One moment, you’re peacefully slumbering in bed, visions of sugar plums (or dreams of delivering an important business presentation, only to realize that you are completely nude) dancing in your head. The next, you’re unhappily wide awake.
Waking up in the middle of the night is frustrating, but it’s also completely normal; in fact, according to Dr. Fiona Barwick, PhD, a Clinical Associate Professor of Psychiatry and Behavioral Sciences at Stanford and Director of their Sleep & Circadian Health Program, “on average, adults wake up 10 to 12 times a night.” We don't notice most of these wakeups because they’re so brief — “if we're awake for less than three minutes, we simply don't remember,” she notes.
The occasional full-on 3 a.m. awakening — where we find ourselves fully awake for hours, due to nervousness, a snoring partner, a noisy neighbor, or a pet who has decided that the breakfast buffet starts now — is annoying, but also completely typical.
However, for many of us, regularly waking up in the middle of the night for long periods of time — a phenomenon known as “middle-of-the-night insomnia,” “sleep maintenance insomnia,” or “mid-sleep awakening” — has become an unpleasant part of our daily routine. Half of women in midlife struggle with insomnia, and many of the symptoms of peri/menopause, like hot flashes, night sweats, and urinary tract issues, can make us especially vulnerable to the middle-of-the-night variety of the disorder.
Once you’ve been stuck in this pattern for a few weeks or months, it’s easy to feel like this is just the way your life is now — especially because traditional insomnia medications are of limited use in this situation. But fortunately, there are plenty of solutions that can get you back to bed ASAP.
What causes middle-of-the-night insomnia?
According to Dr. Michael Breus, Ph.D., a clinical psychologist, sleep medicine expert, and founder of TheSleepDoctor.com, when you wake up in the middle of the night, the initial cause is usually something physical — but we stay awake due to psychological factors. More specifically, says Breus, “as you fall asleep, your core body temperature lowers — this is a signal to your brain to release melatonin. But it can't keep lowering all night. It eventually needs to rise, which forces people into a lighter sleep stage. This usually happens around 1-3 a.m. which is the normal time we see middle of the night insomnia.”
Women in menopause who are experiencing hot flashes and night sweats can be especially vulnerable to waking up during this sleep stage, due to those extreme fluctuations in temperature.
Breus cautions that these aren’t the only physical factors in play — people can also wake up from pain, sleep apnea, or even as a side effect of certain medications. So, speaking to a board-certified sleep specialist — especially if your struggles with staying asleep at night have been going on for a long time — is a good place to start.
But while body temperature is likely to wake us up, anxiety is what keeps us awake.
“When we do wake up, usually what wakes us up is not always what keeps us up,” says Dr. Barwick. “What keeps us up is how we respond to the awakening.” Meaning, ironically, being upset that you can’t sleep is more likely to keep you up. If you wake up from a hot flash, Barwick notes, it’s understandable that “we're going to feel frustrated. We're sweating, we have to change our pajamas, have to change the sheets. But the more frustrated we become…the longer we're going to be awake.”
How can I stop waking up in the middle of the night?
According to Dr. Breus, the first step usually involves regulating body temperature, to lessen the chance that you’ll pop awake from extreme heat fluctuations. This can involve HRT treatment for hot flashes for some patients, or cooling the room or bed, with devices like the ChiliPad, BedJet, or even a cooling mattress —any product focused on nighttime cooling could help.
Barwick also notes that some women have success utilizing acupuncture to help lessen hot flashes and recommends trying to identify your personal hot flash triggers: “Alcohol, hot beverages, certain foods, spicy foods, the environmental temperature — all this can trigger hot flashes” for some people. Awareness of your own triggers may help you avoid them in the hours before bed, lessening your chances of waking up from the temperature change.
If you do still wake up, Barwick recommends getting up and trying to relax, rather than lying in bed and stewing — change your pajamas if they’re sweaty, read a calming book, try a meditation app. Try “something to bring down your level of activation,” says Barwick. “Because in order to sleep, we have to be in a relaxed state. The less relaxed we are, the less likely we are to get back to sleep.”
Can a sleep professional help me?
CBT especially designed to treat insomnia (CBT-I) can also be useful in helping sleepers lessen their anxiety about waking up. “CBT-I has the largest evidence base for improving sleep in perimenopausal and menopausal women. All the techniques that are taught, all the strategies that are taught in CBT-I are ones that you literally can do for the rest of your life as often as you want, and there is no downside,” says Barwick.
You can find a trained practitioner through the provider directory on the Society of Behavioral Sleep Medicine. The Veteran’s Administration also offers a free four-module course online called the Path to Better Sleep that gives a basic overview on issues like CBT-I and sleep apnea.
Accepting your sleep patterns may help you sleep better
CBT-I may be able to help you deal with one of the trickiest elements of middle-of-the-night insomnia: worrying about how little sleep you're getting can actually be one of the biggest barriers to getting back to sleep. “Sometimes people come in with misconceptions like, ‘Oh, I shouldn't wake up at all at night and I need to get my eight hours, otherwise my health is going to deteriorate,’ says Barwick. “What that does is increase anxiety about sleep and worsen insomnia.”
Rather than obsessing about hitting eight hours every night or worrying because you don’t get the same quality of sleep you experienced at 25, Barwick recommends remember that “sleep is highly individual;” our own sleep patterns even change over the course of each of our lives, so comparing ourselves to others or our younger selves creates unnecessary stress (and lack of sleep).
Embrace sleep as another thing that becomes different, but not worse, with aging — looking at it this way is the best way to get your insomnia back on track, and yourself back to bed.
By Gabrielle Moss
Gabrielle Moss is the editor at Stripes. She's the author of Paperback Crush: The Totally Radical History of '80s and '90s Teen Fiction. Her work has appeared in the New Yorker, Slate, GQ, Buzzfeed, Marie Claire and elsewhere.
