Morning Struggle: Why Can't I Stay Awake?

Waking up in the middle of the night and struggling to fall back asleep is a common issue, with many potential causes. This phenomenon is known as sleep-maintenance insomnia, and it can be caused by a variety of factors, including stress, underlying health conditions, environmental factors, or changes in sleep cycles due to aging. Certain habits, such as maintaining a consistent sleep schedule, creating a relaxing sleep environment, and avoiding stimulating activities before bed, can help improve sleep quality. However, if these issues persist and significantly impact your daily life, it may be necessary to consult a doctor or a sleep specialist to identify any underlying sleep disorders, health issues, or mental health concerns.

Characteristics and their Values

Sleep-maintenance insomnia

People with sleep-maintenance insomnia may experience unusual daytime fatigue or sleepiness that affects their physical or mental health and ability to function. This can lead to worry about not getting enough sleep, creating a vicious cycle where the anxiety itself becomes the main source of insomnia. It is important to address sleep-maintenance insomnia, as it can cause individuals to miss work and experience performance issues.

To manage sleep-maintenance insomnia, cognitive-behavioural therapy for insomnia (CBT-i) is often recommended as the first line of treatment. CBT-i is a specialised form of psychotherapy that addresses thoughts, habits, and behaviours that interact to affect mental health and outlook. It combines sleep education and therapy techniques to identify and address patterns that affect sleep. Medication may also be prescribed in cases where CBT-i is ineffective.

Additionally, maintaining good sleep habits and a consistent sleep schedule is crucial for improving sleep-maintenance insomnia. This includes creating a sleep-friendly environment, avoiding caffeine, nicotine, and alcohol, and practising relaxation techniques. It is also recommended to avoid screens and electronic devices before bed, as the light from these devices can disrupt the sleep-wake cycle.

Circadian rhythm sleep disorders

There are several types of circadian rhythm sleep disorders, including advanced or delayed sleep-wake phase disorder, irregular or non-24-hour sleep-wake rhythm disorder, and shift work or jet lag disorder. In delayed sleep-wake phase disorder (DSWPD), individuals fall asleep and wake up much later than they would like, often interfering with daily responsibilities. Advanced sleep-wake phase disorder (ASWPD) causes people to feel extremely sleepy in the early evening and wake up too early in the morning. This disorder can also impact their daily lives.

Non-24-hour sleep-wake rhythm disorder (N24SWD) is characterized by a circadian rhythm that extends slightly beyond the regular 24-hour schedule, resulting in bedtimes and wake-up times shifting later each day. This disorder commonly affects blind individuals who cannot perceive light cues to regulate their circadian rhythm. Shift work disorder develops in people with variable work schedules, including overnight shifts, leading to disrupted sleep, insomnia, and extreme tiredness. Jet lag disorder occurs when travelling across multiple time zones, causing the sleep-wake rhythm to fall out of sync with the local time, resulting in sleepiness or alertness at inappropriate times.

Underlying health conditions

Waking up in the middle of the night is not uncommon, and most people experience mini-awakenings without even noticing them—up to 20 times per hour. However, if you are experiencing difficulty falling back asleep, it may be due to underlying health conditions.

Iron deficiency anemia

Iron deficiency anemia can cause people to feel run down and tired during the day. People with anemia often experience exhaustion. While there are many different causes for this condition, treatments always involve addressing the underlying cause.

Sleep disorders

Sleep disorders such as insomnia, sleep apnea, and restless legs syndrome can cause people to wake up multiple times during the night and have difficulty falling back asleep. Insomnia is a sleep disorder characterized by difficulty falling or staying asleep. Sleep apnea is a serious sleep disorder that causes periodic pauses in breathing, often resulting in gasping and snorting noises that disrupt sleep. Restless legs syndrome (RLS) is a sleep movement disorder characterized by an uncontrollable urge to move the legs due to uncomfortable sensations.

Mental health conditions

Mental health conditions such as anxiety, depression, and chronic fatigue syndrome (CFS) can also impact sleep. Anxiety can affect a person's ability to fall asleep, and feeling anxious throughout the day can cause daytime fatigue. Depression is a mood disorder that can disrupt sleep, making people unable to sleep properly or causing them to sleep too much. CFS is characterized by extreme tiredness that may prevent people from getting out of bed, and the fatigue does not improve with sleep.

Other medical conditions

Other medical conditions that can cause sleep disruptions include thyroid disorders, diabetes, and changes in blood sugar levels. Thyroid disorders have been shown to increase the time it takes to fall asleep, reduce sleep duration, and increase sleep disruptions. Diabetes can lead to variations in blood sugar levels, which can impact sleep quality. Low blood sugar levels during sleep can also cause disruptions, making it difficult to wake up and causing daytime drowsiness.

Environmental factors

Noise: Unwanted sounds, such as traffic, a neighbour's loud music, or even a pet can interrupt your sleep. If you are sensitive to noise, consider using earplugs, a white noise machine, or a fan to create a more peaceful sleep environment.

Light: Exposure to light, especially bright lights, can interfere with your sleep. This includes screen time from electronic devices like phones, tablets, or televisions. It is advisable to avoid screens before bedtime and opt for lower lighting to promote melatonin production and prepare your body for sleep.

Temperature: A comfortable sleeping temperature is essential for staying asleep. Hormonal changes, such as those experienced during perimenopause, can cause night sweats and hot flashes, making it difficult to stay asleep. Regulating your bedroom temperature and using layers of bedding that can be adjusted can help mitigate this issue.

Daily Habits: Your daily habits and lifestyle choices can also impact your sleep. For example, consuming caffeinated beverages late in the day, spicy foods close to bedtime, or alcohol before bed can disrupt your sleep. Additionally, engaging in vigorous exercise right before bed can affect your sleep schedule. It is recommended to avoid these substances and activities close to bedtime to promote better sleep.

Circadian Rhythm: Your body's internal clock, known as the circadian rhythm, regulates your sleep-wake cycles. However, factors like shift work, jet lag, or irregular sleep schedules can disrupt this rhythm and make it challenging to stay asleep. Maintaining a consistent sleep schedule, including bedtime and wake-up time, can help synchronize your body's internal clock and improve your sleep quality.

It is important to identify and address any environmental factors that may be contributing to your sleep disturbances. Making adjustments to your surroundings and daily habits can significantly improve your sleep quality and duration.

Sleep hygiene

Environment

• Make your bedroom a comfortable, dark, quiet, and slightly cool space.
• Minimise noise by using heavy curtains and rugs to absorb sound, or use a sleep machine that provides white noise or soothing sounds.
• Minimise light with light-blocking curtains or shades.
• Ensure your mattress and pillows are comfortable and not worn out.

Habits and Routines

• Stick to a consistent bedtime and wake-up time every day, including weekends.
• Adopt a relaxing bedtime routine, such as reading or meditating.
• Avoid screens for a while before bedtime.
• Get adequate exercise during the day, but not right before bed.
• Avoid caffeine after lunchtime and spicy foods close to bedtime.
• Limit alcohol consumption late at night.
• If you smoke, try to quit.

Good sleep hygiene can help you fall asleep more easily and improve your sleep quality. However, it's important to note that sleep hygiene alone may not cure serious sleep problems or disorders. If you have persistent sleep difficulties, it's best to consult a doctor for advice and treatment.

Frequently asked questions