All the reasons you wake up at night – and how to fix it

Do you struggle to sleep through the night without disruptions? If so, you’re far from alone. Sleep disturbances are something of an epidemic in the UK, with almost one in five people in the country getting insufficient sleep, according to the charity Mental Health UK.

But it isn’t just nodding off which is the problem but actually staying asleep. According to the not-for-profit Benenden Health, which recently commissioned a sleep survey of 2,000 adults across the country, half of those aged 55 and over are woken in the night by the need to go to the toilet; while either ambient noise, snoring, job stress or general anxiety led to sleep disruptions in anywhere between 13 and 30 per cent of the respondents.

Unsurprisingly, this isn’t good for our long-term health, with sleep quality being just as important as the number of hours we spend in bed. Last year, a major study published in the scientific journal Neurology, found that people who experience disrupted sleep during their 30s and 40s, a time when many are either juggling young families or busy work-life patterns, are more likely to suffer from memory loss or cognitive decline later in life.

So why do so many of us struggle to get adequate shut-eye? According to Dr Hussain Al-Zubaidi, lifestyle and physical lead for the Royal College of GPs, sleep is complex: during the night, we repeatedly cycle between various phases, from light to deep and finally to rapid eye movement (REM) sleep where most dreaming occurs.

“When we sleep, each 90-minute cycle moves through various stages and depths in terms of how unconscious we are,” says Dr Al-Zubaidi. “If you manage to get into the deeper phases of sleep, not much will wake you up. But it’s between the sleep cycles [or in the lighter phases] that you’re more likely to be disturbed.”

So, assuming that you go to bed at 10pm, what are some of the common disruptors which can affect you at various times of the night?

Why you wake up in the first two hours (10pm to midnight)

Dr Al-Zubaidi points out that the beginning of the night is actually the most critical, because at this point each sleep cycle is quite short, making you more susceptible to being woken up again.

“[During] the first early cycles, you only get brief moments in deep sleep, around 10 to 15 minutes,” he says. “It’s only if your sleep stays uninterrupted that you can get to cycles four or five, where you start getting those much longer periods of deep sleep. But if you’re woken up in that early stage, then everything resets again.”

Too much screen time before bed

According to Dr Virginia Skiba, a sleep medicine specialist at Henry Ford Health and spokesperson for the American Academy of Sleep Medicine, research suggests that blue light emitted from our phones, tablets or laptops can suppress levels of melatonin, the sleep hormone, making it both harder to drift off in the early part of the night and harder to stay asleep when you do.

“Disconnect from electronics at least 30 minutes to an hour before bed,” advises Dr Skiba. “Instead of using your phone before bed, I recommend finding something that helps you relax and wind down, such as reading a book, colouring or listening to relaxing music. Wearing blue light glasses in the evening [while watching TV or on your phone] may help regulate melatonin production in some individuals, but the findings are mixed.”

Feeling too hot

Something else which can wake us during the first hour or two in bed is simply being too hot. “The body uses temperature as a sleep-triggering signal,” says Dr Al-Zubaidi. “When it notices a drop in temperature, it will release hormones which make you feel sleepy. And so it can be very difficult to try to go to sleep or maintain sleep if you’re feeling quite warm.”

This is why the old trick of accessing the cold side of the pillow can help you nod off, because it gives the body the cooling trigger it needs to access deeper sleep. “Another trick is to open the window before going to bed, or spraying a little bit of cold water on your bedsheets, just to bring the temperature down,” says Dr Al-Zubaidi.

Why you don’t sleep well between midnight and 6am

At the start of each 90-minute sleep cycle, the body returns to lighter phases where you’re more aware or you might move around. “You’re technically asleep, but you’re still feeling things, you’ve got active control of what’s going on, your brain’s just in a lighter activity mode,” says Dr Al-Zubaidi. “So it’s in those moments that you’ll notice that painful shoulder, or the need to wee which might trigger you to wake up.”

Needing to wee

As we get older, more and more of us start to experience the call of nature in the middle of the night. But Dr Skiba says that this can be exacerbated by drinking too much fluid in the evening.

“I recommend reducing fluid intake around one to two hours before bedtime,” she says.

If you’re not consuming excess fluid in the evening, but still waking up to use the bathroom multiple times a night, Dr Skiba suggests getting checked for obstructive sleep apnoea. This is when your breathing stops and starts, causing you to wake up momentarily, which then makes you aware that your bladder needs emptying.

According to the NHS, waking up multiple times per night to urinate can be a sign of obstructive sleep apnoea.

Eating too late at night

Studies have shown that eating dinner late in the evening can make you more vulnerable to sleep disruption as the body’s digestive processes will be interfering with your circadian rhythms.

“This can lead to heartburn or acid reflux since stomach acid can flow back into the oesophagus when you lay down too soon after eating,” says Dr Skiba. “Try and have your last meal around two to three hours before bed. If you’re still hungry late at night, avoid eating a large, unhealthy meal and grab a light snack like a banana, yogurt or a handful of nuts.”

Drinking alcohol

Alcohol is great for relaxation and sometimes makes it easier to fall asleep quicker, but research has shown that it causes problems later in the night as it reduces the duration of the REM sleep phase, meaning that our sleep tends to be lighter and more prone to disruption.

“As a diuretic, alcohol also increases the need to urinate, leading to more trips to the bathroom during the night,” says Dr Cheryl Lythgoe, advanced nurse practitioner at Benenden Health. “To allow your body enough time to metabolise the alcohol and reduce its detrimental effect on sleep, it’s best to avoid alcohol at least three hours before bedtime.”

Vitamin deficiencies

According to Dr Lythgoe, persistent sleep disruptions in the middle of the night can also be a sign of various nutritional deficiencies, including magnesium, iron, calcium and vitamin D.

“Magnesium is crucial for muscle relaxation and neurotransmitter function, and a deficiency can cause restless sleep,” she says. “Similarly, low levels of vitamin D are linked to poor sleep quality and quantity. Iron deficiency may cause restless leg syndrome, while calcium helps the brain produce melatonin and its deficiency can affect sleep quality.”

To address this, she recommends trying to follow a more nutrient-rich diet. “The Mediterranean diet for example, which is rich in magnesium, calcium and tryptophan, has been linked to better sleep quality and fewer insomnia symptoms,” she says.

Sleep apnoea

Obstructive sleep apnoea (OSA), where breathing repeatedly stops and starts, sometimes dozens or hundreds of times, is one of the few things which can wake you up during the deepest sleep phases. It occurs because the muscles in the back of the throat relax too much, causing the airway to either narrow or collapse.

Snoring can be a telltale sign, but not everyone with OSA snores, and not everyone who snores has OSA.

“People often wake up in the middle of the night, puffing or choking,” says Dr Al-Zubaidi. “As a result, people with OSA have terrible sleep and they often need to use CPAP [continuous positive air pressure] machines to recreate the pressure in the airway, which is normally there when they’re awake.”

However, if you’re suffering from sleep apnoea, Dr Lythgoe says that addressing congestion in your sinuses through nasal sprays, losing weight or simply changing your sleeping position can make a big difference.

“It’s more prevalent in those who are overweight and have a neck size greater than 40.6cm,” she says. “It’s also more common in older men, smokers, regular alcohol drinkers and people who sleep on their backs. Maintaining a healthy weight and regular movement is the first thing I’d recommend. I’d then suggest avoiding alcohol, cigarettes, vapes or sedative type medications as these can all relax the muscles in the throat, increasing the likelihood of airway obstructions [during sleep].”

Why you can’t sleep after 4 or 5am

Low mood

Researchers have found that people who suffer from anxiety or depression, have a greater tendency to wake at an abnormally early time in the morning, curtailing their sleep.

“We know this is a very clear symptom of depression and there are lots of theories as to why this happens,” says Dr Al-Zubaidi. “One idea is that for most of human existence, if you were depressed, that would be associated with a survival risk – you couldn’t find food, you were under threat from another tribe – and so waking early was a way to help you mitigate that threat.”

If you’re repeatedly waking two or three hours earlier than normal with symptoms of anxiety or low mood, Dr Al-Zubaidi recommends trying to find different ways to manage or compartmentalise your thoughts.

“It could be setting aside time for journaling or writing down the things that you’re worried or nervous about to try and ‘time-box’ all of that to a different part of the day,” he says. “So for example, maybe at 8 or 9am, you set aside 15 minutes for jotting down those anxieties and giving yourself the space to ruminate, but at a time which isn’t at night. And of course it’s also important to try and support the depression symptoms by maybe getting active and trying to improve nutrition.”

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