What can you do when you stay awake in bed for a long time? Is it better to get up? Start reading?
Diane
— elDiario.es reader
You turn over in bed. You open your eyes and look at the clock. It’s 3:30 in the morning. You try to go back to sleep, but your thoughts keep spinning and you don’t feel comfortable in any position. When you start to feel sleepy again, there’s only half an hour before the alarm goes off.
Waking up in the middle of the night and not being able to get back to sleep is a common experience that can harm our quality of life and our health. This phenomenon, called maintenance insomnia, differs from initial insomnia (difficulty falling asleep) and can appear as the consequence of various physical, psychological and environmental factors.
Why do we wake up in the middle of the night?
From an evolutionary perspective, nighttime awakenings may make sense. In prehistoric times, polyphasic sleep (divided into several phases) was common, because it allowed humans to alternate between periods of sleep and wakefulness to protect themselves from predators and other dangers. However, in modern society, instead of sleeping between dusk and dawn, we concentrate all of our sleep into eight hours, but our brains don’t always get there.
The causes of maintenance insomnia can be varied, but the most common is the incidence of stress and anxiety. When the mind is overloaded with worries, the body produces more cortisol, the stress hormone that activates the nervous system and makes it difficult to relax. During the night, cortisol levels should decrease, but in highly stressed people this doesn’t always happen, which can lead to waking up earlier than expected.
The depth of sleep in the second half of the night is usually slightly lower than in the first half. Around 3:30 p.m., the brain tends to become somewhat active
Diego Garcia-Borreguero
— sleep neurologist
“The depth of sleep in the second half of the night is usually a little lower than in the first half,” Dr. Diego García-Borreguero, neurologist and medical director of the Sleep Institute, explains to elDiario.es. “Around 3:30 a.m., the brain tends to become somewhat active. In situations where, due to stress, there has already been greater daytime activity, this can cause less deep sleep, or a greater number of awakenings, or directly an early awakening,” he specifies.
The second most important cause is clinical depression, which causes early awakening among its symptoms. Then, disruptions to circadian rhythms can also cause waking up in the middle of the night, which is called advanced sleep phase syndrome. “There are people who start their sleep cycle very early, and by eight or nine o’clock they feel more sleepy, but due to social obligations they go to bed later. They have a very short sleep latency, they lie down and fall asleep very quickly,” explains Dr. García-Borreguero. “But at four or five in the morning, they wake up as if they have already had enough sleep, even if it has only been five hours.”
These people might sleep longer if they went to bed when they start to feel sleepy, but their schedule may prevent this. The result is a sleep deficit. In addition, there are other less common factors that can influence, such as sleep apnea, certain medications or hormonal changes during menopause, which influence the regulation of body temperature and mood, thus contributing to awakenings. nocturnal.
Of course, poor sleep habits, such as consuming caffeine or alcohol before bed, can have a negative impact. Although alcohol can make it easier to fall asleep, it interferes with deeper phases of sleep, such as the REM phase, and can cause waking up during the night. Additionally, using electronic devices before bed, such as cell phones and tablets, exposes the retina to blue light, thereby inhibiting the production of melatonin, the hormone responsible for regulating the sleep cycle. .
What happens in the brain when we wake up in the middle of the night
The human brain follows an internal circadian rhythm that regulates sleep and wake cycles, influenced primarily by light and darkness. When we wake up in the middle of the night, the brain can become confused, especially if the lights come on or we start thinking about the worries of the day. Maintenance insomnia is linked to hyperactivation of the hypothalamic-pituitary-adrenal (HPA) axis, which regulates the stress response. At these times, the brain can interpret that it is time to wake up and start releasing hormones like cortisol and adrenaline, which keep us alert.
It is precisely our diet that can influence the activation of this system in the middle of the night. If we eat a big dinner, with lots of sugar and carbohydrates just before bed, there is a drop in blood sugar called reactive hypoglycemia in the middle of the night, which can wake us up.
There are people who start their sleep cycle very early and at eight or nine o’clock they feel more sleepy, but due to social obligations they go to bed later. They go to bed and fall asleep very quickly, but at four or five in the morning they wake up.
Diego Garcia-Borreguero
— sleep neurologist
“If the last dose took place shortly before bedtime, hypoglycemia occurs a few hours later. Hypoglycemia causes an increase in the activity of the sympathetic nervous system, which produces a state of alert,” explains Dr. García-Borreguero.
What to do when we wake up and can’t go back to sleep
One of the most important strategies for dealing with nighttime waking is to not become obsessed with the idea that we must sleep at all costs. Anxiety about going back to sleep can make the problem worse. The next thing is to get out of bed. “When I can’t sleep, get up, do something different. And when I’m sleepy, if I’m sleepy, go back to bed,” recommends Dr. García-Borreguero, but in the medium term he also suggests a seemingly contradictory strategy: spending less time in bed.
“This involves setting the alarm an hour earlier, for example. So we give the brain a little less time to stay asleep. This will lead to a compensatory mechanism in the following days. The sleep deficit that occurs will be compensated by deeper and more continuous sleep,” explains the neurologist, who warns that this procedure, common in the treatment of insomnia, may require three to five days to show results.
When these approaches don’t work, Dr. García-Borreguero stresses the importance of seeing a healthcare professional to find out why. “If the cause is hypoglycemia, it is recommended to have a small sugary snack when you wake up. If the problem is depression, antidepressant treatment is necessary. If the problem is advanced sleep phase syndrome, treatment will be adaptation by restricting sleep for a few days.
And could melatonin, sold and consumed as a supplement to help you fall asleep, be useful? “The melatonin that we buy in pharmacies generally has a short-lasting effect, around 60 minutes. But that doesn’t help when we need to have high melatonin levels at four in the morning,” says Dr. García-Borreguero. “We can take either time-release melatonin before bed or sublingual melatonin, which is quickly absorbed, upon waking.” [en mitad de la noche]”.
If there is something that is not recommended, it is turning on lights and screens, such as a cell phone or television, when we cannot sleep in the middle of the night. “If we start watching a video at that time, the light from the screen will impact the photoreceptors that we have in the retina, which have a direct route that tricks the brain into thinking it’s daytime, so that we only slept for five hours,” he explains.
