Q: Dear Dr. Sleep,


Thank you.

Larisa Wagner

Naperville, Illinois


A. Dear Larisa,

Awakening in a middle of the night
is one of the most common complaints and is generally considered (rightfully)
as a bad thing. It is really very bothersome when you open your eyes at 3 am
and see that everyone else is sleeping. It is dark, and you really need your
rest before a difficult day. All your worries now pass before your eyes.
Medical thinking and the pharmaceutical industry often concentrate their efforts
on consolidated sleep for 8 hours straight, because the present fashion mantra
states, “we need eight straight hours of sleep to be healthy,” otherwise
damages may occur. However, to achieve a deep eight hours of straight sleep,
some physicians use increasing dosages of sedating antidepressants and
benzodiazepines or slow released hypnotics.


Having said this, clinicians and researchers slowly have
come to the realization that “sedation” is not equal to “sleepiness,” and over
sedating is actually leading to increase in midnight awakening. The bottom line
is that midnight awakening is not always a bad thing.


From the chrono-physiology literature that reports
biological rhythms and their disorders, we now know that humans have a few
“programs” for sleep-wake cycles. Eight hours of uninterrupted sleep and 16
hours of straight activity have come developed later in evolution and often
represent very unstable patterns. No one knows the true number of adults who
are able to sleep 8 hours without interruption, because so many people have a
tendency to wake up once or twice per night. The most stable pattern is four
hours sleep and two hours activity. Imagine, like in the old times, people
would wake up in a middle of the night and be ready to fight with enemies, then
come back to cave, have food, sex and go back to sleep. This “guard reflex” is
imprinted to us and gets elicited by any signs of internal or external, real or
imaginary problems. This reflex is also supported by the urinary reflex which
differs enormously between men and women and even more so as both genders
become older and their bodies undergo some changes into the urogenital tract
that are associated with frequent urination. Usually we wake up and then
realize an urge for urination.


Midnight awakening is especially important in advanced cases
of diabetes. Between 2 and 4 am glucose in blood sugar tends to drops
significantly and might cause heart arrhythmias. The body “prevents” trouble by
“kicking” the person out of sleep. Awakening is a compensatory “offset” of
possible dangerous hypoglycemia.

Midnight awakenings also might be helpful in cases of
unstable angina, pre-stroke conditions, and acid reflux. Psychiatrists knew for
a long time that early morning awakening is the strongest antidepressant.


What is said above should not be interpreted as if multiple
midnight awakenings are always a good thing. As anything in our lives, good
things might bring you troubles, and bad things may have silver linings. It is
important to see a health professional who will differentiate situational
compensatory changes from the signs of dangerous pathology.

This article is meant to diminish the anxiety of bedtime,
which some people have in cases of insomnia. Sleepless nights for them might be
a natural way of fighting internal disorder, similar to fever as a natural way
to fight with infections.


Another very important question is: what could you do with
midnight awakenings before going to see a doctor? Several principles might

  • Sleep is the greatest magnifier of your pre-sleep mood. If
    you are sad before sleep, you will wake up depressed. If you are upset
    before sleep, you will wake up angry. If you go to sleep worried, you will
    wake up with the feeling of being overwhelmed and corned by problems
    multiplied. On the converse, your pre-sleep activity should be something
    that is relaxing and restful in its self, like listening to soothing music
    that suits your taste. Simply stated – the most important thing you can
    do is to develop a pre-sleep ritual or routine to avoid a “worry time”
    before sleep, to make yourself comfortable and to think about sleep as a
    “time out.”
  • Even if you slept badly last night, a very short daytime
    nap might reverse the problem. Remember, a nap as short as 30 minutes is
    a healer, but prolonged daytime sleep longer then 1.5 hours is a “killer”
    (meaning that long daytime sleep can produce negative results such as
    fatigue, headache, and increased blood pressure).
  • When awakening in the middle of the night with feelings
    that you can not fall back to sleep, do not stay in bed – go to the
    bathroom, wash your face with cold water, and, contrary to the common
    opinion, take a little food, like a piece of apple with warm water. After
    that return to bed, as if it is another evening. This simple technique
    will “reprogram” your brain and get your worries about sleep to go away.