Why do I keep waking up at 3 am?

Most of us will wake several times during the night and not realise it as we settle back to sleep so quickly. The time spent awake can be less than a few seconds in duration. However, this is not the case for everyone.

Many people experience waking up during the night. Waking up at the same time each night can be in response to various factors, including sleep disruptions, your sleep cycle, stress, dietary habits, and even underlying medical conditions. Fortunately, there are several solutions which can help alleviate this issue. Finding out what could be causing you to wake up each night is the first step to helping you get the rest you need.

Why can’t I stay asleep?

If you are someone who keeps waking up at 3 am and struggles to settle back down to sleep, stress is likely the cause. Stress can appear in many forms, from your lifestyle to the medication you may be taking. The cycle of stress makes staying asleep increasingly difficult. The more stressed you are, the harder it is to relax and the more tired you feel the next day. Let’s help you to eradicate that stress by establishing why you can’t stay asleep and why you keep waking up at 3 a.m, and how you can resolve your sleep issues.

Nocturia

Nocturia is a condition defined by needing to urinate numerous times throughout the night. Whilst it could be the result of high fluid intake, it can also be the result of an enlarged prostate, pregnancy, medication being taken, or an overactive or prolapsed bladder. Nocturia is commonly confused with a condition called overactive bladder (OAB). Nocturia specifically refers to waking up at night to urinate, while OAB encompasses symptoms of frequent urination, urgency, and potential urinary incontinence throughout the day. Those with Nocturia tend to produce a normal amount of urine overall, but the volume of urine produced increases more frequently during the night.

Doctors will advise you to reduce your caffeine and alcohol intake initially to help reduce the frequency of awakenings through the night, but Nocturia can also be treated with medications and lifestyle changes too. Other contributing factors to Nocturia include menopause, obesity, diabetes, kidney disease, kidney failure, kidney stones, urinary tract infections or congestive heart failure. Let’s explore how you can manage nocturia to help you stay asleep during the night.

Solutions

1. Keep hydrated, but be mindful of timing: While it might seem counterintuitive, staying hydrated during the day is essential. However, limit fluid intake in the hours leading up to bedtime to reduce the need to urinate at night.
2. Monitor medications: Some medications can contribute to nocturia. If you suspect your medication is causing this issue, consult your healthcare provider to discuss potential alternatives.
3. Limit your sodium intake: High sodium intake can lead to fluid retention. Be mindful of your salt intake and try to opt for low-sodium foods.
4. Manage underlying conditions: Nocturia can be linked to various health conditions, such as diabetes, urinary tract infections, or an enlarged prostate. Treating these underlying issues can help alleviate nocturia.
5. Bladder training: Gradually extending the time between bathroom breaks during the day can help your bladder adjust and potentially reduce the frequency of nighttime urination.
6. Medication effects: Certain medications used to treat various health conditions, including beta-blockers, antidepressants, ADHD drugs, decongestants, and steroid-containing breathing treatments, can impact sleep patterns.
7. Digestive problems: Acid reflux and symptoms of irritable bowel syndrome (IBS) can lead to pain, coughing, and discomfort during the night, disrupting sleep.

Remember that the effectiveness of these tips can vary based on individual circumstances, so it’s essential to work closely with a healthcare provider to determine the best approach for managing your nocturia.

Anxiety and stress

Your stress and anxiety levels are likely the first thing to consider if 3 a.m. awakenings are a new annoyance to you. When your body experiences stress, it activates your sympathetic nervous symptom. As a result, you may feel a jolting sensation awakening you in the middle of the night.

You could also experience an increase in your heart rate and blood pressure. These fluctuations in your body can make it difficult to settle back to sleep and leave you feeling exhausted the next day. Stress levels can be increased when something in your life is causing you to feel anxious or worried. If stress is something which is impacting you, consider what the root of the cause could be. Most commonly, stress can be related to changes or uncertainty surrounding your relationships, finances, job or health.

If you feel that stress could impact your sleep, speaking about your stress levels with your doctor is advised if they’re prolonged. Therapies such as CBT (Cognitive Behavioural Therapy) or lifestyle adjustments, including activities like yoga and mindfulness practices or incorporating activities you enjoy, can also reduce stress.

Solutions

Managing anxiety and stress can significantly improve your ability to stay asleep. Here are some tips to help you achieve a more peaceful and uninterrupted night’s sleep:

1. Practice relaxation techniques: Engage in relaxation exercises such as deep breathing, progressive muscle relaxation, or mindfulness meditation before bedtime to calm your mind and body.
2. Create a bedtime ritual: Establish a calming pre-sleep routine that signals your body that it’s time to wind down. This could include reading a book, taking a warm bath, or listening to soothing music.
3. Limit screen time: Reduce exposure to electronic devices like phones, tablets, and computers at least an hour before bed. The blue light emitted by screens can interfere with the production of sleep-inducing hormones.
4. Write in a journal: Keep a journal to jot down your thoughts, worries, and feelings before bed. Writing out your concerns can help you release anxious thoughts and provide a sense of closure for the day.
5. Limit caffeine and alcohol: Both caffeine and alcohol can disrupt sleep and exacerbate feelings of anxiety. Limit consumption, especially in the hours leading up to bedtime.
6. Brain and nerve diseases: Stress impacts how your brain functions and neurological conditions like Alzheimer’s and Parkinson’s can interfere with sleep patterns, resulting in nighttime awakenings. As a result, your lack of sleep can impact your memory further. If you are struggling with your brain function, consider looking at your stress levels to see if your sleep and memory can be improved.
7. Sleep aids: Women may experience nighttime awakenings due to hormonal fluctuations during menstrual cycles or menopause. Hot flashes and night sweats can also disturb sleep. Some women who have trouble sleeping may use over-the-counter sleep aids such as melatonin to help with this.

Remember that finding the right combination of strategies may take time and experimentation. Be patient and consistently implement these techniques to reduce anxiety and stress, improving sleep quality gradually.

Insomnia

Waking up throughout the night or struggling to fall asleep can leave you feeling exhausted the next day. Regular occurrences could indicate you are experiencing insomnia. Insomnia is a common sleep disorder characterised by difficulty falling asleep, staying asleep, or experiencing non-restorative sleep. Those with medical conditions and depression are particularly at risk for insomnia.

Insomnia tends to be more common among older adults due to changes in sleep patterns that occur with ageing. As we age, several changes can contribute to insomnia. The time it takes to fall asleep often increases, while the duration of deep sleep and the amount of time spent in bed decrease. Additionally, older adults may find themselves waking up earlier than desired. The AASM has found that:

• 30 to 35% have brief symptoms of insomnia.
• 15 to 20% have a short-term insomnia disorder lasting less than three months.
• 10% have a chronic insomnia disorder, which occurs at least three times per week for at least three months⁽¹⁾.

Solutions

Managing insomnia and improving your ability to stay asleep involves lifestyle changes, behavioural adjustments, and creating a conducive sleep environment. Here are some tips to help you manage insomnia and achieve a more restful night’s sleep:

1. Establish a consistent sleep schedule: Go to bed and wake up at the same time every day, even on the weekends. Doing so helps regulate your body’s internal clock, improves sleep quality and helps to ensure you don’t wake up frequently during the night. Make sure your bedroom is cool, dark and quiet. You can use curtains, blinds, an eye mask or ear plugs if needed to help you settle to sleep and prevent waking up during the night.
2. Limit bedtime anxiety: If you can’t fall asleep within twenty to thirty minutes, leave your bedroom and engage in a calming activity until you feel drowsy. Activities include reading, yoga, gentle cleaning or listening to music. By doing this, you can prevent associating the bed with anxiety.
3. Exercise regularly: Engage in regular physical activity during the day, but avoid intense workouts close to bedtime. When you exercise, you elevate your core body temperature, which signals the body clock that it’s time to be awake. After about thirty to ninety minutes, the core body temperature starts to fall. The decline helps to induce the feeling of sleepiness.
4. Manage your stress daily: Practice stress-reduction techniques like mindfulness, meditation, or deep breathing exercises during the day to help ease anxiety that may contribute to insomnia.
5. Be mindful of clock-watching: Avoid constantly checking the time when you wake up during the night, as this can increase anxiety and make it harder to fall back asleep.
6. Chronic pain relief: Conditions like arthritis, heart failure, sickle cell anaemia, or cancer can cause discomfort and pain that disrupts sleep and leads to nighttime awakenings. Speak to your GP if this is a concern, as they may be able to prescribe pain relief medications such as Acetaminophen. Some medications may help you if you are suffering from Insomnia, but you should always consult your doctor before trying any new medications.
7. Cognitive behavioural therapy for insomnia (CBT-I): CBT-I can help you manage negative thoughts and actions, which can keep you awake during the night and is generally recommended as the first line of treatment for people with insomnia. Typically, CBT-I is equally or more effective than sleep medications, so it is worth investigating if this sounds like something you are experiencing.

Remember that consistency is key when it comes to managing insomnia. It might take time to see significant improvements, so be patient and stick to these strategies to gradually improve your sleep quality.

What is middle Insomnia?

If you wake up every night, it could be a specific type of Insomnia you are experiencing. Middle Insomnia, also known as middle-of-the-night Insomnia, is a type of sleep disorder characterised by difficulty staying asleep, leading to frequent awakenings at night. This condition disrupts sleep continuity, causing individuals to wake up in the middle of the night. The constant sleep interruptions can significantly impact daily functioning and overall well-being.
The consequences of middle-of-the-night Insomnia go beyond immediate mental and physical effects resulting from the lack of sleep. Research indicates persistent Insomnia can increase the risk of developing chronic health conditions over time.
If you or someone you care about has been diagnosed with middle Insomnia, it is essential to seek appropriate treatment. Proper interventions can help improve sleep quality and ultimately enhance the overall quality of life. Consulting a healthcare professional or a sleep specialist can provide the appropriate treatment to manage and alleviate the symptoms of middle-of-the-night Insomnia.

Sleep Hygiene

Your lifestyle choices can also impact your sleep. Not maintaining good sleep hygiene risks frequent nighttime awakenings and difficulty falling asleep. Consider changes to your bedtime routine. Try the following, and you should find some improvement in your sleep.

Solutions

1. Switch off electronic devices: By switching off electronic devices and limiting how much blue light you are being exposed to, your sleep quality should improve. The emission of blue light from electronic screens disrupts the production of melatonin, an essential hormone that regulates sleep cycles. The body’s circadian rhythm relies on light signals to establish sleep patterns and wakefulness. Consequently, it is advised to refrain from using electronic devices for at least ninety minutes before bedtime.
2. Diet: Your body requires diverse vitamins and nutrients to perform and feel your best daily. These essential components support overall well-being and contribute to a more consistent sleep pattern. By assessing your dietary choices and incorporating a greater quantity of such foods, you will discover that winding down becomes more manageable, and the quality of your sleep improves as well. Opt for foods which are rich in tryptophan. Tryptophan has natural sleep-inducing properties. Before making any significant changes to your diet, it is always advisable to consult with a healthcare professional, such as a nutritionist, who can provide personalised guidance.
3. Reduce daytime naps: Taking naps that exceed twenty minutes can interfere with your ability to fall asleep and disrupt your body’s internal clock. Limiting the duration of your naps and avoiding taking them too close to bedtime is advisable. Doing so can help prevent feelings of disorientation upon awakening.
4. Your environment: For enhancing your sleep hygiene, it’s essential to reserve your sleeping area solely for sleep and intimate activities. Engaging in other tasks can establish a mental link that hinders relaxation. Moreover, removing sources of distraction, guaranteeing comfort, and retiring to bed only when you genuinely feel tired are additional measures to enrich your sleep environment.
5. Room Temperature: The temperature within your bedroom can impact the quality of your sleep, with a cooler room generally being advised. For achieving restful sleep, the recommended temperature is usually around eighteen degrees Celsius. While personal preferences might vary slightly, most healthcare experts recommend keeping the thermostat set between fifteen to twenty degrees Celsius to ensure the best possible comfort while sleeping.
6. Sleep Schedule: Creating a steady sleep routine allows the body to revitalise and restore itself at night. Aim to uphold a consistent sleeping pattern and waking, even on weekends, as erratic sleep schedules can hinder the ease of falling asleep and increase stress levels. Prioritising sufficient sleep will also facilitate waking up early, ensuring you are well-rested.
7. Daylight exposure: Immersing yourself in natural light triggers your brain to initiate the day’s activities. Allocate around fifteen to twenty minutes for exposure to daylight, as it assists in activating your body and readjusting your circadian rhythm, which governs your twenty-four-hour internal clock. You might even integrate this practice into your daily exercise routine to enhance your sleep quality.

Respiratory Issues

Experiencing nighttime respiratory disruptions is common for individuals with orthopnea, asthma, Sleep Apnoea, or other respiratory issues like allergies or a cold. Bronchitis and other lung diseases can also cause breathing difficulties that intensify at night, affecting sleep quality. Even a brief interruption in your breathing, even if it lasts just a moment, can disturb you and create difficulties in settling to sleep again.

Solutions

1. Take medication before bedtime: If you have asthma, keep your inhaler next to your bed and with allergies or colds, take medication an hour before bedtime. In doing so, you allow enough time for your body to reap the benefits of the medication and allow you to feel comfortable enough to settle and stay asleep.
2. Relieve your airways before going to sleep: Try relieving your airways using a face steamer or a hot shower with some eucalyptus essential oil drops on the floor. As the steam rises in the shower, the oil can help ease your airways.
3. Consider your sleeping position: If you feel you are waking up gasping for air during the night, it could be a sign of Sleep Apnoea, and some people find sleeping on their side helps to keep their airways open, preventing nighttime disturbances. You can even use pillows to support your neck and head.
4. Change your bed sheets weekly: Unclean sheets have the potential to trigger or exacerbate symptoms for individuals with allergies or asthma. To avert a congested nose and other sleep-disrupting symptoms, it’s advisable to replace your sheets every week.
5. Medications: If you experience orthopnea, your doctor could prescribe a medication to help improve blood flow, strengthen your heart, or prevent lung inflammation. If you have orthopnea due to heart failure, your doctor may prescribe diuretics, angiotensin-converting enzyme inhibitors or beta-blockers. If your orthopnea is a symptom of COPD, your doctor may prescribe bronchodilators or inhaled steroids.
6. Keep windows closed at night: Irritating pollutants in the air could be affecting your respiratory health. If you suffer from allergies, for example, closing your window at night can help prevent air pollutants from disrupting your sleep.
7. Try a humidifier: Use a humidifier to keep the air moist and help you stay asleep throughout the night. Low humidity levels can exacerbate your cold symptoms and lead to dryness in your nose and throat. Use a humidifier to maintain optimal moisture in the air, helping you to ensure that your sleep is uninterrupted throughout the night.

Obstructive Sleep Apnoea

Obstructive Sleep Apnoea, or OSA, is a very common condition where the walls of your throat relax and become narrow during sleep. As a result, this interrupts normal breathing and causes you to wake up during the night. When someone experiences an Apnoea event, they may feel like they are choking, snorting or gasping for air. This is because the lack of oxygen triggers your brain to wake you from sleeping so your airways can re-open and your breathing can resume as normal. People who experience OSA can also experience symptoms including choking, snoring, feeling excessively tired during the day, morning headaches,, night sweats, waking up frequently during the night for toilet breaks, feeling depressed, anxious, or having poor memory and concentration.

OSA can be caused by having large tonsils or adenoids, increasing age, being obese, having a deviated septum, a small jaw or a large tongue.

Persistent daytime fatigue significantly impacts various aspects of your life, including relationships, engagement in hobbies, and performance at work. Furthermore, insufficient sleep is associated with reduced immune function, making you more susceptible to frequent illness and prolonged recovery periods.
Additionally, those with Obstructive Sleep Apnoea face a higher risk of premature death. The physical consequences of this condition contribute to widespread inflammation throughout the body, which is known to be a catalyst for numerous chronic diseases. For example, Sleep Apnoea increases the likelihood of developing conditions such as type 2 diabetes, glaucoma, asthma, liver damage, irregular heartbeat, and congestive heart failure.
Furthermore, Sleep Apnoea amplifies the chances of experiencing heart attacks and strokes, which can complicate pre-existing health conditions. In pregnancy, Sleep Apnoea can lead to complications such as pre-eclampsia, gestational diabetes, and high blood pressure.
In extremely rare cases, Sleep Apnoea can result in fatal choking during sleep. As a result, inadequate sleep can lead to drowsiness while driving, significantly increasing the risk of motor vehicle accidents. Anyone with Sleep Apnoea is three-nine times more likely to be involved in traffic accidents than those with normal sleep patterns⁽²⁾.

How to get tested for Obstructive Sleep Apnoea

If you keep waking up at 3 am and you think you may have OSA, it may be beneficial to undergo a Sleep Test to determine the presence and severity of Sleep Apnoea. IntusHealthcare offers confidential, efficient, and reliable testing services. It’s important to note that approximately eighty-five per cent of the UK population suffering from Obstructive Sleep Apnoea remain undiagnosed⁽³⁾. Therefore, obtaining a Sleep Test is a proactive step towards addressing your sleep-related concerns.
If you require further assistance or advice regarding Obstructive Sleep Apnoea, please feel free to contact us for support.

Test for Obstructive Sleep Apnoea

Our In-Home Sleep Test is a quick and reliable way to confirm if you have Sleep Apnoea.

The device records your sleep for just one night and monitors your body position, blood oxygen levels, heart rate and Peripheral Arterial Tone. Your data is then sent to one of our NHS-trained sleep technicians, and you will receive a full sleep diagnostic report to determine if you have Sleep Apnoea in as little as ten days.

Learn More

Summary

There are many reasons why you wake up at 3 am every night, but exploring what the cause could be will help you establish the best course of treatment and understand how you can get the sleep you deserve. Sleep is essential for your health and well-being; by prioritising good sleep, your overall well-being will significantly improve and, in the long term, will optimise your health. If you think you could have Sleep Apnoea take our In-Home Sleep Test or contact us for more advice. 

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References

• AASM (2019) Insomnia awareness day facts and stats, Sleep Education. Available at: https://sleepeducation.org/insomnia-awareness-day-facts-stats/ (Accessed: 31 July 2023).
• Simon, D. for B.B. (2018) Sleep apnoea – 15% of vocational drivers could be undiagnosed, Driving for Better Business. Available at: https://www.drivingforbetterbusiness.com/articles/sleep-apnoea-15-of-vocational-drivers-could-be-undiagnosed/#:~:text=Studies%20have%20shown%20that%20when,to%20be%20of%20increased%20severity. (Accessed: 31 July 2023).
• BLF (2015) Obstructive sleep apnoea (OSA) – asthma + lung UKBL, Obstructive Sleep Apnoea (OSA). Available at: https://www.blf.org.uk/sites/default/files/OSA_Toolkit_2015_BLF_0.pdf (Accessed: 31 July 2023).