For some people, it’s not enough to get to sleep, it’s staying asleep that’s hard
By Deborah Jeanne Sergeant
If you regularly sleep well but wake up too early, most sleep advice does not seem to apply. Falling asleep isn’t really the problem.
We recently asked sleep specialist Alice Hoagland, Ph.D., at Rochester Regional Health for tips on improving sleep longevity.
Q: Why do some people wake up too early?
A: Anytime someone has slept four to five hours, they’ve “bled off” the sleep pressure. When we first go to sleep, we’re sleepier than later in the day. It’s related to physiological causes as to why we are so sleepy. It doesn’t necessarily mean that you’re not sleepy, but you’re not as sleepy as when you first went to bed. It gives your brain the opportunity to start to think. Most human beings start thinking about things that have been troubling them throughout the day. It produces histamine. It’s a very alerting neurotransmitter. This is one of the reasons that when people wake up at 2 a.m., they fire off histamine that keeps them awake one or two hours, when they run out of histamine.
Q: What can people do to sleep longer?
A: You really do need to figure out why you’re waking up. One of the things we want to do is build up the sleep pressure sufficiently so when you wake up in the middle of the night, you’re sleepy enough to go back to sleep. Sleep restriction or compression helps. If you normally go to bed at 11 and get up at 7, that’s an eight-hour window. For a brief period, we have you got to bed at 12:30 to build up sleep pressure. I don’t recommend people randomly start doing this for themselves as there is a complex strategy involved. By and large, that’s a mainstay.
Q: What should people avoid doing if they wake up in the middle of the night?
A: Sometimes people wake up at 3 a.m. and they do preventive peeing. Their bladder isn’t that full, but they don’t want to think about it. Sometimes it helps but more often than not they’re more alert. Don’t’ use screens when you wake up in the middle of the night. Many of our patients use their phones for their alarm clocks. Its’s rare that someone who wakes up in the middle of the night doesn’t pick up their phones. Move the phone to someplace where there’s no access. Occasionally, I ask them to plug in the phone elsewhere.
Q: Should people get up?
A: There’s not a lot of research. It’s unlikely to be any help. Engaging in activity raises the core body temperature which causes you to wake up. Getting up to cook or bake circumvents that.
Q: What should people do if they have racing thoughts?
A: Anytime you wake up in the middle of the night and you start thinking, there’s an emotional component and it can be a conditional response. It’s important to learn how to control some of this catastrophic thinking in the middle of the night. Again, there are some strategies for doing this. It is a matter of learning how to control how you process information in the middle of the night. I recommend if you’re going to reserve the bed for sleeping or sex and you wake up, get out of bed, go to another room. People can get engaged in a good book and override their ability to sleep. It’s better to look at a cheap women’s magazine or something that’s not overly stimulating.
We see this commonly in parents of new babies when babies wake up at 3 a.m., they get up to feed the baby. At four to five months, most babies sleep through the night, but the parents still wake up. It often takes quite a while to learn how to sleep more effectively throughout the night.
Q: Can melatonin help?
A: Melatonin has a pretty short half-life. Its odds for helping you go to sleep are low. Some patients use extended-release melatonin, but I haven’t seen it work for sustained sleep.
Q: What about over-the-counter sleep aids?
A: They should not be using them, primarily because there are long-term cognitive consequences for using them for an extended period of time. Countries all over Europe are banning their use. People take them because they’re over-the-counter and they presume they’re safe.