Sleep Cycle

Waking up Too Early? 5 Simple Solutions
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Does the question "How'd you sleep?" make you want to scream? Those of us plagued by middle-of-the-night waking often feel like punching people who don't know what it's like to stare at the ceiling in the wee hours. Here are the five most common types of middle-of-the-night sleep problems, and what to do about them.

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Problem #1: You're awake for no reason, with your mind spinning.

Middle-of-the-night worrying is probably the number-one type of sleeplessness faced by people of all ages. And boy, is it frustrating. You know you need to relax and get back to sleep, but anxious thoughts and to-do list items keep popping into your head.

What to do

1. Preserve the darkness. Keep the room dark when you wake up. Keep a small book light or mini flashlight next to your bed and use it to navigate your way to the bathroom, or put a dim night-light in the bathroom and leave the door cracked, so you can find your way there. Whatever you do, don't turn on the overhead light in the bathroom once you're inside.

2. Move the clock out of reach. Constantly checking the clock and calculating how long you've been awake only feeds your anxiety: "Oh no, now I'm only going to get five hours of sleep." Set the alarm, then move the clock where you can't see or check it.

3. Write it down, then let it go. On your bedside table, keep a notebook and pen devoted solely to nighttime "worry lists." Using a dim night-light, write down each thought that's bothering you. Then, after you write it down, make a conscious effort to cross it off the list in your mind. In the morning, transfer the action items to your to-do list. Over time, you'll develop faith in yourself that writing down your worries equates with getting them done.

4. Breathe and ease. In his book The Worry Solution, anxiety specialist Martin Rossman recommends a three-step approach to sleeplessness that really works. First, do "belly breathing," which means breathing deeply enough that your diaphragm rises and falls. Next, isolate each part of your body, from your feet up to your neck, by tensing and relaxing it. Finally, imagine yourself in a favorite place, such as lying in the sun on the beach. Use all of your senses; imagine that you're hearing the waves and smelling the salt air. If it doesn't work the first time, do all three steps again in the same order.

What to Do When Bathroom Trips Interrupt Your Sleep

Problem #2: You wake up to use the bathroom and can't get back to sleep.

Whether it's once a night or over and over, popping awake to use the bathroom disrupts your sleep cycle and cuts into your restful REM sleep. The best solution for this problem, officially called "nocturia," is prevention. If you don't wake up in the first place, you won't lose those precious zzz's.

What to do

1. Drink liquids by day but not at night. If you stay well hydrated during the day, you can get away with not drinking in the evening. Experts in nocturia recommend cutting out all liquids after 8 p.m., and by 7 p.m. if you're an early-to-bed type. Most types of tea -- black, green, or white -- are diuretics, so no tea after late afternoon. Herb teas are usually fine until 8 p.m., but check the ingredient list for dandelion, which is also a diuretic. And resist that after-dinner glass of wine; alcohol has a twofold effect on sleep, making you have to go and stimulating your central nervous system.

2. Talk to your doctor about bladder problems. If you suffer from overactive bladder, the sudden need to go is going to jar you awake. Ask your doctor about bladder retraining, physical therapy to strengthen pelvic floor muscles, and other treatments.

3. Guys, seek help for prostate problems. When the prostate is enlarged, it blocks the flow of urine, resulting in the need to go, often in small amounts. This condition, also called benign prostatic hyperplasia, is worth seeking help for.

4. Watch out for hidden liquids. Don't eat foods with high liquid content, such as soup or fruit, for three hours before bed. If you're having soup for dinner, make it an early meal.

5. Ask the doc about a prescription. If nighttime urination is your only problem and lifestyle strategies don't work, a prescription antidiuretic called desmopressin might be the solution. A recent study by the American Urological Association found that the drug doubled the amount of sleep time between bathroom trips.

Problem #3: Pain wakes you up.

Chronic pain of all kinds is one of the most common sleep disrupters; between 60 and 90 percent of people who suffer from some type of chronic pain sleep poorly, studies show. Mild pain can have as profound an effect on sleep as extreme pain -- yet many people don't take pain's effect on sleep seriously.

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What to do

1. Manage pain proactively. Chronic pain and lack of sleep can quickly become a vicious cycle, each worsening the other. Even more problematic, once pain is strong enough to wake you up, it's harder to treat. Pain management experts stress the importance of treating pain just as it starts or taking preventive pain control medications. Migraine sufferers can benefit from preventive medications such as beta-blockers; arthritis and fibromyalgia sufferers can get long-term relief from the tricyclic antidepressant nortriptyline, which is prescribed off-label to block pain signals.

2. Don't take naps. People in pain often get into a problematic pattern of not sleeping well at night and then taking long naps during the day because they're tired. But you need sufficient "sleep debt" to trigger sleepiness and relaxation when it's time to go to bed. Experts suggest avoiding naps altogether or, if that's not possible, limiting them to less than 30 minutes and taking them before 3 p.m.

3. Distract with reading. Many people find that reading works to soothe them back to sleep by taking their mind off the pain. However, reading can also backfire if you get caught up in your book and read too long, use an overly bright light (tricking your brain into thinking you should be awake), or read something too exciting or disturbing. Instead, choose a book that's easy to read in small installments and isn't a page-turner, and keep it handy for those times when you find it hard to fall back to sleep. Some people find books of quotations, poetry, or simple meditations useful for this purpose.

Distractions and digestion

Problem #4: Your environment won't let you sleep.

Light, sound, temperature changes, and vibrations all have the effect of putting your body on alert. Recent sleep studies have shown that even when subjects don't fully awaken from exposure to stimuli, they experience "microarousals" that disrupt sleep.

What to do

1. Block street noise with white noise. Planes, trains, and automobiles all can disrupt your sleep. If the rumble of streetcars, the whine of leaf blowers, or the snoring of your dog is a problem, try soothing your ears with white noise. Some people prefer wave machines or CDs of nature sounds, while others find that oscillating fans work just as well. And of course, you can always wear earplugs.

2. Make darkness your friend. Check your bedroom for any light source that could be disturbing your sleep. Use blackout curtains or shades to block streetlights, or use a double layer with shades underneath and curtains on top. (There's a reason hotels do this.) Put tape over the small lights from smoke detectors and appliances and charge laptops, phones, cameras, and other devices in another room. Use an alarm clock without a lighted dial, or cover it with a scarf. Instead of nightlights, keep a mini flashlight next to your bed and use it when you have to get up.

3. Keep your cool. Heaters that turn on and off during the night are a major sleep disruptor, and an overly warm room isn't conducive to deep sleep. Oddly, though, many people need to feel warm to fall asleep. So what to do? Turn the heat down, but use an extra comforter or blanket that you can toss off as you warm up.

4. Check the house for creaks. If a door routinely wakes you when it opens, oil the hinges. If the floor above your room creaks, put down a rug. You may feel a little silly making a big deal about house noise, but it beats wearing earplugs all the time -- or yelling at family members.

Problem #5: Your digestive system won't let you sleep.

A growling stomach can wake you -- and your partner -- and heartburn or gas can leave you lying awake in misery. Then there's gastroesophageal reflux disease (GERD), which can disrupt your sleep without your realizing it. (You might wake with a sour taste in your mouth but not know what woke you.)

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What to do

1. Eat smaller, more frequent meals. This is a general remedy for heartburn, but it works wonders for most digestive issues that disrupt sleep. If your schedule allows it, eat a substantial snack in the late afternoon and then a smallish early dinner. (And no midnight snack.) It's also best not to eat for two to three hours before bedtime.

2. Eat stomach-soothing foods. Reserve burritos and your favorite spicy chip dip for lunchtime, and let evenings be spicy-food-free. Anything with chili in it is likely to give you heartburn, as is anything acidic, such as tomato soup. Also avoid fatty foods, which put pressure on the valve at the lower end of the esophagus. Instead eat lots of vegetables and high-fiber grains to keep digestion moving efficiently.

3. Strengthen your digestion. Probiotics can help with stomach upset by encouraging the growth of healthy bacteria in the intestines. Digestive enzymes are valuable for those with chronic stomach upset, which is often caused by irritation of the stomach lining. For heartburn and GERD, take calcium after meals; recent studies show it strengthens the valve between the esophagus and the stomach.

4. Sleep on your side, with a body pillow. Lying on your back is a recipe for digestive upset. If you're not a natural side-sleeper, a body pillow can help you get more comfortable. If you suspect GERD, try sleeping on the left side, which recent studies show eases pressure on the esophagus.

5. Keep antacids handy. Although you don't want to be popping digestive aids regularly, sleep is important. Keep antacids in your bedside drawer for occasional attacks of heartburn and an anti-gas medication handy for painful gas and cramping.

Melanie Haiken

Melanie Haiken discovered how important it is to provide accurate, targeted, usable health information to people facing difficult decisions when she was health editor of Parenting magazine. See full bio

about 1 year, said...

None of these are my problems my problem is I just wake up at really early times.

about 3 years, said...

my undiagnosed husband has major problems with waking and not being able to sleep again. He refuses to take his ambien

over 3 years, said...

Actual useful things, such as what to do when I have done every single thing on this list and still cannot sleep.

over 3 years, said...

It only started recently. Like, a month ago. I was sleeping fine. Go to bed at 8, wake up at 7. Good to go. Now I go to bed at 12, wake up at 4. 4 hours? Are you kidding me? That's so .... like... it's illogical, that ALONE could be the reason why I can no longer sleep.

over 3 years, said...

I see it's been over a year and a half since I commented on this article. I "graduated" from a CPAP to a BiPAP about 6 months ago - pressure was too high for my stomach to handle all the air being pushed into it (i.e. - motor boating when I walked - putt, putt, putt). I have only slept without the machine for 2 nights in a year and a half. I am doing much better with the sleeplessness, but it will take my body a while to recover all the years (possibly 20) of poor sleep.

over 3 years, said...

You should always address severe sleep problems to a Physician. Sleep Apnea can cause severe health problems. If you snore, stop breathing when you're asleep, are overweight, or have a short, thick neck, these can all be symptoms of, or cause sleep apnea. I was diagnosed with severe obstructive sleep apnea during a sleep study that was ordered by a Board Certified Sleep Specialist Physician. It was so bad that they put me on CPAP during the primary sleep study! I was stopping breathing up to 60 times per minute! I saw the Specialist the next day, and he ordered a fitting to be done for my CPAP to be done ASAP. I have been using it nightly for over three years, and am sleep much better, am not foggy during the day, and am not nodding off constantly when awake. Plus, my Dr. sent me to a Sleep Therapist for Sleep Hygiene therapy. Best thing that I've ever done! She taught me much about the things that we all do wrong that disturbs our sleep, and messes up our sleep patterns. I am a permanently disabled RN that spent 30 years, pretty much my entire career, in the Operating Room. I was stricken by a malignant spinal cord tumor, which crippled me, and I live in constant pain for ten years now. I finally got my really messed up sleep schedule back on a more normal day/night pattern, and usually only wake once per night for a bathroom break. My sleep is short, usually 5-6 hours, because of pain issues from the damage from the tumor removal, and lately rapidly advancing degenerative spine, and joint arthritis, plus growing older (58) you tend to sleep less. Remember these things: see your Dr. for snoring, and/or stopping breathing at night-if your bed partner says you're doing these, don't argue, or ignore, GO SEE YOUR DR! Bed is for the "3 S's- Sleep, Sex, Sickness. NO TV, laptop, cellphone, games, or reading! LIGHTS OUT! NO music, or light. Make sure that your bed is comfortable, the temperature is comfortable, and you're comfortable BEFORE bedtime. Say your good nights, go to your room, shut the door, make sure your alarm is set and the clock is facing where you don't see the time, get in bed, turn out all the lights, get in a comfortable position, and go to sleep! Set a bedtime, and a wake time-stick to these every night, every day! No heavy meals, or snacks, no exercise, no "blue screens" (TV, computer, smartphone, video games), excitement, work around the house, or heavy reading at least two hours before bed. If you want to read, go to a quiet place, with a reading light (no bright overheads), a comfortable chair, and a light read (no heavy/exciting/'page turners") for a short time to relax before bed. Nothing to get your thoughts buzzing, and turning. It's all about slowing down, relaxing, settling your mind, and being comfortable BEFORE lying down for the night. A Sleep Therapist is a great person to help you get your sleep in order, after seeing a Sleep Specialist, if your Primary Dr feels you need to be seen. Good Luck, and God Bless all!

over 4 years, said...

I turn on a body scan recording and never make it beyond feet or legs....

over 4 years, said...

the breathing part about th beach n waves''

about 5 years, said...

I have tried all ths but no change.

about 5 years, said...

If you are really having a hard time staying awake during the daytime, and problems sleeping, request a full blown sleep study. I finally did, and found out that my body would go into REM sleep, what your body needs to rest/repair itself, and come right back out of it. In a 6.5 hour sleep study, they had over 1,000 events of my body either not sleeping, or restless leg taking me out of the REM cycle. I've now had a CPAP for 5 nights, and am doing much better.

about 5 years, said...

I believe that we are blessed with glimpses of God's Kingdom every day--a special kindness, the glint of the sun off of a hummingbird's wings, a loving memory--you get the idea. I watch for these each day and recount them at night when I pray "Thy Kingdom come."

about 5 years, said...

Many years ago our family suffered a suicide. I found an excellent counselor. During one of the sessions she made a relaxation tape specifically for me that is described in the Rossman book. Soft music accompanied her instructions for deep breathing, relaxation of each muscle group, and then the imaginative journey to my "happy place." It was probably 30 minutes long, but I never was awake that long! That was the best money I ever spent.

about 5 years, said...

As usual, excellent tips explained simply!

about 5 years, said...

Some very good points here. My favourite sleep regime is to have the radio on timer for say 30 minutes, and listening to a talkback programme. Guarantee every time, I never hear the radio turn off.

about 5 years, said...

After many years of sleepless nights and foggy and daylight hours , I discovered that I can function at 110% physical and mental capacity. Whereas daylight hours, it feels like I'm having a shots of liquor throughout the day. I adjusted my schedule to go to night school 6PM and my work schedule from 12AM to 10AM. I'm in bed by 11AM and up by 5PM. I don't know why I can get by on 5 or less hours of sleep is beyond me. I had my breakfast at 10:30PM today, my lunch will be 3:30AM, and my dinner will be about 7:30AM. Today, actually tomorrow Monday, I'm going to incorporate 1 hour of exercise and see how my body will adjust to it. Maybe this sleep pattern came from my birthing hour which was between 9PM-10PM that could explain my sleep and activities pattern.

about 5 years, said...

I was having a lot of problem sleeping through the night, and discussed it with my doctor, to see if she would prescribe a bill I could take to help me sleep longer. Most nights I'd be fully wide awake about 3 hours after going to sleep. She did not want to prescribe sleeping pills, due to my heart condition, BUT she suggested getting some over the counter Melatonin. I began taking 5 mg each night when I was settling for the night, but it just wasn't quite enough. I now take 10 mg each evening, and I sleep soundly through the night. Another thing it helped with was my husband's snoring. He'd been tested and does not have apnea, but if he takes a 5 mg of melatonin each night, he snores far less, and much quieter. Both of us have PTSD, and are getting older, which still beats the alternative.. dying.

about 5 years, said...

I was going crazy w/barking dogs, neighborhood noises, etc., I slept well in hotels with a/c hum but not at home ,my husband found a product which creates noise--there are many on the mkt but most stop after an hour but these go all night--manufacturer is "Marsona", I bought a simple one & a fancy one, the simple one you can turn up the volume and/or frequency of simple white noise--I took it EVERYWHERE and stopped worrying about sleeping. Funnily, I don't seem to need it any more. In 2004 I went to hospital for thyroid surgery & worried about snoring roomies--they put me in the only room with 3 beds & I was between two buzz saws but I didn't care! (probably still stoned). Now we sleep with soft rock music--my husband always did but I couldn't stand it so I slept in another rm for years, but I missed him. I think the difficulty wasn't the noise, it was my stress level--he was getting more & more impaired, lotsa physical problems, and I'm kind of a stress freak anyway. Now I pretty much sleep like a baby. But just HAVING the noisemaker made me feel secure at first, if a dog started to bark I'd just poke it. The noisemaker, not the dog!

about 6 years, said...

I am writing this at 3.30am ....this is the time I wake up every day and then getting sleep is very difficult.Most times as soon as I get up I switch the light on......I think that is where I go wrong. Need to preserve darkness and see if it works.

about 6 years, said...

I am going to try out all these solutions. I am usually in bed by about 9.30, and up at 0530 for my morning bike ride, but wake up many times between these times. It is very frustrating. I don't take naps, but can easily nod off whilst reading the morning paper at breakfast!

about 6 years, said...

My husband has trouble sleeping and now he wears a eyemask such as we get on the airplanes and I keep myself from tossing and turning nor reading in bed while he is asleep. Things are getting better after reading this article.