Chantrey's Sleeping Children, Lichfield Cathedral

Chantrey’s Sleeping Children, Lichfield Cathedral by Cornell University Library, on Flickr

Regular readers will know that I have issues with sleeping, and that I have an interest in reading about sleep and about dreams.  I came across a term that is new to me and probably describes a problem some of you have at night: middle insomnia.

Middle insomnia is not the inability to fall asleep initially, but when you wake up in the middle of the night and can’t get back to sleep.

Most people know that normally we go through cycles throughout the night. We have deeper, slow wave sleep and periods of lighter sleep. You are more likely to be in that lighter sleep later into your sleep an that’s also when you are more likely to wake up fully.

I know that my most “fragmented” sleep occurs after 3am. I have also read that as I get older this is more likely to occur.

At one time, I had middle insomnia really bad. If I went to sleep at midnight and woke up at 3am, that was it for the night. Could not get back to sleep. It happened so often, and I seemed to get through the next day okay, that I was convinced I only needed 3 or 4 hours of sleep. But it did catch up with me if it happened more than 3 nights in a row.

My remedies included going to bed earlier, going to bed later and even taking a nap during the day. None was helpful.

Though I was eventually diagnosed with sleep apnea (which causes you to stop breathing intermittently throughout the night) which disrupts your sleep, apnea sufferers often fall back to sleep quite easily.

Several people suggested to me that it might be from eating too close to bedtime. More reading told me that anxiety and bipolar disorder make you more prone to waking up.

For aging males, an enlarged prostate gets you up during the night to urinate, but many people just use the bathroom and go back to sleep, so something else is going on with middle insomnia.

If the middle insomnia is a short-term condition, I would blame stress. For long-term bouts, it is usually recommended that you reexamine the generally advised good sleep hygiene practices.

Avoid any light sources in your bedroom. Besides dark curtains and no nightlights or light from hallways, I’ve seen recommendations to covering or turning away digital clocks. Electronics (phones, stereos, microwave ovens etc.) give off blue-spectrum light that, though small, disturb sleep. I realized a few years ago that my kitchen at night is lit up by 9 LED light displays at night. Getting up from your sleep cave and going into the bathroom where you turn on a light might trigger a waking-up part of your brain.

Melatonin is a naturally occurring compound found in animals (and plants and microbes) that in animals is a hormone that varies in a daily cycle and creates the circadian rhythms that trigger sleep and other biological functions. You can buy melatonin supplement over-the-counter in the United States, but they are not harmless. Taking some at 3am will not put you back to sleep. More effectively, people have used them to “reset” their inner clock by taking the supplement at the same time each night before going to bed on a regular schedule. In other countries, the sale of this neurohormone is not permitted or requires a prescription, so taking a few tablets because you had a bad night would not be recommended.

Besides light, noise can wake you. Since it’s tough to soundproof your room, many people turn to earplugs (which I find very helpful) or white noise machines. (I have read that those rainforest and ocean wave recordings sound nice when you’re awake – and that’s when you should listen to them!)

Melatonin production is part of the cool down before sleep that includes diminished light for an hour before bed, avoiding exercise, eating and even brain activities like reading or doing those online games. I know plenty of people who swear by reading themselves to sleep and I do often nod off when reading. The problem isn’t falling asleep though, it’s what it does to your brain later in the night.

Like reading, alcohol is one of those things that people will say helps them sleep, even though study after study shows that it is a sleep disruptor. A recent study published in the journal Alcoholism: Clinical & Experimental Research, showed that alcohol seems to increase deep sleep, but reduces the lighter REM sleep when we dream.

Quick list of things to consider:

  • Set up your room as a dark, quiet place.
  • Don’t make the bedroom your reading room or office. Answering email on your iPad for a half hour before sleeping is not a good idea. Reading a paper book or magazine is better than an e-reader.
  • Set a regular time to go to bed.
  • Exercise can help you sleep if it occurs more than 2 hours before getting in bed.
  • Avoid alcohol and caffeine (that includes sodas and chocolate) for 5 hours before sleep. That wine might make you fall asleep but the drop in blood-alcohol levels later might wake you up and keep you up.

Some of these tips and more can be found online at the National Sleep Foundation and the University of Maryland Medical Center.