Why do I keep waking up at 3am and how can I stop? A doctor of sleep medicine answers

It’s a familiar scene: You’ve nailed your wind-down nighttime routine, fallen asleep fast… only to then be wide awake at 3am. But why? Waking up briefly in the night is normal, but periods of wakefulness lasting around thirty minutes or more can be a sign of a larger sleep issue.

While there’s plenty we can do to help ourselves go to sleep — such as getting our bedroom temperature right, blocking out ambient noise and ensuring we’re sleeping on the best mattress for our sleep needs — for many of us actually staying asleep can be the sticking point to our overall sleep quality.

Age, environmental factors, health conditions and underlying sleep disorders can all contribute to nighttime wakings. Waking in the middle of the night can also be down to middle insomnia, the most common type of insomnia , affecting two-thirds of insomnia sufferers. Here, we'll explore why you might be waking up at 3am, plus how to stop. Let's get started.

Waking up at 3am — 7 common causes

Factors outside your control, as well as your environment, can all contribute to waking up in the middle of the night. Here are seven of the most common:

1. Stress and anxiety

Sleep expert Olivia Arezzolo attributes some middle of the night waking to an increase in levels of cortisol, the stress hormone. "This prepares you to wake the next day, but if your baseline levels of cortisol are too high, it will wake from you from sleep too early – you’ll know this is the case if you feel anxious and restless and it’s difficult to return to sleep,” she says.

2. Caffeine consumption

What you’ve eaten or drunk that day can also disturb your sleep. “Stimulants like coffee, which has a very long half-life, takes a long time to leave your system and should be avoided after lunchtime,” explains Dr Allie Hare , consultant of sleep medicine at the Royal Brompton Hospital, London. “Smoking, as well as alcohol (which particularly disrupts REM sleep in the second half of the night) will make it more likely you will wake prematurely.

“Stimulants like coffee, which has a very long half-life, takes a long time to leave your system and should be avoided after lunchtime,” says Dr Hare, “Smoking, as well as alcohol (which particularly disrupts REM sleep in the second half of the night) will make it more likely you will wake prematurely."

3. Screen time

Pre-bedtime scrolling on your phone impacts your ability to both fall and stay asleep, due to the blue light emitted from our screen supressing our levels of melatonin , the hormone that helps us feel sleepy. “Using phone, laptop or TV in the two hours before bed can trigger broken sleep because blue light supresses melatonin,” explains Olivia.

What's more, studies show that using social media immediately before bed can inhibit your ability to stay asleep.“You’re 66 percent more likely to wake up during the night if you use social media within 30 minutes before sleep, fact,” says Olivia. This happens because using social media gives us a dopamine hit that can make it trickier for our brains to switch off.

4. Your environment

In order to fall asleep and stay asleep, there are certain environmental factors that should be taken into consideration. For example, sleeping on the best pillow and mattress for your sleep needs an position will help you stay asleep longer.

Ensuring your bedroom is the right temperature and removing sources of ambient light and sound will also minimize any nighttime disturbances that could be causing you to wake up at the same time every night.  "If your room is too warm or stuffy or there’s external noise, this can disturb your sleep too, making you wake up fully," explains Dr Hare.

5. Advancing age

Research shows that as we age, night waking can be more common, particularly in women going through menopause or perimenopause, which can begin from the early forties onwards.

6. Underlying sleep disorders

While environment and lifestyle factors play a significant role in your ability to fall and stay asleep, underlying sleep disorders such as insomnia, sleep apnea and restless leg syndrome can all cause sleep irregularity.

Symptoms such as struggling to fall and stay asleep, daytime fatigue and irregular sleep cycles are indications that you could be suffering from a sleep disorder. Tracking your sleep habits with a sleep journal will help a sleep specialist identify any

7. Frequent nighttime peeing

Consuming too much fluid too closely to bedtime can lead to a nighttime trip to the bathroom. However, if you are making more than one visit to the bathroom a night, it could be a sign of underlying nocturia, a sleep disorder that is characterized by taking more than one bathroom break per night.

Age, medication and undiagnosed health conditions could be behind any frequent nighttime peeing - and the reason you're awake at 3am. If you're at all concerned by your nighttime bathroom habits, seek advice from your doctor.

What is middle insomnia and how do you know If you have it?

In addition to the above, frequent night waking can be caused by a sleep disorder called middle insomnia. Middle insomnia is the most common type of insomnia and affects two-thirds of insomnia sufferers.

“It’s also known as ‘sleep maintenance’ insomnia, essentially waking during the night and struggling to return to sleep again,” explains Dr Hare. “As we move towards the early hours of the morning, our need for sleep is increasingly satisfied so our drive to remain asleep is less.”

According to Dr Hare, we’re more likely to find it more difficult to return to sleep as we progress towards morning. “Brief wakenings during the night are entirely normal,” she says, “But if we’re often looking at the clock and panicking, thinking ‘Oh no, I know I won't be able to get back to sleep now’ we can actually increase the likelihood that we’ll struggle to get back to sleep before our alarm goes off.”

Alongside frequent night wakings, symptoms are waking up feeling groggy, severe daytime fatigue, irritability, and impaired cognitive ability. One study shows that over two thirds of people with middle insomnia report the condition negatively impacts their waking hours.

“If you’ve been struggling with any form on insomnia, and it’s happening on more than three nights per week for several months, Cognitive Behavioural Therapy for Insomnia (CBTi) can be very helpful, and this can now be accessed digitally or through your health practitioner,” says Dr Hare.

Waking up at 3am — how to stop

Clock watching at 3am? Here’s Dr Hare’s advice on how to manage night-waking.

Don't stay in bed: If you find yourself awake at 3am, you might be tempted to stay in bed and try to get back to sleep - don't. Instead, get up, move to a different room and and do something peaceful for about half an hour.

Don't try to force yourself back to sleep: Sleep can't be forced and the harder you try, the less likely it’ll happen. On occasion sleep doctors even advise people to try to stay awake instead - known as paradoxical intention - flipping what you are trying to do to the reverse, and you might find you return to sleep more easily because you’re not forcing it.

Avoid staying in bed longer: After a night of broken sleep it can be tempting to stay in bed longer in the morning or going to bed earlier to ‘catch up’ on lost sleep: sticking to a regular bedtime and wake schedule helps realign your sleep/wake rhythms, helping your sleep patterns become more regular.

Count backwards from 1,000: If we wake in the night and there’s something on our mind, cognitive distraction can help - try counting backwards from 1,000 in sevens to see if this helps you to drift off.

Avoid ruminating: If you often struggle to ‘put the day to bed’, try constructive worry – simply designate five or ten minutes before bed to jot down everything that is worrying you, and potential ways you might solve the problem, then leave the list until the morning.

Try not to worry: Although it’s hard, avoid worrying about occasional night-wakings, it’s normal for humans to sometimes struggle with sleep, especially during periods of stress. Try to trust in your body: your need for sleep will, in most cases, eventually overcome any worries or anxieties. The less you try to fix or control your sleep pattern, the more likely it is to settle down.

Seek help if your 3am waking persists: If you find you’re often struggling with long periods of being awake in during night and it’s gone on for more than a few weeks, please see your doctor and consider CBT for insomnia (CBTi), a form of cognitive behavioural therapy which is proven to be the most effective treatment for chronic insomnia.