Waking Up in the Early Morning Without Trying

Causes

1. Stress

Stressors, including major changes in your life, can affect your ability to fall asleep, how soundly you sleep, and what time you wake up. Symptoms usually start within 3 months after a stressful event and usually don’t last longer than 6 months.

Other symptoms:

• Aches and pains
• Anxiety
• Difficulty focusing
• Loss of appetite or overeating
• Increased use of nicotine, alcohol, or other substances

Treatment and urgency: If your symptoms are severe or not going away, then short-term psychotherapy may help you understand your reactions and manage stress better.

2. Depression, anxiety, and other mental health problems

Depression, anxiety, post-traumatic stress disorder, and other mental health problems, can all lead to difficulty sleeping. Common mental disorders can affect people at any stage of life, but most often start in young adulthood and affect women more often than men.

Other symptoms:

• Persistent sadness, hopelessness, or worthlessness
• Worrying a lot
• Not enjoying activities that you used to like
• Changes in eating patterns
• Withdrawing from family, friends, and activities
• Problems focusing
• Feeling overly guilty
• Thinking about suicide

Treatment and urgency: See a mental health professional if you have sadness or anxiety that lasts for more than a couple of weeks, causes significant distress, or interferes with daily activities. Many mental health conditions can be treated with talk therapy, medication, or a combination of both treatments. If you have suicidal thoughts, get help immediately. Options include calling 911 or 988 (the Suicide and Crisis Lifeline), or going to the ER.

3. Substance or medication-induced sleep disorder

A variety of substances and medications can affect your sleep. These include caffeine, alcohol, nicotine, and stimulants like cocaine. Many prescription medications can also affect your sleep, including steroids, decongestants, antidepressants, stimulants for ADHD (like Adderall), and some medications used to treat heart disease. Withdrawal from other substances can disturb your sleep, including marijuana, opioids, and anxiety medications.

Other symptoms: Substance or medication-related sleep problems can cause a range of symptoms that vary depending on what you’re using. Examples include:

• Faster heartbeat, loss of appetite, paranoia, risky behavior (cocaine)
• Anxiety, digestive issues (caffeine)
• Slurred speech, impaired thinking and memory, poor coordination (alcohol)

Treatment and urgency: If you’re using substances like caffeine, nicotine, alcohol, or marijuana, reducing your use may help improve your sleep. Talk to your healthcare provider if you start having insomnia after a change in medication. You may need a different dose, switch to another medication, or find strategies to manage the side effect.

4. Breathing-related sleep problems

Chronic medical conditions like obstructive sleep apnea, congestive heart failure, and chronic obstructive pulmonary disease (COPD) often disrupt sleep. These diseases interfere with normal breathing and limit the amount of oxygen that’s delivered throughout your body, causing awakenings.

Other symptoms:

• Loud snoring, pauses in breathing during sleep, waking up gasping for air, headaches, high blood pressure (sleep apnea)
• Shortness of breath, cough, wheezing, producing a lot of mucus (COPD)
• Shortness of breath (especially when lying flat), leg swelling, cough, reduced ability to exercise (congestive heart failure)

Treatment and urgency: See a healthcare provider to get an accurate diagnosis and treatment of sleep apnea, congestive heart failure, and COPD, and to discuss ways to improve your sleep.

5. Primary insomnia disorder

In some cases, insomnia isn’t caused by stress, a health problem, medication, or other substance. This type of insomnia is called primary insomnia disorder. It occurs more commonly in middle-aged and older adults.

Other symptoms:

• Difficulty staying asleep
• Feeling tired during the day
• Irritability and mood swings
• Problems with memory and concentration

Treatment and urgency: If you often have difficulty sleeping or get very poor sleep, talk to your healthcare provider about potential treatments. These may include lifestyle changes like improving your bedtime habits, talk therapy, and prescription medications.

Treatment

At-home care

If you have trouble falling asleep or staying asleep through the night, the most important first step is to create habits that help you sleep.

• Stick to a sleep schedule. Go to bed and wake up at consistent times each day.
• Create relaxing routines. Develop a soothing ritual before bedtime to help your body relax and prepare for sleep. This may include taking a shower, doing some light stretches, drinking herbal tea, listening to calming music, or reading a book.
• Limit bright light before bedtime. Avoid using your phone or other devices with bright screens for at least an hour before bedtime
• Avoid stimulating substances. Stop drinking coffee or other caffeinated beverages at least 12 hours before bedtime and stop smoking nicotine products at least 6 hours before you go to bed.
• Limit alcohol. Although alcohol often causes sleepiness, it makes it harder to stay asleep and affects the quality of your sleep.
• Avoid naps. Daytime naps can make it harder to sleep through the night.
• Reserve the bed for sleeping. If you use your bed for activities other than sleeping, like watching TV or using electronics, your brain is less likely to associate your bed with sleep and relaxation.
• Create a soothing sleep environment. Keep your bedroom cool, dark, and quiet.  Consider using an eye mask or earplugs if needed to block out bothersome light or noise.
• Exercise during the day. Regular exercise can help with sleeping at night. But try not to exercise close to bedtime because it can be stimulating.
• Do deep breathing. If you’re having trouble relaxing when trying to fall asleep or getting back to sleep, deep breathing can be calming. Slowly take a deep breath through your nose for 5 seconds (the inhale should be big enough to expand your belly.) Hold the breath for 5 seconds. Then slowly let it out through your mouth for 5 seconds. Repeat this for 5 minutes while trying to focus only on your breathing and feeling your body relax.
• Relieving muscle tension. Take a few slow, deep breaths. With each breath, tense one muscle group at a time, then release it as you exhale. Start with your face and neck and gradually move down the body with each breath until your whole body feels more relaxed.

Other treatment options

• Therapy. Cognitive behavioral therapy for insomnia (CBT-I) is a short-term treatment (usually 5–6 weeks) that has been found to be effective. Your primary care provider or mental health professional can do CBT-I, and it is also available online. It focuses on helping you change habits and patterns of thinking that may be making it hard to sleep well and helps you learn and practice techniques that relax your body to make it easier to sleep.
• Sedating/hypnotic medications. If CBT-I doesn’t help, you and your provider can discuss the potential benefits and risks of taking a prescription medication for sleep. These include zolpidem (Ambien), eszopiclone (Lunesta), suvorexant (Belsomra), and doxepin. Medications work best when not taken daily—only occasionally—and for just a few weeks at a time. When taken for long periods of time, they can become less effective as your body gets used to them.