What can you do when you stay awake in bed for a long time? Is it better to get up? Start reading?
Diana
— reader of elDiario.es
You turn around in bed. You open your eyes and look at the clock. It’s 3:30 am. You try to go back to sleep, but your thoughts are spinning non-stop and you don’t feel good in any position. When you start to feel sleepy again, there is only half an hour until the alarm goes off.
Waking up in the middle of the night and not being able to fall asleep again is a common experience that can negatively affect our quality of life and our health. This phenomenon, known as maintenance insomnia, differs from initial insomnia (difficulty falling asleep) and can appear as a consequence of various physical, psychological and environmental factors.
Why do we wake up in the middle of the night?
From an evolutionary point of view, nighttime awakenings may make sense. In prehistoric times, polyphasic sleep (divided into several phases) was common, as it allowed humans to alternate between periods of sleep and wakefulness to protect themselves from predators and other dangers. However, in modern society, instead of sleeping between dusk and dawn, we concentrate all our sleep into eight hours, but our brain does not always achieve this.
The causes of maintenance insomnia can be diverse, but the most common is the incidence of stress and anxiety. When the mind is overloaded with worries, the body produces more cortisol, the stress hormone that activates the nervous system and makes it difficult to relax. During the night, cortisol levels should decrease, but in people with high levels of stress, this does not always happen, which can lead to waking up earlier than expected.
The depth of sleep in the second half of the night is usually somewhat less than in the first half. Around 3:30 onwards the brain tends to activate somewhat
Diego García-Borreguero
— sleep neurologist
“The depth of sleep in the second half of the night is usually somewhat less than in the first half,” explains Dr. Diego García-Borreguero, neurologist and medical director of the Sleep Institute, to elDiario.es. “Around 3:30 a.m. onwards the brain tends to activate somewhat. In situations in which, due to stress, there has already been greater daytime activity, it can cause less deep sleep, or a greater number of awakenings, or directly an early awakening,” he clarifies.
The next most important cause is clinical depression, which produces early awakening as one of its symptoms. Next, disturbances in circadian rhythms can also cause awakenings in the middle of the night, something called sleep phase advance syndrome. “There are people who start their sleep cycle very early, and at eight or nine o’clock they feel more sleepy, but due to social obligations they go to bed later. They have a very short sleep latency, they get into bed and fall asleep very quickly,” says Dr. García-Borreguero. “However, at four or five in the morning they wake up as if they had already had enough sleep, even though it has only been five hours.”
These people could sleep longer if they went to bed when they start to feel drowsy, but their schedules may prevent this. The result is a sleep deficit. In addition, there are other less common factors that can influence, such as sleep apnea, certain drugs or hormonal changes during menopause, which influence the regulation of body temperature and mood, contributing to nighttime awakenings.
Of course, poor sleep habits, such as consuming caffeine or alcohol before bed, can have a negative impact. Although alcohol can facilitate the onset of sleep, it interferes with the deeper phases of sleep, such as the REM phase, and can cause awakenings during the night. Additionally, using electronic devices before bed, such as cell phones and tablets, exposes the retina to blue light, inhibiting the production of melatonin, the hormone responsible for regulating the sleep cycle.
What happens in the brain when we wake up in the middle of the night
The human brain follows an internal clock that controls the circadian rhythm, which regulates sleep and wake cycles, influenced primarily by light and darkness. When we wake up in the middle of the night, the brain can become confused, especially if lights turn on or if we start thinking about the day’s worries. Maintenance insomnia is related to hyperactivation of the hypothalamic-pituitary-adrenal (HPA) axis, which regulates the stress response. At these moments, the brain can interpret that it is time to wake up and begin to release hormones such as cortisol and adrenaline, which keep us alert.
Precisely our diet can influence to activate this system in the middle of the night. If we eat a big dinner, with plenty of sugar and carbohydrates just before going to sleep, in the middle of the night a drop in blood glucose called reactive hypoglycemia occurs, which can wake us up.
There are people who begin their sleep cycle very early, and at eight or nine o’clock they feel more sleepy, but due to social obligations they go to bed later. They get into bed and fall asleep very quickly, however at four or five in the morning they wake up
Diego García-Borreguero
— sleep neurologist
“If the last intake was shortly before going to sleep, hypoglycemia occurs a few hours later. Hypoglycemia leads to an increase in the activity of the sympathetic nervous system, which produces a state of alert,” explains Dr. García-Borreguero.
What to do when we wake up and can’t go back to sleep
One of the most important strategies for managing nighttime awakenings is to not become obsessed with the idea that we must sleep at any cost. Anxiety about going back to sleep can aggravate the problem. The next thing is to get out of bed. “When I can’t sleep, get up, do something different. And when I feel sleepy, if I do, go back to bed,” recommends Dr. García-Borreguero, but in the medium term he also proposes an apparently contradictory strategy: spend less time in bed.
“It consists of setting the alarm clock an hour earlier, for example. So we are giving the brain a little less time to stay asleep. This will lead to a compensatory mechanism in the following days. The sleep deficit that occurs will be compensated with deeper and more continuous sleep,” explains the neurologist, and warns that this procedure, common in the treatment of insomnia, may require three to five days to give results.
When these approaches don’t work, Dr. García-Borreguero insists on the importance of consulting with a medical professional to discover why. “If the cause is hypoglycemia, it is recommended to have a small sugary snack when you wake up. If the problem is depression, antidepressant treatment is required. If the problem is a sleep phase advance syndrome, the treatment will be adaptation by restricting sleep for a few days.”
And melatonin, which is sold and consumed as a supplement to help you fall asleep, could be useful? “The melatonin that we buy in pharmacies usually has a short duration of effect of about 60 minutes. But this does not help when what we need is to have high melatonin at four in the morning,” explains Dr. García-Borreguero. “We can take either extended-release melatonin before going to sleep or sublingual melatonin, which is rapidly absorbed, when we wake up.” [en mitad de la noche]”.
If there is something that is not recommended, it is turning on lights and screens, such as a cell phone or television, when we cannot sleep in the middle of the night. “If we start watching a video at that time, the light from the screen will impact the photoreceptors that we have in the retina, which have a direct highway that makes the brain believe that it is daytime, when we have only been five hours of sleep,” he clarifies.
* Darío Pescador is editor and director of the Quo magazine and author of the book your best self Posted by Oberon.
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