Transcription
Frequent nighttime awakenings are a frustrating problem for many people, especially as you age. And while there are many techniques that can help you fall back asleep, what works best is to try to stop those awakenings before they happen. So, in this video, I'm going to walk you through the key reasons you might be waking up at night and how to prevent them.
Hey everyone, I'm Dr. Michael Bruce, the sleep doctor. There are a number of factors that contribute to frequent nighttime awakenings or what we sleep doctors call fragmented sleep. Oftentimes, these are things that you're doing during the day that are making it harder for you to stay asleep at night. And unfortunately, it can be difficult to connect something that you're doing in the morning with our sleep problems that we might be having at 3:00 in the middle of the night.
Now, as you age, you experience a natural change in your sleep patterns, resulting in less time, unfortunately, in deep sleep. Therefore, with more time spent in lighter stages of sleep, you just wake up more easily. So, what I thought I would do is start by talking about the key reasons you're waking up at night. Then I will talk about some of the small simple changes that you can make right now to minimize the negative impact on your sleep that these factors are likely to have. Finally, if that does not work, I will outline some of more advanced strategies that you can use to hopefully minimize those disruptions for good.
The first one might sound obvious, but I still see it all too often. Caffeine. Most people do not know this, but caffeine has a quarter life of 10 to 12 hours. That means if you drink a cup of coffee at 2 in the afternoon, which is about 100 milligrams of caffeine, you'll still have 25% or around 25 milligrams swimming around in your body at 2:00 in the morning. That is like waking up in the middle of the night and drinking a cup of black tea or having a can of soda.
Remember, caffeine makes us feel awake by blocking a chemical known as adenosin. Adenosin is a key part of our sleep drive and it's the main way our body knows it's getting sleepy. So if you still have caffeine in your system even a little bit, your body won't be getting as much adenosine as it should be. Meaning it's not getting the message, hey, I'm getting sleepy. And that's why you're getting a second wind and it's much harder to fall asleep.
I'm probably not telling you a ton that you don't already know here, but I think the real issue with caffeine is that it's incredibly easy to misjudge how much we're getting on a day-to-day basis, especially as we age. Our bodies can metabolize caffeine a little bit slower. What's more, you might not be feeling any of the effects of that caffeine as you lay down and go to sleep. In fact, you probably feel pretty tired and you fall asleep easily. But just because you don't feel it doesn't mean it's not impacting your body. And that's why I think this one can be so sneaky. It can be hard to connect the dots and say, "Hey, maybe all that coffee I had 12 hours ago is what's keeping me up."
So, what can you do about it? First, do me a favor. Stop any and all caffeine by 2:00 p.m. No more afternoon lattes or coffees with dessert. If you're already done that and are still waking up frequently at night, I would suggest gradually moving that cut off time earlier and earlier into the day. Ideally, you drink most of the caffeine that you have as early as, let's say, 10:00 a.m. If you're drinking most of your day's caffeine before noon, chances are a lot of it will be metabolized out of your body by bedtime.
Another thing to think about is the amount of caffeine that you're drinking. Even if you're cutting yourself off early in the day, if you're getting four or 500 milligrams or four to five cups per day, there will still be a significant amount in your bloodstream in the middle of the night. I do not have a specific recommendation on the right amount of caffeine any one person should be getting because our bodies tend to metabolize it slightly differently, but I do have two recommendations. One is to simply start tracking the amount of caffeine that you're getting every day. You can look up the caffeine content for a variety of drinks online, and by counting how much you're getting, you'll have a great baseline. The second thing is to try to drink the exact same amount every day. I know it can be easy to wander back to the coffee pot and top off your mug with more coffee. Later, you say to yourself, "Wait, did I have four cups? Did I have five?" Remember, your body loves consistency. If you can set a baseline for yourself and stick to that consistently, then it will be a lot easier to monitor caffeine's impact on your sleep and if necessary, reduce the total amount you're drinking in a way that you're able to sleep through the night and still enjoy your favorite beverage.
Next is another beverage you might enjoy regularly, but it can have a huge factor in why you're waking up in the middle of the night. You guessed it, alcohol. I know most people think alcohol helps you sleep. In fact, alcohol is probably the most widely used sleep aid in the world. But while alcohol can help you fall asleep more easily, it's terrible for your deep sleep and your ability to stay asleep during the night.
Since alcohol is a seditive, it can send your body into a deep sleep quickly, which is why most people use it as a sleep aid, but that's not what's supposed to happen. Your body is supposed to go through the lighter stages of sleep first. When alcohol disrupts your sleep cycle, it can be difficult for your body to readjust during the remainder of the night. As alcohol wears off, your body experiences something called homeostatic recovery, and it tries to actually compensate. So, you spend more time in those lighter stages of sleep, contributing to frequent awakenings and restless sleep. There's also evidence to suggest that alcohol disrupts your melatonin production, interferes with your circadian rhythm, and since it's a diuretic, can both dehydrate you, and make you wake up more frequently to pee.
So, here's what you should do. Stop alcohol at least 3 hours before bed, and limit yourself to two drinks maximum. Also, make sure to drink a glass of water right after each alcoholic beverage. This should give your body the time it needs to metabolize the alcohol before it's time for bed. But if that doesn't work, honestly, I would suggest running an experiment and stopping alcohol entirely for 2 weeks. Or at the very least, limit yourself to only having alcohol one night a week. My guess is you will pretty quickly see that on alcohol-free nights, you're not only sleeping more deeply and waking up less frequently, but you will also feel more rested in the morning.
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Another reason you may be waking up frequently at night is that your body is lacking a key vitamin or mineral it needs to sleep without disruption. Now, there are a lot of different things we could look at here, but I want to first focus on one of the biggest ones I see people missing, which is vitamin D. Vitamin D helps regulate your production of melatonin, which remember is the hormone that controls your sleep-wake cycle. And studies show that people with low levels of vitamin D experience very poor quality sleep, including having more frequent awakenings during the night.
As humans, we used to spend a lot more time outside. But as society has evolved and we built things like houses and cars, we just don't get as much exposure to vitamin D as we probably should. And as we age, our bodies absorb vitamin D less efficiently. In fact, one research study estimate suggests that up to 35% of people in the US have a vitamin D deficiency. So, there's a good chance you're not getting the vitamin D you need and it could be causing wakeups in the middle of the night.
The good news is the solution there is really simple and you don't need to buy anything or take a pill. All you need to do is go outside. That's it. On average, 15 minutes a day of sunlight exposure should be all you need for your body to get adequate amounts of vitamin D. Plus, early exposure to vitamin D can also help you wake up more quickly and feel more energized during the day. You might have a hard time believing this one actually works. After all, how does something you do first thing in the morning help you out in the middle of the night? But by getting the right amount of vitamin D your body needs, your melatonin cycle will run more efficiently, meaning your body will be better prepared for sleep at night and therefore sleep more deeply and for longer periods of time.
If increasing your amount of vitamin D isn't helping with your nighttime awakenings, I would suggest seeing if there's another vitamin or mineral deficiency that's possibly keeping you up at night. There are quite a few different possible deficiencies here. So, I'd say the best place to start is to have your doctor do some blood work to see what your body may be missing. Honestly, this is such an important step to take to me that it's totally worth the time, effort, and potential cost. I'd suggest talking to your doctor about looking at deficiencies in not only vitamin D but also magnesium, vitamin B, iron, and zinc. If your blood work can identify a deficiency in one of those areas, simple, cost-effective over-the-counter supplementation might be just what you need to sleep through the night.
Next, I want to talk about your sleep environment, or as you probably call it, your bedroom. Your sleep environment has a huge impact on your ability to stay asleep during the night. This is especially true the older you get. As I mentioned earlier, as you age, your body naturally spends less time in those deeper stages of sleep. And it's in those lighter stages of sleep when you are more likely to awaken easily. Fortunately, there are things you can easily do to your sleep environment that will not only naturally help you get deeper sleep, but can also minimize disruptions that have the potential to wake you up when you're in the light stages of sleep.
One of the biggest ways your sleep environment impacts your sleep is temperature. Like a lot of people, you might think a warmer bedroom is best for sleep, but actually it's the opposite. A warm bedroom may make you feel tired, but actually what your body needs is cold air. That's because your body prepares for sleep. It slows its metabolism down and naturally lowers its core body temperature. A cooler room, say in the 63 to 67° range, will enable you to sleep better as your body is closer to the room temperature. A warmer room, on the other hand, will make your body feel out of alignment with the sleep environment, potentially contributing to nighttime awakenings.
In addition to temperature, two other parts of your sleep environment that can disrupt your sleep are sight and sound. As you get older, your sleep is naturally less deep, so you're more sensitive to stimuli in your environment. Something as simple as a porch light coming in from the window bouncing across your eyelids can be enough to wake you up at 3:00 a.m. The same with sounds. Hearing a car drive down the street, an airplane flying overhead, or even the sounds of the house settling can wake you up in the middle of the night. Not to mention any noises your bed partner might be making, especially snoring.
What I suggest is to wear an eye mask and to use a white noise machine. Both can be very inexpensive to buy and generally comfortable to use. By using the eye mask to block the light and the white noise to block out any sounds, you'll be minimizing the amount of disruptions that could be interfering with your sleep.
Now, if a cooler bedroom, an eye mask, and white noise machine still are not enough, there are even more things you can do to tailor your sleep environment to promote longer stretches of uninterrupted sleep. One thing you could try is a weighted blanket. Many people find the downward pressure from the blanket can help settle their body better throughout the night, assisting in reaching a deeper stage of sleep. Remember to buy one that weighs roughly 10% of your body weight. If you go over that, you might feel very uncomfortable and it might be a little hot.
Another thing I would suggest if you continue to wake up in the middle of the night and can't get back to sleep is to purchase a new pillow and potentially a new mattress. Now, I know these can be a big investment, so I'd suggest starting with a new pillow first since they're a bit cheaper, but my guess is you've probably been sleeping on your current pillow for five, maybe 10 years. They really aren't meant to last that long. In fact, most pillows should be replaced about every 18 months to two years. As your pillow ages, it's probably not giving you the support you need in your head, neck, and even in your upper back. You might feel comfortable enough when you are falling asleep, but slight misalignment in your head, neck, and back can become exacerbated over several hours of sleep. The less comfortable you are as you sleep, you guessed it, will cause you to wake up more in the middle of the night.
Similarly, a new mattress might be just what your body needs to feel more at ease when you're sleeping. Oftentimes, what I see if someone's been sleeping on the same mattress for 10 years and maybe they bought a durable, high-quality bed, so it seems like it's still doing fine. But what gets neglected here is that your body changes over time, not your bed. So, what was comfortable 10 years ago might not be what your body needs today. And because that change can happen so gradually, we tend not to notice that growing discomfort. But a new bed and the right bed can have a tremendous immediate impact on your comfort as you sleep.
Finally, I want to talk about one of the biggest factors that might be causing you to wake up in the middle of the night. Stress. You probably know what I'm talking about, right? It's that feeling of waking up at 3:00 a.m. and not being able to turn your brain off. And while I've talked before about a lot of tips and strategies for what to do when this happens, I want to address how to prevent it from happening in the first place.
Now, there's no universe where I'm going to magically help you stop feeling any kind of stress. Boy, I wish there was. But what I can help you do is minimize your stress levels right before you go to bed. It turns out the way we go to bed has a big impact on the quality and the quantity of our sleep and our ability to reach deeper, longerlasting periods of sleep. Think about it. If you're stressed out after a long day and you do nothing to lower that stress and then you lie down in bed, do you think you're going to get good sleep? Of course not. You may be so tired from the day that you boom fall asleep easily enough. But again, that stress in your body, that cortisol will make it difficult for you to stay asleep.
So, I have three things that I want you to do. The first is called my power down hour. How it works is you take the last hour before bed and you break it up into three 20inut chunks. The first 20 minutes is spent on stuff you just got to get done. Put away the dishes, tidying up, laying out your clothes, whatever you need to do to finish up your day. The next 20 minutes is for hygiene. Brush your teeth, take a shower, whatever you need to do. The final 20 minutes is for something relaxing like breathing, meditating, reading, prayer, whatever helps center your body as well as your mind.
The next thing I want you to do before bed is avoid blue light. That's the type of light that comes from your phone, your television screen, your tablet, and your computer. Blue light can be very stimulating and it can send the wrong message to your brain about when to be awake versus when to be asleep. So, if you're getting a lot of blue light before bed, your body is getting a lot of extra stimulation, which can exacerbate feelings of stress and anxiety. Not what you want when you're trying to fall asleep. So, I would advise that you avoid blue light for at least 1 hour before bed. But if you're still waking up in the middle of the night, honestly, if you can stretch that to 2 hours before bed, I think that might be better.
The third thing you should try is a worry journal. This is where you take a piece of paper and you write everything down that is stressing you out. It only takes about three minutes, but it's a great way to unload some of the day stressors and some perspective on things. Honestly, most of the things that we worry about at night don't seem so scary when we see them written down on a piece of paper. The key here is to remember that you don't need to solve your problems or make those worries go away. Just start identifying them and the first step in the process.
Finally, if you tried all three of these things and stress is still causing you to wake up in the middle of the night, I recommend looking into some daytime stress management practices. Things like mindfulness, meditation, yoga, or therapy. Things that you can do during the day to manage your stress levels and therefore improve your sleep at night. Again, what we do during the day has tremendous impact on our ability to sleep through the night. So, it's worth spending that time figuring these things out. There's a lot of different ways to go here. So, I will leave it up to you to guide yourself on that part of the journey.
Hopefully, by implementing these changes, you will be able to sleep deeper and for longer periods of time. If there's anything that's helped you sleep through the night, please let me know in the comments below. And if you do continue to wake up in the middle of the night, don't worry. I've got some tips here that you can use to help yourself get back to sleep. This is Dr. Dr. Michael Bruce, the sleep doctor, wishing you sweet dreams.