Why You Keep Waking Up in the Middle of the Night (And What To Do About It)

Why Do I Keep Waking Up In the Middle of the Night?

Waking up at 3AM is one of the most common insomnia complaints I hear. Many people come in frustrated because they keep waking up in the middle of the night, sometimes once, sometimes multiple times, and can’t fall back asleep. They want to know “why am I waking up in the middle of the night?” or “how do I stop waking up in the middle of the night?” What I also hear is the stress and anxiety that kicks in when they wake. The truth is, the awakening itself is not necessarily the problem. Brief middle of the night awakenings are actually a normal part of sleep. As we move through sleep cycles, we enter lighter stages about every 90 minutes, and during those lighter stages it’s easier for something to push us into full wakefulness. This includes:

• Hot flashes or night sweats

• Needing to urinate

• Pain

• Lights or sounds in the room

• Alcohol wearing off

• Anxiety

• Irregular sleep schedules or excess napping causing irregular sleep rhythms 

• The bed becoming associated with wakefulness

Waking up isn’t the problem.

What happens next is.

What’s Making It Worse

The following are things people often do when they wake up in the middle of the night that are actually adding to the sleep struggle:

• Worry about waking up and feeling pressure to fall back asleep.

• Getting pulled into racing thoughts or overthinking that shows up. Using daylight hours to learn how to manage thoughts will go a long way in helping with this at night. 

• Using the time to problem solve, think about to-dos, check work emails, etc.

• Scrolling on your phone. Blue lights aside, scrolling is often stimulating and promotes dissociation, not relaxation.

• Staying in bed. If you feel awake and alert and haven’t fallen back asleep within 20 minutes, get out of bed and do something boring in another room in the house. Allow your bed to be associated with sleep, not wakefulness

• Trying hard to fall back asleep. Forcing sleep almost never works and just increases frustration and anxiety. If all else fails, use the time to rest your body quietly.

What To Do When You Wake Up at 3AM

1. Don’t panic

   Waking is normal and pressuring yourself to fall back asleep will have the opposite effect. Be wary of thoughts like, “I need to fall back asleep in the next 45 minutes or else tomorrow will be awful” or “If I fall asleep right now I’ll still get 6 hours”.

2. Focus on the body

   Redirecting your attention away from thinking and towards relaxing your body is always a good idea. Use a body scan, a progressive muscle relaxation, or deep breathing to ground and calm your body. As with most things, these skills are best practiced and developed during daylight hours, not in the moment of need.

3. Get out of bed

   The goal is for your bed to be associated with sleep, not wakefulness. If you still feel alert after 20 minutes, then get out of bed and do something quiet and boring until you feel sleepy again. 

4. Stop trying to fall back asleep

   This sounds counterintuitive, I know. But pressure to fall asleep never leads to sleep. If you’re in bed feeling frustrated, shift your goal from “sleep” to “rest”.  Lie quietly and allow your body to rest without trying to make sleep happen. Paradoxically, removing pressure often allows sleep to return.

Some Good Sleep Tips

1. If racing thoughts or overthinking are common for you at night, use daylight hours to practice directing focus away from thoughts or other cognitive skills. Nighttime is not the best time to learn how to manage thinking.

2. If you have stress or anxiety, consider if it’s time to address those.

3. Take inventory of what’s going in your body: alcohol, caffeine, and nicotine all make sleep worse.

4. Set your environment up for sleep success. This includes temperature, lighting, sound, and general comfort.

5. Regular exercise decreases daytime fatigue and improves sleep quality.

When It’s Time for More Help

If falling asleep or staying asleep frequently is an ongoing issue for you, it may be chronic insomnia.

Cognitive Behavioral Therapy for Insomnia (CBT-I) is considered the gold standard treatment for chronic insomnia and has been shown to be more effective long-term than sleep medications. It works to reset sleep rhythms, increase the internal drive to sleep, address sleep-disrupting patterns of thinking, and identify and shift behaviors that are worsening sleep. You can learn more here.

Katie Bernard, LCSW is a licensed therapist and certified CBT-I therapist. If you would like to schedule a consultation with Katie to discuss if CBT-I is right for you call 941-216-5464 or click here.