It is a frustratingly common scenario: You fall asleep easily at bedtime but are wide awake at 2 or 3 in the morning. Only after a half-hour or more of staring at the ceiling can you finally fall back to sleep. This middle-of-the-night insomnia happens to everyone every once in awhile. It is an appropriate, normal response to stress, doctors say.
But for a significant number of people it can become a chronic disorder. In fact, this type of insomnia is the most common, more so than having trouble falling asleep at bedtime.
About 30% of American adults have symptoms of some sort of insomnia each year, according to scientific studies. Chronic insomnia is generally defined as having difficulty sleeping at least three times a week for three months or more.
How to Handle a 2 a.m. Wake-Up
When it comes to sleeping difficulties, waking up—and staying up—in the middle of the night is more common than having trouble falling asleep at bedtime. But what you choose to do can make the problem much worse.
Chronic problems falling asleep at bedtime are often associated with stress and anxiety, says Michael Perlis, director of the Behavioral Sleep Medicine Program at the Perelman School of Medicine at the University of Pennsylvania. Waking up too early is often linked to depression. Either type of insomnia can be caused by a circadian rhythm disorder, where there is a mismatch between one’s biological clock and normal sleep times.
Middle-of-the-night awakenings can be caused by medical conditions like sleep apnea, chronic pain or gastroesophageal reflux disease (GERD). Older adults are more likely to wake up overnight. Hot flashes from menopause and some prostate conditions that cause frequent urination can drive people out of bed.
The best thing to do to prevent an occasional bout of middle-of-the-night insomnia from turning into a chronic problem seems simple: “Nothing,” says Dr. Perlis. “Don’t sleep in. Don’t nap. Don’t go to bed early the next day and everything will turn out fine.”
Compensating for sleep loss can fuel chronic insomnia, because it can make it tougher to sleep the next night. It is better to use caffeine to power through the day, Dr. Perlis says. If you have to get extra rest because of an important work presentation, go to bed later the next night. “Balance the books,” he says.
There are particular pitfalls, however, with middle-of-the-night insomnia. Light—from a bathroom switch or sticking your head in the refrigerator—is one. A pulse of bright light in the middle of the night can immediately suppress levels of the hormone melatonin, which is involved in regulating the sleep-wake cycle. Light at night can also throw off the circadian time system, says Daniel J. Buysse, a professor of psychiatry and clinical and translational science at the University of Pittsburgh School of Medicine.
Depending on the time of night, bright light could make it tougher to fall asleep the next night or make you wake earlier in the morning. Dr. Buysse advises his insomnia patients to use night lights. He also recommends that people stay off their computers and smartphones.
Some doctors also forbid TV-watching in the middle of the night, though Dr. Buysse isn’t so rigid. “Don’t sit 2 inches away from the TV. And wear sunglasses,” he says.
If you can’t sleep in the middle of the night, don’t go grab a snack, Dr. Buysse says. There’s mounting scientific evidence that calories eaten then lead to more weight gain. Also, doing something rewarding, like gobbling ice cream, can easily condition the body to keep waking up on subsequent nights.
Jennifer L. Martin, a clinical psychologist and sleep specialist at UCLA, tells her insomnia patients that, if they wake up in the middle of the night, they should resist the urge to look at the clock.
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