenic state - the transitional state of consciousness between wakefulness and sleep that occurs as your body transitions from one sleep stage to another (don’t worry we’ll get to sleep stages in a minute!).
Unfortunately, many of us can’t resist checking the time… and then suddenly, your mind starts racing thinking about all the important tasks you have to do tomorrow or how much sleep you need to get through the day. This can lead to feelings or anger, frustration and anxiety that makes it almost impossible to go back to sleep!
If you can’t go back to sleep quickly, you won’t get enough quality sleep to keep you refreshed and healthy. That’s why It’s important to figure out what’s waking you up so you can treat the problem and get some quality sleep!
In this blog we’ll explain how sleep works, why you’re waking up in the middle of night, and how to go back to sleep!
How does sleep work?
Throughout the night you fluctuate between 4 different sleep stages. There are four stages of sleep in each cycle. Stage 1, 2, & 3 are called non-rapid eye movement (NREM) stages that are lighter stages of sleep and stage 4, the rapid eye movement (REM) stage is a deeper stage of sleep that is essential for memory, learning and creativity and where your most vivid dreams occur (1, 2).
During a typical nights rest you go through 4 to 6 sleep cycles that range anywhere from 70 to 120 minutes. In the earlier part of the night the cycles are shorter and more NREM dominant, throughout the night the cycles gradually increase with REM stage being more dominant until you wake up in the morning (3).
Short term sleep deprivation can make you feel drowsy, reduce your productivity, affect your mood, and cause fatigue. While long term sleep deprivation can increase your risk of chronic health conditions including diabetes, heart disease, obesity, and depression! (4)
While getting 7-9 hours is recommended, what’s equally important is your quality of sleep and waking up throughout the night can affect both your mental and physical health!
What causes you to wake up at night and how to fix it!
There are many reasons why you wake up during the night. Identifying the cause is first step to be able to fall back asleep!
1. Your body clock is broken!
Every one of us has an internal body clock known as your circadian rhythm that’s involved in many biological and physiological functions over the 24-hour period that include wakefulness, core body temperature, and hormone release that impact growth and metabolism (5).
Your circadian rhythm is mainly driven by changes in light and darkness in your environment. For example, light exposure, especially during the day strongly regulates your circadian rhythm.
If you go to bed late at night and sleep during the day, then overtime your circadian rhythm will be disrupted. This can result in you waking up at weird hours throughout the night because your brain is confused if its daytime or night time (6).
Get as much sunlight during the day as possible and go to bed and wake up at the same time each day to help regulate your circadian rhythm, improve your sleeping patterns, and reduce waking up during the night. Long day time naps (longer than 30 minutes) can also disrupt sleep and should be taken with caution (7).
2. You’re too darn hot!
Feeling too hot can make it hard to fall asleep and stay asleep! Your body temperature plays a very important role in regulating your hormones, appetite, weight, but also your sleep too!
When you wake your core body temperature is low and slowly heats up during the day, as it approaches bedtime your body starts to cool down.
To get restful sleep, we need to have a cool core body temperature that is influenced by your body temperature and your bedroom temperature. What bedroom temperature is most ideal for sleep varies depending on the person, however around 18 degrees is considered optimal for most (8).
While it sounds counterintuitive, taking a hot shower or bath before bed can help to improve sleep. The reason why is that after exposure to hot water your body is actively cooling itself down and dumping heat from the body to lower your core body temperature that can support a good quality sleep! (9)
3. You need to pee!
Nocturia aka having to pee at night is common! Nocturia is more prevalent in older adults, however can happen at any age. The cause of nocturia can vary depending on factors such as lifestyle choices and medical conditions.
Medical conditions that can cause nocturia include urinary tract infections (UTIs), prostate and bladder complications, diabetes, anxiety, kidney disorders, sleep apnoea, and neurological disorders.
Some medications can also cause nocturia, in particular diuretics that are used to manage high blood pressure (10).
Lifestyle choices can also cause nocturia, with the most common cause being excessive consumption of liquids. Alcohol and caffeine are also diuretics that can cause you to wake to urinate.
To reduce waking up during the night to pee, reduce the amount of liquids you drink 2 to 4 hours before going to bed and avoid caffeine and alcohol close to bedtime. If you are still experiencing nocturia, speak to your doctor to see if there is an underlying medical condition or medication causing it.
4. You’re stressed and anxious!
Anxiety is one the most common reasons for waking up during the night. If you wake up and experience worrying thoughts, anxiety, and an increased heart rate it’s likely that you have an overactive sympathetic nervous system.
Your sympathetic nervous system aka ‘fight or flight system’ is important as it keeps you from danger, however sometimes there is no real danger, only perceived danger, and this causes you to struggle to be in a relaxed state and can contribute to sleep complications (11).
Stress can also be due to other medical conditions such as anxiety disorders, PTSD, bipolar disorder, depression, and other mental health disorders. If you experience night terrors this may also be a sign of an anxiety disorder.
If you wake up during the night with anxious thoughts you can try practice deep breathing, meditation, or read something boring. Also, avoid using your phone or other electronics that make your brain think it’s time to wake up and work!
If you are still feeling stressed and waking up during the night and feel like nothing is helping, have a chat to your doctor to see what options are available to you to help manage stress and anxiety.
5. You drink alcohol too close to bedtime!
While alcohol has a sedative effect that can make you feel relaxed and sleepy, it can also contribute to poor sleep and multiple awakenings during the night.
Drinking alcohol before bed can cause you to fall asleep quicker, however this type of sleep is typically lighter NREM sleep as alcohol suppresses REM sleep. This reduces overall sleep quality that can lead to shorter sleep duration and more waking up during the night.
How alcohol affects sleep depends from person to person. If you’re going to drink, avoid drinking too close to bedtime! (12)
6. You drink caffeine too close to bedtime!
Caffeine is a stimulant that is an awesome tool for improving focus and attention during the day, however when consumed too late in the afternoon evening this can affect your sleep causing light and restless sleep.
The reason why is that caffeine can stay in your system for up to 8 – 10 hours. How long caffeine stays in your system depends on the person and how they metabolise caffeine. Some people can drink a coffee right before bed and fall asleep, while others will have a coffee at 2pm and struggle to get quality sleep (13).
Avoid coffee in the afternoons/evenings. Black and green tea also contain caffeine and should be consumed with caution!
7. Your bedroom is too distracting!
Your arousal threshold (something that wakes you up) will vary depending on what sleep stage you’re in. In the earlier stages of sleep are the lightest that are when you’re most likely to wake up to loud noises such as your partner snoring, noisy housemates, a toilet flushing, doors slamming or loud traffic.
If you leave your blind or curtain open you may experience light coming in from outside sources such as your annoying next-door neighbour, another room, or the sun rising that may trick your brain into thinking it’s time to wake up when your still super sleepy.
To avoid any noise and light distractions that can wake you up at night your room should be dark, cool, and quiet. Make sure you close your blind and curtains fully and remove any external noise as best as possible. Otherwise, it may help to wear an eye mask or use ear plugs.
8. You’re scrolling late at night!
Using your phone late at night is stimulating for your brain and can wake you up during the night. Scrolling through Facebook, Twitter, Instagram or Tik Tok late at night may be messing with your sleep.
Firstly, electronics emit blue light that supresses your body’s natural production of the ‘sleep hormone’ melatonin. Secondly, these apps are hyper-arousing to the nervous system and make your brain active instead of being in a relaxed state required for sleep.
Avoid all electronics at least an hour before bed to calm your nervous system to signal to your brain that it’s time to go to sleep. You can also download apps that block blue light or in some cases turn on night mode on your electronic devices that can automatically do it for you!
9. You ate too close to bedtime!
While eating a heavy meal can help you to feel relaxed by releasing tryptophan, an amino acid (protein) that helps you to feel relaxed and sleepy. Eating too close to bed time can make it harder to fall asleep and stay asleep.
Food is a source of energy that disrupts your sleep if eaten to close to bedtime. If you try to sleep just after a big meal you may experience acid reflux, where you stomach acid moves up into your oesophagus causing heartburn. Or maybe you are haven’t given your body an opportunity to digest the food causing symptoms such as bloating, cramping, flatulence, diarrhoea, that could nudge you out of sleep.
To avoid waking up during the night don’t eat within 2 hours of falling asleep. Also make sure you eat enough during the day as low blood sugar (hypoglycamia) can also wake you up.
Intermittent fasting has shown to be beneficial for inducing a good night’s rest and may be a good option for troubled sleepers (15).
10. You have a breathing issue!
Sleep apnoea is a condition that causes you to stop breathing and wake up frequently during the night that is one of the most common sleeping disorders.
In sleep apnoea your body awakens to open your airway and goes back to sleep almost immediately, this process can repeat hundreds of times throughout the night that causes broken sleep and is more common than you may think. In fact, one in four men over the age of 30 have sleep apnoea to some extent.
If you find yourself jolting awake and needing to catch your breath or you’re constantly fatigued during the day this, this may a strong sign of sleep apnoea. One of the best ways to treat sleep apnoea is to cut back on alcohol and lose weight. A breathing machine known as CPAP (continuous positive airway pressure) machine is commonly prescribed for treating sleep apnoea.
Sleeping difficulties can also be caused by other breathing difficulties such as a stuffy nose, cold or seasonal allergies. Even structural issues can cause airway obstruction, such as a deviated septum, large tonsils, or an overly large tongue. Speak to your doctor to check if you suspect you may have an underlying breathing complication causing poor sleep.
11. You have these medical conditions…
There are also many other types of medical conditions that contribute to poor sleep. Pain conditions such as arthritis, fibromyalgia, and neuropathy can cause painful symptoms affecting the joints, muscles and nerves that can keep you up at night.
To Learn more about how to manage sleep when experiencing pain check out the article How to Sleep Well Even if You’re Suffering from Chronic Pain!
A thyroid condition could also be causing sleeping difficulties caused by hormone imbalances. If you have an overactive thyroid your heart rate and adrenaline is increase that can cause insomnia and anxiety. While an underactive thyroid is associated with sleep apnoea.
If you take too higher dose of medication for an underactive thyroid to replace thyroid hormones this can also cause symptoms of an overactive nervous system. Speak to your doctor to get your thyroid hormones checked and to see if your thyroid medications may be contributing.
Depression is often overlooked as a cause of sleep disruptions. People with depression may find it difficult to fall asleep and stay asleep during the night. This can cause people with depression to feel sleepier during the day and taking longer day time naps causing a negative cycle that further exacerbates sleep issues. Depression can be managed through counselling, medications, diet and lifestyle changes (eg. exercise) (15).
Menopause can also cause many sleep issues with hot flashes and insomnia being the most common symptoms. To learn more about how menopause affects your sleep and how to manage it read How Menopause affects Your Sleep and What You Can Do About it!
Treating an underlying condition may help you sleep better and manage insomnia. If you suspect you have one of these conditions, speak to your doctor who can help to diagnose and manage your condition.
12. You take these medications…
While medications can be useful for treating medical conditions, some medications can also affect your sleep including beta blockers, statins, theophylline, corticosteroids, antidepressants (SSRIs), nicotine patches, stimulants (Ritalin and Dexedrine), and thyroxine. Even over the counter medicines for colds, allergies and headaches can affect your sleep such as antihistamines, and pain-relief medications (16).
13. You’re getting older!
Ageing is natural part of life, however, as you age, your internal body clock known as your circadian rhythm that determines when you're sleepy and when you wake up starts to shift. This occurs around the age of 40 (17).
Researchers aren’t exactly sure why this happens; however, this can lead you to waking up earlier reducing the amount of sleep you get. You’re probably getting tired earlier naturally, but if you’re used to staying up you may not notice that you're more tired.
Support your body’s changing sleep schedule by aiming to go to sleep earlier, this may take some time initially and you may find yourself lying awake starring at the roof, however over time your circadian rhythm will adjust and will help to you to get more sleep overall.
Take Home message
How to fix your midnight insomnia all depends on the cause. For example, if your circadian rhythm is off, get more sunlight during the day. Your bedroom environment should be cool, dark and free of distractions such as noise and light. Avoid drinking liquids, caffeine, and alcohol and eating dinner too close to bedtime.
If you’re nervous system is overactive, try relaxation techniques like deep breathing, meditation, stretching or reading a book and have a hot shower or bath before bed. Remember, if you can’t get back to sleep, avoid looking at the time!
Sometimes the best thing you can do is nothing at all! By that I mean don’t sleep in late, avoid long day time naps, and make radical changes in your sleep routine. Within two to five days your problem should resolve itself.
If your sleep problems continue speak to your doctor to ascertain if there are any underlying medical conditions such as anxiety, depression, thyroid conditions, pain conditions or menopause causing your sleep complications.
If you have any questions or need support with your health, feel free to email our head nutritionist Ben at ben@13seeds.com.au
Disclaimer:
This article does not constitute as medical advice and does not take into consideration your personal circumstances. Please see your medical professional before implementing the above.
References:
- http://healthysleep.med.harvard.edu/healthy/matters/benefits-of-sleep/learning-memory
- https://pubmed.ncbi.nlm.nih.gov/19506253/
- https://www.ncbi.nlm.nih.gov/books/NBK526132/
- https://www.cdc.gov/sleep/about_sleep/chronic_disease.html
- https://pubmed.ncbi.nlm.nih.gov/21939733/
- https://www.nhlbi.nih.gov/health-topics/circadian-rhythm-disorders
- https://journals.lww.com/co-pulmonarymedicine/Abstract/2006/11000/Good_sleep,_bad_sleep__The_role_of_daytime_naps_in.2.aspx
- https://www.fbscience.com/Landmark/articles/pdf/Landmark1054.pdf
- https://www.sleepfoundation.org/bedroom-environment/best-temperature-for-sleep
- https://www.auajournals.org/doi/abs/10.1016/S0022-5347%2805%2967961-X
- https://www.sciencedirect.com/science/article/abs/pii/S0022395609000211
- https://www.sleepfoundation.org/nutrition/alcohol-and-sleep
- https://www.ncbi.nlm.nih.gov/books/NBK223808/
- https://www.sleepfoundation.org/physical-health/intermittent-fasting-sleep
- https://www.sleepfoundation.org/mental-health/depression-and-sleep
- https://www.everydayhealth.com/sleep/medications-that-affect-sleep.aspx
- https://www.nature.com/articles/s41598-018-33195-3
