Waking up multiple times during the night is a common occurrence for many people. According to sleep experts, brief awakenings or arousals lasting less than 3 minutes are considered a normal part of the sleep cycle. However, regularly waking up and having difficulty falling back asleep can lead to poor sleep quality and daytime fatigue.
What causes multiple awakenings at night?
There are several potential causes for frequent nighttime awakenings:
Poor sleep habits
Poor sleep habits like inconsistent bedtimes, exposure to blue light from screens before bed, uncomfortable sleep environment, and consumption of caffeine, alcohol or heavy foods too close to bedtime can all impair sleep quality and lead to awakenings.
Underlying health conditions
Certain medical conditions that cause pain, breathing issues, gastroesophageal reflux, frequent urination or anxiety can disrupt sleep. Some examples are:
- Chronic pain conditions like arthritis or nerve pain
- Gastroesophageal reflux disease (GERD) or heartburn
- Benign prostatic hyperplasia (BPH) in men, causing frequent urination
- Obstructive sleep apnea, which causes breathing interruptions
- Anxiety disorders
- Restless leg syndrome
Medication side effects
Some medications can interfere with sleep and cause awakenings as a side effect. These include certain blood pressure medications, steroids, stimulants and medications that increase urination frequency.
Changes in age and hormones
As we get older, it becomes more difficult to obtain deep, restorative sleep. Hormonal changes during menopause in women and andropause in men can also impair sleep quality.
Disruptions from partner
For people who share a bed with a partner, disruptions like loud snoring, tossing and turning, or getting in and out of bed can lead to awakenings.
How much night waking is considered abnormal?
According to the American Academy of Sleep Medicine, brief episodes of nighttime awakenings are normal. However, if you regularly:
- Wake up more than twice per night
- Stay awake for 20 minutes or longer during the night
- Spend 30 minutes or more awake total over the course of the night
It may indicate an underlying sleep disorder or health condition causing poor sleep quality. Chronic excessive nighttime awakenings are linked to daytime fatigue and impaired cognitive function.
When to see a doctor
You should consult a doctor or sleep specialist if:
- You regularly wake up more than twice per night and have difficulty falling back asleep
- You feel tired or unrefreshed during the day despite getting 7-8 hours of sleep
- You wake up gasping or with heart palpitations
- You have symptoms of anxiety, depression or restless legs when trying to sleep
- Your partner notices loud snoring, breathing interruptions or leg twitching
A sleep study or polysomnogram test can help diagnose potential sleep disorders like sleep apnea, restless leg syndrome or insomnia. Underlying health conditions may also need to be managed.
Tips to prevent frequent nighttime awakenings
Here are some tips to improve sleep quality and minimize awakenings at night:
Follow a regular sleep-wake schedule
Going to bed and waking up at the same time each day sets your body’s internal clock and promotes better sleep.
Limit daytime naps
While short power naps can boost energy, long or late naps can make it harder to sleep at night.
Wind down before bedtime
Activities like light reading, gentle yoga, or taking a bath can prep your mind and body for sleep. Avoid stimulating activities within 1-2 hours of bed.
Limit caffeine, alcohol and heavy meals before bed
These can worsen sleep disturbances and cause awakenings to use the bathroom.
Optimize your sleep environment
Factors like light, noise, temperature and bed comfort impact sleep quality. Use blackout curtains, a fan or white noise machine, and comfortable mattress/pillows.
Manage stress and anxiety
Relaxation techniques, cognitive behavioral therapy or medications can help lower anxiety and prevent insomnia.
Avoid screens before bed
Light from screens can impair melatonin release and keep your brain activated, making it hard to fall back asleep.
Exercise regularly
Moderate exercise during the day can deepen sleep. Avoid vigorous workouts close to bedtime.
Consult your doctor
If lifestyle and behavioral changes don’t help, speak to your doctor about underlying causes and medical management. This may include sleep aids, treating medical conditions or cognitive behavioral therapy for insomnia.
Conclusion
Waking up briefly a couple times per night is normal and does not negatively impact health. However, regularly having long or excessive awakenings usually indicates an underlying issue leading to poor sleep. Consulting a doctor to identify and treat the root cause, along with practicing good sleep hygiene, can help minimize disruptive nighttime awakenings and improve sleep quality long-term.
