Cut Down on Nighttime Wake-Ups: A Survey & Advice

Who would you guess wakes up more frequently at night because of stress and anxiety? Adults who are young, middle aged, or old?

What the Sleepless Nights survey tells us about middle-of-the-night awakeners, together with a dash of commentary and advice.

Sleep is less deep & restorative when disrupted by wake-ups in the middle of the nightWho would you guess wakes up more frequently at night because of stress and anxiety? Adults aged

(a) 18 to 24

(b) 25 to 34

(c) 35 to 44

(d) 45 to 54

(e) 55 and above

According to a recent survey of 1,000 adults in the United States, the youngest adults lead the pack, with 46% of the 18- to 24-year-olds reporting stress-related wake-ups at night.

Does this surprise you? Maybe so and maybe not. But data can sometimes contradict expectations. Following are a few more findings taken from the Sleepless Nights survey conducted October 19 by OnePoll,* an online market research firm, together with a dash of commentary and advice.

Waking Up in the Middle of the Night

It’s not unusual to wake up once or even a few times during the night. In fact, in the OnePoll survey, less than 1% of the respondents reported never waking up at night. But having lots of nighttime awakenings is a problem. It’s a symptom of sleep maintenance insomnia.

You might think the total amount of sleep you get is actually more important than the number of wake-ups you experience. But this isn’t true. Sleep interrupted by frequent wake-ups is not as restorative as the same amount of sleep gotten all at one time, according to a study published in the November issue of Sleep. People who sleep in fits and starts miss out on a significant amount of deep sleep, the study shows. They report feeling unrefreshed in the morning, and waking up in a bad mood.

In addition to waking up in the middle of the night, 39% of the respondents in the OnePoll survey reported feeling exhausted on awakening in the morning—and this complaint was more frequent among the young and middle-aged than in adults 55 and older. This suggests that quite a few Americans aren’t getting the amount or type of sleep we need.

Reason #1: Bathroom Calls

About 74% of the respondents reported that one reason for their middle-of-the-night wake-ups was the need to go to the bathroom. This is not surprising given the ages of the respondents (43% were 55 and older). But not only does having to void several times at night decrease sleep quality. It also puts you at greater risk for developing chronic insomnia.

So if your nighttime wake-ups are due to an overactive bladder, have a look at the blog I wrote last December on ways to cut down on the need for bathroom calls at night.

Also, a few preliminary studies I’ve seen in the past year suggest that supplements containing pumpkin seed extract, alone or in combination with soy isoflavones, may reduce symptoms of overactive bladder. If you’re game to try the pumpkin seed extract/soy isoflavone supplements, keep in mind that like most plant-based medicines, they may need to be taken a few weeks before you notice effects.

Reason #2: Temperature Changes at Night

About 36% of the respondents reported usually waking up in the middle of the night because they were too hot, and about 19% reported awakening because they were too cold.

Some of this may have to do with changes in core body temperature at night. From a high in the evening, your temperature falls by about 1.5 degrees Fahrenheit during the night, bottoming out a few hours before wake-up time and then rapidly rising again. No wonder that during the first part of the night you’re piling the covers on and in the last part, throwing them off.

Especially if you tend to sleep hot, my blog on tips for overheated sleepers may help.

Reason #3: Stress and Anxiety

Finally, 32% of all survey respondents blamed their nighttime wake-ups on stress and anxiety—which isn’t so surprising. But the suggestion that the youngest adults are the most prone to stress-related wake-ups gives pause.**

Pressure to get into a good college, find the right job, land securely among the “haves” rather than the “have-nots” at a time when in the United States the haves and have-nots are growing farther and farther apart . . . Is young adulthood more stressful now than in times past?

What do you think?

* Results of this poll, which I accessed on 12/4/2015, are no longer available online. Use the contact form on the menu bar if you’d like me to send you a copy.

** Only 37 adults aged 18 to 24 participated in the survey, so the findings on young adults may not be very reliable. Yet other research has shown at least that the number of young adults who experience insomnia is actually quite high.

An Insomnia Treatment of Her Own

A few weeks ago I got an email from Julie, who’d written to me about her insomnia before. Here’s how she began:

“I am happy to share with you, 5 months later, that I am sleeping peacefully and soundly! It didn’t happen overnight, but my improvement did happen because of the sleep restriction you recommended!”

“This woman is persistent,” I thought, and read on. I discovered that, while Julie’s first attempts at this insomnia treatment were strikeouts, rather than give up, she found ways to modify the sleep restriction protocol so it eventually worked.

Modifying sleep restriction for insomnia can lead to more satisfying sleepA few weeks ago I got an email from Julie, who’d written to me about her insomnia before. Here’s how she began:

“I am happy to share with you, 5 months later, that I am sleeping peacefully and soundly! It didn’t happen overnight, but my improvement did happen because of the sleep restriction you recommended!”

This woman is persistent, I thought, and read on. I discovered that, while Julie’s first attempts at this insomnia treatment were strikeouts, rather than give up, she found ways to modify the sleep restriction protocol so it eventually worked.

“I can now say that I’ve gone over a full month without any bad sleep,” she wrote, “and I’m now sleeping 7 plus hours a night!”

I decided to interview Julie, and here are excerpts from the conversation:

Insomnia Returns

Your insomnia started several months ago. What threw your sleep off track?

A health scare, which later turned out to be a false alarm. I didn’t sleep a wink that night, worrying about all the possibilities. . . . All it took [was] 4 bad nights to send me into the chronic insomnia pattern I experienced for the next 5 months: a few good nights followed by sleepless nights—up and down the roller-coaster.

You decided to try Sleep Restriction Therapy (SRT) for insomnia. What led to that decision?

I’d had an insomnia problem 14 years earlier that lasted for 2 years. It was caused by a bladder problem after the birth of my last baby. . . . I tried SRT but was unsuccessful with it because I needed to cure the bladder problem first.

I never expected to sleep poorly again after what I went through and solved 14 years ago. It was a total shock that the insomnia came back as horribly as before, only this time I couldn’t blame it on my bladder! I decided to take aggressive action. I purchased The Savvy Insomniac, and a book by Dr. Arthur Spielman. Everything I read encouraged me to try SRT again.

A Rocky Start

How much did you restrict your sleep at first, and how did you fare?

To begin SRT, I averaged my previous week’s sleep and came up with 4½ hours. I decided to stay up until 1 am and get up at 5:30. At first, I decided to stay in bed during those 4½ hours whether I was sleeping or not. My results were terrible! I alternated between zero sleep nights and 2 to 3 hours [of sleep]. Determined to force this to work, I started to get out of bed when I wasn’t sleeping. That didn’t work, either. I got an occasional 4-hour night but I was so sleep deprived [that] I didn’t feel comfortable driving at night, which was a deal-breaker for me.

You say that SRT called up lots of anxiety. Can you elaborate?

Being that regimented just threw me for a loop. I really dreaded the evenings. I would be up for hours after my family went to bed, waiting to fall asleep until the right time. For me, staying up later than the gang was . . . stressful. [And] looking at the clock, especially at bedtime, seemed to cause me stress.

Also, there was an 11-mile hike I was looking forward to in a month, and I put pressure on myself to be in good shape by then. Every day that I couldn’t . . . increase my time in bed, I would get discouraged and feel that going on the hike would be an impossibility. I also worried that health-wise it was not good to spend [such a] short time in bed for an extended period—and this was not looking to be a short-term project for me.

Rewriting the Rules

So you decided to make some changes. What were they?

The thing I discovered is I had to do [SRT] in a flexible way that worked with my environment and my personality. I decided to come up with a modified version of SRT, one I could stick with long-term.

First, I needed to be able to go to bed when my family did. . . . And I needed to start with 6 hours [rather than 4½].

I was not going to watch the clock strictly. I [would go] to bed at approximately 11:30 and get up at 5:30, but it worked best if I didn’t look at the clock.

Since even in normal times I usually had a few wake-ups an hour or 2 before it was time to get up, I vowed to get out of bed at one of these wake-ups, or at 5:30, whichever came first.

I did not put a time limit on how long I would keep up this routine, so there was no pressure to improve. I also vowed to make this a background project in my life—do my 6 hours in bed and go about the rest of my life.

How well did your modified protocol work?

I had one of my longest periods of good sleep . . . followed by some “off” nights. Then another record-long period of good nights, followed by 2 weeks of off-and-on.

Once I got past that, things improved at a quicker pace. I went a month with only 1 bad night, then a month with 3 bad nights, then, finally, a month with no bad nights. Two months into the project, I bumped up my time in bed by 15 minutes. Two weeks later, I added 15 minutes more. I’m now up to about 7½ hours’ sleep per night.

Julie’s right where she wants to be with her sleep. The way she got there–and the changes she made to SRT–wouldn’t be helpful for everyone. But my hat’s off to anyone who can take this insomnia treatment and tweak it in ways that work.

If you’ve managed a similar feat, please share your story here.