Sleep Fragmentation: Why Can't I Sleep After Waking Up?

Sleep is an essential part of our lives, and disruptions to our sleep cycle can have a significant impact on our health and well-being. Experiencing difficulty falling back asleep after waking up in the middle of the night, known as sleep-maintenance insomnia, is a common issue that many people face. This phenomenon can be attributed to various factors, including insomnia, stress, pain, food, and our sleeping environment. While occasional nights of disrupted sleep are not a cause for concern, persistent patterns of sleep disruption may require professional help. This paragraph will explore the reasons behind sleep difficulties and provide strategies to help individuals improve their sleep quality.

Why can't I sleep after I wake up?

Sleep-maintenance insomnia

There are several factors that can increase the risk of sleep-maintenance insomnia. One factor is age—as people get older, the amount of time spent in deep sleep decreases, which can affect the circadian rhythm or sleep-wake cycle, causing people to wake up in the middle of the night. Another factor is sex—women are more prone to all forms of insomnia, especially during perimenopause or menopause when changing hormones can cause night sweats and hot flashes. Additionally, people with certain mental health conditions, such as depression, anxiety, or post-traumatic stress disorder (PTSD), may be more susceptible to sleep-maintenance insomnia.

There are various techniques and treatments that can help manage sleep-maintenance insomnia. One effective approach is cognitive behavioural therapy for insomnia (CBT-i), which is a specialised form of psychotherapy that addresses thoughts, habits, and behaviours that interact to affect mental health and outlook. CBT-i combines sleep education and therapy techniques to identify and address patterns that affect sleep, such as beliefs or emotions that contribute to poor sleep. Maintaining good sleep habits and practising relaxation techniques can also be beneficial. This includes creating a bedtime routine, exercising daily, and making the bedroom sleep-friendly by keeping it cool, quiet, and dark. Avoiding substances like caffeine, nicotine, and alcohol around bedtime can also improve sleep quality.

In some cases, medication may be recommended to treat sleep-maintenance insomnia. Antihistamine-containing products can be used as sleep aids, but it is important to consult a doctor before taking any medication. Additionally, sleep apps like Calm and Headspace can be helpful tools for improving sleep quality.

Ageing and sleep

Ageing has a significant impact on sleep patterns and quality, and it is common for sleep to change as individuals get older. While older adults require the same amount of sleep as younger adults (around 7-8 hours a night), their sleep patterns differ. Older people tend to fall asleep and wake up earlier in the day and take longer to fall asleep at night. They also wake up more frequently throughout the night and often take daytime naps in addition to sleeping at night.

These changes in sleep patterns as we age are due to two main reasons: intrinsic age-related changes and changes due to ill health or stress. As people age, the hormones that promote sleep are released earlier in the day, resulting in sleepiness earlier in the evening and waking up in the early hours of the morning, known as Advanced Sleep Phase Disorder. Age-related health conditions, such as chronic pain, medication changes, and chronic illnesses, can also disrupt sleep. Additionally, retirement, loss of loved ones, and financial stress can contribute to sleep disturbances.

Sleep disorders become more prevalent with age, including insomnia, sleep apnea, restless leg syndrome, periodic limb movement disorder, and REM behaviour disorder. Approximately 22-54% of older people experience sleep apnea, and 17-60% suffer from insomnia for more than three months. These sleep disturbances can also impact the bed partner's sleep quality. It is recommended to consult a doctor if persistent sleep problems occur, as effective treatments are available for snoring, sleep apnea, and insomnia.

To improve sleep quality as we age, it is crucial to maintain a consistent sleep/wake schedule, engage in daily exercise, and practice relaxation techniques. Creating a bedtime routine and ensuring adequate exposure to sunlight during the day can also promote better sleep. While sleeping tablets can be used for short periods, they are not recommended for long-term use. Instead, natural techniques such as meditation, listening to relaxing music, or performing a full-body scan can help induce sleep.

Relaxation techniques

Waking up in the middle of the night and struggling to fall back asleep is called sleep-maintenance insomnia. This is a common issue, with up to one in five Americans experiencing it. If this is an occasional occurrence, it is not a cause for concern. However, if it becomes a pattern, it is recommended to consult a doctor to identify the cause and adjust your sleep habits.

• Breathing exercises: Taking slow, deep breaths is a simple way to relax. Try diaphragmatic breathing by placing one hand on your upper chest and the other hand just below your rib cage. Breathe in through your nose so that your belly pushes against your hand. This exercise can reduce stress, increase relaxation, and strengthen the diaphragm.
• Progressive muscle relaxation: This technique involves focusing on one area of the body at a time, tensing the muscles, and then releasing. Start at the head or foot and work your way down. This method can help you achieve a deep sense of relaxation.
• Full-body scan: Close your eyes and breathe slowly. Focus on your face and relax the muscles. Move to your neck and shoulders, and continue relaxing the muscles in different parts of your body until you reach your feet.
• Yoga nidra: This is a form of meditative yoga intended to induce calmness and improve sleep. It involves bringing your attention to different parts of your body, noticing any sensations or tension, and visualizing the tension leaving through your breath.
• Meditation and visualization: Try meditating or visualizing a calming scene to relax your mind and prepare for sleep. One technique is "leaves on the stream," where you imagine yourself in a forest, sitting by a stream, and placing your thoughts on leaves that float away.
• Listen to calming music: Choose music that you find relaxing, either in or out of bed. Avoid using your cell phone as the blue light can cause further arousal.
• Create a bedtime routine and ideal sleep environment: Establish a consistent sleep schedule and cultivate daytime habits that promote sleep. Ensure your bedroom is quiet, dark, cool, and free of distractions.
• Choose appropriate bedtime snacks: Avoid caffeine, nicotine, and alcohol before bed as they can disrupt your sleep.

Sleep disorders

Waking up in the middle of the night and struggling to fall back asleep is a common issue, often referred to as sleep-maintenance insomnia. This can be caused by a variety of factors, including underlying health conditions, stress, pain, food, and the environment in which one sleeps.

If you are experiencing insomnia, it is recommended that you avoid napping during the day, as this can disrupt your sleep schedule. Instead, try to stick to a consistent bedtime and wake-up time, even on weekends. Creating a bedtime routine, exercising daily, and practicing relaxation techniques can also help improve your sleep quality. Relaxation techniques include deep breathing, meditation, and progressive muscle relaxation, which involves tensing and relaxing different muscle groups throughout the body. Additionally, cognitive-behavioral therapy can help address negative thoughts and beliefs about sleep.

If you are experiencing insomnia regularly, it is important to seek help from a medical professional. A doctor can help identify any underlying causes and recommend lifestyle changes or refer you to a sleep specialist. They may also suggest trying sleep apps like Calm and Headspace. In some cases, medication may be prescribed, although this is typically a last resort after exploring other options.

In addition to insomnia, there are several other sleep disorders that can impact an individual's sleep-wake cycle. These include circadian rhythm sleep disorders, such as Delayed Sleep Phase Disorder, Advanced Sleep Phase Disorder, Irregular Sleep Wake Disorder, and Shift Work Sleep Disorder. These disorders are characterized by a misalignment between an individual's sleep schedule and their internal clock or external factors such as work schedules. Treatment for circadian rhythm sleep disorders may include light exposure, medicine, and behavioral modifications.

Sleep tips and tricks

Sleep is essential for physical and mental well-being, but many people find it challenging to get enough quality sleep each night. Here are some tips and tricks to improve your sleep:

Evaluate your sleep habits and bedroom environment

Firstly, it's important to evaluate your sleep habits, also known as sleep hygiene, and make any necessary adjustments. This includes creating a bedtime routine, such as taking a bath, reading a book, or practising relaxation techniques like meditation or deep breathing exercises. You should also try to exercise daily, as this can help regulate your sleep schedule. Additionally, assess your bedroom environment to ensure it's optimised for sleep. This includes investing in a supportive mattress and pillow, comfortable bedding, and maintaining a cool, dark, and quiet space.

Limit light exposure and practise yoga or meditation

Melatonin is a crucial hormone for sleep that is produced in darkness. Therefore, limit your exposure to bright lights before bedtime, and use blackout curtains or a sleep mask to block out light during the night. Practising yoga or meditation can help release stress and tension, improve your sleep quality, and promote relaxation.

Avoid screens and establish a sleep schedule

Avoid looking at screens before bedtime, as the bright light from phones, tablets, and televisions can interfere with melatonin production and stimulate wakefulness. Instead, establish a consistent sleep schedule by going to bed and waking up at the same time each day. This will help regulate your body's internal clock and improve your overall sleep quality.

Manage your body temperature

Maintain a cool bedroom temperature, as a hot sleeping environment can affect thermoregulation, making it harder to fall and stay asleep. A temperature between 60°F and 67°F (15.6°C and 19.4°C) is ideal for promoting comfortable sleep. Taking a warm bath before bed can also help speed up thermoregulation, relaxing your body and preparing it for sleep.

Remember, if you consistently struggle to fall asleep or experience insomnia, it's important to consult a doctor or sleep specialist to identify any underlying sleep issues and develop a personalised plan to improve your sleep quality.

Frequently asked questions