Why You Wake Up in the Middle of the Night

It's a familiar scenario: You roll over, wide awake in the middle of the night. You check your phone to see that it’s around 3 a.m. Or maybe it’s 2 a.m., or even midnight. The point is, it’s too early to be this awake, and now your mind is racing. 

Sleep scientists refer to these overnight awakenings as “wake after sleep onset.” One study found that more than one-third of us wake up in the middle of the night three or more nights per week. Experts say for most, these wake-ups aren’t cause for concern… if you’re able to easily get back to sleep. 

So, what triggers these midnight awakenings, and when should you be worried? Let’s examine the common causes of 3 a.m. wakeups and useful strategies for achieving more restful sleep.

The Role of Hormones in Night-Time Wake-Ups

Our good buddy cortisol, best known as the body’s stress hormone, is usually the one to blame for waking you up. It plays a pivotal role in managing our sleep architecture, helping to structure our 24-hour body clock known as our circadian rhythm. 

Research shows that cortisol levels naturally begin to increase between 2 a.m. and 3 a.m. That little uptick can usually be slept through. As Jenna Gress Smith, Ph.D., a clinical health psychologist specializing in sleep medicine, describes, “Most people wake up several times during the night, sometimes without remembering.”

But add in a little stress, anxiety, or caffeine too late in the day, and that touch of extra cortisol jumps your body awake, elevating your heart rate and alertness. Consequently, people may find it challenging to return to slumber.

Common Culprits of a Good Night’s Sleep 

Recognizing what is waking you, and keeping you awake, is the first step to addressing it. Here are the most common reasons you’re staring at the ceiling in the middle of the night.

1. Stress

Mental stress, worry, and anxiety are perhaps the most common reasons you’re not sleeping well, and the relationship between stress and sleep disruptions is well-documented. 

“When you feel stressed, your brain kicks into fight-or-flight mode, flooding your body with hormones including adrenaline and cortisol to prepare you to fight, flee, or freeze,” says Gress Smith. “That response can trigger an array of physical symptoms, such as a quickened heart rate, dizziness, or a dry mouth.”

To counteract these effects, experts say carving out dedicated time during the day to address stressors can help to compartmentalize concerns long before bedtime. Incorporating relaxation techniques like guided meditation and mindfulness practices can promote relaxation, too.

2. Low Blood Sugar

Michael Breus, Ph.D., a psychologist who specializes in sleep disorders, says nutritional imbalances can disrupt sleep patterns. “The first question I ask [my patients] is, ‘When was the last time you ate? ' Often, they’ve finished their last meal at 7 p.m.; now it’s 3 in the morning—that’s eight hours later—so guess what? They’re out of fuel.”  

Prolonged periods between meals, especially if dinner is consumed several hours before bedtime, may leave individuals susceptible to drops in blood sugar during the night. In response, the body initiates that cortisol-driven wake-up call, signaling the need for sustenance. 

Striking a balance between satiety and lightness before bedtime is key to preventing nocturnal hunger pangs. A nutritionally balanced dinner or a snack, such as a combination of complex carbohydrates and protein, can help stabilize blood sugar levels throughout the night. One unexpected hack from Breus: raw honey. He says that the body can’t metabolize it quickly, and it can be enough to hold you over until morning.

3. Sleep Cycles

Our bodies love routines. We’re in one even when we’re asleep, cycling through different types of routine sleep throughout the night. 

 “The length of each stage varies throughout the night, with longer deep sleep earlier in the evening and longer REM sleep—lighter sleep when dreams occur—as morning approaches,” says Gress Smith. “Your arousal threshold—how easy it is for something to wake you up—varies depending on what sleep stage you’re in.”

Habitual awakenings at the same time each night can often be attributed to conditioned responses, whereby the body's internal clock anticipates arousal during lighter stages of sleep. Environmental factors, such as car alarm blaring or keeping your room too warm at night, may further exacerbate these interruptions. 

To address this, it’s best to outsmart your body’s routine with your own. Adhering to consistent bedtime rituals signals to the body that it's time to unwind, and creating optimal sleep conditions (blackout shades, cool bedrooms and sheets, and ear plugs if you need them) can promote uninterrupted rest.

4. Aging

As humans age, physiological changes alter our sleep architecture. Research shows that older people spend less time overall in the deepest sleep stage. Their circadian rhythms shift, too, meaning they get sleepier earlier in the evening and also naturally wake up earlier in the morning. 

For people in this group, avoiding haphazard naps throughout the day, getting enough exercise, and using light to manage their natural rhythms can ensure they’re sleeping through the night.

5. Medical considerations

It’s important to consider how some specific medical issues or changes might be affecting your sleep.

Certain drugs, for instance, are capable of disrupting the delicate balance of our circadian rhythms. From antidepressants to antihypertensive medications, various pharmaceutical agents can exert effects on sleep quality and duration. 

Hormonal changes in women during perimenopause and menopause, sometimes aligned with hot flashes, can affect rest, too. For others, medical issues such as obstructive sleep apnea, periodic limb movement disorder, and other parasomnias are known for middle-of-the-night issues. Consulting with healthcare professionals to evaluate these factors is paramount for mitigating nocturnal disruptions and optimizing sleep and overall health outcomes.


While often benign, sleep disturbances can stem from various factors, from stress and anxiety to fluctuations in blood sugar levels and disrupted sleep cycles. By identifying the underlying triggers and implementing targeted strategies, such as stress management techniques, balanced nutrition, and optimizing sleep environments, individuals can reclaim restful nights and wake up feeling refreshed. Additionally, considering medical factors and seeking professional guidance when needed ensures a comprehensive approach to addressing nocturnal disruptions, ultimately promoting better sleep and overall well-being.


Sleep Foundation

National Library of Medicine

Dr. Livingston enjoys taking care of patients from the mild to the wild. He is the doctor for you, if you have been to other places and told there was nothing that could be done for your or told “It’s all in your head”. He accepts all types of cases including workers compensation, auto accident and personal injury cases. He believes chiropractic can help everyone add life to their years and get them back to doing what they love.

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