Key points
- Brief awakenings are part of sleep, and many go unnoticed.
- The real problem is difficulty getting back to sleep: it affects about 8% of adults and takes a much greater toll on the day[2].
- In the middle of the night: do not check the time, and get up if sleep does not come back[4].
- With CBT-I, the time spent awake at night falls by 26 minutes on average[3].
Normal or not?
Sleep is organised in successive cycles, and brief awakenings between two cycles are normal, especially in the second half of the night. Most last a few seconds and leave no memory at all.
In a large American survey, 35.5% of adults said they woke at least three nights a week, and for more than 90% of them this had been going on for more than six months[1]. But waking up is not necessarily a problem: what makes the difference is how long you stay awake and what it does to your day.
What really matters
Another survey shows that 7.7% of adults have trouble getting back to sleep after waking, and that their days are the most affected: an impact five to seven times greater than in people who wake once or twice without difficulty[2].
Why do we wake up at night?
- Age: sleep becomes lighter and more fragmented as we get older.
- The body: pain, needing to pass urine, hot flushes, reflux, breathing difficulties. People with pain are more than four times as likely to have trouble getting back to sleep[2].
- The mind: stress, rumination, anxiety or depression. This is also more than four times as likely in people with a mental health condition[2].
- Habits: alcohol in the evening (it helps you fall asleep but disturbs the second half of the night[6]), a lot of caffeine[2], irregular hours, naps, too much time in bed.
- Other sleep disorders: sleep apnoea, restless legs syndrome.
To understand what keeps insomnia going, read what causes insomnia.
Waking too early in the morning
Waking well before you meant to, with no way of getting back to sleep, is one of the three forms of insomnia. If these early awakenings come with sadness that does not lift, a loss of interest or intense tiredness, talk to your doctor: insomnia and depression often feed each other[5].
What to do in the middle of the night
- Do not check the time. Working out how long you have left raises the tension. Turn the clock away.
- If sleep does not come back after twenty minutes or so (an estimate), get up and go to another room to do something quiet, in soft light[4].
- Go back to bed when you feel sleepy again, and repeat if you need to: this is stimulus control.
- Avoid screens and bright light, which wake you up further.
- Do not compensate in the morning: keep to your usual wake-up time, even after a bad night, to save your drive to sleep for the following evening.
Take care at night
Leave a night light on to show the way if you get up during the night, especially if you are older or take sleeping medication: the risk of falling is real.
What CBT-I changes
A meta-analysis of 20 trials (1,162 adults) shows that by the end of CBT-I, the time spent awake at night falls by 26 minutes on average, the time taken to fall asleep by 19 minutes, and sleep efficiency rises by about 10 percentage points, with effects that seem to last[3].
It works on exactly what keeps awakenings going: the time spent in bed, through sleep restriction, and the link between your bed and being awake, through stimulus control.
When to talk to a doctor
- Loud snoring, pauses in breathing noticed by someone close to you, waking with a start and a choking feeling.
- Needing to pass urine several times a night.
- Unpleasant sensations in your legs with an urge to move them.
- Pain that wakes you, or very early waking with low mood.
- Frequent waking for several weeks that affects your days.