It is a common story. You haven't slept well for three days now. The alarm is set for 7 a.m. You get into bed early, hoping that tonight you'll fall asleep early and stay asleep. Instead, you wake up at 2 a.m., staring at the ceiling, wide awake, frustrated and worrying about how you'll function at work the next day. It takes more than two hours to fall back asleep and, before you know it, the alarm is blasting and a new day begins.
Why do nighttime awakenings happen?
There are a myriad of reasons why someone may suffer from middle of the night insomnia, ranging from internal to external causes. External causes may include outside noise (passing cars, a snoring bed partner), light in the room, bedroom temperature (too warm or too cold), sleeping with pets, having a bed partner that moves around too much, an uncomfortable mattress, or even having children who wake up and come to your room.
Internal causes of sleep disruption are vast and varied and include the following:
Gender and Age: Sleep tends to become lighter and punctuated with more awakenings as we age, with older adults often napping throughout the day and experiencing more broken sleep at night. Younger women may notice changes in their sleep pattern associated with their menstrual cycle, having broken sleep just before they menstruate. Pregnancy is a well-known sleep disruptor due to heartburn, leg cramps, back pain, fetal movements, nighttime urination and vivid dreaming. Menopause tends to be a significant cause of broken sleep in middle-aged women since hormonal changes can lead to hot flashes, night sweats, increased heart rate, stress and anxiety.
Medical: Sleep apnea should be evaluated, especially if you snore at night and/or are overweight and awaken unrefreshed in the morning. Chronic pain conditions such as arthritis and fibromyalgia are commonly linked with nighttime awakenings. Although it is normal to occasionally use the bathroom at night as we get older, frequent urination should be evaluated and treated. Diabetes, thyroid disease, kidney disease, chronic lung disease, heart conditions, and medications like beta blockers and diuretics have all been linked with nighttime awakenings. This list is definitely not exhaustive, either.
Psychiatric: Stress, depression and anxiety are common sleep disruptors and should all be evaluated thoroughly by a medical professional.
When should I worry that it might be a problem?
Occasional trouble staying asleep is quite normal and not necessarily a cause for concern. Sleep professionals like to use the "rule of threes" to figure out whether you should seek help. Consult with your doctor if the problem happens at least three times a week, with at least 30 minutes awake at night, and continues for at least 30 days.
What can I do at home?
There are a number of things that one should try at home for a few weeks.
1. Don't fall prey to the "sleep extension" trap. We often think that spending more time in bed (going to bed earlier than normal or sleeping in) will help us catch a few extra minutes of shut-eye. This actually is one of the worst things someone with insomnia can do. Instead, consider spending a little less time in bed (going to bed an hour or so later but waking up at the same time as usual every day and not sleeping in). It is counterintuitive but often works. You might want to consult with a sleep professional to figure out just how much time you should actually be spending in bed.
2. Don't nap. Napping during the day only steals sleep from the night. If you absolutely must, a short nap (no longer than 20 minutes!) taken in bed may be OK if done before 2 p.m.
3. Limit alcohol, nicotine, liquids, heavy meals and exercise all within three hours of bedtime. All of these things can significantly disrupt sleep at night.
4. Avoid caffeine within eight (or more) hours of bedtime. Although caffeine can make it hard for you to fall asleep, it can also make your sleep quality much more broken throughout the night.
5. Don't lie in bed at night if you can't sleep. Instead, get up, go to a different room and do something quiet, calm and relaxing in dim light (no screens -- the blue light can be too alerting to the brain). Only return to bed once you are sleepy again.
6. Don't watch the clock. Calculating how many hours you have until you need to get up in the morning only brings about frustration and anxiety -- two things that make it harder to fall asleep.
7. Work on managing stress, anxiety and depression. Try out some relaxation exercises before bedtime to help wind down, learn about and practice mindfulness meditation, and avoid stressful conversations within a few hours of bedtime. Seek help from a qualified mental health professional if you struggle with managing depression and anxiety on your own.
8. Keep your bedroom quiet, dark and at a comfortable temperature. Make sure there's nothing external that can awaken you. Keep the bedroom temperature cool and comfortable. And earplugs, a white noise machine, light blocking shades or a sleep mask can all help.
If you've tried the above recommendations and they just aren't working, strongly consider seeking help. A sleep specialist can evaluate any other factors (medical, psychiatric, etc.) that may be interfering with your sleep and may suggest an overnight sleep study. Effective treatments do exist -- medication as well as drug-free cognitive behavior therapy for insomnia -- which help you get to sleep and stay asleep more regularly from here on out.
Just like diet and exercise, sleep is unique to each person and important for optimal health. So here's one more thing to consider if you're suffering from insomnia: a new mattress. Sleep Number® beds adjust on each side to your ideal level of firmness, comfort and support -- your Sleep Number® setting -- for your best possible sleep.