8 Common Sleep Problems—and How to Fix Them, According to Sleep Experts
Waking Up With Anxiety in the Middle of the Night
The Problem: Likely a specific emotional stressor (like a breakup) that affects your sleep long after you feel like you’ve healed emotionally. This type of insomnia comes later in the night. You might be able to get to sleep at a normal time, but you end up waking up feeling sad or anxious in the middle of the night, and tossing and turning until it’s time to get up. Sleep comes in fits and starts, rarely offering any deep, restful sleep.
“This type of insomnia usually has a clear precipitant," says sleep-medicine specialist David Neubauer, MD, a sleep-medicine specialist and an associate director of the Johns Hopkins Sleep Disorders Center, in Baltimore. Neubauer calls this situation "conditioned arousal," which, he says, is common. "Sleep problems like this may have been initially caused by an external trigger, but over time they become self-propagating. Eventually the individual is conditioned to become anxious about their sleep."
How to Fix It:
Cognitive behavioral therapy (CBT) is often used in cases like this. "CBT aims to stop the behaviors that are perpetuating the insomnia," says Susie Esther, MD, a specialist in sleep-disorder medicine at Charlotte Eye, Ear, Nose, and Throat Associates, in Charlotte, North Carolina, and the president of the American Academy of Sleep Medicine. Typically, a therapist will work with a patient for four to eight weeks―in sessions that last from 30 minutes to two hours―to assess, diagnose, and treat the underlying problem, such as relationship worries. The therapist will teach the patient things like progressive-relaxation techniques and point out actions that are getting in the way of deep sleep, such as rehashing conversations that occurred earlier in the day. (To find a therapist, go to the website of the National Association of Cognitive Behavioral Therapists, at nacbt.org.)
Acupuncture. "Acupuncture may help reduce anxiety and induce deeper sleep," says Rubin Naiman, PhD, the director of NewMoon Sleep, LLC.
Avoiding wine. "There is a notion that alcohol will help you sleep," Dr. Neubauer says. "And while it often does help you fall asleep quicker, your sleep will be more disrupted."
Accepting some awakenings. The experts stress that nighttime awakenings are perfectly normal―much more normal, in fact, than the elusive solid eight hours people think they should be getting. Most people will roll over and go back to sleep, but those with insomnia become conditioned to feel anxious when they awake during the night. "You need to accept that you will wake up some, so reassure yourself in the middle of the night that nothing catastrophic will happen if you are awake for a while," Dr. Esther says. To that end, she suggests keeping the glaring electric clock off the bedside table. "Clock watching will only increase your anxiety about being awake."
You Fall Asleep So Early That You Wake Up Early—and Can't Fall Back to Sleep
The Problem: Your job, schedule, and/or family leave you understandably exhausted by the end of the day. So much so that you fall sound asleep as early as 7 p.m., but never for the whole night. You might wake up around 2 a.m.―by a child crying, a spouse snoring, or a need to use the bathroom―and never manage to fall back to sleep. You lie awake until 5 a.m. or so—when you feel like it’s a normal hour to get up and go.
How to Fix It: “You’re spending too much time in bed,” says Dr. Susie Esther. Instead, establish a standard waking time and stick to it seven days a week, then work backwards to figure out what your bedtime should be. So, if you want to get up at 5 a.m., plan to be asleep by about 10 p.m.―not 7 p.m.
“Gradually adjust your bedtime so you’re able to stay awake later—that will help your body adapt to the new schedule,” says Esther. To quell middle-of-the-night worrying, Dr. Esther suggests, instead of lying in bed, get up and do something relaxing, like having a cup of decaffeinated herbal tea. “Staying in bed and trying to sleep will just wake you up more,” says Dr. Esther. “Sleep isn’t something you can ‘try’ to do."
You Suffer From Chronic Insomnia
The Problem: Can't remember a time when you didn't have trouble sleeping? You take longer than an hour to fall asleep, wake several times throughout the night, and stay awake for anywhere from a few minutes to an hour each time. Sleep medications help to some degree, but leave you feeling drowsy the next day. You’ve tried every trick in the book: yoga, doing vigorous exercise earlier in the day, avoiding caffeine, and reading or writing in a journal before bed. No luck.
How to Fix It:
Pay even more attention to your evening routine and sleep environment. "Good sleep habits don't necessarily solve sleep problems, but they do create a foundation for improved sleep," says Dr. Neubauer. Good habits include things such as keeping the bedroom cool and dark, using a fan or a white-noise machine to create a blanket of sound, and using the bed exclusively as a place for sleeping―and not for watching TV or working, for example.
Make an appointment at a sleep clinic. This is a smart step for people with a long history of sleep issues. Most often this involves office visits (which will not necessarily be overnight observations), during which the patient will undergo a physical examination and work with a doctor to assess and diagnose the cause of the sleep problems. (For more information or to locate a sleep specialist near you, go to the website of the American Academy of Sleep Medicine, at aasmnet.org.)
Hormonal Changes Are Wreaking Havoc on Your Sleep
The Problem: You’ve never had trouble sleeping―until menopause hit. Now, no matter what time you go to bed, you have problems falling and staying asleep. Tossing and turning is the new norm. Taking over-the-counter or prescription medications helps, but leave you feeling sluggish in the morning—not refreshed. You’re worried about the risks of hormone-replacement therapy to treat menopause symptoms (like hot flashes).
How to Fix It: There is some evidence that hormonal changes can have an effect on sleep. If hot flashes are a big issue, Dr. Neubauer points to studies that have shown that sleeping in a cooler-than-normal room can help prevent them.
Use caution regarding over-the-counter sleep medications. They contain some type of antihistamine, which can stay in the body for a long time. “It takes about 18 hours for your body to clear out 50 percent of the active drug. For most of your waking hours, it will still be in your system, making you drowsy,” says Naiman.
Consider taking 0.3 milligram of an over-the-counter melatonin supplement about 20 minutes before bedtime since the production of melatonin (a naturally produced hormone that helps regulate circadian rhythms) drops off as we age.
Go for a checkup. “Around the time a woman reaches menopause, other risk factors may emerge, such as sleep apnea,” Dr. Neubauer says.
You're a Night Owl, but It Leaves You Totally Groggy During the Day
The Problem: You've always been nocturnal, but the situation has gotten worse over the years. You're now so alert late at night and stay up until well past midnight watching TV, reading, deleting emails, and organizing things around your home or for your family. But your super-early wakeup time leaves you feeling incredibly drowsy, irritated, and exhausted during the day. But no matter what you do, you're wide awake when you should be hitting the sheets the next night.
How to Fix It: Start slowing down and readying yourself for an earlier bedtime, and Naiman also suggests blocking blue light. “The blue end of the light spectrum―emitted by ordinary lightbulbs, televisions, smart phones, and computer screens―suppresses melatonin,” Naiman says. Consider buying special lightbulbs as well as blue-light blocking glasses for watching TV and looking at screens (if you insist on checking your email or reading on your phone) and reducing the amount of light in general. “Being exposed to too much light at night is the environmental equivalent of caffeine,” says Naiman. So at least two hours before bed, dim the lights. Find time earlier in the day for catching up on email and organizing.
You're Always Too Wound Up to Fall Asleep
The Problem: You often stay up until midnight or later, reading or catching up on work. When you realize how late it is, you jump into bed—but you're still too stimulated to fall asleep for at least another hour. Maybe the tendency is now exacerbated by an erratic schedule, and any sleep you do end up catching isn't very restorative, since you're usually just dreaming about work you've just been doing.
How to Fix It: “We can’t always design a sleep schedule that fits with our work schedule, and that can especially be a problem for someone with genetic night-owl tendencies,” says physician and sleep researcher Gary Richardson. He suggests careful napping to help balance out your sleep schedule, especially on days when you have an early wakeup call. Try lying down and relaxing and getting up after one hour, regardless of whether or not you actually dozes.
“Napping can interfere with nighttime rest if you sleep too much,” he cautions. And rather than racing to bed when you realize how late it is, set a regular bedtime and develop a relaxing evening ritual, which, ideally, should begin at least half an hour before getting into bed. This could include things like a warm bath and some reading, with the lights as low as possible.
You Actively Stay Up Late Because It's the Only 'You' Time You Can Get
The Problem: You stay up until midnight or later to have some precious downtime or finish what you weren't able to during the day, even at the expense of getting a good night’s sleep. You might also sleep very lightly and off and on, since you might still be stimulated from what you'd been doing during that downtime.
How to Fix It: Take 30 minutes or so earlier in the day to do the things that are keeping you up (like checking email and writing lists). And remember that getting enough sleep is one of the best ways to treat yourself after a long day.
Practice "letting go," says Naiman. Work on managing stress by exercising more and, if possible, delegating your work and chores so you don't feel like you have so little time to complete everything. “We’re such an active, ‘doing’ culture, and then we get into bed and try to ‘do’ sleep,” Naiman says. “You can’t just ‘go’ to sleep, but you can learn to let go of waking.”
Waking Up—and Not Hitting the Snooze Button—Seems Nearly Impossible
The Problem: You struggle with an innate tendency to stay up really late, then hit snooze so many times in the morning. When you do get into bed, it takes you a while to fall asleep, and the whole cycle repeats itself. Maybe you've tried going to bed earlier so you'll have less trouble getting up in the morning, but then you just lie awake and end up hitting snooze a million times anyway.
How to Fix It: While avoiding caffeine in the afternoon and the evening is a wise move, Richardson says that having caffeine first thing in the morning can be helpful for people who have trouble waking up.
Modulate your exposure to light. This could help reset your internal clock gradually, according to Richardson. "Too much light at night will push your clock even later," he says, so the key is to keep the lights dim the closer it gets to bedtime. Then also maximize your light exposure first thing in the morning—if you can go outside in bright sunlight for some exercise, that would provide a double whammy of wakefulness.
Taking a melatonin supplement (0.3 milligram before bed) might help if light manipulation isn't enough, Richardson suggests. It may help pull your internal clock to an earlier hour so you can get the sleep you need and not want to toss your alarm clock out the window every morning.