If you struggle to get a good night’s sleep you’re not alone. According to the CDC, 35 percent of adults are short on sleep. Not surprisingly, the stress of coronavirus isn’t helping. One of the top questions Parsley’s members have been asking over the past few months is, “Why am I waking up in the middle of the night?”
When interrupted sleep becomes a chronic problem, you don’t just feel fatigued during the day, you’re at increased risk for serious health conditions. According to Michael Zielinski, DO, a physician with Parsley Health, studies show night shift work is associated with higher mortality rates, indicating that good quality night sleep is an important factor in overall health.
He says brain fog is a common complaint among sleep-deprived patients. Other problems associated with inadequate or poor quality sleep include increased pain and irritability, as well as elevated blood pressure and higher cortisol levels, which can lead to inflammation. According to Dr. Zielinski, inflammation can predispose you to conditions including heart disease and dementia. Other health issues associated with inflammation include leaky gut, allergies, migraines, and acne.
Good sleep doesn’t just refresh you—it also sets you up for optimal health. An ideal night’s sleep, says Dr. Zielinski, is one in which you sleep soundly for about seven to eight hours. But, he emphasizes that the “magic number” of hours varies. For example, one patient Dr. Zielinski recently saw, routinely gets six hours of sleep and wakes up feeling energized. For this individual, more sleep wouldn’t be helpful. Conversely, some people need more than eight hours of shut-eye per night. Determining your optimum amount of sleep, says Dr. Zielinski, is as simple as asking yourself how you feel when you wake up.
While getting the requisite quantity of sleep is important, so is the quality. According to Dr. Zielinski, waking up in the middle of the night, even once, limits the time you spend in the deep and rapid eye movement (REM) phases of sleep, which he says “never lets your body totally relax.” Consequently, “there’s some musculoskeletal issues because your muscles start to tighten and tense as you awaken.” Additionally, and perhaps more importantly, he adds, night waking “affects your cortisol levels, which is essentially your stress hormone. And that’s why you need to get that restful sleep.”
To treat night waking, it’s important to first address the root of the problem. Below are some of the most common causes you can’t stay asleep and how to manage them.
15 reasons you’re waking up in the middle of the night
Anxiety is one of the most pervasive reasons people have trouble getting deep, restful sleep. And while there’s plenty to be anxious about right now, there are ways to cope. Dr. Zielinski often recommends keeping a journal and a pen by your bed so you can jot down your thoughts when your mind is racing in the middle of the night. You can also try journaling right before bed to get out any anxious thoughts. He emphasizes the importance of avoiding your phone when you can’t sleep. Not only does the blue light it emits interfere with your body’s circadian rhythm (which regulates your sleep-wake cycle), the mental stimulation you experience when doing things like checking email and your social media feeds make it hard to relax.
As noted above, all of your screens (including your phone, tablet, television, and computer) emit blue light, which “stimulates your pineal gland to wake you up,” says Dr. Zielinski. He recommends avoiding electronics for at least two hours before bedtime. If you do need to be in front of a screen before bedtime, he recommends wearing an inexpensive pair of blue light blocking glasses.
Some people have a gene, called CYP1A2, which makes them more sensitive to caffeine than others. If you fall into this category, Dr. Zielinski recommends avoiding caffeine after noon. Not only can caffeine rev you up and lead to restless sleep, as a diuretic, it can also increase the chance you’ll have to wake up to urinate.
Sleep apnea occurs when a momentary pause in breathing or snoring due to a blocked airway rouses you from sleep. According to Dr. Zielinksi, there’s now a home sleep test that’s available without you having to do an in-lab sleep study to make a diagnosis. Also, instead of treating sleep apnea using a CPAP machine, which is loud and often uncomfortable, Dr. Zielinksi says specialized dentists can create an oral appliance that is just as effective in maintaining an unobstructed airway.
Digestive issues, and acid reflux in particular, are common causes of waking up at night. Quick fixes include avoiding snacks after dinner and/or eating your last bite at least three hours before you go to bed. Dr. Zielinski also emphasizes the importance of addressing the underlying factors contributing to your digestive issues, pointing to SIBO (small intestinal bacterial overgrowth) as a common cause of indigestion.
Night waking can be caused by hormonal imbalances such as those that occur with hyperthyroidism and perimenopause. Particularly for women who are perimenopausal, Dr. Zielinski recommends maintaining a cool sleeping environment. (This can also be helpful for people with night sweats.)
If you frequently wake up to urinate and struggle to fall back asleep, Dr. Zielinski suggests restricting your fluids at least two to three hours before bed.
According to Dr. Zielinski, alcohol makes it easier to fall asleep—but harder to stay asleep. “People will fall asleep quickly, but then, a couple of hours later, they actually will wake up because the alcohol has worn off, and then they have a really hard time going back to sleep.” He explains, “as you metabolize [alcohol] through the liver it causes heightened arousal.” If this affects you, consider substituting your alcoholic beverage of choice with a flavored seltzer after your first or second drink.
While most of us are staying put right now, a new sleep environment and a different schedule (or time zone) can wreak havoc on your sleep. To mitigate the effects of travel, do your best to practice good sleep hygiene; stay off of your electronic devices before bed, stick to your usual sleep schedule as closely as possible, and make sure your bedroom is as cool, dark, and quiet as possible.
Electromagnetic frequency (EMF)
According to Dr. Zielinski, “there’s a subset of people who are very sensitive to the electromagnetic frequencies from phones and other electronic devices.” For such patients, he recommends sleeping with your phone in a different room, using a blocking agent for your phone, or even shutting your router off at night.
Elevated body temperature
For optimum sleep, your body should be significantly cooler than it is while you’re awake. Dr. Zielinski suggests trying a cooling mattress pad and/or adjusting your thermostat so it dips at night. He also notes taking a hot bath before bed, while relaxing, can elevate your body temperature, making it hard to keep cool while you’re sleeping.
Pain, says Dr. Zielinski, is a frequently overlooked reason behind waking up in the middle of the night, particularly for older adults who may have chronic shoulder pain, neck pain, and/or arthritis. If pain is causing your restless sleep, curcumin or turmeric with bioperine (a black pepper derivative) often help because they are anti-inflammatory agents, explains Dr Zielinski. Fish oil is another supplement that may help with pain. Dr. Zielinski says his team frequently recommends yoga and stretching as well.
Low blood sugar
Low blood sugar, or hypoglycemia, is another factor in night waking that’s commonly neglected, says Dr. Zielinski. If you don’t get enough calories and your sugar drops in the middle of the night, you might wake up hungry. If you find yourself opening the fridge or the pantry at 2 am, he suggests snacking on a sweet potato with almond butter before bed to ensure your blood sugar is stabilized throughout the night.
Restless legs syndrome
Dr. Zielinski describes restless legs syndrome as “an indescribable urge” to move your feet and legs which can contribute to night waking. Iron deficiency is often behind this condition and bloodwork is required to make a diagnosis, he says.
If muscle cramping in your legs interrupts your sleep, Dr. Zielinski says this might be a sign of an electrolyte, calcium, or magnesium imbalance. Often, taking certain types of magnesium before bed works very well, but lab work can help identify imbalances that your doctor can address.
Resolving restless sleep patterns naturally
If you are struggling with waking up in the middle of the night, the first step is understanding what’s causing it in the first place. Parsley Health’s doctors and health coaches work with members frequently to get to the bottom of why they’re not sleeping well and help to find a solution. According to Dr. Zielinski, you will need to answer a series of detailed questions about your sleep and health so the doctors and health coaches can understand your sleep habits and the issues you’re experiencing. They’ll also ask about any supplements or medications you may be taking and may recommend specialized testing.
Your treatment will be highly individualized, depending on both the causes of your night awakenings and your personality. For example, Dr. Zielinski says while meditation can help with anxiety, it’s not for everyone. For those who are “more driven, type-A” in nature, Dr. Zielinski often recommends a biofeedback program such as the HeartMath app instead. (He suggests wearing your blue blocker glasses if you do end up using an app to help you fall back to sleep.) While journaling in the middle of the night is helpful for some, others are better served by 15 minutes of exercise. Likewise, if a digestive issue is keeping you up, your doctor may come up with a plan that combines nutrition, supplements, and adjustments that fit your lifestyle.