What to Do About Middle-of-the-Night Insomnia

Couple Awake in Bed

Have you ever spent a few hours wide awake in the middle of the night and found it difficult or nearly impossible to fall back to sleep?

Everyone has a rough night now and then, so don’t worry too much about that. But if it has become a regular occurrence, your health may suffer.

In my clinical experience, patients begin to see negative impacts on physical and psychological well-being when poor sleep occurs for a few consecutive nights and that pattern continues for a period of a month or two.

“Nocturnal Awakening” is the most common type of insomnia I see with my mid-life women.

If you are like these women, you fall asleep easily. Sometimes before your head even hits the pillow. But sometime between 1 and 4 am you find yourself awake.  The problem isn’t necessarily that you woke up. It’s normal to wake up several times (briefly) during the night. Typically you don’t realize you woke up. “Normal” sleepers roll over and go right back to sleep.

What are some of the CAUSES?

There are several reasons that you may wake in the middle of the night and find that falling back to sleep is difficult . . . or doesn’t happen at all. Many causes can be rooted in your physiology, such as:

  • Hormone imbalance
    • Cortisol
    • Melatonin
    • Insulin
    • Thyroid
    • Estrogen/Progesterone
  • Blood Glucose Fluctuations
  • Night Sweats

ANXIETY is often the the cause of your inability to return to sleep.

Your mind can become the enemy of your blissful beauty rest . . .

Here’s what often transpires . . .

You become anxious about being awake. You begin to worry that tomorrow is going to be awful if you don’t get enough sleep tonight. The anxiety now makes getting back to sleep even more difficult. Now that you’re wide awake your mind begins racing, along with your heart rate if you really go to those worrisome places in your mind. So here you are, staring at the ceiling. Anxiety seems to rise up in our psyches and then in our bodies once the house is dark and quiet. You begin ruminating over the HUGE to-do list you’ve created for the next day. And then worrying about your kids. Soon you are feeling anxious about a few chronic health-related complaints, wondering if there is something really WRONG with you. My dear friend Pat Wise, an extraordinary therapist, calls it “Awfulizing”.

Why do you “Awfulize” during a 3 am Nocturnal Awakening?

Once you’ve crawled under the covers, you are unable to “busy” yourself with the daytime activities that may be your go-to strategy to distract your anxious mind. Your relative isolation sinks in. Your thoughts feel overwhelming and seem inescapable. Sure, if things were THAT awful you do have a close friend or sister who’d answer her cell phone. But she probably doesn’t get enough good sleep of her own.

Awfulizing can become a habit.

A few years ago. I was living on the beautiful island of Guam with my soon to be husband. By most of my friends’ opinion, I should have been having the time of my life. The problem was that I was living off my savings. I still struggle a bit with getting my sense of security by the amount of money in my bank account. Awesome by day, but at night I developed the habit of ruminating and worrying. Time passed slowly in those months without a “job”. So I experimented with most of the strategies listed below. They worked!

Do You Find Yourself Anticipating a Bad Night?

When I dig deep into the history-taking conversation with a patient who has poor quality sleep, I often discover that she is anticipating problems with sleep before she even gets into bed. Her worrisome thoughts are already beginning to well up, maybe subconsciously, without her awareness. Does this resonate with you?

There’s no shortage of sleep hygiene tips out there.  You MUST incorporate them routinely into your self-care plan. Maybe your room is dark and cool, your pets even have their own bedroom, your partner doesn’t snore, you’ve balanced your hormones so no more night sweats and you don’t have to get out of bed in the middle of the night to use the bathroom. Maybe your bedtime routine is the envy of your friends; a hot Epsom salt & lavender bath, chamomile tea, journaling and prayer. All fine and dandy to aid you in falling asleep. Until your “Nocturnal Awakening” hits. You wake up to simply roll over but your mind starts racing . . .

Insomnia can cause Anxiety and Anxiety can cause Insomnia.

Anxiety is a whole person issue. Your biography informs your biology and your psycho-spiritual self drives your physiology.  Once the pattern of Nocturnal Awakenings sets in, your physiology WILL change, and not for the better. So there’s a good chance that the unrelenting stress on your body as a result of your persistent insomnia takes a toll on your ADRENAL glands . So you’ll need to address imbalances in the circadian rhythm of cortisol production. Your brain is going to be effected as well. Melatonin, which is produced by the pineal gland may need to be tested.

Here’s What Can You Do

If it’s true for you that you find yourself lying awake with your mind racing at 3 am, here are a few of my favorite tips:

  • Question your thoughts.

Can you be absolutely certain that what you are worrying about is definitely going to happen? Byron Katie says…..

  • Make certain topics OFF LIMITS

Just say no to worrisome thoughts about your health concerns, finances, kids, tomorrow’s to do list. Do decide what you WILL allow yourself to think about (cooking, flower arranging, a scene in a comedy, vacations, sheep, ha, ha)

  • Pray

Reinhold Niebuhr’s, serenity prayer, “Grant me the courage to change the things I can change, the serenity to accept the things I can’t change, and the wisdom to know the difference.”, The Lord’s prayer, or a prayer of gratitude. Anytime is an opportune time to hand over your worries to God or your “higher power”

  • Breathe

Count each breath, up to 10 and keep repeating. If your mind wanders, just pick up with the number you left off on.

  • Listen to a guided meditation on CD or YouTube.
  • Check out www.HeadSpace.com. The 10 minutes for 10 days FREE app is amazing. You can keep repeating the 10 days over and over without upgrading.

*** I just treated myself to a set of Bose wireless earbuds, sweet!

  • Rub these 2 calming acupuncture points:

Yin Tang is located between your eyebrows, use your middle finger. Heart 7, know as Shenmen or Spirit Gate is located in the wrist crease on the pinky side. Rub this one with your thumb. You can rub both with opposite hands at the same time. Many of my patients report falling back to sleep within 5 minutes.

What if you’re still awake after 20-30 minutes?

Get up and head to another room. It’s important to keep negative thoughts and worries out of the bedroom. Find a comfortable chair with dim lighting. Read, (do NOT look at phone, tablet or computer-blue light on retina shuts down melatonin production) draw, pet the cat, crochet or listen to music. Once you become sleepy, go back to bed.

My current thoughts on segmented or biphasic sleep.

Here’s an example of biphasic sleep. Maybe it’s your typical pattern. You fall sleep with no problem but you wake up after 4 hours. Your’e wide awake for 2 or even 3 hours. Then you are able to go back to sleep and get another (often good quality) 3 – 4 more hours of sleep. So you slept a total of 7 – 8 hours. Just not uninterrupted. This sleep pattern may not be so “awful” for your health. I’ve been researching segmented sleep and will keep you posted as I learn more.

Don’t Stress Over the Problem

Whatever your current sleep pattern looks like, you ARE doing your best with the tools you have now. Stressing over it won’t solve anything. Work on your plan to improve sleep, and give it time.

Fix Your Physiology

If you’re Nocturnal Awakenings are due to imbalanced physiology, you’ll need to uncover the root-causes. I start working with women by taking an in depth history followed by recommending the appropriate Functional Medical-type diagnostic testing.

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