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I have no trouble falling asleep. Most nights, my head hits the pillow, and that\u2019s all I remember.<\/p>\n
But several times a week, I find myself wide awake at 2.00am \u2013 stressing about a work deadline, wondering if my daughter is adjusting to her new school or making a note on my phone to get the car washed. Usually, I get back to sleep in an hour, but when my 8am alarm goes off, I feel groggy, wishing I\u2019d had that extra shut-eye.<\/p>\n
This inability to stay asleep is called maintenance insomnia, says Dr Julia Kogan, a health psychologist and insomnia specialist based in Chicago. While it\u2019s common to wake at night, some people have trouble getting back into slumber. Anxious thoughts are a common cause. \u201cPeople wake and cannot shut their mind off, which interferes with their ability to fall back asleep,\u201d says Kogan.<\/p>\n
The sleep disorder can impair a person\u2019s daily function, but there is treatment. Here\u2019s what you need to know about maintenance insomnia.<\/p>\n
While many people think of insomnia as trouble falling asleep, there are different forms, says Dr Jamie Zeitzer, professor of psychiatry and behavioral sciences at Stanford University. Some people have difficulties falling asleep (sleep onset insomnia), some wake too early in the morning (early waking insomnia) and some find themselves up in the middle of the night (maintenance insomnia, named for the inability to \u201cmaintain\u201d continuous sleep).<\/p>\n
Many people suffer from a combination of these, and Zeitzer says maintenance insomnia, on its own or experienced with other forms of insomnia, is fairly common. Nearly 20% of those with insomnia symptoms in one 2014 study experienced extended middle-of-the-night wakings.<\/p>\n
It\u2019s normal to wake up at night, says Zeitzer. For instance, you might need to go to the bathroom or simply wake at the end of a sleep cycle, when sleep is the lightest. He says most people don\u2019t remember their brief wakings and aren\u2019t impaired by them the next day. But others aren\u2019t so lucky.<\/p>\n
\u201cIt\u2019s not necessarily what wakes people up, but what happens after with their mind that keeps them up,\u201d Kogan says. Some people wake up at night and their mind starts racing, keeping them awake. They may even worry about losing sleep and that stress also keeps them awake, creating a frustrating cycle of wakefulness.<\/p>\n
Maintenance insomnia can look different from person to person, Kogan adds. One might experience one or two long windows of wakefulness a night, while another wakes up and falls back asleep many times.<\/p>\n
Maintenance insomnia can cause a number of mental and physical health issues, including impaired daytime performance, anxiety, headaches and body aches, says Dr Olabimpe Fashanu, a sleep physician based in Maryland. Sleep loss can also increase the risk of other conditions, including obesity, diabetes and cardiovascular disease.<\/p>\n
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There isn\u2019t always a single underlying cause, but several factors can contribute to the inability to stay asleep, says Kogan.<\/p>\n
Stress and anxiety:<\/strong> The most common reason for maintenance insomnia is high stress and anxiety, says Kogan. When some people wake, they start thinking \u2013 perhaps about their to-do list, daily stressors or the stress of not being able to get good sleep.<\/p>\n \u201cNightmares related to anxiety, PTSD or other mental health conditions can also make it hard to return to sleep,\u201d Kogan says.<\/p>\n Lack of sleep drive:<\/strong> A lack of sleep drive, or not being sufficiently tired, can also keep people up at night, Kogan says. Common causes for low sleep drive include taking naps during the day and staying in bed longer than necessary. \u201cPeople with maintenance insomnia think that spending more time in bed will help them get more sleep, but it usually leads to less sleep overall,\u201d says Kogan.<\/p>\n Physical pain and discomfort:<\/strong> Pain is often associated with insomnia. It can wake a person up and make it difficult to fall back asleep, Zeitzer says. Painful, chronic conditions can spark long-term sleep issues, but even temporary issues like a backache or sunburn can cause problems.<\/p>\n Other uncomfortable and anxiety-inducing medical disorders are associated with sleeping issues, says Kogan. These include neurological disorders (like migraines and inflammatory diseases), cardiovascular disease and breathing disorders. Medications associated with many of these conditions can themselves cause nighttime awakenings, says Kogan.<\/p>\n Age and gender:<\/strong> Older adults tend to wake more often because they\u2019re more prone to neuropathy, urinary problems and acid reflux, according to Zeitzer. \u201cEven in the absence of these stimuli, older adults generally experience lighter sleep, which can mean more wakings,\u201d he says.<\/p>\n skip past newsletter promotion<\/p>\n Practical advice, expert insights and answers to your questions about how to live a good life<\/p>\n Privacy Notice: <\/strong>Newsletters may contain information about charities, online ads, and content funded by outside parties. If you do not have an account, we will create a guest account for you on theguardian.com to send you this newsletter. You can complete full registration at any time. For more information about how we use your data see our Privacy Policy. We use Google reCaptcha to protect our website and the Google Privacy Policy and Terms of Service apply.<\/span><\/p>\n after newsletter promotion<\/p>\n Women, especially those approaching menopause, are also more prone to maintenance insomnia due to hormonal changes, according to a 2015 study.<\/p>\n People with maintenance insomnia think that spending more time in bed will help them get more sleep, but it usually leads to less sleep overallDr Julia Kogan<\/p>\n Imperfect sleeping environments: <\/strong>Noise, light, heat, cold, an uncomfortable bed, a snoring partner and other environmental stimuli can contribute to maintenance insomnia, says Fashanu.<\/p>\n Individual responses to disturbances vary from person to person. For example, some might wake up to the soft sound of footsteps down the hall, while others can sleep even with the TV blaring. \u201cSome people do better with sleep disruption in general,\u201d Fashanu says.<\/p>\n Treatment for maintenance insomnia typically depends on the underlying cause, says Fashanu. If physical pain or environmental factors are causing frequent wakings, remedying those factors is often enough. Therapy or psychiatric medications can stop sleep disruptions caused by anxiety.<\/p>\n If these factors are ruled out, other treatments are available.<\/p>\n CBT-I: <\/strong>Cognitive behavioral therapy for insomnia (CBT-I) is a form of therapy that \u201cessentially teaches you not to care about your insomnia, which enables you to go back to sleep much faster\u201d, says Zeitzer. It is considered the go-to treatment for maintenance insomnia. It typically takes six to eight sessions to rewire how a person thinks about sleep and create new sleep behavior.<\/p>\n Medication:<\/strong> Sleeping pills like Ambien or Lunesta can help for short-term use, but Kogan doesn\u2019t recommend sleep medication before other options have been explored. \u201cInsomnia is often related to cognitive and behavioral factors, so sleep meds are often a band-aid if those factors are not addressed,\u201d she says, adding that regular and longterm use of over-the-counter medications is not recommended.<\/p>\n Experts don\u2019t recommend melatonin for this form of insomnia, either. \u201cMelatonin is naturally produced by the body and often supports falling asleep. Most people don\u2019t have a melatonin deficiency and therefore it\u2019s not particularly helpful, especially for maintenance insomnia,\u201d says Kogan.<\/p>\n A restful bedtime routine:<\/strong> A relaxing bedtime routine can help prevent long wake windows, says Kogan: \u201cIt\u2019s helpful to have a 30-60 min buffer zone before bed where the person is shutting down devices and engaging in deep relaxation activity, such as deep breathing, progressive muscle relaxation and other relaxing activities.\u201d<\/p>\n She also says it can be helpful to spend some time earlier in the day \u2013 not right before bed \u2013 writing out any to-do items, worries or concerns, to clear one\u2019s mind before getting to sleep.<\/p>\n When it comes to treating insomnia in general, Fashanu advises seeking treatment sooner rather than later. She says that, over time, people with maintenance insomnia develop maladaptive habits, such as prolonged time in bed and clock watching, making sleep quality even worse. \u201cChronic insomnia is harder to treat the longer it\u2019s been going on,\u201d she adds.<\/p>\n","protected":false},"excerpt":{"rendered":" I have no trouble falling asleep. Most nights, my head hits the pillow, and that\u2019s all I remember. But several times a week, I find myself wide awake at 2.00am \u2013 stressing about a work deadline, wondering if my daughter is adjusting to her new school or making a note on my phone to get<\/p>\n","protected":false},"author":1,"featured_media":25205,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[51],"tags":[15241,4025,4820],"class_list":{"0":"post-25204","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health","8":"tag-2am","9":"tag-sleep","10":"tag-waking"},"_links":{"self":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts\/25204","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=25204"}],"version-history":[{"count":0,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts\/25204\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/media\/25205"}],"wp:attachment":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=25204"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=25204"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=25204"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}How do you treat maintenance insomnia?<\/strong><\/h2>\n