You’re in bed by 10pm, reading instead of scrolling on your phone, and your eyes are already beginning to droop. Before you know it, you’re sound asleep… until 3am. From then on, you’re tossing and turning, trying to block out your partner’s snoring and attempting to halt the washing machine of thoughts that are keeping you awake.

It doesn’t matter how good your evening routine is; many people find themselves waking up in the middle of the night more often than they’d like. Does that mean we’re not getting a good night’s sleep or that we’re never well rested? We asked four doctors for their expert opinion on nocturnal awakenings – and how to prevent them.

In some situations, yes – it’s perfectly normal to occasionally wake up in the middle of the night.

Dr Aditi Desai, president of the British Society of Dental Sleep Medicine, says that waking in the night is not always a sign of poor sleep quality and can be considered normal under certain circumstances. “Nocturnal awakenings three or four times a night is normal for most people when they can fall back asleep straight away,” says Dr Desai.

Dr Deborah Lee, a GP with Dr Fox Pharmacy, explains that we go through up to eight sleep cycles per night, each one lasting 80–100 minutes, and it’s perfectly normal to rouse between these stages of sleep. “The lightest stage of natural sleep is stage one NREM sleep, which lasts between one and five minutes, and from which you’re easily rousable,” says Dr Lee. “When you are in deeper sleep, such as stage three NREM and REM sleep, you’re less likely to be woken up by things like loud noise, your partner moving in the bed or changes in light or temperature. Experts believe we probably do wake several times in the night but go back to sleep quickly and don’t remember it in the morning.”

However, if you find yourself waking up in the night and struggling to fall back asleep, Dr Lee says it shouldn’t take longer than 20 minutes to get back to sleep – then there could be a bigger issue at play.

There are multiple reasons you could be waking up in the middle of the night, from restless leg syndrome and gastroesophageal reflux disease to sleep disorders like sleepwalking and night terrors.

Anxiety, depression and stress are common causes of a poor night’s sleep, while hormonal fluctuations and changes can result in disturbed sleep. Dr Kat Lederle, a sleep and circadian rhythm specialist at The London General Practice, says that waking up in the middle of the night is one of the symptoms of this period, and according to research, up to 60% of menopausal women suffer from poor sleep.

Many medications, such as antidepressants, decongestants, beta-blockers, diuretics and steroids, can also interfere with sleep, while use of substances like caffeine, nicotine and alcohol during the day can also cause us to wake more frequently throughout the night.

However, the most common cause of waking in the night is insomnia. Many of us think of insomnia as the complete inability to sleep, but it’s actually a much more nuanced condition.

“Insomnia isn’t simply ‘not sleeping’,” says Dr Lederle. “It can also mean that you struggle to fall asleep or to stay asleep; it can mean you wake up too early, leaving you feeling unrefreshed and poorly rested. How long you experience sleep problems for can also vary. Acute or short-term insomnia lasts for a few nights or a couple of weeks. Chronic or long-term insomnia means struggling with sleep on three nights or more per week for at least three months, and it impacts your daytime functioning.”

One of the biggest causes of insomnia is stress. “Generally, cortisol levels are at their lowest around midnight,” says Dr Lee. “They start to rise two to three hours after going to sleep and continue to rise with the highest levels around 9am. Rising cortisol levels are part of the natural awakening response. However, in chronic stress, cortisol levels are dysregulated, and for those with anxiety or disorders such as PTSD, cortisol levels may already be elevated. Stress switches on the sympathetic nervous system, preparing the body for ‘fight or flight’ mode, which causes you to wake up.”

If you find yourself waking up once or twice in the night and falling back asleep promptly, it’s unlikely to have much impact on your waking life or overall health.

However, if you find that you’re staying awake for long periods of time during the night, whether that’s at the beginning of the night, during or early in the morning, it could lead to or worsen certain health issues.

“Lack of sleep is associated with an increase in many physical health conditions: diabetes, higher blood pressure, weight gain, development of cardiovascular disease and certain types of cancer too,” says Dr Lederle. “It can also affect our looks and skin. Because it affects our ability to think through problems and our decision-making and risk assessment, we’re also more prone to accidents when we’re sleep deprived.”

But it doesn’t stop there. Dr Lederle says poor sleep also affects how we feel and how motivated we are to socialise. “Therefore, there might be a connection between poor sleep and loneliness or social withdrawal. When we lack sleep, we become irritable, angry, anxious and experience low moods.”

Whatever the reason for waking, whether it’s anxiety, snoring or insomnia, if you find yourself consistently waking up multiple times in the night and struggling to get back to sleep quickly for several weeks, you should consider seeing a GP or sleep specialist.

Dr Lizzie Hill, a senior lecturer in sleep physiology at UWE Bristol, says if you experience persistent sleep problems that interfere with your daily life or you’ve been told you snore or stop breathing while you’re asleep, it’s a good idea to consult your GP or community pharmacist in the first instance. “They can help identify any underlying issues, recommend appropriate treatments or interventions and refer you to a sleep specialist for further investigation if required,” she says.

There are several things you can do to help prevent yourself from waking during the night.

Dr Hill suggests paying attention to your body’s signals and prioritising good sleep habits. “If you’re unsure about your sleep patterns, keeping a sleep diary can be a helpful tool to understand your sleep timing better and identify any potential triggers for your sleep disruption,” she says. “To improve sleep quality, establish a consistent sleep schedule, create a relaxing bedtime routine and ensure your sleep environment is comfortable and free from distractions. Limiting caffeine and screen time before bed can also help. If you wake up during the night, try relaxation techniques such as progressive muscle relaxation, breathing exercises or visualisation to help you fall back asleep. If all else fails, get out of bed until you feel sleepy again.”

Dr Lee says to consider the conditions of your bedroom: is it too hot? Too light? Too noisy? Is your phone bleeping all night with notifications?

Ultimately, it’s important to remember that everyone’s sleep needs are different. What works for one person might not work for another. Dr Hill also recommends watching out for fitness trackers that might suggest you’re awake more frequently throughout the night than you really are: “Listen to your body – not just your wearables.”

Images: Getty