10 Reasons You Wake Up in the Middle of the Night (and How to Fix Them)

Sleep patterns change with age — but insomnia is not a given. Here’s what older adults need to know to get enough sleep.

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Waking up in the night more often than you used to? That’s common and not entirely avoidable — we naturally spend less time in deep sleep as we age. That means many of us wake up an average of three or four times each night as we get older. Still, there could be other factors at play that you can do something about.

“All sleep problems are unfortunately much more common in older adults,” says Molly Atwood, Ph.D., a psychologist and behavioral sleep specialist at Johns Hopkins School of Medicine. “Part of it is that as our body changes, the sleep centers in our brain begin to change, too. We release less of the hormone melatonin.”

It’s also not uncommon for older adults to have medical conditions, suffer pain, or be on medications that affect sleep, she says. And then there are the big lifestyle shifts, like retirement, that can lead sleep habits to become more variable.

Waking up from a peaceful night slumber can be annoying, but it may not be cause for concern as long as you feel rested the next day, says Christopher Winter, M.D., author of The Sleep Solution: Why Your Sleep Is Broken and How to Fix It. “We put such a premium on falling asleep fast and never waking up, when really, it’s about how good you feel the next day,” says Dr. Winter. “That’s the goal.”

If those nighttime wakeups are coupled with profound sleepiness during the day, however, Dr. Winter says it’s time to call your doctor or a sleep specialist for help.

Atwood agrees, adding these warning signs to the list of times to loop in your doctor:

• You’re waking up in the middle of the night at least three days per week and it’s taking you at least 30 minutes to get back to sleep
• You’re feeling really fatigued or irritable during the daytime
• Your concentration is off
• You’re having difficulty with memory

“All of these are reasons to seek some help because insomnia is very treatable, even in older adults,” says Atwood.

One thing that won’t help: getting frustrated, she adds. If you wake up and can’t fall back to sleep, don’t fight it — get out of bed and do something relaxing and enjoyable, like drawing, knitting, or gentle stretching.

“You’re much more likely to notice sleepiness when you’re calm, and you can go back to bed and sleep easier,” Atwood says.

Let’s look at what might be keeping you up.

1. Medications

If your insomnia starts around the time you begin a new medication, it could be due to the drug. Some common offenders:

• Corticosteroids, such as those used to treat inflamed muscles and joints due to tendinitis or rheumatoid arthritis
• Blood pressure medications, such as beta-blockers
• Anti-depressants, such as SSRI’s (selective serotonin-reuptake inhibitors)
• Nasal decongestants

Important tip: Don’t stop any prescribed medication without consulting your doctor first. Doing so can put your health at risk. If you’re taking any of these medications and have concerns about your sleep, talk to your doctor or pharmacist about adjusting the dosage, taking the meds at a different time of day, or trying an alternative treatment.

2. Sleep apnea

Sleep apnea is a disorder where your breathing repeatedly stops during the night. While apnea can jolt you awake gasping and choking for air, it’s more likely to wake your partner than you. Apnea also wouldn’t make it hard for you to fall back to sleep, but if it wakes you to the point of awareness, that creates an opportunity for something else to keep you up, Atwood says.

Regardless, you’ll want to schedule a sleep test if you notice any of these symptoms:

• You feel exhausted during the day and/or need to take naps
• You snore loudly
• Your breathing stops during sleep (likely, someone else would notice this)
• You wake up with a dry mouth and/or headache

Apnea symptoms can vary by gender, says Atwood. For example, middle-of-the-night gasping occurs in men more often than women. Women often report feeling rundown and sluggish during the day.

If you’re diagnosed with sleep apnea, your doctor may have you try a CPAP (continuous positive airway pressure) machine, which delivers air pressure through a mask to help you sleep. Can’t imagine sleeping with a mask on your face? You’ll get used to it when you—and your partner—are sleeping a lot better. Studies show that treating even mild sleep apnea can improve quality of life.

3. Leg movements or sensations 

Restless legs syndrome (RLS) can be hard to describe, but if you’ve ever had that tingly, creepy-crawly, “electric” sensation — that makes you really, really, really want to move your legs — you know exactly how it feels.

RLS acts up during times of rest — while you’re seated on a flight or lying in bed — and unlike things like muscle cramps or neuropathy, it’s very specific to the evening, Dr. Winter says. Usually, RLS makes it harder to fall asleep, but it can wake you in the night as well. Getting up and walking for a few minutes usually makes it go away.

Many people with RLS also have something called periodic limb movement disorder (PLMD), where you kick or twitch your legs repeatedly (usually every 5 to 90 seconds) during the night, according to the Cleveland Clinic. Diagnosing PLMD takes an overnight sleep study to record your number of leg movements. These movements may not fully wake you, Dr. Winter says, though you’ll probably feel sleepy the next day.

Luckily, both conditions can be medically treated. Because RLS can be from iron deficiency, you’ll want to rule that out first. With treatment, RLS symptoms typically improve, and quickly—in as little as two nights.

4. Mood problems (stress, anxiety, depression)

If you wake up in the night and your heart’s pounding, your mind’s racing, or you feel tense, stress or anxiety could be to blame, says Atwood. If you wake up ruminating or dreading the day, particularly if it’s early morning, those could be signs of depression.

The science-backed therapy called cognitive behavioral therapy for insomnia (CBTI) can improve your sleep and your mood. With CBTI, a therapist talks to you about your mental and emotional state as well as behaviors that might be throwing off your sleep systems. You’re asked to track your sleep and how many times you wake up in the night. Then, your therapist works with you to come up with a plan, including behavioral changes and relaxation techniques.

Belly breathing is one relaxation technique that Atwood teaches her patients. The idea is to breathe out longer than you breathe in, so your belly rises and falls. Try this: Breathe in through your nose for a count of three, and then out through your nose for a count of four or five. “That triggers the opposite of the fight-or-flight response in your autonomic nervous system,” she says.

With CBTI, you usually see results pretty quickly, in six to eight sessions, Atwood says. You can search for a CBTI provider here.

Learn other relaxation techniques in a SilverSneakers LIVE Mindfulness & Meditation class.

5. Urge to pee

If the urge to pee happens multiple times a night, you may want to see your primary care doctor or urologist to rule out a urinary issue, like an enlarged prostate, Dr. Winter says. This is particularly recommended if the urge seems out of proportion with the amount of urine you’re producing, he adds.

If you pee frequently during the night and day, that could point to a kidney or bladder issue, such as kidney disease or urinary infection. If you pee frequently during the night but little during the day, that may be a sign of a sleep disorder like sleep apnea. Excessive thirst and urination could also be a sign of diabetes, according to the Mayo Clinic.

Beyond that, the problem — and solution — could be simple: Try to stop drinking earlier in the day. Start with two hours before bed, and if that doesn’t work you can gradually increase it up to four, Atwood suggests.

6. Overheating

Our bodies are programmed to experience a drop in core temperature a couple of hours before bed, and to keep falling throughout the night, reaching a low point in the early morning and gradually warming again shortly before we wake. But a bedroom that’s too hot may be uncomfortable and interfere with your body’s temperature regulation.

Keep the thermostat between 60- and 67-degrees Fahrenheit for the best sleep. If you’re cold when you go to bed, consider adding layers to your bedding rather than wearing more clothes, Dr. Winter suggests. “A lot of people when they go to bed are overdressed, and when they get hot at night it’s not easy to get out of your clothes. But it’s easy to kick off a cover.”

7. Coffee too close to bedtime

Caffeine has an average half-life of five hours. This means that after five hours, half of it is still in your system. But it could be as long as nine and a half hours depending on how your body processes it.

Stop caffeine intake eight hours before you plan to go to bed. To wind down at night, consider caffeine-free options, like chamomile tea, Dr. Winter suggests.

8. Too much alcohol 

Yes, alcohol can help you fall asleep. But once your body processes it (this happens quickly) that sleepiness subsides, waking you up before you’re fully rested.

Try to cut yourself off four hours before bedtime, Atwood suggests. And stick to health guidelines: Men, limit yourself to two drinks, and women to one.

9. Falling asleep with the TV on

Or the radio, or a podcast, or music. “The brain is sensitive to changes in the volume of noise,” Atwood says. “So if something is suddenly a bit louder, our brain is going to want to attend to it to make sure we’re safe. That can definitely wake you up.”

Can’t take the silence? Try a white noise machine. Because white noise is monotone, it can drown out changes in volume — a great trick if you happen to live in a city or loud neighborhood.

10. Too much sleep

Often when we’re older, we experience a mismatch between our sleep need and our sleep opportunity, Dr. Winter says.

“It’s kind of this cruel trick that life plays on us,” he says. “When we’re in our 30s and have kids all over the place, all you want is extra time to sleep.” But when you’re older and retired, you may not need as much sleep, though you have more time to do it.

The National Sleep Foundation recommends 7 to 8 hours of sleep per night for older adults. So if you’re going to bed at 9 o’clock and sleeping until 7, which is 10 hours, then pauses or interruptions in your sleep make total sense, Dr. Winter says.

Try staying up a little later, Dr. Winter suggests. “Instead of getting into bed at 9, stay up until 10,” he says. “Keep your wake time the same. It’s shrinking the window for sleep, not shifting it.”

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