Up at 4 A.M.? Fall Back Asleep the Natural Way

All you did was get out of bed to pee. And now you're tossing, turning, and stressing your way toward dawn. Figure out what's up with middle-of-the-night insomnia so you can finally get the rest you need.

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Forget sheep—what I should count instead are all the hours I've been up in the middle of the night. There's nothing worse than lying in bed and watching the sky turn from black to shoot-me-why-can't-I-sleep blue. But that's what happens when I pop awake at 3 or 4 A.M. and my mind gets on the worry hamster wheel: When did the tax guy need me to fax him the W-2 form? Did I lock the back door? Why hasn't my client replied to my email yet? Oh, God, did my email to the client even go through?!

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To be clear, falling asleep when I first slip into bed around midnight has never been a problem. Show me a pillow and I'll show you a conked-out woman—at least for the first few hours. But once a week or so, an innocuous wake-up in the middle of the night—you know, getting up to grab the blanket that I accidentally kicked off the bed, or hearing a random noise—leaves my mind switched on for hours. As my husband lies next to me, practically grinning in his sleep from all the delightful rest he's getting, I stare wide-eyed at the clock. By morning when the alarm goes off, I'm a groggy, foggy mess. Moreover, in the light of day I realize that the problems I lost so much sleep over are mostly really big nothings.

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Experts call this "sleep maintenance insomnia," which they define as regularly taking more than 30 minutes to return to sleep, associated with distress—and it's very common, explains John Winkelman, M.D., Ph.D., associate professor of psychiatry at Harvard Medical School. "You wake up to use the bathroom, for example, and can't return to sleep because you are mentally and emotionally stimulated," he says.

There are many of us in Sleep Maintenance Insomnia Camp—nearly a third of the population reports trouble falling back asleep in the middle of the night, says the National Sleep Foundation, a nonprofit research group. And women are 50% more likely than men to have problems sleeping through the night. As we age, it becomes even more difficult to get a full night's rest "because our sleep gets more fragmented and we wake up more," explains Nancy Collop, M.D., professor of medicine and neurology at Emory University and director of the Emory Sleep Center. Restless legs syndrome, shifting hormones, and hot flashes are all among the culprits. And of course, regardless of age, more wake-ups mean more opportunities for the worries to creep in.

Surprisingly, women aren't rushing to fix the sleep maintenance problem. "Middle-of-the-night wakefulness tends to be what I call a doorknob complaint," says Winkelman. "Only when patients are walking out of an appointment with their hand already on the door, will they say, 'Oh, by the way…'" But it's important to your health to resolve the issue—losing even a few hours of shut-eye multiple nights a week can increase your risk of memory loss, weight gain, heart attack, and stroke, says Charles Bae, M.D., a neurologist and sleep medicine specialist at the Cleveland Clinic.

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Bottom line: Through-the-night sleep isn't a luxury—it's a basic need. Below, experts not only demystify how a worry wakes you up but also offer smart solutions to help you drift off again easily. The best part about the sleep aids you'll find here? They're all pill-free. Read on to get your sleep on.

Reading a few paragraphs of a book (just enough to distract you from your worried thoughts) may help you doze off again.

How Worrying Flips Your "On" Switch

Even if you haven't been jolted out of sleep by a noise or a kick by your bedmate, waking briefly a few times a night could happen naturally at the end of any 90-to 120-minute sleep cycle, before you reenter lighter stages of sleep. But when the worrywart within joins the party, that momentary wake-up turns into hours of lost sleep.

  1. A concern surfaces. If we're not sure how something will play out at work tomorrow or what we'll do if the school event gets rained out, our primitive mind prepares us for the worst possible outcome. That's because, back in our cavemen days, there was survival value in assuming things would end badly—it allowed us to be prepared in case we needed to flee for our lives.
  2. The brain triggers a little freak-out. The primitive part of the brain—the amygdala—thinks your idle ruminations are urgent matters that need to be dealt with right away. In a process called cognitive fusion, it treats worried thoughts as if they're real emergencies.
  3. The body becomes very alert. Your amygdala has just initiated a fight-or-flight response to get you ready to take on whatever's coming. Your brain releases adrenaline and cortisol, and your body reacts: Your heart rate and blood pressure rise, and your muscles may even start to tighten.
  4. You're wide awake on the worry treadmill. People tend to catastrophize in the middle of the night—in other words, your brain makes a big deal out of everything. The larger our problems seem, the more alert the body becomes (again, that's adrenaline at work) to try to solve those problems.

The Problem with Popping a Pill at 4 A.M: "Sleeping pills do not usually treat the cause of the insomnia," says Meir H. Kryger, M.D., a physician and professor of medicine at the Yale School of Medicine. And there are all sorts of problems with pills. Over time, your body can adapt to the medication so that you'll need a higher dosage. Plus, there's the risk of "rebound insomnia"—the insomnia returns the second you stop taking the pills. The safest solution is to get the help you need to address the anxiety that's keeping you awake, but if you must reach for a pill, don't grab an OTC sleep aid. Popping one at 3 or 4 A.M. doesn't allow enough time for it to wear off before you wake up in the morning. Instead, talk to your doctor about Rx options with a very short half-life so that if you take a pill, it's gone from your system in three or four hours.

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Your Fall-Back-Asleep Prescription

Try these solutions in the middle of the night, or anytime you can't readily drift off. There's no one-sleep-aid-fits-all, so test out one or two each night until you find what works best for you.

  1. Do some "belly breathing." Focus on expanding your diaphragm, the muscle at the bottom of your rib cage. This stimulates your vagus nerve, which activates your parasympathetic nervous system, sending a message to the brain to relax. "It dissipates the fight-or-flight response, calms you down, and makes you feel sleepier," says Chad LeJeune, Ph.D., professor of psychology at the University of San Francisco and a founding fellow of the Academy of Cognitive Therapy. Try this: While either sitting up or lying down in bed, place a hand on your belly. With every inhalation, your hand should be pushed out by your abdomen.
  2. Get out of bed. "If 15 to 20 minutes have passed and you're still awake, get out of bed, go out to the couch, and do something quietly relaxing, like looking through a magazine," says Lisa Medalie, a behavioral sleep medicine specialist at the University of Chicago who has helped many women work through middle-of-the-night anxiety. The reason it's important to head to the sofa instead of staying tucked underneath the covers? "If the bed is repeatedly linked with frustration and restlessness, over time it will trigger anxiety and make your insomnia nights more frequent," Medalie explains. Also, walking around starts the blood flowing again and helps the muscles relax, reversing your body's fight-or-flight response.
  3. Note—and release—your worries. One classic fix that experts suggest: Keep a notepad on your nightstand and write down to-dos buzzing in your brain. Another method is to acknowledge and then release each worry as it occurs to you—i.e., There goes an anxious thought. And another.
  4. Take a "mental stroll." Visualize locales that bring you a sense of peace—perhaps your favorite vacation spot or your grandmother's home. Readers swear by this one: Karen Cooperstein, 47, imagines the route she used to walk to school as a child. "I try to recall each neighbor's name and what their house looked like," she says. "Somehow by pushing my memory, I get out of my own way. I always fall back asleep before I make it to school in my mind." Lisa Munjack, 49, pictures herself going through a sequence of yoga poses, as if she's taking an actual class. "Usually by the third sun salutation, I'm out," she says.
  5. Listen to something calming. Turning on some white noise can help you get back to sleep by giving your mind something to focus on—in this case, the constant and predictable flow of sound—besides your anxieties, say experts. You could try a device like the Marpac Dohm-DS ($50, Amazon), which emits a steady, monotonous white noise. Or download an app like Sleepmaker Rain (free for both iPhone and Android); it can lull you back to sleep with the soothing sound of rain pattering. Just note that it may be better to use background noise only occasionally, since it's possible for your brain to become reliant on the sounds, making it harder to fall asleep without them.
  6. Call in the pros. If DIY sleep solutions don't work, and you've had trouble falling or staying asleep three times a week for a month or more, it's worth seeking professional help from a primary care doctor, a sleep specialist, or a therapist. They can help address any physical issues or get to the root of your anxiety.

This story originally appeared in the January/February 2015 issue of Dr. Oz The Good Life.

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