Reading: It’s 3:00 A.M. Do You Know Where Your Sleep Is?

Health

It’s 3:00 A.M. Do You Know Where Your Sleep Is?

4 startling reasons why this gremlin strikes

By Sheryl Kraft

Your eyes pop open.

You’re wide awake.

Time to get up?

But wait: It’s still pitch dark outside. Ummm…maybe that’s because it’s only three thirty in the morning.

What happens next seldom varies. You keep flipping into new sleep positions, hoping one will work. But nothing does, and meantime you’re noting every 15 minutes that goes by. Alarming thoughts course through your over-wired brain: Did I forget to lock the front door or turn off the stove? How can I save for retirement when the cost of my dental bills and insurance premiums keeps going up? And, scariest of all, if I’m awake half the night, how will I get through my crazy-busy work day tomorrow?

Eventually you do fall back to sleep — but not until you’ve stressed yourself so much that the next day you’re like an extra in The Walking Dead.

People who are awake in the middle of the night may feel very lonely, but in fact they have plenty of company: More than 10 percent of Americans — and more women than men — report suffering from the two types of insomnia sleep onset, meaning you have trouble falling asleep, and sleep maintenance, the 3 a.m. wake-up call described above. There are a few medical conditions that could be contributing factors, including arthritis, asthma, chronic pain, gastrointestinal problems, endocrine problems and sleep apnea. But if your doctor has eliminated those, then the answer to why sleep-maintenance insomnia is so common among women may lie in the theories and explanations below.

Relax, say some historians: You don’t have a sleep disorder; you’re just following the example of your pre-industrial ancestors. “Segmented, or biphasic, sleep was the natural pattern of human slumber in the Western world and perhaps elsewhere from time immemorial to the modern age,” explains historian and sleep expert Roger Ekirch, PhD, award-winning author and professor of history at Virginia Tech. Before the Industrial Revolution, people in Europe and North America didn’t necessarily sleep fewer hours than we do, he says, but they broke their snooze time into two segments, called first sleep and second sleep.

That changed over the course of the nineteenth century, with the advent of gas lighting and, later, electric illumination, Ekirch says. These stronger and cheaper forms of artificial light enabled people to work (and play) much longer into the evening. So bedtimes were pushed later and later, disrupting our circadian rhythms and reordering our sense of time.

While gas and electric light were the major reasons for our changing sleep pattern, there were other powerful factors as well, says Ekrich. The Industrial Revolution, which began in the eighteenth century, brought not only new technologies but changes in cultural attitudes toward work and rest. In the new capitalist age, he explains, “Sleep [came to be seen as] a necessary evil, best confined to a single interval, and early rising became a very popular reform movement.”

You see where this is going. When you wake up in the middle of the night, you’re not suffering from a disorder and you needn’t feel anxious. You’re just a throwback, following our ancestral rhythms.

You’re waking up at that hour because that’s when you cycle from deep sleep into lighter sleep. “The average person wakes up about six times each night,” says James C. Findley, PhD, clinical director of the Behavioral Sleep Medicine Program at the Penn Sleep Center in Philadelphia. Most of the time, he says, these wakings are so brief that we don’t remember them. But once you’re past the deep-sleep stage (the first four or four and a half hours of slumber), it’s sometimes not so easy to roll over and snooze again after you’ve awakened. So if you turn in at, say 11:00 p.m., says Findley, by three in the morning you’re mostly out of deep sleep and shifting into longer periods of lighter sleep. And since your brain is more active during light sleep (the REM stage), it’s more likely that you’ll awaken.

What can you do? Findley suggests cognitive behavioral therapy, a treatment that is also endorsed by the NIH, the American Academy of Sleep Medicine, and the American College of Physicians. The specific technique he advocates is called bedtime restriction. Here’s how it works. Let’s say you typically go to sleep at 10:00 p.m. and wake five hours later at 3:00 a.m. Try “restricting” yourself to bed for five hours — but a different five hours. If you want to start your day at 6:00 a.m., go to bed at 1:00 a.m. Set that time in stone; don’t ever go to bed earlier. You’ll sleep for the same amount of time, but you’ll be getting up at a much more decent hour. Once the routine is working well, try moving your bedtime back by 15-minute intervals each week until you get to the point where you can go to bed earlier than 1:00 a.m. but stay asleep until 6:00 a.m., when you want to wake up.

You’re waking up simply because you’ve had enough sleep. “One of the most important causes of insomnia can be spending too much time in bed,” says Shalini Paruthi, MD, assistant professor in the division of pulmonary medicine at St. Louis University School of Medicine. For example, if you only need six hours of sleep but you turn in at 9:30 p.m., when you wake up six hours later it may be simply because you’re done. Of course, 3:30 a.m. is not an ideal time to start your day, so try going to bed later.

If you never had this problem until you got older, then, yup, aging and its good friend menopause are playing a role. For one thing, says Findley, as we age we tend to get less of that deep sleep. But there’s more. If you’re post-menopausal, you need no introduction to night sweats. These are caused when the hypothalamus, which regulates your body temperature, becomes confused by fluctuating estrogen levels.

However, says Mary Jane Minkin, clinical professor at Yale and practicing ob/gyn, there’s a newer hypothesis for why menopausal women often awaken in the early hours: Their pituitaries may be making them do it. “When estrogen declines,” she explains, “the hypothalamus sends a hormone called GnRH [gonadotropic releasing hormone] to the pituitary gland. And since the hypothalamus is thought to produce GnRH most actively in the early morning hours, this activity may stimulate the nearby sleep center, which is also located in the hypothalamus.”

The remedy for night sweats and early-hour wakefulness? Estrogen replacement may help, says Minkin, as may SSRI and SNRI antidepressants. One of her favorite non-medical remedies is Remifemin Good Night, which contains German black cohosh for hot flashes and various herbs for sleep.

So instead of lying awake and anxious, consider trying one of the approaches above. Or just give up and follow the lead of our ancestors, who embraced their wakefulness as a time to do some chores, converse with neighbors, have sex, or even steal some firewood. You say your partner has no trouble sleeping through the night, and your house has no fireplace? In that case, just pick up your phone and email, text or tweet. Someone you like is sure to be awake at that hour, too.

  1. Nancy White

    This is pretty common for me. I find putting the bbc on my phone with earplugs gets me back to sleep in 15 minutes!

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