By Nina Bahadur
“Normal” has some wiggle room here.
Waking up in the middle of the night can be a real drag. One minute you’re dreaming about an amazing breakfast sandwich, the next you’re wide awake, disoriented, and dismayed to see that it’s only 3 A.M.
Nighttime wake-ups, also known as “nocturnal awakenings,” are pretty common. For a 2010 study in Psychosomatic Research, researchers interviewed 22,740 people about their sleep habits, finding that 31.2 percent of participants reported waking up at least three nights per week. And in a 2008 Journal of Psychiatric Research study of 8,937 people, 23 percent said they woke up at least once every night.
If this sounds a lot like your sleep experience, should you be concerned?
Waking up in the middle of the night isn’t automatically something to worry about.
It might feel like “good sleep” means not waking up at all until your alarm goes off, but that’s not true. Waking up at night can be normal. It’s the cause and frequency that help determine whether or not there’s actually a problem.
A loud noise outside, anxiety, needing to pee, and medical conditions like sleep apnea, restless legs syndrome, and an overactive thyroid can all cause nighttime wake-ups.
Because there are so many different things that can wake you up, there’s no specific number of awakenings that is a cause for concern, Brandon Peters, M.D., a board-certified neurologist and sleep medicine specialist, tells SELF. “[The number can] vary night by night due to different reasons,” he says. Some of those reasons are NBD.
It’s really common to wake up briefly in certain stages of sleep, which you may or may not even remember.
When you’re asleep, you cycle through different sleep stages called 1, 2, 3, 4, and REM sleep (though some schools of thought combine stages 3 and 4 as one).
According to the National Sleep Foundation, stage 1 is the lightest phase of sleep. In that time, your arousal threshold is lowest, meaning it may be easy for noise, light, or some other environmental factor to wake you up.
Your dozing gets deeper in each progressive stage until you reach REM sleep, where your muscles are pretty much paralyzed and most of your dreaming occurs. Once a REM sleep segment is complete, you cycle back to stage 1. This process usually takes around 90 minutes, so if you shoot for eight hours of sleep each night, you’ll likely go through around five full sleep cycles.
Dr. Peters tells SELF that people often wake up between sleep cycles when their arousal threshold is low, but these awakenings are super short, and you might not remember them in the morning. “It is normal to roll over, adjust the covers, or to even respond to noises in the environment,” he says.
If you wake up in the middle of the night and struggle to get back to sleep, though, you might be experiencing middle-of-the-night insomnia.
Regularly waking up for at least 20 to 30 minutes at night might be a sign that you have middle-of-the-night insomnia, Dr. Peters says, which can be distressing. “The major cause for concern that patients complain about is experiencing nighttime awakenings that keep them up,” Nesochi Okeke-Igbokwe, M.D., an internal medicine specialist, tells SELF. For some people, insomnia can be especially detrimental when it really starts edging into the seven to nine hours of sleep recommended for adults every night.
When you wake up and can’t get back to sleep, you might be tempted to watch the minutes tick away on a clock. Try not to do this, since worrying about not getting enough sleep could just make it harder to sleep, Dr. Peters says. Instead, he suggests setting an alarm before bed each night and covering it up so you can’t check the time: “If you wake at night and don’t hear the alarm, it doesn’t matter what time it is. You get to go back to sleep. This will reduce the likelihood that the awakening will start the mind racing and contribute to insomnia.”
Once you feel like a solid chunk of time has passed and you’re still not tired, get out of bed and do something relaxing, Dr. Peters says. Read a book, listen to music, or work on a puzzle. (Try to keep the lights low so you don’t throw off your circadian rhythm.) When you feel sleepy again, put yourself back to bed.
If you have to resort to these methods often, Dr. Okeke-Igbokwe says that your first step should be to assess your sleep hygiene practices. Are you sleeping in a cool, quiet, and dark room? Do you regularly go to bed and wake up at the same time? Do you cut yourself off from caffeine by mid-afternoon? Do you give yourself time to wind down and avoid screens before bed? If the answer to all those questions is “yes,” Dr. Okeke-Igbokwe recommends chatting with your doctor about other potential causes for your insomnia (like anxiety or stress) and how to treat them.
If you often wake up more than once a night to pee, you might need to reevaluate your fluid intake or see if there could be a medical cause.
It’s fine to need a bathroom trip every now and then in the middle of the night. But getting up to pee multiple times can be the result of drinking too much water, consuming alcohol before bed (as a diuretic, it can make you churn out more urine), or taking a medication that has the side effect of making you pee, like a high blood pressure drug that contains a diuretic.
It might also happen because of a condition like a urinary tract infection (UTI) that irritates your bladder or overactive bladder (when your muscles in the organ contract too much).
If you make some lifestyle tweaks such as not downing a glass of water before bed but you’re still waking up all the time to pee, see your primary care doctor or a specialist like a urologist for guidance.
Really, the biggest red flag surrounding nighttime wake-ups is feeling excessively sleepy during the day.
If you constantly feel wildly tired during the day no matter how many or few times you wake up at night, that is worth looking into. Excessive daytime sleepiness can be a sign of various issues, like sleep apnea, a condition in which your breathing repeatedly stops and starts while you sleep.
There’s obstructive sleep apnea, caused by your throat muscles relaxing; central sleep apnea, caused by your brain failing to send proper signals to your muscles to help you breathe; and complex sleep apnea, which is when someone has both obstructive and central sleep apnea. Waking up in the night while gasping for air or choking can happen with all forms of the condition, according to the Cleveland Clinic. So, if you have any number of nighttime wake-ups where you are struggling to breathe, talk to a doctor about that possibility.
The culprit here could also be something like asthma, which often gets worse at night. This can happen because increased nighttime levels of the stress hormone cortisol cause inflammation that makes your airways swell, prompting asthma symptoms such as coughing that wake you up. Or it could be because your bedroom and bed are full of allergens that inflame your asthma, like dust mites. Either way, nighttime asthma flares can lead to subpar sleep and a lot of daytime drowsiness.
Whatever is causing your excessive daytime sleepiness needs to be addressed. See a doctor for help.
The bottom line? There’s no magic number of nocturnal awakenings that is inherently problematic. Context matters, as do your energy levels throughout the day.
Look at the big picture view of your nocturnal awakenings, Dr. Okeke-Igbokwe says. Consider how many times you are waking up each night, yes, but also how long you’re awake, how much total time you spend awake each night, and how you feel the next day.
While frequent nighttime wake-ups might be no issue for some people, they can leave others feeling wretched. Don’t just accept feeling tired all the time—work with your doctor to figure out what’s interrupting your rest.
Learn more on SELF.