WAKING UP AT 3 A.M.? WHEN IT’S NORMAL AND WHEN IT’S NOT

Many of us have the experience of randomly waking up in the middle of the night. But when it starts to happen regularly, at or near 3 a.m., you may start to wonder whats going on.

Sleep medicine doctors say those 3 a.m. awakenings happen all the time.

This is quite common at all ages, but even more so as one gets older, says Arun Agarwal, MD, the medical director of the sleep lab at Northwells Putnam Hospital in Carmel, New York.

Certain lifestyle adjustments can minimize these nighttime awakenings, he says. But trouble falling back asleep can signal an underlying medical issue for which you should see a healthcare provider.

Heres how to decipher what youre dealing with, according to sleep medicine physicians.

Why Waking Up at 3 A.M. Is Normal for Most People

It is common to have multiple awakenings at night that are brief, says Aarti Grover, MD, the medical director of sleep medicine at Tufts Medical Center in Boston. You can have up to two to three short awakenings in most adults, which typically do not disrupt your sleep.

People typically go through five full sleep cycles per night, with each lasting about 90 minutes, Dr. Grover explains. During the first half of the night, slow-wave sleep, which is typically deep sleep, is prioritized, she says. The latter half of the night involves more stage one (the lightest phase of sleep) and REM sleep, which is typically when we dream, Grover says.

Transitioning into lighter sleep can lead to more awakenings with minor disruptions from a faint noise, temperature change, or subtle movements, she adds.

Levels of the stress hormone cortisol may also play a role. Cortisol levels are lowest just before you go to sleep and then start to rise in the early morning hours to restore your energy levels and wake you up, Dr. Agarwal says.

Any disturbance to this pattern can cause those 3 a.m. wake-ups, Grover says.

Why Older Adults Are Naturally More Inclined to Wake Up at 3 A.M.

Sleep patterns change with age, and several factors increase the odds of waking up at 3 a.m. later in life.

• A Shifted Body ClockA shifted body clock is important at extremes of age. The young sleep late, sleep longer, wake up quite late, and sleep deeper without awakening. Older adults want to sleep earlier and sleep time is shorter, so they find themselves awake very early in the morning, Agarwal says. This is normal.
• Lighter SleepYou spend less time in restorative deep sleep as you age, Grover says. That means you spend more time in lighter sleep, when its easier to be woken up, she adds.
• Lower MelatoninAs we age, there is a reduction in the production of melatonin, a hormone that is produced during darkness to help consolidate sleep, Grover says.
• Increased Nighttime UrinationYou may be waking up at 3 a.m. simply because you need to use the bathroom. In men, this can be due to an enlarged prostate gland. In women, it can be tied to hormonal shifts caused by perimenopause and menopause, Grover says.
• Physical Discomfort and Medical IssuesIt is common for older adults to develop health problems like acid reflux, arthritis, and hot flashes, Grover says, which can lead to more awakenings.

Other Reasons You May Be Waking Up at 3 A.M.

Complications linked to getting older arent the only reason you may find yourself waking up at 3 a.m. Other reasons include:

• Stress and AnxietyCortisol spikes, racing thoughts, and nighttime panic that are common with anxiety disorders can lead to an increased number of brain arousals, Grover says.
• Medications That Disrupt SleepThere are many medications that can also fragment your sleep, Grover says. These include antidepressants, which can reduce REM sleep and increase leg movements, along with beta-blockers, which can alter REM sleep, Agarwal adds.
• Sleep DisordersSleep conditions like sleep apnea (which causes starts and stops in breathing at night) and insomnia (which makes it hard to fall asleep and stay asleep) can lead to nighttime awakenings, Grover says.
• Lifestyle and EnvironmentTaking naps during the day and late-night meals can disrupt your sleep. Alcohol is also a potential sleep-disruptor, per Grover. While alcohol can help patients to fall asleep initially, this also suppresses REM sleep and causes more awakenings after four to six hours after it has been processed by the liver, she says. Too much caffeine in the evening may also cause you to wake up at 3 a.m.

What to Do (and Avoid) When You Wake Up at 3 A.M.

It can be frustrating and jarring to wake up at 3 a.m., especially if you cant easily fall back asleep. But doctors say that what you do next matters.

If you arent sleeping after 20 minutes, Agarwal suggests getting out of bed and doing a quiet activity like reading in low light. This breaks the poor sleep cycle the brain has fallen into and helps restore the underlying healthy cycle, he says. It also can help you get physically tired enough to go to sleep, Grover says.

Relaxation techniques like progressive muscle relaxation, deep breathing exercises, and box breathing (equal counts of inhaling, holding air, and exhaling) can also be helpful, per Grover.

While tempting, doctors say its important not to keep checking the clock, looking at your phone, or turning on bright lights. This can subconsciously train your sleep cycle to wake you up at 3 a.m., making the problem worse, Agarwal explains.

Lifestyle Changes Can Promote Better Sleep

Youre not powerless when it comes to sleep continuity, which is why doctors suggest making lifestyle changes.

• Optimize your sleep environment. The best way to set up your bedroom for better sleep is to keep the room cool, dark, and quiet. This helps to prevent external environmental triggers from waking you up during light sleep stages, Grover says.
• Adjust your evening habits. That includes setting a wind-down routine, trying to finish eating two hours before bed, and curbing alcohol and caffeine, Agarwal says.
• Work on managing stress levels. This is often easier said than done, but doing what you can to manage stress can help minimize nighttime awakenings, Grover says.
• Keep a consistent sleep-wake schedule. That means trying to go to bed and wake up at the same time every day, according to Grover. This also stabilizes your circadian rhythm and internal sleep clock, she adds.

When to See a Doctor About Your Sleep Issues

Grover says you should talk with your doctor if you experience any of the following.

• You continue to wake up multiple times each night despite changes in your habits.
• You make frequent trips to the bathroom during the night.
• You have repeated snoring, choking, or gasping episodes, which could be signs of sleep apnea.

She also flags poor sleep quality that leads to brain fog and trouble going about your daily routine as a concern. These could be signs of an underlying sleep disorder, Grover says.

The Takeaway