Why You Wake up in the Middle of the Night

Waking up Can Be Normal and May Not Represent Insomnia

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.

Woman looking anxious in bed
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Idealized Sleep May Not Reflect Reality

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 many adults do not. As we become older, more awakenings occur at night and more time may be spent awake. Why do these occur?

What Causes Awakenings at Night?

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. Older men with enlarged prostates tend to have trouble fully emptying their bladders, so they may wake up repeatedly at night to urinate.

In general, if you remember waking more than once per hour at night, this may be excessive.

Normalizing Wakefulness

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.

It is harmful if you wake at night and immediately look at the time, especially if your mind starts racing, calculating the time you have slept (or the time you have left to sleep), or if you become emotionally upset (angry, frustrated, anxious) because of the awakening. None of these feelings are conducive to sleep.

To reduce the stress associated with awakenings, make some simple changes. Set an alarm clock so that you do not oversleep. Then either turn the alarm clock so that it faces away from you in bed or cover it up. If you wake in the night, at first you will look to it out of habit. Tell yourself that it doesn't matter what time it is, since the alarm clock is not blaring, it is not time to get up. The good news is that you get to sleep more! Roll over and try to go back to sleep. In time, you will stop checking the clock, and the awakenings that do occur will be shorter.

The abnormality is when these awakenings last too long and lead to insomnia. Even in this scenario, solutions exist.

How to Fix Insomnia

If you spend more than a few minutes getting back to sleep, you may benefit from interventions to relieve insomnia. Sleep hygiene is a great way to ensure a restful, relaxing whole night sleep. Avoid stimulants such as caffeine and nicotine close to bed, exercise regularly, stay away from foods at dinner which can promote heartburn, and make sure your sleep environment is devoid of bright light or disruptive sounds.

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.

A Word From Verywell

If you continue to struggle with difficulty getting back to sleep, speak with your healthcare provider 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.

2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Peters, BR. Irregular bedtimes and awakenings. Sleep Med Clinic. 2014;(9)4:481-489. doi:10.1016/j.jsmc.2014.08.001

  2. Anderson KN. Insomnia and cognitive behavioural therapy-how to assess your patient and why it should be a standard part of careJ Thorac Dis. 2018;10(Suppl 1):S94‐S102. doi:10.21037/jtd.2018.01.35

Additional Reading
  • Kryger, MH et al. Principles and Practice of Sleep Medicine. Elsevier, 6th edition, 2017.

By Brandon Peters, MD
Brandon Peters, MD, is a board-certified neurologist and sleep medicine specialist.