Why Do I Keep Waking Up at 3 a.m. Every Night?

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• Wait—so regular early-morning wake-ups might be normal?
• When should you be worried about waking up at a particular time?
• What should you do when you wake up—and if it just keeps happening?

Struggling to get a full night of sleep is bad enough. But waking up every night, checking the clock and seeing the same single-digit number appear over and over is a whole other scenario. Not only does it leave you zonked, but it can also make you feel downright unsettled, too.

Unfortunately, persistent pre-dawn awakenings are more common beginning in midlife and beyond, says Funke Afolabi-Brown, M.D., a triple board-certified sleep medicine physician and member of the advisory board for the nonprofit Project Sleep.

In most cases, they’re not worth freaking out about. “Sleep isn’t supposed to be eight uninterrupted hours,” says Shelby Harris, Psy.D., a licensed psychologist board-certified in behavioral sleep medicine. “Waking at the same time every night isn’t necessarily a sign that something is wrong; it can simply reflect normal changes.” And worrying about sleep disruptions can actually make the situation worse, she says.

However, there are times when repetitive rousing can signal something more serious. And if you’re having trouble falling back to sleep afterward or feeling fatigued during the day, it’s worth addressing, because poor sleep itself is linked to heart problems and a host of other health issues. “Sleep is something we do every single night, so we’ve got to pay attention to it and take care of it,” Dr. Afolabi-Brown says.

Meet the experts: Funke Afolabi-Brown, M.D., a board-certified sleep medicine physician, founder of Restful Sleep MD in Horsham, Pa., and a member of the advisory board for the nonprofit Project Sleep; Shelby Harris, Psy.D., a licensed psychologist board-certified in behavioral sleep medicine and a clinical associate professor at Albert Einstein College of Medicine in New York City.

Wait—so regular early-morning wake-ups might be normal?

Yes, especially during perimenopause and menopause, thanks to hormone changes that can affect your slumber. Decreasing estrogen and fluctuating progesterone alter your sleep architecture, making it lighter and more fragmented, with less deep sleep, Dr. Afolabi-Brown says.

That means you’re likely more sensitive to things you might have dozed through before, like a snoring spouse or a sliver of moonlight. “It’s not like you’re just annoyed,” she says. “Your physiology has changed.” Other symptoms linked to perimenopause, such as hot flashes, may also wake you. Because the night is front-loaded with deep sleep for everyone, you might still be able to snooze through the disruptions during the first few hours after nodding off—it’s in the wee hours, where lighter stages of sleep prevail, where all this is far more likely to affect you.

A scroll through social media will show you tons of people are dealing with the same 3 a.m. habitual wake-up. And some influencers would have you believe that they’ve ID’ed the cause: cortisol spikes.

It’s not entirely out of left field. Cortisol, the so-called stress hormone, does follow a circadian pattern, dropping in the evening as you prepare to drift off and rising in the early morning to get you ready for the day. And that curve may shift a bit to the left during midlife, meaning the upward swell occurs earlier than before, Dr. Afolabi-Brown says.

But merely blaming that spike for waking you up—and implying that something’s off with your levels—is a drastic oversimplification, Harris says. And Dr. Afolabi-Brown notes there’s no evidence lowering morning cortisol levels fixes these kinds of sleep issues.

That said, stress—and the complex way it evolves—can factor into regular wake-ups, Dr. Afolabi-Brown says. In her practice, she hears many midlife women say they pass out the instant their head hits the pillow. However, once they’ve gotten a few hours of rest, their brain starts to swirl with the anxieties of the day.

And once it happens a few times, these rousings can then become a new source of anxiety, creating a learned response that perpetuates the problem. “Now your brain is like, ‘Oh my goodness, we’re going to wake up, we’re going to dread that wake-up, it’s going to be horrible,’” Dr. Afolabi-Brown says. “We’re going to be tired and frustrated, and then it becomes this self-fulfilling prophecy.” It’s important to recognize, though, that this doesn’t mean sleep problems are all in your head—it’s just that anxiety triggers a physical response that can keep you tossing and turning.

When should you be worried about waking up at a particular time?

While habitual 3:00-a.m. wake-ups are often normal, particularly in women in their midlife years and beyond, there are times when they can point to something more serious, Dr. Afolabi-Brown says. One potentially surprising cause: depression.

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Perimenopausal women are about 40% more likely to have depressive symptoms than those who haven’t yet entered that life stage, concludes a systematic review and meta-analysis in the Journal of Affective Disorders. And while you might associate this mood disorder with fatigue, a recent review article in Neuroscience Research notes that 90% of people with depression have sleep disruptions.

Then there’s obstructive sleep apnea, a condition in which you temporarily stop breathing at night. This risk also rises with age, doubling among women after age 50, per a review in the journal CHEST. “When you have a pause in breathing during sleep, it will trigger some wake-ups,” Dr. Afolabi-Brown says. “And for some women, they may start to have difficulties falling back asleep.”

Other sleep disorders—insomnia and restless legs syndrome, for example—may also be to blame and warrant treatment. Without it, these conditions can lead to other health complications, such as developing or worsening type 2 diabetes, high blood pressure, cognitive issues, and heart disease.

What should you do when you wake up—and if it just keeps happening?

First, rest assured that there’s likely nothing ominous or otherworldly about it. “Most of the time, waking at a particular time isn’t, by itself, a sign of something serious,” Harris says.

Then do what you can to break the cycle. Start by practicing good sleep hygiene—sticking to a relatively stable sleep schedule, keeping your bedroom dark and cool, and creating a screen-free wind-down routine before you turn in.

If you do wake up earlier than you’d like, do less, not more, Harris recommends. Avoid looking at the clock or calculating how many hours you have left in bed—and definitely don’t pick up your phone. Instead, “keep things dark and boring,” she says. Get cozy and allow yourself to simply rest, rather than desperately trying to get back to sleep. Calm a busy mind with neutral, repetitive exercises like slowly counting backward.

Still wide awake, or up long enough that you feel frustrated? At that point, it may be better to get up and leave your bed. Keep the lights low and do something quiet, such as reading a paper book, until you feel sleepy again, she says.

If you keep waking up at the same time for more than a week or two, it’s probably time to take further action. Look at the pattern before reaching for a sleep supplement or medication, Harris suggests. Start by keeping a sleep diary—jotting down when you went to bed and woke up, how many awakenings you remember, and habits like caffeine and alcohol intake that may play a role. Share all this with your primary care doc or a sleep specialist.

Also, stay on the lookout for other symptoms that could be related. For example, tell your doctor if you notice loud snoring or gasping during the night (or your partner tells you about it) or wake up with a headache or dry mouth, or still feel sleepy. Those signs could point to obstructive sleep apnea, Dr. Afolabi-Brown says. Other signs to mention include mood changes and trouble concentrating during the day, along with leg movement, excessive sweating, or pain at night, Harris says.

Even if you don’t have any other warning signs, you don’t have to accept suboptimal slumber as a consequence of aging. “Some changes are normal, but persistent, distressing sleep problems are treatable,” Harris says. That might involve addressing an underlying issue—for example, using an oral appliance or airway pressure device for sleep apnea or considering hormone replacement therapy for menopausal symptoms—or starting cognitive behavioral therapy for insomnia.

“The goal isn’t necessarily perfect, uninterrupted sleep; it’s getting to a point where nighttime awakenings aren’t controlling your day—or your relationship with sleep,” Harris says.

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