Dear Dr Sleep,

I am waking up almost exactly at 3 am every night. Some times I could go right back to sleep, but sometimes it takes me a few hours. Please explain what other problem I might get besides fatigue in the morning. I am 43, have stable diabetes, do not require insulin, am moderately obese, otherwise, I am fine. I work in a consulting firm, travel frequently and my sleep schedule is not set. What are your comments and advice?

Sincerely,

Damita S. Houston, TX

Dear Damita,

Midnight awakenings might be a good or bad thing depending on the situation and medical condition. Let’s talk about good aspect of midnight awakening in relation to your situation. In diabetes, even in stable diabetes, the blood glucose level is usually increased during sleep between 2 and 4 am. This is due to the specifics of glucose metabolism. In case of diabetes, a low glucose level may produce a sort of turbulence in the body including heart rate instability and restless motor activity. This usually causes arousal, which has a compensatory function to “offset” wrong sleep with heart arrhythmias. In this case, awakening is good. In severe cases of diabetes midnight awakening is especially good because it allows the patient to wake up and check glucose level and take insulin or food as the case may be. Taking too many sleeping pills prevents the person from waking up during glucose drops, which sometimes will result in heart palpitations. Midnight or early morning awakenings are positive phenomena in case of depression and other conditions.

The negative effects of prolonged or frequent midnight awakenings are sleepiness, fatigue, loss of concentration, and lapses of judgment the next day. Physically it may cause muscle spasms (fibromyalgia), blood pressure swings, headaches, and deterioration of existing problems.

It is very important to avoid self-treatment and consult your doctor or a sleep specialist who has the tools to differentiate “good” and “bad” reasons.

Have a healthy sleep and Happy Holidays!