For months I've been waking up at 3am, unable to fall back asleep — two doctors have finally explained why and how to stop it

Picture the scene: you climb into bed and drift off with ease… only to be wide awake again around 3am. This has been my reality for the last few months.

I’m often then left wide awake in the middle of the night, heart racing and unable to fall back to sleep. I had to find out why this was happening, so I tracked down two sought-after sleep experts to give me some answers...

“Although frustrating, waking up around 3-4am and being unable to fall back asleep is a common problem and may be more frequent in women,” explains behavioral sleep specialist Dr Carleara Weiss, PhD, MS, RN, a Sleep Science Advisor at Aeroflow Sleep.

Here, Dr Weiss, along with Dr. William Lu, MD, a sleep medicine physician and Medical Director at digital sleep clinic Dreem Health, each explain the potential reasons behind these 3am wake ups, plus their advice on how to fall asleep quickly again.

Why do I keep waking up at 3am?

As annoying as it is, I know that I’m certainly not alone in waking up at 3am or 4am most days. Being unable to stay asleep all night is a common problem, and there are many different reasons behind it.

“Arousals during sleep can be attributed to various causes,” explains Dr Lu. “These range from underlying issues like hormonal changes due to aging or menopause, or specific sleep disorders such as insomnia or sleep apnea.

"Additionally, environmental factors and lifestyle choices play a significant role,” continues Dr Lu.

“Simple elements like light exposure, noise levels, room temperature, consumption of caffeine or alcohol in the evening, and inconsistent bedtimes can all contribute to those frequent 3-4 am awakenings.”

Let’s take a closer look at some of the most common reasons behind those 3am wake ups...

Insomnia and other underlying sleep issues

Underlying sleep issues can cause you to wake up at 3am. These include insomnia, a disorder characterized by problems falling and staying asleep, as well as waking up at night.

There’s also sleep apnea, characterized by interrupted breathing at night, and nocturia, the repeated need to urinate at night. Parasomnias, such as sleep walking or sleep talking, could also be to blame for your nighttime waking.

If you suspect that you could have an underlying sleep issue, speak to your doctor to get professional advice and to discuss treatment.

External factors

Don’t underestimate how much of an impact noisy neighbors, snoring partners or a blinking light from a charging device can have on your ability to stay asleep all night too.

Brushing up on your sleep hygiene, which means that your bedroom is optimally set up for sleep, is step one. That means ensuring all ambient light is blocked out, that your bedroom is the right temperature for sleeping, and it's quiet too.

Your mattress can also cause you to wake up through the night, so it's worth investing in the best mattress for your body.

Lifestyle choices

Inconsistent bedtimes, late night sugary snacks, caffeine and alcohol consumption can each interfere with an optimal sleep cycle, and ultimately your ability to stay asleep all night.

You might not think that your nightcap, afternoon cappuccino or heavy meal before bed affects your sleep (you have no trouble falling asleep, after all).

However, if you’re partial to the above habits and wonder why you can’t sleep through the night, it’s worth reconsidering your choices.

Hormonal fluctuations

Both the menopause and perimenopause, which is the stage leading up to menopause, cause fluctuations in hormone levels, which can impact both sleep quality and quantity for women aged 35 and over.

Most notably, a drop in estrogen can make it difficult for women to regulate their temperature at night, which can lead to night sweats and hot flushes. (Investing in one of the best cooling mattresses can help with this.)

A drop in progesterone further disrupts the ability to both fall and stay asleep, while elevated nighttime levels of cortisol can add to difficulties staying asleep and fuelling feelings of anxiety.

Stress and anxiety

Stress and anxiety cause cortisol levels, the hormone responsible for making us feel alert during the day, to rise. Unsurprisingly, being in a heightened state of arousal makes it difficult to fall asleep and stay asleep.

“Waking up with a racing mind, heightened alertness, or worry often signals sleep disturbances related to stress and anxiety,” explains Dr Lu.

Ding ding ding, we have a winner. Waking with a racing heart and a head full of whirring thoughts feels all-too familiar to me.

If that resonates with you too, Dr Lu and Dr Weiss share their tips to falling back to sleep when elevated stress levels have woken you up further down the page.

The culprits behind my 3am wake-ups

For me, my racing heart and quickened breathing indicates that my 3am wakes are caused by stress and anxiety.

As a woman in the 40+ age category, the underlying cause of this could be due to an increase in cortisol, the hormone responsible for our fight or flight response.

During perimenopause, which is the reproductive life stage I'm likely in, rising cortisol levels are exacerbated by a drop in key hormones that are pivotal to sleep quality. These are estrogen and progesterone.

Regardless of the root cause of my underlying anxiety, the result is the same — I’m left wide awake in the middle of the night.

This, explains Dr Weiss, is due to a Cortisol Awakening Response (CAR). “CAR is a natural surge of the hormone cortisol that happens within the first 30-45 minutes after waking,” she explains, noting that cortisol functions as an alarm clock, preparing our bodies for the day by boosting alertness, energy, and focus.

“Although the peak in CAR occurs between 30-45 minutes after awakening, cortisol production begins to increase around 3am to 4am.

"Therefore, people suffering from sleep disorders, such as insomnia or OSA, or mental health issues such as anxiety and depression, may have a heightened cortisol level or be sensitive to its rise, which may cause an early morning awakening,” she explains.

How to tell what's waking you up in the middle of the night

Underlying sleep disorder or stress and anxiety — how can you tell what's keeping you awake at night? "This is a critical question, because daytime symptoms may be similar," explains Dr Weiss, who recommends exploring the symptoms you're experiencing in addition to your 3am wake ups.

"For instance, daytime symptoms such as fatigue, brain fog, irritability, and lack of attention or concentration may be common for a person experiencing nighttime awakenings due to obstructive sleep apnea (OSA) or stress and anxiety," continues the sleep apnea expert.

However, those with OSA will experience different nighttime symptoms to someone with anxiety, such as loud snoring, a dry mouth and coughing.

"They may also have a sore throat and a dry mouth, and sometimes halitosis upon awakening, which does not apply to those experiencing stress and anxiety," explains Dr Weiss.

In addition to staying in tune with your symptoms, Dr Lu recommend thinking about thinking about what is happening in your day to day life. "A recent history of stress in your daily life can further suggest that your nighttime awakenings are stress-related," he explains.

How to fall back asleep when you're awake at 3am

If elevated stress levels are the cause of your nighttime awakenings, both Dr Weiss and Dr Lu agree that the key to falling back to sleep is to regulate your sympathetic nervous system.

"This can be done by keeping lights low and not checking the time, and by slowing your breathing," advises Dr Lu. "If you have a racing mind, counting breaths or silently naming objects can help as well."

What's more, Dr Lu notes that it's important to attempt to lower levels of stress during the day, as well as keeping consistent bedtimes, earlier caffeine cutoffs, and regular movement, which can all lower elevated cortisol levels.

Wide awake at 3am? Here's some of our tried and tested methods to falling back to sleep:

1. Try the 4-7-8 breathing method

The 4-7-8 breathing method was popularized by Dr. Andrew Weil, whose team call it a "perfect, portable stress antidote." To practice the breathing method, you inhale for 4 second, hold the breath for 7 seconds and exhale for 8 seconds.

You can repeat this cycle a further 3-4 more times, noting how your nervous system begins to feel regulated and feeling of anxiety dissipate.

2. Follow the 15 minute rule

Our sleep writer Ruth Jones swears by the 15 minute sleep rule when she's struggling to fall asleep. If after 15 minutes she hasn't fallen asleep, she gets up and does a low-stimulation activity, such as reading or stretching.

This is advice that I've taken on board when I wake up in the middle of the night. If, after a few minutes of doing something relaxing in a different room, I return back to bed once the feeling of anxiety has worn off. Usually, this is enough to help me fall back to sleep.

3. Try cognitive shuffling

Another tried and tested technique to falling back to sleep when you're wide awake at night is the cognitive shuffling method. The sleep technique, developed by Canadian scientist, Dr. Luc P. Beaudoin, involves visualizing seemingly random objects and thoughts.

'Shuffling' your stream of consciousness effectively switches off racing thoughts, which helps to break the cycle of rumination. If you need a steer on where to start, think only of objects beginning with one specific letter.

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