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Waking up in the middle of the night is common and can be caused by everything from stress and lifestyle habits to illnesses. Sleep problems occur primarily when you have recurrent awakenings and difficulty falling back asleep, which can lead to fatigue, irritation and difficulty concentrating.
Common causes of sleep disturbance are stress, alcohol, caffeine, nicotine, screen time late at night. Irregular sleep times and too little physical activity also have an impact. Physical problems such as sleep apnea, pain, reflux, asthma, allergies and restless legs can also disrupt sleep. Other factors that also play a role are hormonal changes, anxiety, depression, bedwetting, diabetes and thyroid problems.
You've already slept for a couple of hours but then you wake up – again – and the clock shows 03:17. Maybe you feel wide awake, maybe you need to get up to pee, maybe you wake up with a heart palpitations, sweating or a feeling that something is disturbing your sleep without you really understanding what's going on?
You're far from alone in waking up in the middle of the night, it's relatively common. The reasons why you wake up can be because you're stressed, lifestyle habits such as alcohol, hormonal changes or a treatable illness.
Why do I wake up in the middle of the night?
Our sleep goes in cycles and between these cycles the brain can become more easily awakened. However, waking up becomes a problem when they become so obvious or long-lasting that you notice them, have difficulty falling back to sleep, which in turn leads to you being tired, irritable and unfocused the next day.
Sleep problems, or insomnia as it is also called, are about having difficulty falling asleep, waking up several times a night or waking up very early before the alarm clock and not being able to fall back asleep. Recurring problems over a long period of time are important to investigate in order to understand what triggers them and what keeps them going.
4 common reasons why you wake up at night
- One of the most common explanations is that you are stressed. What happens then is that the brain revs up even when the body is tired. It can be easy to fall asleep without any major problems when you go to bed, but the problem arises 2-4 hours later when you suddenly wake up and start thinking about work, finances, relationships or things that await you the next day.
- Alcohol is another common cause. A glass in the evening can make it easier for you to fall asleep, but then your sleep can become shallower later in the night. This can cause you to wake up more often, feel anxious in your body or not feel rested despite many hours in bed.
- Caffeine, nicotine and late screens can also contribute. Caffeine can remain in the body for a long time, nicotine acts as a stimulant, and bright light from your mobile phone can disrupt the brain's circadian rhythm. A late cup of coffee or energy drink or having your mobile phone right before going to bed for a little too long is enough to disrupt your sleep.
- Other everyday causes that contribute to sleep problems are irregular bedtimes, late-day naps and too little physical activity. The body likes rhythm. Ensuring regular bedtimes and getting up at about the same time every day can help with more stable sleep.
When nighttime awakenings are due to the body
Sometimes it is the body itself that wakes you up during the night, for example, you may be affected by sleep apnea, pain, reflux, asthma, allergies, hormonal changes or restless legs.
Sleep apnea
With sleep apnea, breathing becomes shallow or takes short breaks during sleep. This can cause snoring, morning fatigue, dry mouth and waking up with a feeling of being “thrown up” from sleep.
Sleep apnea is often associated with snoring, but the condition also contributes to breathing being severely affected during sleep and causing breathing to stop. Some people notice that they wake up many times, sleep restlessly or have to get up to urinate several times a night. So nighttime urination can sometimes be a sign of a sleep-related breathing problem, not just a full bladder.
Pain
Pain, such as osteoarthritis, back pain, headaches or long-term pain in muscles and joints, can also disrupt sleep. When the body is still, certain pain signals become more noticeable, and small changes in position can be enough to wake you up in the middle of the night.
Reflux, asthma or allergies
Reflux, i.e. acid reflux from the stomach, can also cause awakenings with a cough, burning behind the breastbone or a sour taste in the mouth. Asthma and allergies can also cause similar nocturnal disturbances through coughing, wheezing or nasal congestion.
Restless legs
Another cause is restless legs. Cramping, tingling or a strong need to move the legs, especially in the evening and at night, are symptoms of having restless legs. The problems can make it difficult to fall asleep again and are sometimes linked to low iron levels.
Hormones, mood and nighttime awakenings
Hormones have a major impact on our sleep. Especially for women during menopause, when night sweats and hot flashes are a common cause of waking up in the middle of the night.
Pregnancy can also cause more disrupted sleep, including more frequent urination, reflux, back pain and altered breathing. After childbirth, sleep is often affected both by hormones and by the disruption of sleep rhythms.
Mental health is another reason that often contributes to sleep problems. Anxiety often causes the body to be on alert and then you are easily awakened by small signals. In depression, it is common to wake up early or have shallower sleep with many awakenings.
If you wake up with a pounding heart, strong anxiety or feelings of panic, it may be due to nocturnal anxiety or a panic attack. The symptoms are not imaginary - the body's stress reaction is real and can be felt especially clearly when it is quiet around you and the distractions of the day disappear.
That's why nighttime urination and blood sugar play a role
Another common reason for waking up in the middle of the night is because you need to go to the toilet, so-called nighttime urination. This is common, for example, with increasing age and can be associated with high fluid intake late at night, alcohol, caffeine, diuretics, overactive bladder or prostate enlargement. But it can also be seen in diabetes, heart failure, sleep apnea or hormonal changes.
In diabetes or pre-diabetes, increased thirst and increased urination can disrupt the night. Some also describe night sweats, anxiety or palpitations when blood sugar fluctuates greatly, although such symptoms are not specific and can have several other explanations.
The thyroid gland is another possible explanation. When overactive, the body can go into overdrive with palpitations, a feeling of heat and difficulty sleeping. Therefore, blood tests of thyroid hormones can sometimes be an option to do as part of the investigation when sleep has changed without any other clear reason.
What you can do yourself - and when you should seek help
What you can start with yourself is to try to see a pattern in how and why your sleep is disturbed. This can be by writing a diary where you note the time of awakening, is it about the same every night? Do you need to pee? Do you snore? Do you have more stressful periods, perhaps drinking more alcohol, taking new medications or spending more screen time than usual?
Many people experience an improvement in their sleep by following these tips:
- Have as regular a bedtime as possible, even on weekends.
- Avoid caffeine late in the day and alcohol close to bedtime.
- Keep the bedroom dark, cool and quiet.
- Avoid mobile phones, tablets and bright lights just before going to bed.
- If you don't fall asleep within about 20 minutes, get up for a while and do something quiet in dim lighting until sleepiness returns.
If you have long-term sleep problems, it is recommended that you seek treatment to get the right help. This may involve CBT-I, cognitive behavioral therapy, and helps you break patterns that keep sleep problems alive, such as restlessness in bed, irregular times and an increasingly strong connection between bed and wakefulness. Another aid you can get through healthcare is medication that helps you sleep and can be used for a short time, but they rarely solve the root cause on their own.
You should seek care if the symptoms last for weeks to months, affect work, mood or concentration, or if you have clear warning signs. In healthcare, an investigation may include questions about sleep habits, mental health, medications, snoring, menstruation or menopause, and sometimes blood tests or sleep recording. If sleep apnea, thyroid disorder, iron deficiency or blood sugar disorders are suspected, further testing may be necessary.
