Sleep Disturbance – Why can’t I get back to sleep in the early hours?

Do you find that you wake up in the early hours of the morning for no reason at all and you can’t get back to sleep? Do you find yourself thinking about everything and anything, however random? Do you find yourself tossing and turning until morning – not able to return to sleep? Early morning waking can happen for many reasons.

Are you a Morning Lark or Night Owl?

It may be that you are more likely to be an early riser due to your genetics. Genetic differences have some influence on whether we are more likely to be early risers or late risers.

We tend to find that people fit into one of 3 categories with their sleep patterns – either they are morning people and tend to prefer early mornings to staying up late at night (Morning Larks), they prefer staying up late at night and sleeping in a bit later in the mornings (Night Owl), or they are somewhere in between (Hummingbird).

Our sleep pattern also changes depending on our age. Children tend to be morning larks but during adolescence shift to become night owls. During adulthood their sleep pattern settles, only to change again in later adulthood where there is a shift back towards a preference for mornings. In addition, there is a slight gender difference with more female Morning Larks and more male Night Owls.

Why can’t I get back to sleep?

One of the questions we are asked at The Good Sleep Clinic repeatedly is “Why am I not able to get back to sleep when I wake up in the early hours?” In order to understand this, it is important to understand how and why we sleep and the different factors which impact on our sleep.

Jenny, a patient of The Good Sleep Clinic, told us how she couldn’t understand why it was happening:

“I do everything right, I don’t drink caffeine late in the evening, I have a bath and get a nice early night, but I always wake up at 3.30am, and then that’s it! I’m up for the morning! It’s exhausting and I can’t seem to change it”

So why is this happening to Jenny?

There are many reasons why people wake up during the night. These can be medical and/or psychological. Here is a list of some of the factors which affect waking at intervals during the night (this list is not exhaustive):

Medical causes for sleep disturbance

  • Hormone changes (perimenopausal/menopausal/postmenopausal)
  • Breathing difficulties such as Sleep Apnoea
  • Pain
  • Changes to blood sugars as seen in diabetes
  • Restless legs
  • Other conditions impacting on motor skills, such as multiple sclerosis or Parkinsons

If you suspect you have one of the above medical difficulties, it is advisable to speak to your GP.

Psychological causes of sleep disturbance

  • Habitual problem – sleep pattern has changed, probably triggered by a period of anxiety/stress
  • Anxiety, Depression, and other mental health problems
  • Nightmares and post-traumatic reactions
  • Pressure on sleep times, such as seen in shift work and travelling through time zones.

If your night-time waking is due to a psychological process or a combination of psychological processes, you may need treatment with psychological therapy, however there is lots you can do to improve your sleep yourself. It helps to understand why it may be happening.

Why do I wake up early in the morning/throughout the night?

Sleep Drive/Sleep Pressure

As soon as we wake up in the morning our brain starts to process a huge amount on information. This “processing” requires energy and the brain gives off a bi-product called adenosine. It is the build-up of this chemical which leads us to build-up Sleep Drive, also known as Sleep Pressure.

Sleep drive makes us feel tired and sleepy and without it we would not be able to sleep. We need sleep drive in order to fall asleep AND to stay asleep throughout the night. This can be observed in our everyday lives with kids. A toddler who is used to having a nap in the day may start to drop their nap – the effect is that they feel sleepier at bedtime and sleep more consistently throughout the night. The same is true for adults. If you have ever had a night when you have had very little sleep you will find that the next night you feel much sleepier at bedtime and are most likely to sleep a lot better the following night.

Sleep drive is also influenced by other factors, such as our cognitive and physical exertion. The more exercise we do, the more sleep drive we will have at bedtime. The more cognitive demands we face during the day, such as studying, socialising, concentrating on work, the more sleep drive builds up.

One of the difficulties with insomnia (finding it difficult to sleep or waking up at repeated points during the night), is that it can make us feel very tired and lethargic which can lead us to reduce the amount of physical activity we do and cognitive stimulation we engage in. This is understandable, however reducing our physical and cognitive activity can impact on the amount of sleep drive we build up, which can then result in increased difficulty sleeping.

People often think that if they are really tired and able to fall asleep easily then they must have enough sleep drive to ensure a good night’s sleep. The problem is that we can have enough sleep drive to fall asleep but we do not have sufficient sleep drive to ensure we sleep the whole night through. This can mean that we end up waking up at various points throughout the night.

If I wake up earlier in the night, I can get back to sleep more easily – why can’t I get back to sleep in the early hours of the morning, at 3:30am?

When we sleep it allows our brain to rest and replenish. All of the adenosine which has built up during the day is flushed away during the night. In theory, by the morning, we will be refreshed and ready to start all over again. If you wake up at 1:30am your brain has not had enough of a chance to flush away the adenosine and you still have enough sleep drive to allow you to get back to sleep without too much effort. However, by 3:30am your brain has done a lot of the work already and you may not have enough sleep drive to get back to sleep for the final part of the night.

Should I be trying to get an early night if I wake up too early?

Knowing that they will wake early in the day, many people bring forward their bedtime in an attempt to ensure they get sufficient sleep. This can be helpful if you feel that you are becoming more of a Morning Lark and your sleep pattern would benefit from shifting an hour or so earlier. However, in most cases this makes the problem worse.

By getting an early night, you may be reducing your time during the day to build up sleep drive. This may get in the way of you having a good night’s sleep and can lead to increased night waking and early morning rising. In addition, if you are going to bed early in the evening, your body may not have produced enough melatonin – the chemical which acts as a signal to the body that it is time to go to sleep.

Another factor to consider is the time between eating dinner and going to sleep. Ideally your body would have at least 2 hours between eating and going to bed as this gives your body time to metabolise your food and lower your core body temperature (a lower core body temperature is required in order to sleep).

Thought Racing in the Middle of The Night

A ‘racing mind’ is a very common feature of Insomnia. This is because we become increasingly worried about our sleep affecting us, which in turn makes sleeping more difficult – it becomes a vicious cycle.

Your sleep problems may have been triggered by a short period of stress/anxiety or a change in medication, or a change to your working pattern, but the reason your sleep difficulties continue is very often due to your psychology. This means that the original stressor may disappear but you are left with sleep difficulties and you don’t understand why.

This is often because you have developed sleep anxiety – this is when you start to feel worried about your sleep and the impact that lack of sleep will have on you and your life. It is this sleep anxiety which can maintain your insomnia, even after the original trigger has disappeared.

How do I break the cycle of waking up too early?

There are several things you can do to break the habit of waking up too early

  • Go to bed later – This may sound counterintuitive if you are trying to get more sleep but at first you will need to help your body understand when it is supposed to sleep. For a week try going to bed 30mins-1 hour later than your normal bedtime. This will help to build up sleep drive so that when you go to the bed the following night, you find it easier to sleep through the night. You should only be going to bed when you feel really tired.
  • Don’t toss and turn, get up – If you don’t easily fall asleep, get up and do something relaxing for 20-30 minutes until you feel sleepier. Do this if you don’t easily fall asleep and if you wake in the middle of the night. Tossing and turning can often lead to increased worry about not sleeping which makes it more difficult to fall asleep.
  • Step up your activity in the day – Try to ensure that you engage in physical and mental activity during the day. This can be difficult if you’re exhausted but it has a massive impact on your sleep drive and is likely to help you to sleep through the night.
  • Remember – they are just thoughts – If you are finding it hard to get back to sleep due to a racing mind in the middle of the night, try to recognise that they are simply thoughts running through your mind. Recognise those reoccurring thoughts and remind yourself that it is simply your mind focusing on one particular thought – as it often does. Then, try to focus on the here and now, such as focus on your breathing. Mindfulness at this point can be very helpful.
  • Cut down screen-time before bed – IPads, phones, Netflix and other TV shows can be really bad news for sleep. Not only do they give off blue-light which makes it more difficult for your mind to switch off and wind-down afterwards but the content is also stimulating and engaging. It is important to give yourself sufficient time to wind-down without using screens, ideally at least 45 minutes before you turn out the lights.

If you would like some further help with your sleep disturbance, get in touch.

Dr Maja Schaedel