Why You Wake up in the Middle of the Night

Waking up Can Be Normal and May Not Represent Insomnia

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It is normal to wake up at night. In fact, if you didn’t, that would be a different problem entirely. Prolonged time spent awake at night may be a symptom of insomnia. In this context, awakenings can become deeply distressing. Why do awakenings happen at night? How do you know if you are waking up too much? Learn about awakenings at night and consider if you need help.

Many people have an idealized vision of what sleep should be: you should fall asleep instantly, sleep through the night without waking, and jump out of the bed in the morning fully recharged. Children may sleep like this, but few adults do. As we become older, more awakenings occur at night and more time may be spent awake. Why do these occur?

There are multiple potential causes of nighttime awakenings. It is normal to wake up as part of transitions between cycles of sleep stages. It is necessary to wake to change positions, roll over, or adjust the covers. Noises in the environment should normally prompt waking to ensure safety. Parents of young children often wake to attend to their needs. In some cases, it may be necessary to wake to urinate (as occurs in nocturia).

Awakenings may also be abnormal: early morning awakenings may occur in depression and very frequent awakenings may be a sign of obstructive sleep apnea. Pain may prolong wakefulness, but we are generally not aware of pain once we fall asleep. Menopause may lead to night sweats, often also due to sleep apnea. In general, if you remember waking more than once per hour at night, this may be excessive.

No matter the cause of the awakening, it does not have to be a source of distress. Everyone wakes at night and no one ever complains about it if they go right back to sleep. The abnormality is when these awakenings last too long and lead to insomnia. Even in this scenario, solutions exist.

If you spend more than a few minutes getting back to sleep, you may benefit from interventions to relieve insomnia. If more than 15 to 20 minutes are spent awake, observe stimulus control and get out of bed. Go do something relaxing until you feel sleepy and then come back to bed. If you wake towards morning, you may just get up and start your day early. This can help to reinforce the bed as a place for sleep, not wakefulness.

When insomnia becomes chronic, occurring 3 nights per week and lasting at least 3 months, treatment with cognitive behavioral therapy for insomnia (CBTI) may be preferred. It can also be helpful to not check the alarm clock at night. If you continue to struggle with difficulty getting back to sleep, speak with your doctor about additional treatment options.

It is normal to wake up at night, but if it occurs too frequently and you can’t get back to sleep easily, get the help you need to sleep better.

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Article Sources
  • Kryger, MH et al. "Principles and Practice of Sleep Medicine." Elsevier, 5th edition, 2011.