I fall asleep easily every night, but after about four hours, I wake up and am wide awake. It often takes me an hour to fall back asleep. I don't think it's stress. Sometimes I think it could be eating before bed, but other times I eat before bed and sleep fine. What could be going on?
Difficulty falling asleep or staying asleep is called insomnia, and it's a common condition, as you can tell from all the ads for sleeping pills. One-third of the population will experience a sleep disorder at some time in their life and one in 10 have chronic sleep problems.
To diagnose a sleep problem, a doctor will take your sleep history and often ask you to keep a sleep diary. In your brief question, you've provided useful information about your sleep history and also hit upon common causes of insomnia. Since you're not awake worrying, you are probably correct that stress is not the cause. However, it could be eating too much, drinking alcohol or caffeine, or vigorous exercise—all of these behaviors can be problematic too late in the day. The combination of these behaviors also could be the issue. For example, eating late may not keep you up, but eating late and drinking alcohol does.
It's also important to ask yourself other questions: Could the room environment (temperature, lighting, or noise level) change at the time you wake up? Are you woken up by a bed partner who snores or has restless legs? A partner may be able to provide clues about your sleep problem (such as severe snoring). Also, medical conditions or the drugs used to treat them may be associated with sleep disorders.
One key point to know is whether the problem is chronic or recent and short term. You seem to be describing a problem that occurs almost every night and is not related to your behaviors, as best you can tell. Yet even if your behaviors didn't cause the problem, they may be able to cure it.
You can take steps to fix the problem, such as going to bed and getting up at the same time every day. Also, if you can't fall asleep, don't stay in bed. Get up and do a relaxing activity until you're tired.
Another way to solve the problem is through sleep restriction. Sounds like fighting fire with fire, doesn't it? But it can work. Take the total time you sleep each day (not the total time in bed) and set your alarm so that is all you are allowed in bed. At first you'll sleep less if you continue to wake up in the middle of the night. But over days, and by slightly extending the allowed time in bed, you may re-establish a normal sleep pattern.
If your problem continues despite behavioral changes, talk to your doctor. Medications—over-the-counter or prescription—should not be the first step in treating a chronic problem. Their effectiveness, other than for short-term problems like jet lag, is not well established, and they often have side effects. A small number of patients require full sleep evaluations in a sleep lab, and your doctor can determine if that is needed.
For more information on sleeping problems, please visit The National Institutes of Health.
