• With Mayo Clinic sleep specialist

    Timothy Morgenthaler, M.D.

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Question

Insomnia: How do I stay asleep?

I wake up in the middle of the night and can't get back to sleep. What can I do?

Answer

from Timothy Morgenthaler, M.D.

Waking up in the middle of the night is called sleep maintenance insomnia, and it's a common problem. Midsleep awakenings often occur during periods of stress. To help stay asleep through the night, try some of these strategies to relieve insomnia:

  • Establish a quiet, relaxing bedtime routine. For example, drink a cup of noncaffeinated tea, take a warm shower, or listen to soft music.
  • Stretch or do some gentle yoga. This can ease tension and help tight muscles relax.
  • Put clocks in your bedroom out of sight. Clock-watching causes stress and makes it harder to go back to sleep if you wake up during the night.
  • Avoid caffeine after noon, and limit alcohol to one drink several hours before bedtime. Both caffeine and alcohol can interfere with sleep.
  • Get regular exercise. But keep in mind, exercising too close to bedtime may interfere with sleep.
  • Go to bed only when you're sleepy. If you aren't sleepy at bedtime, do something relaxing that will help you wind down.
  • Wake up at the same time every day. If you go to sleep later than usual, resist the urge to sleep in.
  • Avoid daytime napping. Napping can throw off your sleep cycle.
  • If you wake up and can't fall back asleep within 20 minutes or so, get out of bed. Go to another room and read or do other quiet activities until you feel sleepy.

In some cases, insomnia is caused by a physical condition such as sleep apnea, restless legs syndrome or chronic pain. Treatment for an underlying condition may be necessary for insomnia to get better.

Insomnia can be linked to mental health disorders, particularly depression. Both depression and insomnia may improve with medications such as antidepressants or psychological counseling.

If you keep having sleep problems, talk to your doctor. In order to determine the cause and best treatment for insomnia, you may need to see a sleep specialist. Over-the-counter sleep aids rarely offer significant help for this problem. Your doctor may prescribe medication and have you try some other strategies to get your sleep pattern back on track.

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References
  1. Mahowald MW. Disorders of sleep. In: Goldman L, et al. Cecil Medicine. 24th ed. Philadelphia, Pa.: Saunders Elsevier; 2008. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-1-4377-1604-7..00412-7&isbn=978-1-4377-1604-7&uniqId=270858628-4#4-u1.0-B978-1-4377-1604-7..00412-7. Accessed Aug. 4, 2011.
  2. Siebern AT, et al. Insomnia and its effective non-pharmacologic treatment. Medical Clinics of North America. 2010;94:581.
  3. Manber RN, et al. Insomnia and depression: A multifaceted interplay. Current Psychiatry Reports. 2009;11:437.
  4. Glidwell RN, et al. Comorbid insomnia: Reciprocal relationships and medication management. Sleep Medicine Clinics. 2010;5:627.
AN01611 Sept. 30, 2011

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