You drift off to dreamland just fine but then something, a noise, a partner's tossing and turning, jars you awake.
Now your mind races with an ever expanding to-do list of worries that you can't shut off.
When the alarm buzzes, you start the day feeling grouchy and slightly dazed.
It's common for people to wake up in the middle of the night. What's important is not to let it snowball, sleep specialists say.
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Our sleep cycles include brief periods of wakefulness but deep sleep makes us forget about these awakenings.
"It's normal to have one or two a night," said Dr. Brian Murray, a sleep neurologist at Sunnybrook Health Sciences Centre and a professor at the University of Toronto. "It's when it's multiple that I worry."
Sleep experts say if someone wakes up multiple times a night, it's a red flag.
Chronic sleep problems are linked to heart disease, high blood pressure and some cancers. It can also affect hormone levels, which increases the risk of obesity and Type 2 diabetes, sleep specialists say.
Julie Snyder of Toronto said she has stretches of days or weeks when she'll consistently wake up at 1:15 a.m., and again at 4 a.m. The broken sleep leaves her feeling short on patience.
"I know my husband's clock is on and every time I go to the bathroom, I do have a tendency to look at the clock and dread," Snyder said.
The reason it's harder to doze off again is the drive to sleep is lower in the second half of the night, Murray said.
Anxiety of not sleeping
"The problems occur when people's minds start to race and they start to worry about things," he said. "Looking at the clock will make people feel anxious about not falling back to sleep. That causes the body to release fight-or-flight hormones, which interfere with the sleep onset process."
It's important not to get worked up about one bad night's sleep because anxiety itself makes it difficult to fall asleep.
Looking at the clock will make people feel anxious about not falling back to sleep.
- Dr. Brian Murray
Back in prehistoric times, people had to catch some shut-eye while trying to stay safe from sabre-toothed tigers and bears. They got by with around seven hours of sleep without naps.
Now we artificially manipulate light conditions and heat and generally get good quality sleep, Murray said. But when there is a problem, anxieties around sleep perpetuate it and deny us the eight hours we need.
"That's why one of the mainstays of treatment for chronic insomnia, it's not medication, it's talk therapy," he said. "Behavioural management of insomnia is the go-to management strategy."
The strategy for middle-of-the-night insomnia also includes:
- If you're wide awake, don't stay in bed.
- Keep your room quiet and dark.
- Read quietly in a dimly lit area until drowsy.
- Avoid smartphones, e-readers and tablets that send a blast of light to the brain.
- If you must watch TV, try wearing sunglasses.
While those tips apply to people of all ages, there are stages of life when adults are more susceptible to insomnia, such as times of emotional stress.
Root of the problem
Dr. Danielle Martin, a family physician in Toronto, often sees that pattern at her office. Like Murray, she advises people to avoid sleeping pills because all medications carry risks.
"For some people, a sleeping pill can be useful for a short period of time and in times of particular stress. But if taken regularly, these medicines are addictive and they can cause falls, especially in older people. If you feel you need a pill to get to sleep most nights, it's worth having a conversation with your doctor to try to get to the root of your insomnia," the CBC Health contributor said in an email.
Instead Martin suggests:
- Stick to a regular sleep schedule. Go to bed at the same time every night and get up at the same time every morning — even on weekends. And no naps.
- Create rituals to wind down at bedtime that don't involve screens. A warm bath or a short meditation are good examples.
For menopausal women, one small recent study suggested light stretching before bed could help with mood and sleep disturbances. Martin said everyone should try to get regular exercise, just not right before bedtime when it could keep you from drifting off to dreamland.
In the elderly, geriatricians advise against a type of sleeping pill called a sedative hypnotic not only because it can increase the risk of falls, but it may also contribute to daytime sleepiness and confusion. People should be aware that sleep patterns tend to shift naturally towards earlier bedtimes and awakenings as we age.
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In terms of diagnosis, Murray said he also looks out for sleep apnea, a disorder that closes the airway and blocks breathing and can wake up a sufferer dozens of times every night, and movement disorders such as restless leg syndrome, which can also interrupt a person's sleep.