From the Guidelines
Frequent nighttime waking can be caused by several factors, including poor sleep hygiene, medical conditions, psychological issues, and lifestyle habits, and addressing these underlying causes is crucial to improve sleep continuity and overall quality of life. To improve sleep continuity, establish a consistent sleep schedule, create a comfortable sleep environment (dark, quiet, cool room), and develop a relaxing bedtime routine 1. Medical causes include sleep apnea, restless leg syndrome, chronic pain, acid reflux, and prostate issues causing frequent urination. Psychological factors like anxiety, depression, and stress significantly impact sleep quality 1. Certain medications (including some antidepressants, blood pressure medications, and corticosteroids) can disrupt sleep, as can substances like caffeine, alcohol, and nicotine when consumed close to bedtime 1. For persistent sleep issues, consider keeping a sleep diary to identify patterns and triggers. If nighttime waking continues despite improving sleep habits, consult a healthcare provider who may recommend cognitive behavioral therapy for insomnia (CBT-I), medication adjustments, or treatment for underlying conditions 1. Sleep disruption often results from the brain's arousal systems overriding sleep maintenance mechanisms due to internal or external stimuli, highlighting the importance of addressing both environmental factors and potential medical causes.
Some key factors to consider when addressing nocturnal awakenings include:
- Establishing a consistent sleep schedule and creating a comfortable sleep environment
- Identifying and treating underlying medical conditions, such as sleep apnea or chronic pain
- Addressing psychological factors, such as anxiety or depression, through therapy or counseling
- Avoiding substances that can disrupt sleep, such as caffeine, alcohol, and nicotine
- Considering cognitive behavioral therapy for insomnia (CBT-I) or other non-pharmacological interventions
It is essential to prioritize the treatment of underlying causes of nocturnal awakenings, rather than just managing the symptoms, to improve overall sleep quality and quality of life 1. By addressing the root causes of sleep disruption, individuals can reduce the frequency and severity of nighttime awakenings and improve their overall health and well-being.
From the Research
Causes of Nocturnal Awakenings
The causes of nocturnal awakenings can be categorized into several factors, including:
- Social factors: divorce, separation, or widowhood, low scholastic level, domestic income less than 915 dollars a month, or unemployment 2
- Environmental factors: working constraints, overcharge of external events, deep intrapsychic conflicts, or interpersonal conflicts 2
- Medical and physiologic causes:
- Legs impatience syndrome
- Recurrent limbs shakings syndrome
- Breathe stop during sleep
- Narcolepsy
- Excessive medicine or hypnotic drugs use
- Some central nervous system injuries
- Every nocturnal awakening (related to aches)
- Surgical operation 2
- Chronobiological factors: night working or day-night shift, time lag related to jet-lag flights, significant gaps between the internal biological clock and environmental synchronizators 2
- Toxic factors: amphetamines, antidepressors, medication against anorexia and tubercular disease, caffeine and alcohol excessive use, chronic alcoholism 2
- Behavioral factors: poor night routines, regular intellectual activities close to bedtime, late meal in the evening, noisy or unhealthy environment, physical hyperactivity or sleeping after each lunch 2
- Psychiatric factors: insomnia often appears with psychiatric disorders such as a major depressive episode, an anxiety disorder or schizophrenia 2
- Psychological factors: overstimulation of waking system, conditioning phenomena, fear of not falling asleep, intrapsychic and interpersonal conflicts 2
Sleep-Related Problems in Medical Conditions
Nocturnal awakenings can also be related to sleep-related problems in common medical conditions, such as:
- Lung disease: oxygen desaturations, coughing, or dyspnea 3
- Gastroesophageal reflux: awakenings from heartburn, dyspepsia, acid brash, coughing, or choking 3, 4, 5
- Chronic renal disease: insomnia, insufficient sleep, sleep apnea, or restless legs syndrome 3
- Fibromyalgia and other causes of chronic pain: sleep disruption increases the sensation of pain and decreases quality of life 3
- Infectious diseases: insomnia and hypersomnolence 3
- Menopause: insomnia, sleep-disordered breathing, restless legs syndrome, or fibromyalgia 3
- Cancer or receiving cancer therapy: insomnia or other sleep disturbances that affect quality of life and daytime energy 3
Relationship Between Gastroesophageal Reflux Disease and Sleep
There is a bidirectional relationship between gastroesophageal reflux disease and sleep disturbances, with nocturnal gastroesophageal reflux events resulting in sleep disturbances, including difficulty in falling asleep, sleep fragmentation, and early morning awakenings 4, 5