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Waking up in the middle of the night

Do you panic if you wake up in the middle of the night? Do you worry that waking up in the middle of the night means your whole night’s sleep is ruined?

Please remember that waking is a normal part of our sleep pattern – it’s just most of us don’t remember it because it is so brief. However, when we do wake up completely and for longer, it can be a worry.

In this post, Dr Lindsay Browning answers 5 frequently asked questions about waking up in the middle of the night. She explains why it is quite natural, what you can do, when to perhaps have any concerns, and what you can do about it.

5 Frequently Asked Questions (FAQs) about waking up in the middle of the night

1. Is it normal to wake up in the middle of the night?

Firstly, it is important to understand that it is completely normal to briefly wake or stir, and to roll over, etc., between sleep cycles. However, we usually don’t realise and swiftly go back to sleep.

Sleep cycle pie chart — The Sleep Cycle – it is natural to wake between R and N1

Also, the definition of being “awake” versus less deeply asleep is a fine line.

At the beginning and end of a sleep cycle, we are much closer to consciousness and much more aware of our surroundings. Therefore, we are much more likely to wake up briefly.

We certainly have frequent arousals during the night that we will not be aware of most of the time, because they are not long enough to form long-term memories. We can’t even say that we “always” wake up in between each sleep cycle, although that is very common.

However, it is commonly understood that most people have brief arousals during the night (especially between sleep cycles) but most of the time we are completely unaware of these.

If you do wake up significantly enough to realise you have woken up, you may think you may think you have ruined your night’s sleep. However, please remember it’s just a normal part of sleep, and as long as you get back to sleep again relatively quickly and you don’t wake up multiple times during the night, this is not likely to be a problem.

2. What are the main reasons why wake in the middle of the night?

There are a number of reasons why you make be waking up in the middle of night, including:

Your bedroom environment – your bed may uncomfortable or the temperature in the room is too low or too high
Hormonal shifts – pregnancy, perimenopause and menopausal symptoms can affect sleep
Food and drink – caffeine, alcohol and sugar can also cause us to wake as the effect wear off through the night
Stress and anxiety – you may wake up and focus on your worries making it harder to get back to sleep
Underlying sleep condition – see below

As you can see, there are many things to consider if you are waking up in the middle of the night.

Be aware that during periods of stress or when we are in pain or unwell, it is more common for what are usually awakenings you don’t usually notice to be a little longer. The usual brief arousals (where we may roll over or readjust the covers) turn into longer memorable periods of being awake. Even though, we may only wake up briefly, if we are aware that we have woken up, this can trigger us to become anxious and frustrated that we have woken. Then, especially if we look at the time, this can even further increase anxiety and causes us to start thinking about what time it is and how long we have left until morning. This can make it even harder to fall back to sleep.

If you are feeling well and still waking, especially at a consistent time between sleep cycles, then it may be that there is a regular sound or noise that is causing you to wake, such as the heating kicking in (boiler firing up).

3. Could waking up at different times indicate an underlying health issue?

Yes. Waking up multiple times during the night, especially in the middle of sleep cycles, is a sign of disrupted sleep and poor quality sleep. It is often caused by a medical sleep, issue such as obstructive sleep apnoea or restless leg syndrome.

In fact, with obstructive sleep apnoea, the person may wake up multiple times during the night without even realising it (because they go back to sleep again so soon after waking). However, this constant disruption to their sleep can cause significant daytime fatigue the next day.

In addition, when women go through the menopause, the hormonal imbalance can cause them to wake up due to hot flashes or night sweats. Pregnancy and perimenopause symptoms can also affect sleep.

Finally, if someone has insomnia, they often more anxious, especially about the need to sleep well, and that increased anxiety can make waking up in the night more common.

4. What should I do if I wake up in the middle of night consistently?

If you are waking up multiple times in the night (as opposed to once to go to toilet), then it might be a good idea to find out if there is something causing you to wake up.

Speaking to GP for further tests is essential, especially if it could be sleep apnoea.

Also, if your awakenings are causing you distress and you struggle to get back to sleep again quickly, then this is a sign of insomnia. Again, you should speak to a healthcare professional to find out if there is a medical cause for this. You can also discuss if you need treatment for the insomnia, such as the NICE recommended Cognitive behavioural therapy for insomnia (CBT-I).

5. What should you and what shouldn’t you do if you wake in the middle of the night?

If you wake, try to stay calm and remind yourself it is natural to wake briefly between sleep cycles.

Ideally, you should have a consistent sleep routine and bedtime. ‘Preparation’ before bed can help reduce you waking in the night.

Elements of a good bedtime routine

If you know you are worried about something or feeling stressed, write down your concerns, do some journalling or practise relaxation techniques before bed too, so that these anxious feelings are less likely to be on your mind should you wake.

If you do wake in the middle of the night, cognitive distraction techniques are useful, such as counting backwards from 1000 or doing some gently breathing methods. Even getting up for a short time can be better than laying in bed worrying about getting back to sleep. Try not to let your mind start whirring.

It is very common, if you wake, to check the time and also many have the habit of picking up their phones. Try not to do either of these things!

Checking your phone in the middle of the night is not a good idea, for the following reasons:

If you check the time when you wake up, it tends to just make you increasingly anxious and frustrated about how little you have slept or how much time is left until morning.
You may see messages or emails that are either anxiety producing or lead you to start thinking about them (or worse, responding to them!), waking you up even further.
You may be tempted to start scrolling through social media to pass the time, or to start playing a game
The bright light can suppress melatonin production, making it even more difficult to go back to sleep.