Getting back to sleep when wide awake 

It’s happened again – you find yourself waking up in the middle of the night.  It’s too early to get up but your mind is racing from one thought to another with worry, anxiety or concerns of being too tired for the new day.  You have no problem falling asleep but you can’t seem to stay asleep for a seven or eight hour stretch at a time.  After about four hours asleep, you abruptly wake up.  Try as you might falling back to sleep is a struggle to say the least but this dilemma actually has a name – sleep-maintenance insomnia. 

Insomnia is usually thought of as trouble falling asleep when you first get into bed at night.  Another form of insomnia is sleep-maintenance insomnia or sleep –interruption insomnia which is difficulty staying asleep or waking up too early with difficulty getting back to sleep. 

Symptoms of sleep-maintenance insomnia 

This irritating but common sleep pattern affects millions of people often beginning in mid-life around age 40 and older.  The sleep pattern of this type of insomnia includes the following insomnia symptoms:

·      Sleeping only a few hours, then waking up

·      Waking up suddenly and being unable to fall back to sleep

·      An in-between state where one feels half-awake while sleeping

·      Waking up too early and being unable to get back to sleep also known as early-morning awakening

·      Waking up briefly but frequently throughout the night

Common causes of sleep-maintenance insomnia

There are a variety of causes of what makes a person wake up in the middle of the night.  Everyone is different as to their reason but here are some common causes making getting a full night of sleep without interruption difficult to do:

·      Being depressed - Depression can disrupt one’s ability to reach a deeper level of sleep.

·      Menopause – For women, menopause an d insomnia go hand  in hand as does perimenopause and insomnia. Many women are able to sleep better when they get better control over hot flashes.

·      Alcohol – Some people may use alcohol as a sleep aid before they get into bed.  But as soon as the effects wear off, the person’ consciousness will drift to the surface waking them up.

·      Medical issues – Chronic pain, especially back pain or arthritis, sleep apnea, asthma, restless leg syndrome or snoring from a partner, can all lead to trouble staying asleep.

·      Dawn phenomenon – Also called the dawn effect, this is a term used to describe an abnormal early-morning increase in blood sugar (glucose) – usually between 2 and 8 am  - in people with diabetes.  The liver may be producing too much glucose to keep blood sugar levels going too low during the night. Our bodies produce hormones, including cortisol, glucagon, and epinephrine which increase insulin production to get you up out of bed to start the day, otherwise we’d be too weak to get out of bed.  This effect could be causing a person to wake up much earlier than anticipated.  

What to do to get a full night’s sleep

No one wants the hassle of dealing with an early morning wake-up call before we are ready to get out of bed.  The last thing most people want to do is take a sleeping pill as they can have side effects of daytime drowsiness, dry mouth or throat, dizziness, changes in appetite, constipation an d having trouble with weaning yourself off of them.

There is a special type of short-term therapy that is recognized as a first-line of treatment for insomnia instead of medication called cognitive behavioral therapy for insomnia or CBT-I.  This therapy teaches people to change their unproductive thoughts of stewing over worries or experiencing anxiety attacks in the middle of the night.  This therapy is just as effective as sleeping pills for both sleep-maintenance insomnia and trouble falling asleep at the start of the night but without the side effects of medication.

Here are some other ways to combat sleep-maintenance insomnia aiding in getting a fully rested night of sleep:

·      Make your bedroom a sanctuary for sleep - Bedrooms are for sleeping, intimacy and other restful activities such as meditation and reading for pleasure.  At night, keep it cool, dark and quiet.  Block out noise using a fan or other appliance producing a steady “white noise.”  Have a comfortable mattress and  keep all electronics out of the bedroom including cell phones, laptops, iPads and computers.

·      Have a regular sleep schedule – Go to bed and wake up at the same time each day helping to synchronize your sleep-wake cycle. 

·      Limit awake time in bed – If you have woken up in the middle of the night and it’s been more than 20 minutes and you still can’t fall back to sleep, get out of bed and do something relaxing such as reading until you feel sleepy again. 

·      Get regular exercise – Any form of aerobic exercise such as walking or jogging can help you fall asleep faster, get more deep sleep, and awaken less often during the night. 

·      Don’t watch the clock – Turn your alarm clock to face the wall and  resist the temptation to check the time on your smartphone. Counting the time lost sleeping only increases stress and anxiety, delaying your return to slumber.  In addition, exposure to blue and green light from your clock phone, tablet, or computer can make you feel more alert.  

·      Get comfortable in bed – Visit the bathroom  to empty your bladder if it might be full. Make sure your bedroom is cool and dark and  that you  don’t feel too warm or chilly.

·      Relax – Try progressive muscle relaxation.  Work your way through the different muscle

groups in your body from your feet, legs, torso and arms.  Tense the muscles in each group for five seconds before releasing the tension all at once. If any muscles hurt, skip that muscle group. Take deep, slow breaths in between tensing muscle groups.