How to go back to sleep in the middle of the night

What’s stopping you falling back to sleep?

If you regularly wake up and can’t get back to sleep for at least 20 minutes, for no clear external reason, you may have a type of insomnia known as sleep maintenance insomnia. It’s thought to affect 30% of people with

. It may be especially common among midlife women, which scientists think may be connected to a few different things, including and like night sweats.

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The signs you might have maintenance insomnia

• unlike people with sleep onset insomnia, who can’t fall asleep in the first place, with sleep maintenance insomnia you wake multiple times throughout the night, or wake up and lie awake for hours
• some experts also think waking up earlier than you’d choose to – at 5.30 rather than 7, for example - is a type of maintenance insomnia
• whatever your pattern, you end up with broken sleep that doesn’t refresh you because you don’t spend long enough asleep – and the sleep you do get is poor quality

Maintenance insomnia can be frustrating and exhausting – but there are proven tips that can change the way you deal with night-time waking so you can get the restorative sleep we all need.

The stress hormones stopping you getting back to sleep

Ever lain awake, feeling increasingly stressed about getting back to sleep? Then you’ll know the most challenging thing about maintenance insomnia is feeling so worried about sleep, the anxiety itself keeps you awake.

It can be a difficult pattern to get out of because stress can trigger you to wake up in the first place. Research has found waking early from sleep is linked to a rise in a hormone called adrenocorticotropic hormone (ACTH), which triggers your body to pump out stress hormone cortisol, causing alertness.

Lack of sleep can worsen feelings of stress, creating a vicious cycle.

Find useful information on other areas of sleep with our

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The golden rules to help you get back to sleep

Get out of bed

It may be the last thing you feel like doing when you’re desperate to go back to sleep. But most experts agree you should get out of bed if you’ve been awake for around 20 minutes. The reason? Lying in bed awake can mean your body and mind start to associate being in bed with frustration and wakefulness, which is likely to make the problem worse.

• go into another room and do something soothing, like reading a book (keep the lighting low) or listening to relaxing music. You could also find a chair to do progressive muscle relaxation or breathing exercises - see below
• head back to bed when you feel sleepy

Stay away from screens

It may be tempting to hop onto Instagram or scroll through a news website if you’re awake in the night but it’s not a good idea.

• avoid looking at your phone. The bright light from tech can affect your sleep by disrupting your body clock. And even if you have the light setting low, research shows looking at social media can lead to raised levels of arousal that may interfere with your sleep.
• don’t be tempted to watch TV – although it gives off less blue light than other devices, it still emits some, and that may be enough to affect your body clock. Plus, research shows TV can over-stimulate your mind, especially if you’re watching it in the bedroom because your brain and body may stop associating being in bed with rest

Relax your muscles

Progressive muscle relaxation (PMR) involves tensing one muscle group at a time and is based on the idea that physical relaxation can help promote mental calmness. Lots of people with insomnia find it can help them get back to sleep. Here’s how to do it:

• you can try it in bed, or - especially if you’ve been awake for more than 20 minutes - get up and sit in a comfortable chair
• go through each set of muscles in your body, starting with your feet, tensing the muscles and then relaxing
• with each set of muscles, inhale, squeeze the muscle group for five to 10 seconds, then exhale and quickly release the tension
• have a break for around 10 seconds, then repeat with the next muscle group, moving from the bottom to the top of your body
• work your way up through the muscles groups one at at time, going from your legs to your bottom, pelvic floor, tummy, arms, hands, neck and shoulders

Try breathing exercises

Slow, deep breathing can help move your body out of the high-cortisol fight-or-flight response and into a state of relaxation, triggering your nervous system to lower your heart rate, blood pressure and levels of cortisol. And it may even promote the release of sleep-inducing hormone melatonin.

There are a few different breathing techniques you could try:

• you could try simple deep breathing into your belly. You can stay in bed and bend your knees up over a pillow - or get up and do it in a chair if you’ve been awake for a while. Put a hand on your chest and another on your tummy, then take slow, deep breaths through your nose, letting your tummy rise and your chest stay still. Then breathe slowly through pursed lips
• you can find lots of other techniques to practise on meditation apps and online, so you know what to do if you wake in the night.
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At the moment, there isn’t enough research into the different methods to show what helps the most.

Avoid clock-watching

Watching the minutes tick by is likely to add to any stress you already feel about being awake, putting you into a state of arousal and making it harder to go back to sleep. You could turn the clock away from you, and it’s a good idea to leave your phone in another room at night so you’re not tempted to look at it.

Stop it happening - get the basics right

Brush up on your sleep hygiene to make sure you’ve got the right conditions for sound sleep – this can help you stay asleep as well as nod off in the first place. Certain other things are particularly important when it comes to preventing night-time waking, such as:

• drinking alcohol messes with your sleep – it’s a sedative, so it may help you fall asleep at first, but as your liver processes it, later in the night, your sleep may be disrupted
• caffeine doesn’t just stop you going to sleep initially – research has shown it also interferes with the deep sleep stage and may affect your ability to stay asleep
• health issues that need sorting out. Some underlying health conditions can trigger you to wake up in the middle of the night. And sleep disorders can trigger night waking – such as
  sleep apnoea
  , which causes your breathing to stop and start during sleep, waking you up lots of times in the night. It’s important to deal with any of those to improve your chances of solid sleep

When to see your doctor

You should see your doctor if you think you may have any underlying conditions or sleep disorders that could be causing you to wake up, or if:

• improving your sleep hygiene hasn’t helped
• you’ve had sleep problems for several months
• lack of sleep is affecting your daily life
• you also have low mood or anxiety symptoms

Not sure whether you should see a doctor? Try our

to work out whether an appointment with your doctor could be your best next step.

How does your doctor diagnose maintenance insomnia?

Your doctor would ask you questions about your sleep and may diagnose based on your answers. If they suspect an underlying cause, such as sleep apnoea, they may refer you for a sleep study.

What treatments can your doctor offer for night-time waking?

Your doctor can refer you for treatment for any underlying conditions or sleep disorders. And they may be able to refer you for CBT for insomnia (CBT-I), which can help change the way you think and feel about waking in the night, so you don’t get into the stress cycle that can keep you awake.

Doctors try to avoid prescribing

– and in any case, these medicines are usually aimed at helping you fall asleep when you first go to bed. Some people take sleeping pills when they wake in the middle of the night but this isn’t recommended. The sedative effects can take several hours to wear off, which means you may feel very drowsy the next morning.