By Tim Bonfield
Reviewed by Michael W. Smith, MD
You set the alarm for 6 a.m., but for the third day this week you wake up at 1 a.m. instead. You know you need more rest, but falling back asleep takes a long time. When you finally do doze off, before you know it, your alarm clock is ringing.
If that sounds familiar, you may have a common form of insomnia that makes it hard for you to stay asleep.
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What Makes You Wake up in the Night?
Middle-of-the-night insomnia affects almost twice as many women as men. It becomes more common in middle age.
Chronic pain, sleep apnea, and the need to get up over and over to use the bathroom are some things that can interrupt your sleep. So can the hot flashes of menopause.
Meanwhile, life's stresses take their toll. Marriage troubles, job losses, aging parents, or children leaving home all can leave your mind racing in the night.
Once you start waking up at night, a vicious cycle can begin. The more you worry about losing sleep, the harder it becomes to stay asleep.
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"Everyone wakes up at night once in a while. Most people roll over and go back to sleep. But some people begin to fret about it," says clinical psychologist Theresa Lengerich, PsyD. She's the director of behavioral sciences at the Bethesda Family Medicine Residency Program in Cincinnati.
"As you lay there, you become tense, which makes it harder to fall back asleep. And then you become even more upset," Lengerich says. "If this continues night after night, it can become a conditioned response that can cause insomnia all by itself."
Sleep Hygiene to Help You Get Better Sleep
"Sleep hygiene" sounds like it has to do with cleanliness, but it actually refers to improving some of your habits to give you a better night's sleep.
Some of the steps you can take are changes to your daytime routine:
• Avoid naps during the day
• Get regular exercise
• Make sure you go outside during the day to get exposed to natural light. This helps you maintain a healthy sleep-wake cycle.
There are also steps you can take as you get close to bedtime that can improve sleep:
• Avoid caffeinated drinks and alcohol
• Don't use tobacco products
• Don't have a large meal close to bedtime
• Avoid emotional discussions before going to bed
It's also important to keep up a regular sleep-wake schedule -- during the week and on weekends too. Try to go to bed and wake up the same time every day.
When to Call the Doctor
Lengerich recommends a "rule of threes" to help you decide whether to see a doctor:
• Are you waking up at least three nights a week?
• Does it take longer than 30 minutes to get back to sleep?
• Has this been going on for 30 days or more?
If you can say "yes" to these questions, you should seek professional help.
The good news is that insomnia can be treated.
While you and your doctor are trying to figure out what's causing your sleep problems, you may be prescribed a sleep medication. You can also check with your doctor to see if an over-the-counter medication is useful.
The sleep medication can help treat insomnia while you try other kinds of therapy.
If you have no underlying conditions, your doctor may recommend a sleep study. This can be done at a local sleep disorders center or sometimes in your home.
During the study, experts monitor you while you sleep to determine if you have sleep apnea, restless leg syndrome, or other treatable disorders.
If your insomnia is not connected to a physical health problem, then you may be referred to a psychiatrist, psychologist, or other therapist. They can provide relaxation training, behavior therapy, and other methods to help you get better sleep.
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