Waking up at 4 a.m. and can’t fall back asleep

Q:  My problem is awakening too early and then I can’t fall back asleep.  I have no trouble falling asleep at first, but I seem to awaken every morning about 3 or 4 a.m. and then struggle with what to do.  Should I get up and out of bed when this happens?

A:  The pattern you are describing isn’t all that unusual.  Early wake-ups like this have the unfortunate name of “terminal insomnia” and is something many insomniacs experience from time to time.

Your description suggests you may be awakening after your third or fourth sleep cycle, probably right after a REM dream phase when sleep is lightest, and before a new roughly 90 minute sleep cycle would normally begin.

Such early wake-ups may result from our homeostatic sleep drive being reduced significantly after 4 or 5 hours of sleep, while also being in a somewhat hyperaroused state, often from stress and/or anxiety.

What normally compensates for the reduction in sleep drive each night is the circadian rhythm — or to put it more precisely the circadian alerting signal — which reaches a low ebb in the early morning hours and normally enables us to fall back asleep when sleep drive is reduced.  But if we are in a hyperaroused state from excessive levels of stress or anxiety, our circadian alerting signal may be increased, which in turn can make falling back asleep more difficult.

Keeping a consistent sleep-wake schedule, and especially a consistent wake time, tends to strengthen your circadian rhythm and may help counter this. But what may be equally if not more important is to just let the worry go about waking up too early.

Instead be reassured that you will benefit from the sleep you have had, and especially from the most refreshing deep sleep phases that predominate in the earliest sleep cycles.  Be confident you will be able to function reasonably well the next day.

By letting some of the worry go, we tend to be able to fall back asleep more easily.

When early morning awakenings like this happen, you may be better served by just relaxing in a drowsy state in bed, even if not actually sleeping.  However, if you’re definitely not drowsy, wide awake, and especially if you are getting frustrated with your inability to sleep, it may be better to get up and out of bed so as to not inadvertently create a learned negative association with your bed.

If you continue to struggle with this, you might benefit from taking a look at a good sleep training program that you can systematically work.  This will enable you to deal with early morning wake-ups while simultaneously countering excessive stress and anxiety.

By taking a multi-pronged sleep training strategy, be confident you can at least sleep better, if not restore a normal sleep pattern.

Explore posts in the same categories: Health, Insomnia, sleep

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2 Comments on “Waking up at 4 a.m. and can’t fall back asleep”

  1. […] concern about circadian rhythm is well placed.  Circadian rhythm, along with sleep drive, are the two internal components that largely control sleep.  It’s […]

  2. Marcus M Says:

    Hey another amazing post:) loads of beneficial information given in this post keep them coming as I’m really enjoying them! thanks for sharing!

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