What To Do When You Wake Up in the Middle of the Night (& What To Avoid)

First, let’s discuss what goes into a recipe for quality sleep. A good sleep relies on a combination of elements both inside and outside of the bedroom to help you fall and stay asleep. Your activities throughout the day can impact your energy and alertness, and your bedtime routine can determine how rested and ready you are for a full night’s sleep.

Another factor to keep in mind is your circadian rhythm, or your 24-hour cycle of wakefulness and sleep. Your circadian rhythm works in tandem with your biological clock and is regulated by light, hormones, and body processes that determine when to sleep or be awake. When this timing goes off-kilter, it can cause sleep interruptions.

Some reasons you may be waking up are as follows.

If you’re stressed out, anxious, and/or your mind is racing, it can affect the quality of your sleep, as well as other important aspects of your health. And, if stress or anxiety is awaking you in the middle of the night, know that you’re far from alone. Surveys have found a significant correlation between stress and a subpar quality of sleep.²

Stress is a blanket term that can apply to several situations. For example, work may be particularly stressful, requiring you to be up extra early or stay late in the office. Or, there could be a family situation that’s been occupying your thoughts. If your troubles with sleep also coincide with other symptoms, such as persistent sadness, feeling constantly on edge, or a loss of interest in everyday activities, anxiety or depression might be playing a role too. In any of those situations, it’s best to reach out to your healthcare provider for help.

Ultimately, waking frequently in the middle of the night can feel like a vicious cycle. You know you need to get more sleep to help alleviate stress, but your stress awakens you, which causes even more stress or sleep anxiety, and round and round it goes. Just remember, you’re not alone in this particular struggle, and there are tips to help you fall back asleep that can help break the cycle.

If you suffer from acute (short-term) or chronic (ongoing) pain, it can also interfere with falling asleep, staying asleep, and waking refreshed.³ In fact, the more intense your pain is, the harder it can make it to fall back asleep. If you have short-lived pain due to an injury or accident, it’s likely only a temporary disruption. If you find that you’re in chronic pain that consistently interferes with your sleep, consult your healthcare provider to find a lasting solution.

Hormonal fluctuations are other reasons it can be hard to fall back asleep. And, unfortunately, women are more susceptible to them. Changes in the hormone progesterone, especially during menstruation, can send you on a wild goose chase for sleep in the middle of the night. Pregnancy, and later in life, menopause, can both also lead to waking up before you’re ready due to the whirlwind of hormonal changes your body is going through.

Getting up to urinate at night, or nocturia, once in a while is a normal part of life. But doing so too frequently can be a sign of other issues that may need to be addressed. Drinking too many liquids too close to bedtime may be to blame, as can being pregnant or having an enlarged prostate. However, if you’ve eliminated excess liquids too close to lights out and are still waking to use the loo, always talk to your healthcare provider to see if there may be an underlying issue.

Certain medications may also interfere with your sleep patterns. Common culprits include alpha- and beta-blockers, SSRI antidepressants, and corticosteroids. Side effects of these can interfere with your hormones or bodily functions to prohibit a completely restful sleep. Be sure to talk to your healthcare provider if you suspect your medications are causing you to wake up mid-sleep and/or are making it increasingly difficult to fall back asleep.

If addressing the possible causes of waking in the middle of the night listed above doesn’t solve your sleep issues, you might be dealing with a more persistent problem such as insomnia, sleep apnea, or another sleep disorder. Consistently waking up in the middle of the night and having trouble falling back asleep is referred to as sleep maintenance insomnia (i.e. trouble staying asleep). Up to one in five people have this type of interruption.⁴ 

Likewise, if you find yourself dealing with other symptoms like excessive snoring, or even difficulty breathing during sleep, you may want to get tested for sleep apnea, a range of conditions that most commonly involve your throat muscles occasionally blocking your airway during sleep. Talk with your healthcare provider if you think you have issues with insomnia or other disorders.