It’s 2 a.m. and you’re wide awake. Again. What’s the deal?
First, understand that waking up in the middle of the night is completely normal and part of our human DNA, says Jose Colon, MD, founder of Paradise Sleep and author of The Sleep Diet. “Nobody sleeps through the night,” Dr. Colon says. In fact, he says even 4 to 6 nocturnal awakenings are considered normal. “This goes back to our caveman days where one would wake up, scan the environment, make sure there are no tigers, and then go back to sleep,” he says.
That last part is key: You should be able to go back to sleep. If you can’t, one of the following sleep stealers may be standing between you and a good night’s rest. Here’s why you keep waking up in the middle of the night, and exactly how to start snoozing peacefully again.
Sleep stealer: having to pee
Nocturia (nighttime urination) has many triggers. But if you find yourself waking up two to four times a night to pee even when you limit your evening drinking, your balance of water and electrolytes may be off, says Jonathan Steele, RN, executive director of WaterCures.org. If you consume too much water without enough salt, your body may try to jettison some H20, which may explain why you’re waking up in the middle of the night to pee.
Sleep solution: About 30 minutes before going to sleep, drink a small glass of water with a pinch of unprocessed sea salt, Steele suggests. “Unprocessed salt helps the water to get into all of our cells,” he says. You need to take the salt with H20 to ensure your body retains both, he adds.
Sleep stealer: a hot room
According to the National Sleep Foundation (NSF), feeling hot can make it hard to stay (and fall) asleep. “The temperature of the room, what you wear or don’t wear to bed, the sheets and blankets-all figure in to keeping your body at the right temperature,” says Marc Leavey, MD, a primary care specialist with Mercy Medical Center in Baltimore.
Sleep solution: People can sleep comfortably at a range of temperatures. But a room temp between 60 and 65°F is ideal for most, the NSF reports. Also, try a bath before bed, Dr. Leavey suggests. “Taking a warm bath raises your temperature in the tub slightly, while exiting the tub triggers a slight drop in temperature-a signal that your brain associates with sleep,” he explains.
Sleep stealer: mild depression
Just as people with major depression can have trouble falling or staying asleep, so too can the 17 percent of women who have a low-grade form of the illness. But because their depression symptoms-which include negative thoughts, excessive worry, lack of energy, and body aches-aren’t as severe, women with mild depression are less likely to be diagnosed with sleep issues.
“There’s a complex relationship between sleep and mild depression, and it can be difficult to determine which came first,” says Aarti Gupta, PsyD, founder and clinical director of TherapyNest, a private psychology practice in Palo Alto, CA. It’s a vicious circle, she says: Depression symptoms set up poor sleep habits that can cause you to stay up or wake up in the middle of the night. “And without a good night’s rest, it’s difficult to function at your highest capacity the following day-which manifests as feeling tired, sad, and mildly depressed and sets up the cycle for lack of sleep for the next day.”
Sleep solution: Because the symptoms of mild depression can be similar to those many women experience during menopause, it’s important to discuss your mental health history with your primary care doctor or a psychologist to determine whether your depressive symptoms existed prior to menopause or if the hormonal changes triggered or exacerbated them. Your physician will design a treatment plan that includes talk therapy, lifestyle changes, medication, or all three.
Sleep stealer: your late-night Instagram addiction
If your bedtime routine involves scrolling through Twitter and Instagram, your updates may be messing with your sleep. “Exposing eyes to light during the evening stops the body from making melatonin, the sleep hormone,” explains Richard L. Hansler, PhD, of the Lighting Innovations Institute at John Carroll University in Ohio. From tablet screens to smartphones, electronic devices are light sources people tend to hold close to their faces, which may make them potent sleep disrupters.
Sleep solution: Dim your room lights and aim to make your last hour before bed screen-less. Too hard? Research suggests the blue light emitted from smart phones is the most problematic. Dimming your phone or tablet’s light, and holding it at least a foot or two from your face, makes it less likely to mess with your slumber.
Sleep stealer: getting older
Everyone has a biological clock that determines when they get tired at night and when their body wakes up in the morning. But starting around age 40, your clock begins to shift. Researchers aren’t sure exactly why this happens, but the result is that your body will naturally wake up increasingly earlier, decreasing the amount of sleep you’re getting, explains Hans Van Dongen, PhD, director of the Sleep and Performance Research Center at Washington State University. By the time you hit your 60s, you could be waking up 2 hours earlier than you did in your 30s.
Sleep solution: Move up your bedtime to accommodate your body’s new sleep schedule. If you’re worried that you’ll lie awake because you’re going to bed earlier than you’re used to, Van Dongen offers reassurance. “You’re probably naturally getting tired earlier, but it’s easy to ignore or not notice the sleepiness if you’re used to staying up late,” he says. “Most older people find that when they start getting into bed earlier, they fall asleep easily.”
Sleep stealer: drinking alcohol before bed
While that second cocktail may make you sleepy, it can also disrupt your restful night’s sleep. “Alcohol has a sedative effect that, if you drink enough, can put you to sleep quite easily,” Dr. Leavey says. “Over the first few hours, you metabolize that alcohol, with the alcohol producing a form of sleep that can prevent the healthy rapid eye movement sleep that is most restful.” This lack of REM sleep will make the second half of your night restless and fragmented.
Sleep solution: The best cocktail to drink before bed? It doesn’t exist, Dr. Leavey says. “If you are going to drink, you may not be able to sleep,” he adds. (There’s a reason “happy hour” is early in the evening.) Take it easy on the booze and quit drinking a few hours before you go to bed, and you’ll give your body time to metabolize the alcohol before you try to sleep.
Sleep stealer: breathing problems
When you have a stuffy nose-whether from seasonal allergies or a cold-you’re likely to toss and turn at night because you’re struggling to breathe. But other factors can narrow your airway permanently, such as a deviated septum, nasal polyps, large tonsils, or an overly large tongue. And these conditions can increase sleep disturbances: When researchers at the Sleep and Human Health Institute in Albuquerque, NM, studied 20 people with chronic insomnia, they found that 90 percent of the participants’ middle-of-the-night wakings were linked to breathing issues.
Sleep solution: It won’t treat the underlying issue, but lying on your side may help you sleep better-breathing problems tend to worsen when you sleep on your back, says Steven Y. Park, MD, an assistant professor of otorhinolaryngology at Albert Einstein College of Medicine. If this doesn’t help, make an appointment to see an ear, nose, and throat specialist. The typical course of action is a physical exam to see if there’s a blockage in your nose or throat, says Dr. Park. The fix may be something simple like a nasal breathing strip or a device to help you breathe (such as a CPAP machine), though in some cases surgery is recommended.
Sleep stealer: sleep apnea
Many people think sleep apnea, which causes a person to stop breathing repeatedly during the night-sometimes hundreds of times, for a few seconds to a full minute-and then briefly wake up, affects only overweight men. But as women age, and especially as they go through menopause, they become just as likely as men to have sleep apnea-even if they’re at a healthy weight, says Rafael Pelayo, MD, a sleep specialist at the Stanford Sleep Medicine Center.
In fact, research shows that 17 percent of women likely have sleep apnea but that 85 percent of cases go undiagnosed. One reason is that women have different symptoms than men do. Snoring, a major tip-off that men have the disorder, is less common in women. They’re more likely to develop symptoms related to being sleep deprived, such as difficulty thinking of the right word, clumsiness, fatigue, depression, or anxiety, says Katherine Sharkey, MD, PhD, assistant dean for women in medicine and science at Brown University Alpert Medical School.
Sleep solution: If you notice these symptoms, tell your primary care physician-the medical community is becoming more aware that apnea isn’t just a man’s problem. If your concerns are dismissed, see a certified sleep specialist (the American Board of Medical Specialties has a list here). To determine whether you have the disorder, you’ll likely undergo a sleep test-either in a lab or at home-during which you’ll be monitored for breathing and oxygen levels throughout the night. The most common treatment for apnea is a CPAP (continuous positive airway pressure) machine, which helps maintain airflow while you sleep.
Sleep stealer: thyroid problems
An overactive or underactive thyroid gland could be setting off a domino effect of hormone imbalances that make it hard to fall asleep or stay asleep. “When a thyroid is overactive, your heart races, your adrenaline surges, and you can have insomnia and anxiety,” says Amy Myers, MD, medical director of Austin UltraHealth and author of The Thyroid Connection. When the gland is underactive, a condition that becomes more common after age 50, you’re up to 35 percent more likely to have sleep apnea.
Thyroid problems hit women especially hard-they’re up to eight times more likely than men to have thyroid problems, and up to 60 percent don’t realize their insomnia is thyroid-related. It can be tough to pinpoint a thyroid disorder as the underlying cause of sleep problems, says Dr. Myers. That’s because the other symptoms that accompany such disorders-depression, weight loss or gain, anxiety, and gastrointestinal issues-can seem unrelated to sleep.
Sleep solution: Your doctor can confirm or rule out a thyroid disorder by ordering a series of blood tests: TSH (thyroid-stimulating hormone), free T4, free T3, reverse T3, and thyroid antibodies. In the past, physicians tested only for TSH, but getting all five numbers provides a more accurate assessment of how your thyroid is functioning, explains Dr. Myers. Prescription medications can help get your hormone levels back to where they should be, but lifestyle changes like improving your diet-for instance, eating more foods high in iodine, selenium, and zinc, which your thyroid needs to work properly-can make a significant impact as well.
Sleep stealer: stress
Whether it’s a demanding boss or a troublesome toddler, stress and worry can make it difficult to relax, robbing us of a good night’s sleep. That’s because stress activates parts of your brain associated with attention and arousal, according to a 2012 study published in Experimental Neurobiology, which can cause a “vicious circle” of stress-related insomnia.
Sleep solution: “Stress-reduction interventions, such as mindfulness meditation and progressive relaxation, have demonstrated some effectiveness for sleep disturbances, including frequent awakenings from stress,” says Lekeisha A. Sumner, PhD, a board-certified clinical psychologist at the University of California, Los Angeles. People with serious stress-sleep issues may benefit from psychotherapy, Sumner adds. For example, cognitive behavioral therapy can enhance sleep quality by helping your brain get control of the stress-based thoughts that can wake you while you snooze.
Sleep stealer: acid reflux
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This condition, in which acid backs up from your stomach into your esophagus, can affect your sleep whether or not it results in heartburn. “With heartburn, the discomfort wakes you up. But even if you don’t feel a burning sensation, the acid in your esophagus triggers a muscular reflex to clear it, which can disrupt sleep,” says David Johnson, MD, a professor of medicine and chief of gastroenterology at Eastern Virginia Medical School. This helps explain why people with chronic acid reflux are more than twice as likely to have sleep problems.
Sleep solution: Lifestyle changes like eating smaller meals, not eating late at night, and losing weight can go a long way toward preventing acid reflux, and occasional bouts can be handled with antacids and other OTC drugs. If it becomes a regular occurrence, consult your doctor. “There could be other factors causing reflux-for example, cardiac disease can sometimes lead to heartburn-like symptoms-and a doctor can better diagnose the condition and direct the treatment,” says Dr. Johnson.
Sleep stealer: being a caregiver
Taking care of a relative or friend has its own set of stressors that can disrupt sleep. Recent research shows that 76 percent of caregivers report poor sleep quality-and female caregivers, who outnumber their male counterparts two to one, are more likely to be among them. One reason: Female caregivers may spend as much as 50 percent more time providing care than male caregivers do, and researchers think there may be a threshold of time beyond which the likelihood of health consequences-including poor sleep-escalates. And regardless of gender, “being a caregiver is tough on your mental health,” says Dr. Sharkey. “If your loved one is ill or has dementia, you may become sad and anxious, which affects sleep.”
Sleep solution: “You need peace of mind to sleep restfully,” says Dr. Sharkey. So taking steps to reduce your nighttime anxiety is key. If you’re worried about a loved one falling down on the way to the bathroom, get a bedside commode or install low-level lighting to brighten the path. Hiring a nighttime attendant or asking a friend or family member to take the late shift a few times a week can also help.
Taking chamomile supplements may soothe stress as well. In one study, patients with generalized anxiety disorder who took supplements with 220 milligrams of German chamomile extract for 8 weeks saw a significant decrease in anxiety. If you’re not into popping pills, simply sipping chamomile tea may be enough to help you unwind. (Check out these other natural anxiety remedies if you’re having trouble snoozing.)
Sleep stealer: excess belly fat
When you carry extra weight in your midsection, your body has to work harder to breathe when you lie down, which can cause sleep problems. Belly fat can also trigger higher levels of inflammation in your body that disrupt the neurological pathways that control sleep. This creates a vicious cycle, since research shows not getting enough sleep has been linked to overeating the next day (up to an extra 385 calories!), potentially increasing weight gain.
Sleep solution:Preliminary research from Johns Hopkins University found that the more belly fat you lose, the bigger the improvement you’ll see in your sleep. In addition to cutting calories and stepping up exercise (which will help you lose weight all over your body), try incorporating more monounsaturated fatty acids from foods like olive oil, nuts, and avocados into your diet. “Increasing intake of these fats in a sensible way can be a powerful defense against weight gain, diabetes, heart disease, and belly fat,” says David Katz, MD, MPH, founding director of Yale University’s Yale-Griffin Prevention Research Center.
Sleep stealer: vitamin D deficiency
Research shows that more than 40 percent of U.S. adults have a vitamin D deficiency, a problem that’s linked to cardiovascular disease, cancer, and weaker bones, as well as poor sleep. Research from Harvard School of Public Health found that 12 percent of people with low levels of D slept for less than 5 hours a night, and 57 percent were awake for 90 or more minutes in the middle of the night. The findings aren’t surprising considering that vitamin D seems to have a direct effect on parts of your brain that play a role in sleep, says Michael Breus, PhD, clinical psychologist and diplomate of the American Board of Sleep Medicine.
Sleep solution: Your body produces vitamin D when your skin is directly exposed to the sun, but you can’t always get your daily value of 600 international units (IU) that way-especially in the winter or if your skin is darkly pigmented. If you’re deficient, which your doctor can determine with a blood test, you can boost your levels by eating foods rich in vitamin D, like fatty fish, eggs, and fortified milk or orange juice. But since most women get only 144 to 276 IU a day through diet, a supplement may be necessary. Breus advises his patients to take 1,000 IU of D a day, as well as 500 mg of magnesium at night to boost absorption of the vitamin.
?? Always check in with your doctor before you start taking a new supplement, especially if you are taking other prescription medications.
Sleep stealer: a less-than-positive attitude
“The more favorably you look upon sleep-believing it makes you happy and that you feel refreshed after a full night of rest-the longer you’ll actually sleep every night,” says Hannah Peach, PhD, a lecturer in the psychology department at the University of North Carolina in Charlotte. When she recently asked people questions to rate how favorably they viewed sleep (with 1 meaning strongly disagree and 5 meaning strongly agree), she found that for every point higher their scores averaged, the time they spent in slumber increased by nearly 40 minutes.
Sleep solution: If you have trouble convincing yourself that sleep is something your body needs, which can help ensure that you get enough, try keeping a sleep log. Include how much sleep you got and how you felt throughout the day: how happy you were, how easy it was to concentrate, how hard the afternoon slump hit you. “Sleep isn’t a luxury,” says Peach. “And seeing the truth in black and white can help you understand the impact sleep has on your mood and energy.”