Waking up in the middle of the night is one of the most commonly reported sleep issues. In fact, around 35% of people experience nighttime awakenings at least three days each week and 23% report waking up at least once every night.
Whether you are waking up at night just once a week, every night at 3 a.m., or every few hours, there are many potential causes of nighttime awakenings. From getting older to feeling stressed, we highlight reasons why you may be waking up in the middle of the night.
Reasons You Wake Up at Night
Everyone wakes up periodically during a night of sleep. This is because the body goes through several sleep cycles each night, transitioning through four stages of sleep every 90 to 120 minutes. As a sleep cycle is completed, a sleeper may wake up briefly before falling back to sleep. Typically, people are unaware of these short periods of wakefulness.
Other times, people are aware of waking up at night and may have trouble falling back asleep. Over time, disrupted sleep caused by nighttime awakenings can lead to mood changes, difficulty learning and paying attention, and daytime fatigue. If nighttime awakenings become frequent and begin to interfere with daytime activities, a person may be diagnosed with insomnia or another sleep disorder.
There are many reasons why a person may wake up at night, including hormonal changes, aging, sleep disorders, as well as daytime triggers like stress, travel, and drinking caffeine or alcohol too close to bedtime.
Sleep patterns change as people get older. Older adults tend to spend more time in light sleep and wake up more frequently at night. Older people may spend less time outdoors than younger people, which limits their exposure to sunlight and can disrupt their body’s internal clock. Physical activity may also decrease with age, further contributing to sleep problems in older adults.
Older adults are also more likely to have health conditions or take medications that make it hard to stay asleep. Conditions like arthritis, diabetes, prostate enlargement, and heart disorders may cause older adults to wake up frequently at night.
While the body normally produces less urine at night, some people routinely find themselves waking up in the middle of the night to use the bathroom. Also called nocturia, frequent nighttime urination can cause repeated awakenings and disrupt sleep patterns.
Drinking too much liquid, especially alcohol and caffeine, before bed can contribute to nocturia. However, there are many medical reasons why people may need to urinate multiple times during the night, including:
- Age-related bladder changes
- Overactive bladder
- Urinary tract or bladder infections
- Enlarged prostate
- Chronic kidney or heart failure
- Obstructive sleep apnea
- Certain medications
If left untreated, frequent nighttime trips to the bathroom can increase the risk of falls and negatively affect mental and physical health. If nocturia is making it difficult to stay asleep, it’s important to discuss this symptom with a doctor.
Women and people assigned female at birth experience hormonal changes that can affect sleep patterns and cause nighttime awakenings. For example, some people find it harder to stay asleep in the days before starting their menstrual period, especially if they have severe symptoms of premenstrual syndrome.
People may also experience sleep problems in the time leading up to and after menopause. During this stage of life, fluctuating hormone levels may trigger uncomfortable hot flashes, which are more common at night. Changes in mental health are also common during menopause, including symptoms of depression and anxiety that can make it challenging to stay asleep.
Pregnancy hormones can also lead to sleep difficulties. Around one-third of people in their first trimester report sleep issues and nearly two-thirds have sleep issues by the third trimester. Causes of sleeping difficulties often change during the course of a pregnancy. Nausea, nocturia, and backache can interrupt sleep early in a pregnancy, while later in the pregnancy sleep may be disrupted by heartburn, fetal movement, or general discomfort.
Stress is a natural response to challenging situations, but too much stress can lead to sleep issues. Common sources of stress include pressures at work, traumatic or upsetting experiences, and major life changes. Stress can cause both physical and emotional symptoms that may interfere with falling and staying asleep.
When sleep disruptions are caused by stress, a person may find themselves feeling anxious, sad, or distracted at bedtime. Stress can also cause uncomfortable physical symptoms that may wake a person up at night, like a racing heart, sweating, and painful muscle tension.
A person’s diet, schedule, and daily activities all impact their nighttime sleep. Caffeine, food additives, and spicy foods may trigger sleep difficulties in some people. Alcohol can disrupt a person’s sleep patterns and may cause them to wake up multiple times during the night.
Workplace and social demands can make it challenging for people to maintain a consistent sleep schedule. Irregular sleep schedules have been linked to a variety of negative effects, including mood changes, diminished daytime functioning, and trouble falling asleep and staying asleep.
Other factors that may contribute to nighttime awakenings include jet lag from travel across time zones, not getting enough exercise or physical activity during the day, exercising too close to bedtime, and excessive daytime napping.
Pain from medical conditions is a common cause of sleep loss. While any source of pain can make it difficult to sleep at night, some of the most likely culprits are headaches, nerve pain, and pain in the muscles, bones, and joints.
Sleep problems are also common among individuals with chronic pain. Chronic pain can make people too uncomfortable to fall asleep or stay asleep, leading to daytime fatigue. People who experience persistent pain can also become depressed or anxious, which may further affect their sleep quality.
Many medications can cause insomnia or poor nighttime sleep. These medications may reduce sleep quality, alter the time spent in deep sleep, or contain ingredients that make it difficult to stay asleep. Medications that may impact sleep include:
- Seizure medications
- Beta blockers
It is important to discuss any concerns about your medication with your health care provider. They can address any potential side effects and evaluate your current dosage.
Along with prescription drugs, many over-the-counter medications can wake you up at night. For example, over-the-counter decongestants and nonsteroidal anti-inflammatory drugs (NSAIDs) may cause nighttime awakenings.
Waking up at night is a symptom of several sleep disorders, which are conditions that affect when people fall asleep, how much sleep they get, and their overall sleep quality.
- Insomnia: Insomnia is the most common sleep disorder and may be diagnosed when a person experiences daytime symptoms as a result of difficulties falling or staying asleep. Insomnia can be short-term with symptoms that last for less than three months, or chronic, which lasts longer.
- Sleep apnea: Sleep apnea involves repeated pauses in breathing during sleep. During these pauses, a sleeper may gasp or snort and briefly wake up. Because many people with sleep apnea are not aware of their condition, doctors may test for sleep apnea if a person reports repeated nighttime awakenings.
- Circadian rhythm sleep-wake disorders: The body has biological clocks that follow a 24-hour pattern called a circadian rhythm. A person may be diagnosed with a circadian rhythm sleep-wake disorder when their internal clock is out of sync with their environment, which can make it difficult to sleep and wake up on time.
- Nightmare disorder: Nightmares are bad dreams that cause a person to wake up, often in the middle of the night or in the early morning. After waking up from a nightmare, a person may feel anxious and have trouble falling back asleep. While occasional nightmares are common, nightmare disorder involves frequent bad dreams that cause sleep loss or make it challenging to function during the day.
Tips to Help You Fall Back to Sleep
If you want to stop waking up in the middle of the night, it may be helpful to think about what may be contributing to nighttime awakenings. Consider whether you can make adjustments to daytime activities that may be affecting your sleep, like shifting your exercise earlier in the day, minimizing caffeine intake, and reducing daytime stress.
If nighttime awakenings have been keeping you up for less than two weeks, try improving your sleep habits. There are a variety of behavioral changes that may help you sleep better and fall asleep faster if you find yourself awake at night.
- Stick to a schedule: Changes in bedtime routines and sleep schedules can make it difficult to get the rest you need. Try to keep a consistent bedtime and wake up at the same time every day.
- Relax before bed: Relaxation techniques like meditation, reading, or listening to relaxing music may help some people fall asleep faster and sleep more consistently at night.
- Don’t toss and turn: Avoid staying in bed if you are fully awake. If you are not able to fall back asleep within 20 minutes of waking up at night, get up and find a calming activity until you are sleepy again.
- Treat discomfort: Adjust the room temperature if you are too hot or too cold. If you are waking up in the middle of the night due to pain, cold or flu symptoms, or allergies, talk to your doctor about ways to reduce your discomfort and improve your sleep.
When to Talk to a Doctor
It is important to contact your health care provider if nighttime awakenings last more than a week or two, if waking up at night is making it difficult to function during the day, or if you believe that a prescription medication is causing you to lose sleep. Doctors and sleep specialists can offer education on healthy sleep, diagnose the cause of sleep issues, and help you get the rest you need.
- Accessed on May 16, 2022. https://pubmed.ncbi.nlm.nih.gov/18374943/
- Accessed on May 16, 2022. https://www.merckmanuals.com/home/brain,-spinal-cord,-and-nerve-disorders/sleep-disorders/overview-of-sleep
- Accessed on May 16, 2022. https://www.merckmanuals.com/home/brain,-spinal-cord,-and-nerve-disorders/sleep-disorders/insomnia-and-excessive-daytime-sleepiness-eds
- Accessed on May 16, 2022. https://medlineplus.gov/insomnia.html
- Accessed on May 16, 2022. https://aasm.org
- Accessed on May 16, 2022. https://www.merckmanuals.com/professional/pulmonary-disorders/sleep-apnea/obstructive-sleep-apnea
- Accessed on May 16, 2022. https://medlineplus.gov/ency/article/003141.htm
- Accessed on May 16, 2022. https://www.uptodate.com/contents/nocturia-clinical-presentation-evaluation-and-management-in-adults
- Accessed on May 16, 2022. https://www.womenshealth.gov/a-z-topics/insomnia
- Accessed on May 16, 2022. https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-menopause
- Accessed on May 16, 2022. https://www.uptodate.com/contents/overview-of-the-treatment-of-insomnia-in-adults
- Accessed on May 16, 2022. https://medlineplus.gov/ency/article/003211.htm
- Accessed on May 16, 2022. https://www.merckmanuals.com/home/fundamentals/the-human-body/mind-body-interactions
- Accessed on May 16, 2022. https://www.uptodate.com/contents/insomnia-in-patients-with-a-substance-use-disorder
- Accessed on May 16, 2022. https://www.healthypeople.gov/2020/topics-objectives/topic/sleep-health
- Accessed on May 16, 2022. https://pubmed.ncbi.nlm.nih.gov/33864369/
- Accessed on May 16, 2022. https://medlineplus.gov/ency/patientinstructions/000757.htm
- Accessed on May 16, 2022. https://www.uptodate.com/contents/approach-to-the-management-of-chronic-non-cancer-pain-in-adults
- Accessed on May 16, 2022. https://www.merckmanuals.com/home/brain,-spinal-cord,-and-nerve-disorders/pain/chronic-pain
- Accessed on May 16, 2022. https://www.nhlbi.nih.gov/health-topics/all-publications-and-resources/your-guide-healthy-sleep
- Accessed on May 16, 2022. https://www.uptodate.com/contents/the-effects-of-medications-on-sleep-quality-and-sleep-architecture
- Accessed on May 16, 2022. https://www.psychiatry.org/patients-families/sleep-disorders/what-are-sleep-disorders
- Accessed on May 16, 2022. https://www.nhlbi.nih.gov/health/sleep-apnea
- Accessed on May 16, 2022. https://www.cdc.gov/sleep/about_sleep/key_disorders.html
- Accessed on May 16, 2022. https://www.uptodate.com/contents/clinical-presentation-and-diagnosis-of-obstructive-sleep-apnea-in-adults
- Accessed on May 16, 2022. https://www.nhlbi.nih.gov/health/sleep/sleep-wake-cycle
- Accessed on May 16, 2022. https://medlineplus.gov/sleepdisorders.html
- Accessed on May 16, 2022. https://www.uptodate.com/contents/nightmares-and-nightmare-disorder-in-adults
- Accessed on May 16, 2022. https://www.ncbi.nlm.nih.gov/books/NBK560720/
- Accessed on May 16, 2022. https://medlineplus.gov/healthysleep.html