Why Do I Keep Waking Up at 3am?

Is waking in the night normal?

Yes. Sleep runs in cycles of about 90 minutes, and towards the end of each cycle sleep is lighter. In the second half of the night there’s less deep sleep and more light and dream sleep, so brief wakings around 2 to 4am are common. Most people don’t remember them.

In a large US survey, about a third of adults reported waking during the night at least three nights a week. The problem is waking fully and not getting back to sleep.

Why do I keep waking at 3am?

• Stress and worry. Once you’re awake, a busy mind makes it hard to drift off again, and the early hours are when worries feel biggest.
• Alcohol. It can help you fall asleep but disrupts sleep later in the night.
• Needing to pass urine.
• Pain as you move in bed.
• Sleep apnoea, which causes repeated waking, often with snoring or gasping.
• Hot flushes and night sweats, including in perimenopause.
• Reflux.
• Low mood. Early-morning waking is a classic symptom of depression.
• Body clock changes. With age, sleep tends to become lighter and earlier.
• Learned waking. After weeks of waking at the same time, the brain can start to expect it.

What to do when you wake

• Don’t check the time. Turn the clock away. Calculating how much sleep is left raises stress.
• Stay calm and still for a while. Slow breathing helps.
• Get up if you’re still awake after about 20 minutes or start to feel frustrated. Go to another room with dim light and do something calm and boring, like reading. Return to bed when sleepy.
• Avoid your phone and bright screens.
• Write worries down to deal with in the morning.
• Keep your wake-up time the same the next morning, however the night went.

To reduce night waking

• Cut back alcohol, especially in the evening
• Limit fluids in the last couple of hours before bed
• Keep caffeine to the morning
• Avoid long naps
• Keep regular sleep and wake times

If waking has lasted more than a few weeks, CBT for insomnia is the most effective treatment. See CBT-I.

When to see a GP

See a GP if night waking happens most nights, affects how you feel during the day, or comes with snoring, gasping, night sweats or low mood. If you’re having thoughts of self-harm, call Lifeline on 13 11 14.

References

1. Ohayon MM. Nocturnal awakenings and comorbid disorders in the American general population. J Psychiatr Res. 2008;43(1):48-54.
2. Morin CM, Drake CL, Harvey AG, et al. Insomnia disorder. Nat Rev Dis Primers. 2015;1:15026.
3. Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021;17(2):255-262.
4. healthdirect. Insomnia.