Why Do Some Insomniacs Keep Waking Up At the Same Time?

One of the most common complaints that I get from patients is that they keep waking up at the same time in the middle of the night and are unable to get back to sleep, or they keep waking up every 90 to 120 minutes. This phenomenon is called sleep maintenance insomnia, when you are unable to stay asleep during the night. In contrast, sleep onset insomnia is when you’re unable to fall asleep in the beginning of the night.

A low-dose version of zolpidem (Ambien) was recently FDA approved as Intermezzo to treat these middle of the night awakenings. It’s purpose is similar to zaleplon (Sonata), which is a very short-acting sleep aid, so it can be used in the middle of the night to get back to sleep, without the “hangover” effects that people feel with typical sleep aids.

There are a number of different explanations for why some people keep waking up in the middle of the night. One theory is that people with insomnia are hyperarousable, with higher levels of brain activity and stress hormones. If it’s due to these factors, why is it that insomniacs keep waking up at the same time? One possible explanation is that it has to do with sleep stages. Humans go through 4-5 cycles of sleep, where deep sleep (slow wave) predominates in the first half of the night and REM sleep is more common in the second half. As the night progresses, the periods of REM sleep become longer and longer. Since we know that throat muscles are most relaxed during REM sleep, you’re more likely to have breathing pauses during REM, especially if you’re anatomically predisposed (narrowed upper airway anatomy).

This can explain why many people say that they keep waking up at 3AM, like clockwork. Some people wake up when REM length reaches a critical period, whereas other keep waking up with each successive REM period. Transitions into and out of REM can also predispose one to upper airway instability.

One thing I’ve noticed is that in almost all cases, severe insomniacs have very narrowed upper air passageways. On endoscopy, the space behind the tongue is very narrow, and most people can’t (or prefer not to) sleep on their backs, since the tongue is more likely to fall back then supine. Dr. Barry Krakow did a study a while back showing that the vast majority of insomniacs who were resistant to sleeping pills had sleep-breathing problems.

What I’m describing is not necessarily obstructive sleep apnea. Once you obstruct or have partial obstruction, you can either continue the breathing pause for 10 to 40 seconds (this is called an apnea or hypopnea). But if you wake up quickly within a few seconds, then it’s called an arousal. Insomniacs typically have lots of arousals.

This is why even if you have classic insomnia, you need to look for and treat any underlying sleep-breathing problems, regardless of whether or not you have apneas.

If you are an insomniac, what time do you wake up in the middle of the night?

Please note: I reserve the right to delete comments that are offensive or off-topic.

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95 thoughts on “Why Do Some Insomniacs Keep Waking Up At the Same Time?

  1. I’ve never had sleep maintenance insomnia (or any insomnia for that matter) in my entire life until 2 months ago. For the past 8 weeks I cannot sleep more than 3-4 hours to save my soul. It doesn’t matter what time I go to bed either, I will only sleep 3-4 hours and that’s usually between 3-4 a.m. Like you mentioned, it’s like clock work.

    When I wake up, I’m always waking up in the middle of a vivid dream. Needless to say, I have had extremely vivid dreams my entire life. The only difference is now I wake up during them:( And it doesn’t matter how calm and relaxed I am when I go to bed either. It seems I always dream and it has always driven me crazy – and now it drives me even more crazy because they wake me up.

    In the past 8 weeks I have tried various brands and types of melatonin, regular Ambien, and Unisom. None of it works. The only thing that has worked is Ativan but I’m scared to death to take it every night for fear of getting addicted to it. When I take it, I don’t dream at all and I have a great night of sleep. My doctor says I must have a lot of “brain activity” at night so the Ativan must help to shut things down.

    Besides Ativan, is there anything else I can do or take?


    P.S. Is there such thing as “learned insomnia?” This insomnia started when I was under a ton of stress. I’m just wondering if maybe my brain is now “programmed” to wake me up every night after 3-4 hours of sleep regardless of the fact that I don’t have that stress anymore in my life (although I suppose it’s possible I still have other stresses in my life that I’m not even aware of).

  2. Travis,

    One of the classic side effects of the benzodiazepines is REM sleep suppression. If you wake up while dreaming, you’ll remember your dreams vividly. I would begin with cognitive behavioral therapy for insomnia first. You should be able to find a therapist in your area. Another possibility is that you may have a sleep-breathing disorder, so every time your muscles relax in REM sleep, you stop breathing and wake up. If you can’t sleep on your back, then this is a possibility.

  3. I have just discovered your site and find it very helpful and informing.

    I had a total thyroidectomy in 1996 for papillary cancer. I have had surgery for reoccurance twice – the latest was in November 2011. During the past 6 years I have had periods of waking at 3 AM and not being able to get back to sleep for 2-3 hours. In the past during these periods if I meditated or used the Heartmath eMwave biofeedback device I would be able to sleep most nights until approximately 6 AM. However, after my latest surgery to remove a nest of malignant thyroid cells behind the head of my left clavicle, I have been waking up very consistently at 3 AM and not able to get back to sleep until 7 AM or later.

    I had a sleep study about a week ago and was started on cPAP at that time. My wakefulness during the day has markedly improved. But I continue to wake up at around 3 AM and cannot get back to sleep until about 6 AM.

    I have a follow up appointment to review my test results and progress in about a month. Nevertheless, I am concerned about my continued pattern of 3 AM waking. I have been reading DeMent’s “The Promise of Sleep” and am wondering if it makes sense for me to just shift my day so that I get up at 3 AM or would it make more sense for me to try to modify my circadian patterns?

    I would appreciate any advice that you might offer.

    Grace and Peace,


  4. I have been troubled with sleep maintenance insomnia for years but it has increased in severity during the past year. I used to sleep until about 3:00 a.m., but now I can only sleep one hour at a time. Regardless of what time i go to bed, I wake an hour later and this goes on all night. 5:00 a.m. is my final wakeup time. I average 3 or 4 hours sleep nightly.

    I have tried many things. I had a sleep study and found that I had mild sleep apnea. I tried using the CPAP for months and that only aggravated the insomnia. With or without it, I wake up every hour but have more trouble getting back to sleep with the CPAP. Ambien doesn’t work for me nor do any of the natural sleeping aids like LTrypothan, Melatonin, Valerian, 5HTP. I tried increasing my B Vitamins and magnesium. I tested my cortisol levels which were normal. I don’t use caffeine or alcohol, and I do exercise regularly in the morning.

    Finally, I went to a sleep psychologist and worked with Congnitive Behavior Therapy. I followed all the guidelines, did sleep restriction, kept a sleep log, visited with the psychologist regularly. Nothing worked.

    I don’t know what else to do. Is there any hope?

  5. Ms. Fitzhugh,

    Sorry to hear about your sleep problems. As I pointed out in my article, all you need is one apnea to wake you up every hour. One hour is a short sleep cycle. As you fall into deeper levels of sleep, your throat’s muscle tone is diminished, leading to a higher chance of obstruction and arousal. Dr. Krakow published a study that showed that treatment-resistant insomniacs had a very high incidence of sleep-breathing problems.

  6. He i googled around and came across this great site and I have a question.

    First I just want to tell you that I live in Sweden so I’m not sure about what times that’s used in English is. I’m a 17 year old girl having summer holiday.

    Yesterday I fell a sleep 1.30 at night and woke up 5.30. After that I couldn’t sleep properly, or at all.
    Tonight I fell asleep for about midnight time and wakes up at 4 in the night. I remember I had a dream too, a few pieces of it -quite clearly actually. I remember the numbers and events. It was about horses, if that matters.

    My question is: should I talk to someone or just try sleep longer next night?

    It seems that I wake up after 4hours,could it be because I’m reaching a certain state of REM sleep? I think I have worried much lately, longing and blaming. Have been upset with my parents too. And I don’t like to sleep on my back (can’t really think its because of a narrow air passage)

    Thank you so much for reading I really appreciate it!
    Best regards, Kim.

  7. My partner wakes up like clockwork every night between 12-12.10am (after one sleep cycle). We have good routines and sleep hygiene etc and it has not made any difference. This has gone on for over a year and now he will wake up around 12, raid the fridge, then doze till 3am at least, meaning he only has two proper sleep cycles a night. It is really frustrating as we are not sure how to fix the problem as it becomes more disruptive in our lives. Any ideas?

  8. I am 25years old and the last 3 weeks I would wake up at 530am after only been asleep for 5hrs. I have insomnia and always knew I had it but this sleeping pattern is really hurting me.I have 2 boys 2 raise and Im a nanny and maid this cant be happening.is their other ways to cure it other then medications. I have a severe case of heart issues and asthma and Im allergic to magnesium Im just unsure what to do!

  9. I am 15 and I keep waking up at midnight, 3 oclock, and 6:30. Sometimes it’s just the 3 oclock and 6:30 and sometimes its just midnight. Can someone help me? I’m freaked out and my mom won’t take me to a doctor.

  10. I had surgery on my knee twice recently, 6 weeks ago and again 4weeks ago due to complications. Since the initial operation I’ve only had 3 nights of continuous sleep and it’s becoming frustrating and a worry as I’m supposed to commence work again. I wake up at the same time every night and stay awake for 2 hours. I have cut back on pain relief, I only have codeine before bed and none during the day. I’ve tried melatonin but that hasn’t helped and I’m reluctant to use other sedatives as I’d prefer to regulate my sleep naturally. Is this normal after surgery to have these horrible sleeping patterns??

  11. I had a case of labrynthitis over the summer and it completely screwed up my sleep cycle. Very bad anxiety and insomnia for the first few months. I now finally feel like I’m getting better, but am having problems maintaining solid sleep throughout the night. I keep waking up around 1-2am and half of the time I’ll get back to sleep within an hour. The other half of the time I usually stay awake for hours until about 30 minutes before I need to get up in the morning…

    Needless to say, I’m at my wits end trying to get things back to normal. I’ve been taking 500mcg of melatonin for the past two weeks and it has helped enormously. Now I just have to stay asleep.

  12. I have been dealing with this 3:00 am thing since 2007, stress seems to play a major role in it. I am currently on a c pap, still I wake. I wake with a purpose I feel someone is trying to reach me, I hear talking.
    I have tried everything and I mean everything, otc, prescription, holistic, I had one professional tell me I am clairvoyant. This would explain a lot of things. Should I just accept it and live my life to my sleep cycles or can I really change it?

  13. I am 14 years old, and have always been one of the heaviest sleepers i know. Waking up used to be a struggle, and I’d be out once i hit the covers. Lately though, i keep waking up at 2:50- 3:50 every night. Its driving me insane, how do i stop this?

  14. I’m 29 and I have been dealing with waking up between 2-3 everynight since my son was born in 2008, but seems to be getting worse. I don’t seem to have problems with my breathing, but not really sure. I have even tried to take melontoin to help, nut still I wake up;( is there a better.choice?

  15. Kayci,

    Sleep-breathing problems are common after pregnancy. The point of the article is that there may be an alternate explanation to nighttime wake-ups, rather than the traditional insomnia explanation. You don’t have to notice that you’re having breathing problems to have a major breathing problem. For example, waking up to go to the bathroom, or waking up due to hot flushes both have been shown to be due to obstructed breathing, rather than a full bladder or sweating itself. Taking the appropriate steps to improve nighttime breathing is usually recommended, rather than taking a pill or supplement. Good luck.

  16. I wake up every night at 2am regardless of when I go to sleep. I initially fall asleep very easily and sleep well … until 2am. Then I’m awake for 2 to 3 hours. It is exhausting (I work so I can’t just make up the lost sleep during the day). Often I will “get sleepy” after an hour or so and thats about the time my husband cranks up the snoring. I have a sound machine and ear plugs. I’m 50 years old. And I’m tired! I just want a good night’s sleep.

  17. I’m a 21 year old man. I have been having sleeping problem for exactly 3 weeks now. I was in heavy stress and anxiety a week before my insomnia started. My sleep gradually became worse and I even slept for one 1 hour for 2 days in my 1st week of insomnia.

    Most of my stress and anxiety went away on the end of 1st week of insomnia. ButI have been waking up 3 or 4 times every night and I have only 2 or 3 hours of full sleep and rarely 4 hours. I wake up and and sleep after 15 or 30 minutes and wake up 1 or 2 hours later after a dream, which happens repeadly everytime I go back to sleep.

    The doctor even prescribed me low dose zopiclone 3.75mg sleeping pills which I took 4 times on different days. For 2 nights I had 6 to 7 hours sleep with the pills. But on the 3rd and 4th pill I had full sleep 5 and 4 hours.

    Its been a week now without sleeping tablets because I fear of being addicted. I still have the same problem and wake up 3 or 4 times.

    How long does these insomnia last?
    What can I have which will help me increase my sleep?


  18. Thanks for this article. Found it by doing a google search. Like the previous poster Kayci, been doing the 2/3am wake up insomnia after my daughter was born. For a while I thought it was because of habit getting up to check on her. Or stress since I’ve been under alot of stress. Practicing good sleep hygiene, but finally went to doctor and tried ambien for the past month. Which even with ambien, I was still waking up. So now I’m trying to just get through it best I can without the ambien since I found that the withdrawal effects of ambien are not good and it wasn’t working anyhow.

    Breathing problems does make sense. I was told once I have a deviated septum, though no sleep apnea that I’m aware of. I do find that a neti pot cleaning out my sinuses at night or breath right strips do help some. Earplugs and eye mask seem to help. hyperarousable like you state in your article makes a lot of sense too, my poor husband’s snoring even with ear plugs can wake me up.

  19. Thanks to a guest that Dr. Parks interviewed, Dr. Barry Krakow, I am now beginning to overcome my sleep maintenance problem.

    Dr. Krakow offers great detail on how to overcome this problem in his book, which Dr. Park recommended during the interview, entitled SOUND SLEEP, SOUND MIND. Thanks to Dr. Park’s recommendation, I read it and have benefited enormously.

    The protocol takes a little time to get to apply and get used to (it’s a matter of slowing one’s brain wave activity) but, in my case, it has really worked. I am very grateful for the information and help.

  20. For the last 20 months I have been able to sleep intermitently between 11PM and 3AM and then I wake up in a sweat and tingly feeling in my body and I cannot get back to sleep. Sleeping pills do nothing for me. I have been diagnosed with moderate sleep apnea but I cannot get used to the CPAP machine , specially falling asleep on it. I also use a Somnogard mouthpiece but my wife says I still snore with it on.

    20 years ago I had similar problems and I had a Uvulectomy and turbinate reduction. My throat has narrowed into a cathedral like shape over the years. I have been to local ENTs and they recommend laser surgery to open up my airway but I’ve also read that it could be my tongue now blocking my airway.

    Thi situation has caused me to become anxious and depressed and my memory and intelligence is deteriorating.

    Should I have more surgery

  21. I worked overnight shifts as an in room dining server for a year and a half. I just stopped working that shift about 2-3 weeks ago. First after working it for about 7-8 months I noticed that on my days off (when I would sleep at night instead of daytime) I was only able to sleep 3-4 hours and I would wake up around 3am every night so I stopped looking forward to my weekends because it was always a nightmare. Then towards the end something happened and I wasn’t able to sleep either daytime or nightime. That’s when I requested to take me off the shfits. Now I have been working am or pm shifts for almost 3 weeks now but still can’t sleep properly at nights. I would wake up around 2-3am and could hardly go back to sleep. I tried many anxiety pills: klonopin, xanax, valium, lunesta. Nothing really helps or I need a bigger dosage to really knock me out. But if I do that and work an AM shift I am dopey an unable to focus at work.

    I know my issue is from working overnight which I partly resolved already by changing the shift.

    My question is how long it would take for my body to readjust to normal night time sleeping and I could sleep anytime night time without pills which I was always used to until a year ago.

    Thank you!

  22. I’ve been suffering from sleep maintainance insomnia for the last three years. It’s not till recently that I discovered other people were going through this, too. I thought it was just me, that there was something wrong with me in isolation, like stress or whatever. But I’ve had little luck fixing the problem. So now I’m in research mode.

  23. I suffer from insomnia off and on. When I do, I wake at 0300. I joke with my coworker, who also wakes at the same time, that we should call each other in the middle of the night. Melatonin helps a lot. I also avoid alcohol, which seems to have a severe worsening effect on my ability to stay asleep. When I wake, I cannot go back to sleep for a couple of hours. My mind is going a mile a minute, and I feel a strong sense that something is very wrong in my life. In the morning, things always seem better. I will drift off, exhausted, then “jolt” wide awake with an unpleasant thought or memory.

  24. I’m sixty three and I’m on a CPAP and have been for several years. I have OSA and the doctors say that I have a narrowing in the back of my throat and have a large tongue. I don’t drink alcoholic beverages. I don’t have any other physical problems except occasional night time seizures. I have been to two neurologists and they ran all the tests, everything came back normal. I usually wake up every two hours each night but I do fall back to sleep most of the time.
    I feel my night time seizures are brought by my tongue relaxing and I don’t get the oxygen that I need.
    Do you think that the Repose procedure/hyoid suspension/UPPP would help me?

  25. Hi
    I have been having strange sleeping habits since March 2013 which literally developed overnight.
    I can fall asleep most nights very easily, in fact often I am very tired. But then I wake up anywhere between 2-5 hours, and still feel tired (I often need to pee). I can then sleep another hour or so depending on how many hours I slept in the first block. Usually I cannot sleep more than six hours in total. On good nights it is 4 hours plus one on bad nights it is 3 hours plus three. Sometimes I wake multiple times.
    I was very anxious when this problem started and my doctor says I am suffering from generalised anxiety but I don’t think he is right.
    If it was anxiety, why can I fall asleep ok?
    If it is anxiety why can I fall back asleep afet my first awaking ok?
    If it is anxiety why can I not fall back asleep after I have had five hours sleep in total?
    I think I have a sleep disorder or CFS. I have spoken with many suffers of anxiety and there problems seem to be a troubled mind that prevents them falling asleep and/or waking up and not beeing able to return to sleep. Or waking up and sleeping many more hours.
    Does anybody else suffer from this. I am desperate to hear from people who suffer from a similar problem.

  26. I have really stupid sleeping problems. About 8 years ago I switched from working a midnight to 8 am shift to working a regular 9-5. I never had any problems before that. Then it got so that I couldnt sleep at night, I had wicked back pains, muscle, fist, and jaw clenching. It was terrible. This went on for 3 or so years and then I started getting panic attacks. I went on benzos, and yes, they were the ONLY thing that worked for me as well. Felt nothing from any supplement, and nothing even from ambien and lunesta. That worked for 3 years. I am now tapering of of klonopin (do not want to depend on this entire life) and not having issues with panic. I am of course having problems sleeping again. I dont drink ANY caffeine. I have ALL of the proper sleep hygiene things. I exercise at a gym. It just really sucks. I hope that a few months after this taper I will sleep somewhat normal again, but who knows.

    BTW I cant sleep in any position besides my back oddly enough.

  27. For weeks now I’m awake up 2hrs after falling
    Asleep and takes me anywhere from an hour or
    2 to fall back asleep then I’m up 2hrs after that
    I constantly feel tired to the point I feel nauseated
    Please help. I don’t know what to do.

  28. Same here. It’s actually been happening in the last 2 weeks. I keep waking up every hr. Once i get into deep sleep dreaming away i wake up with ringing in ears and head rush. I use C-PAP as I have sleep apnea but it really isant making a difference. Annoying and fraustrating I feel like I am waking up to a heart attack but probably is a panic attack.

  29. I am a chronic insomniac. I fall asleep fine, but wake every hour on the hour. Sometimes I am awake for maybe 10 minutes, often I am awake for more than an hour. My doctors have yet to pin it down. What I dont understand is the baffling consistency of the exact wake times every night. Circadian Rhythms? I practice “proper sleep hygene”, block out any light, wear earplugs, at times listen to white noise or delta binural beats.. I am mentally Ill, however I take my meds in the morning. I don’t consume caffiene, I exercise, keep a sleep log..

    my bodyfit monitor tracks sleep (I have yet to be fully convinced of the accuracy), on a consistent basis, I average 3.5 hours of sleep a night. I am sure you can imagine what this does to your brain and body.

    At this point I will do anything I can to stop this, and I have tried medicine that is not contraindicated with my current psych meds.

    a strange thing.. I often wake with a swollen tongue, teeth imprints on the sides as if it was squeezed against them hard.. painful. Apnea? sleep study?

    my md and psych dont have much to say or are much help. Klonopin buys me 3 hours.. I dont want to waste an emergency tranquilizer practically for an extra hour of sleep.. also even thought its probably the most potent benzo, its effect on sleep sedation isnt great.


  30. Hi steven,

    I’m going nuts at moment, for past few yrs I
    go to sleep fine but wake anywhere from 2am
    -4am. It don’t matter what time I go to sleep
    I wake this time. My gp gave me pill which helps
    you sleep but lasts 4 hrs but it don’t work.
    It’s called sonta or something, 1yr ago I was
    diagnosed with Addison’s disease where I’m on
    fludrocortizone and hydrocortisone steroids,
    also I’m on thyroxine for my thyroid . Please
    help, I just want a normal sleep pattern.



  31. I woke up after exactly 4 hours of sleep every single night. Didn’t use to have this problem until I went through a very stressful & depressing event. My doctor prescribed me Ambien CR & I can honestly say I sleep like a dream now. I get a full 8-8.5hrs nightly with the medication.

  32. I’ve not had a decent night’s sleep in 10 years. I wake up every 1-2 hours. On a rare night I will make it 3 hours. I don’t just groggily wake up and lay in bed, I literally bolt up out of bed wide awake! I usually get a sip of water and use the restroom and go back to sleep. I fall back to sleep no problem, usually in under 30 seconds, but I will wake again in 1-2 hours. And I don’t HAVE to use the bathroom, I just do because I am up so might as well otherwise I will lie in bed wondering if I have to go, should I have gone, etc.. So Frustrating!!

    In 2008 I was diagnosed with mild sleep apnea with an AHI of 8. The mask made me so claustrophobic I couldn’t do it. The sleep tech said my Sleep Apnea was so mild I didn’t have to use the CPAP.. He said 5 AHI is normal so 8 wasn’t that bad.

    Now in 2012 I had another sleep study (at home) and my AHI was in the 30’s and my oxygen was dropping to 51%. Now I had to use the CPAP claustrophobia or not this was life or death. So I have faithfully used it every night since September 2012. I was hoping this would help me sleep threw the night, but no such luck. My AHI is now under 1 every night, usually something like 0.36.

    I do have RLS and I do take Klonopin (.5) which helps for about 3 hours. I don’t want to take more because I don’t want to get addicted. My doctor probably won’t give me more anyway. I really don’t think sleeping pills is the answer.

    One thing that might be relevant is my respiration per minute are like 20-26 where most peoples are like 12-16. So I do breath too fast and I am sure too shallow.

    If anyone has any advice or similar problems please fell free to share anything that might help me. Thanks

  33. Just want to share my experience, wonder if anyone has this problem. I usually have no problem sleeping. I can fall into sleep within 15 minutes after lying down. The problem I have is I will always wake at exactly the same hour and minute for a few consecutive nights in a row. I woke up at 1:30am sharp for 4 nights. Sometimes, I will wake up at 3:03 sharp, also for a few nights in a row. These few nights, I’ve been waking up at exactly 2:25am, and the list goes on for many years now. Doesn’t matter what time I wake up, I will always wake up at 4:55am again later. I never had to use an alarm clock. The only 2 things I have in my room to tell me the time are my handphone and wrist watch. I got tired of this “routine”, I don’t put a clock in my room so I won’t know the time when I’m in there. Myths say that when one wakes up at the exact hour and minute every night means someone or something is staring at the person, so I sleep with my cat every night. My cat sleeps like a log, I mean it doesn’t disturb me. I don’t have problem going back to sleep, I can sleep back almost immediately after seeing the time. Average time of sleep is 5-6 hours. I don’t remember my dreams.

  34. Hi, 2.5 years ago, I was struck out of the blue with SEVERE anxiety/panic adrenaline rushes, etc….Whether this was hormonal or neurotransmitters or what, it was never truly diagnosed. We did lean on the low neurotransmitters (Serotonin) as the culprit. Anyway, severe Insomnia set it. When the adrenaline rushes occurred, I had 0 hours sleep. Then, maybe I’d sleep 1 hour, and wake up and couldn’t sleep the rest of the night/morning. Or, I couldn’t fall asleep as the main issue, then I could fall asleep, but wake up an hour or two later. This went on for 2 years. Lately, for the most part, I can now fall asleep, but I wake up at around 3am every morning. Some times I wake up at 2am, but it’s always around 1-3am. Some of the time I will feel sleepy and can fall back asleep for another hour off/on (more of a snooze not deep sleep, or I will be wide awake and can’t really sleep any more. I almost NEVER feel refreshed from any of the sleep I do get. I’ve taken all herbs, some kinda help, used Gaba/Phenibut, some times helps, Tryptophan rarely helped, 5-HTP too stimulating, valerian didn’t work, Kava helps, etc.. I tried anti-histamines, but they don’t help. I’ve tried Silenor, didn’t help. I tried Ativan, didn’t help me sleep any longer, but because it’s a Benzo, my mood was okay the next day. :) If I’m not going to sleep, I’m not going to sleep and nothing is going to help! Back when this all got really bad, I tried SSRI’s but they made me worse, except for Remeron which helped me sleep for the first time for about 1 week then the effect wore off. Meds mostly made me worse and had bad side effects. Anyway, I just feel that my brain is stimulated by something, adrenaline maybe…I’m on St. John’s Wort now, and that has helped my anxiety/panic I think, hasn’t lifted all my depression, and hasn’t really helped me sleep, although I’m at least falling asleep most of the time but keep waking up. Anyway, you mentioned ” you need to look for and treat any underlying sleep-breathing problems,” How do you treat sleep-breathing problems if that is part of my current insomnia issue? Does sleeping on your back the best, or side for better breathing? I’m not as comfortable on my back, and feel more warm and cozy on my side, my right side usually. My left side makes me feel my heart more and can be uncomfortable. I had a slipped disc in my neck, which was pressing on nerves and might have been the cause of my tight throat muscles at times, I had the disc fixed, but my throat still feels constricted a little, as i can’t swallow my supplements as well as I used to, and just feels funny although a ENT and Endoscopy shows nothing is wrong. So, I might have some sort of breathing issue. What can I try? thanks.

  35. Michael,

    Thanks for submitting your comment. I can’t say without examining you, but just because an ENT exam with endoscopy was “normal,” what you described can still be consistent with a sleep-breathing disorder. It’s likely that you were examined with the endoscope while sitting up. Things can look very different when on your back. Take a look at one of my recent posts on panic and anxiety.

  36. Hi Dr Park

    For the past 18 months I’ve had sleep maintenance insomnia where I wake up every single night at different times between 1-4 a.m. (and lately I’ve been waking up twice a night, the first wake up being around 11-12). Sometimes I get back to sleep, sometimes I have to take sleep aids, sometimes I don’t get back to sleep at all despite sleep aids.

    I had a sleep study which showed only hypopneas and the total AHI was 2.7, my REM RDI was 5.7 and supine REM was 5.3. The study suggested mild sleep disordered breathing but didn’t offer any advice other than avoiding caffeine.

    The insomnia started after a period of stress and I kind of feel like it’s “learned insomnia” but I also can’t ignore the hypopneas, especially since I wake up so alert some times, and often on my back (despite finding it impossible to fall asleep on my back).

    According to my AHI my hypopneas are “normal”. Should they be something to be concerned about? I also had higher REM sleep stealing some of my stage 3 and 4 sleep, and 2 limb movements that either woke me up or sent me to a lighter stage. I also had an x-ray and in my opinion my airway looks a little narrow around the epiglottis area.


  37. Mandy,

    Your situation is quite common. The AHI and RDI can be on the low side or even within normal limits. The problem is that you can still have multiple more subtle, shorter obstructions and arousals that’s not picked up on the sleep study. These can manifest as flow limitations, arousals, grinding, or even limb movements, all of which can disrupt your sleep quality. Even the x-ray may underestimate the narrowing in your airway, since it was most likely taken with you sitting up, and not lying on your back. I’m assuming you can’t sleep on your back, right?

  38. Hi Dr Park

    Thanks for your reply. I definitely can’t fall asleep on my back but I do somehow manage to wake up on my back through the night.

  39. Hi Dr.Park

    I’ve always been a night hawk and nocturnal where I generally enjoy being awake during the night and sleep more often through out the day, but I’ve never had an issue with staying a sleep and keeping a steady sleep up until 2 weeks ago.

    I do suffer from anxiety and have been suffering from depression for a while and I noticed the change in routine one night when I had pulled an all nighter which isn’t unusual for me, but I’ve had some anxious thoughts and fear on my mind that wasn’t putting me to sleep because my mind was so active and not shutting off, normally if this occurs and I start to relax and get to sleep, I would sleep soundly for 6-8 hours or whatever the case may be.

    Latley it doesn’t matter when I go to bed, I will wake up out of a dream(a dream that I generally always remember clearly) after about an hour or so and this happens countless times throughout the night where when I finally do end up getting out of bed hours later, I feel like I’m not refreshed or rested or getting the proper amount of sleep and its causing more anxiety and worry.

    I have suffered many times from sleep paralysis in the past and I don’t sleep on my back ever but I’ve always been able to sleep well without any issues until these last 2 weeks

    I guess my question is- is it possible that my anxiety caused this sleep routine and now my body is used to the occurrence and the power of the mind? I was having trouble falling asleep because I had too many thoughts about sleeping and questions in my head that was probably the cause of not being able to shut down and sleep but now I’ve tried to relax in hope that ill have a good sleep and everything will go back to normal and nothing has changed yet.

    Because of my sleeping patterns, I havn’t been doing a whole lot or getting enough exercise or out of the house much. I’ve kind of just been lazying around and my sleep schedule is all over the map. Is it possible to change this and get back to normal over time or should I look further into having tests done? is it something to worry about?

  40. Hi Dr. Park

    I’ve always been the type of person to be a night hawk and always been nocturnal and loved being up during the night and sleep more throughout the day. Up until two weeks ago, everything with my sleeping seemed to be nothing more than normal. I may not sleep at the proper time always but I always had a refreshed 6-10 hour sleep, whatever it may be and would wake up feeling like I’ve slept well.

    I do struggle from anxiety and my generalized fear is of dying, it happened when I was younger and it was pretty bad but I learned to cope and got through out and it really didn’t affect me all that much. Well, recently being under a lot of depression and stress, I had stayed up and pulled an all nighter which I’ve done plenty of times in the past, but I was having trouble actually falling to sleep and knew I needed sleep because I felt exhausted. I had too much on my mind and started to get paranoid and thinking of reasoning’s of why I hadn’t been sleeping or why my brain wouldn’t shut off. There has been plenty of times when I’ve had a lot on my mind but once my mind shut off to sleep, I was out like a baby sleeping soundly.

    These past 2 weeks have been hell. I’ve been sleeping all over the map, have had a terrible sleep routine. I’m waking up almost every hour out of a dream that I clearly am remembering when I wake up, it’s almost as if I don’t even feel like I’m really sleeping. I feel like I’m missing out on sleep stages and not getting proper sleep, because as this carry’s on through out the night multiple times until I finally feel like getting out of bed and as I do I don’t feel fresh, Kind of feel blah and head kind of feels heavy and eyes feel sore and don’t feel healthy.

    I guess my questions are as follows:

    Is it possible that this has been caused just because I triggered it on my own from anxiety and thoughts and have just been in a routine that was caused out of the blue or is something wrong?

    I don’t know the answers. I went to the doctors twice, they didn’t seem concerned they just chucked me some sleeping pills and I’m not a fan of pills, I took it twice and really didn’t seem to do much. I was having trouble falling a sleep because of worrying a lot and now I’m trying to relax my mind and tell myself everything is okay, I will get a good sleep and I’m going to sleep easier but I am still waking up almost every hour out of a dream and feel crummy everyday and this randomly occurred just two weeks ago.

    I have had some sleep paralysis episodes in the past. I don’t ever sleep on my back. I don’t really know if I have any sleeping or breathing issues because I’ve always slept fine so it seemed up until these last episodes and because this is all happening its causing more anxiety because I feel abnormalities and am un sure what is the best solution or what can I maybe do on my own to feel better or try to get back in a regular sleep routine.

    Just feeling so down in the dump because I have struggled from anxiety a lot in the past and always felt as if something was wrong with certain body parts and always did tests for re assurance and nothing ever was wrong, so whenever I talk about this to people or my parents, they just think its my anxiety and nothing further, and that’s why I feel un certain because I don’t know if this was all caused by anxiety and depression and it’s just became a routine of sleep I’m stuck with and can be changed on it’s own or if I have some sort of sleeping disorder?

    Please help me with this and voice your opinion of what I should consider doing, because its really making me mad.

    Thanks a lot

  41. I had my Uvula removed 20 years ago. About 3 years ago I started waking up between 3 and 4 AM and could not fall asleep. I had a sleep study and had moderate apnea and my palate had webbing and cathedral shaped. Sleeeping pills don’t work. I cannot fall asleep on CPAP. I use a moouthpiece which seems to decrease my snoring. It has affected my memory and cognative behavior. Do you think furtherthroat surgery could help. if so what kind

  42. Brad,

    It’s difficult to say anything definitive without examining you, but poor quality sleep can still occur despite adequate amounts of sleep. Oftentimes, even a sleep study will show no significant apneas. This is a condition called upper airway resistance syndrome, where you’ll have multiple obstructions and arousals every hour without any apneas (which is defined as more than 10 seconds pauses). Some people do well with an oral appliance that pulls the lower jaw forward (pulling the tongue forward), but it’s generally a good idea to see a sleep specialist, ENT or dentist that’s knowledgeable about these issues. Good luck.

  43. Mr. Ovies,

    It’s important to undergo a sleep study with your dental device in place, to check for significant improvement. Without examining you first, it’s difficult to recommend any surgery. However, a good ENT surgeon should be able to give you an answer to your question. Good luck.

  44. Dr Park,
    I have a problem that has been going on for years. I wake up in the middle of the night and my bp is high 174/86 or higher and my heart is beating fast. I always thought it was from my dreams cause I have usually been in a deep sleep dreaming when I wake up. It has gotten worse and now I am anxious at night before I go to bed anticipating my night. I started taking Ativan 0.5 mg and it helped for a while but it got worse. My Dr sent me for a sleep study and they found I do not have sleep apnea but my O2 levels are 88% 20% of the night. The other 80% my O2 levels are fine. Ok, so they started me on 2 l of O2 at night only (no lung problems) and I am still waking up with the same symptoms. I started Ativan 0.5 about 8 pm and then take another at 10 pm. It helped keep me relaxed and my bp’s were great when I would wake up and take it. Problem now I only sleep 2 hrs at a time, not getting a restful sleep, irritable, anxious. They can’t figure out why limited breathing at night and my Dr just thinks I am anxious so he prescribed buspar. I feel I go into fight or flight mode when dreaming and this causes my bps to go up. I am 63 years old, 5’4″ 209 lbs and on 4 bp meds. They keep adding bp meds because this affects my bp during the day. The bp is now under control during the day and ok at night if I take 2, 0.5 Ativan but then I am up every 2 hrs. This is driving me to become more and more anxious to go to bed at night. (I just started Buspar so I don’t know if that will help; also not taking Ativan now with Buspar). After taking Buspar last night for the first, I had terrible insomnia and only slept 2 hrs all night. Any thoughts? Thank you.

  45. Georgia,

    Sorry to hear about your sleep problems. I can’t say without examining you in person, but in general this is a common situation that I see. Even if you don’t have sleep apnea, it’s likely that you stop breathing often, just not long or severe enough to be called apneas. Regardless, you’ll stop breathing more often in REM sleep, when your muscles are most relaxed and when you’re dreaming. I recommend you find a sleep physician or ENT that understands upper airway resistance syndrome. Good luck.

  46. My problem is I wake up every 1-3 hours every night no matter what I do. It is so frustrating!! This has been going on for 10 years. In 2008 I was diagnosed with mild sleep apnea and because the CPAP mask made me claustrophobic they said I was borderline and didn’t really need it. Then in 2012 I started waking up with my heart pounding out of my chest in a state of panic. I had a second sleep study done and my AHI was over 40 and my oxygen saturation dropped to 53%. So I knew it was life or death and began CPAP therapy. I no longer have the pounding heart or oxygen desats, and my blood pressure is normal. However, I still wake up every 1-3 hours. I had hoped CPAP would of helped that but it didn’t. So now I have an AHI of <0.7 and my oxygen stays in the 90%s but I still cannot sleep threw the night. I do have RLS and only recently, for the past 6 months, I take 0.5mg Klonopin at night and it fixes the RLS. So I know the Klonopin is not the problem because I have been waking up for 10 years. The only other thing that bothers me is I breathe too fast. My average breaths per minute are 22. This seems high and I don't know if this has anything to do with my waking up every 1-3 hours. Actually, 3 hours is rare. It's usually more like every 1-2 hours. I just want to sleep. I feel so tired and sleep deprived even though I am in bed 8-9 hours a night it is not a restorative sleep when you are up every hour. Any suggestions??

  47. I’m one of those who wake up at the same time every night (2-3), and though a home sleep study said I had severe sleep apnea, I’m wondering about stuffy nose. Nose is not stuffy before bed, but when I wake up at 2 or 3, at least one nostril is very stuffy, breathing difficult, and my head aching. Since the woman I see every couple of weeks for lymph massage told me rebounding might help the stuffy nose (guessing, I think, it was related to tissue swelling in the nose), I got up at 3 when I woke up this morning and rebounded for 15 minutes or so till the nose was clear and the head not aching, and though I couldn’t go back to sleep afterward, I DID feel sleepier than usual at that hour and felt some optimism for future nights. I nearly always at least SEEM to sleep OK from 9 or 10 to 2 or so.

    My question is this: could a diagnosed apnea be related to (caused by?) sluggish lymph flow?

    What I’ve read of your book, btw, has been a great guide.

  48. Carolyn,

    Having a stuffy nose can definitely make OSA worse, but unfortunately, treating it usually doesn’t cure it. Most people with OSA have stuffy noses, which can prevent proper CPAP or dental appliance use. It’s important to get your stuffy nose taken care of, and then treat your sleep apnea. Good luck.

  49. Thanks for th einformation! This has really helped me understand why I can’t sleep for more than 90 minutes at a time. I almost always sleep between 80-120 minutes at a time waking up 3-4 times a night. I never feel rested anymore and it is driving me crazy! I also saw the part about being resistant to sleep medication which I am. I think I shall get a sleep study done.