What to do if You Can’t Fall Back Asleep

A guide to uncovering the cause of insomnia and what to do when it strikes in the middle of the night.

By Sheryl Grassie

Almost everyone has the occasional experience of waking up in the middle of the night and failing to get back to sleep. Your mind races, you worry about a big meeting at work, you are too hot, or you just can’t get comfortable. Depending on when you go to bed, it could be 2 a.m., 3 a.m., or 4 a.m. and the prospect of having to get up without enough sleep looms.

If this happens on a regular basis, it is considered a type of insomnia, often called sleep maintenance insomnia or middle insomnia. Estimates are that up to one-third of the population experience between one and three episodes of unwanted nightly waking, or insomnia, on a regular basis.

If you suffer from this sleep disorder, the first course of action is to assess the cause. It can take some work to pinpoint the problem, but with a little effort, you may be able to solve your sleepless nights.

Reasons You Might Be Waking Up

Regular waking up in the middle of the night is a type of sleep disorder, especially if you stay awake. It can be caused by physical ailments, environmental circumstances, or lifestyle choices that inadvertently result in poor sleep hygiene. Middle of the night waking may be a natural consequence of aging as our sleep cycles shorten and we spend less time in deep sleep, or the result of a secondary condition like too much stress at work or a recent physical accident.

Finding the Cause of Your Nighttime Waking

Pinpointing the cause or causes of your sleepless nights is worth investigation. Is noise waking you? Is the dog moving around in your bed? Are you too hot? Are you in pain? Are pajamas tangling as you shift your body position during sleep? Is sleep apnea causing you to wake? Sleep experts recommend you start by keeping a sleep journal that details things like:

  • The time you went to bed
  • When and what you last ate before bed
  • Any alcohol consumption; how much and when  
  • Daily caffeine intake; how much and when
  • When and how much you exercised
  • Any naps during the day, duration and at what time
  • Exposure to sunlight, how much and when
  • How many times you woke during the night and approximately how long you were up
  • Any significant life stressors
  • Any physical pain, especially that you are aware of upon waking
  • Thoughts about what woke you (i.e. had to go to the bathroom, noise on the street, etc.)

Once you have done this for a few weeks you should begin to see patterns. For example, maybe you always wake up on nights you have a late glass of wine, or on days when you took a nap. Then you can adjust your choices to ensure a better night’s sleep. The information from this journal will also help enormously if you can’t resolve the problem yourself and need to see a doctor.

7 Sleep Strategies to Help You Fall Back Asleep

The goal is to get back to sleep as quickly and easily as possible. The literature on getting back to sleep in the middle of the night supports some very specific things to do and not to do. Here are some tactics to try.

Deep breathing and muscle relaxation

Start by slowing your breath and concentrating on your body. Breathe deeply and rhythmically and work your way through your body consciously relaxing the muscles. Start with your head, relaxing your head and neck muscles, then move on to arms and chest and work your way down. Most people are asleep before they get to their toes.

Listen to something

Keep a small MP3 player next to your bed and listen to a favorite meditation tape, relaxing music, or a book on tape (preferably something that is not very stimulating). There is a wide variety of options that can be easily downloaded. They range from nature sounds to guided imagery and are wonderful sleep aids. You can target stress reduction, or anxiety, or just listen to a favorite piece of classical music. You’ll be asleep in no time.


This involves getting out of bed and starting over. You can do a shortened version of your bedtime routine like, go to the bathroom, get a drink of water, and go to bed. Or, you can engage in a more elaborate ritual of getting up, lowering the temperature in your room, taking a warm shower, brushing your teeth and going back to bed. In essence, you are telling your body, “We are getting ready for sleep.”

Get up and do something boring

Sleep experts strongly advise that if you can’t fall back asleep within 15-20 minutes, you should get up and go to another room. Do something boring or low key like knitting, reading, or journaling. Keep lights low and do not go on any electronic devices, meaning don’t check emails, watch anything online, or read an eBook. The blue light from electronic devices is believed to interfere with sleep.

Think about staying awake

This reverse psychology approach does seem to work. Lie in bed and think about trying to stay awake. Tell yourself you need to stay awake and your body will naturally try to fight it by making you sleepy.

Put on a pair of socks

Sleep experts recommend you try doing something that mimics the physiological response of sleep. Warming the feet with a pair of socks can increase blood dilation which is a predictor of sleep onset.

Don’t fret and don’t look at the clock

If you find yourself awake, the first thing to do is turn your alarm clock around so you can’t see it. Research shows that people who focus on the time passing generally wind themselves up further. Just relax and estimate those 15-20 minutes. If you haven’t fallen back to sleep, don’t lay there and fret, just employ a strategy mentioned above

Tips for Preventing Nighttime Waking

It has been said many times, “A good night’s sleep begins during the day.” Here are some tips for maintaining healthy sleep hygiene even during the day:

  • Stay away from caffeine later in the day
  • Limit fluids before bedtime
  • Don’t eat late in the evening
  • Stay on a sleep schedule, going to bed and getting up at the same time daily
  • Get exposure to sunlight in the morning
  • Sleep naked
  • Take magnesium
  • Keep your pets out of the bed
  • Get needed support, a new pillow or new mattress
  • Keep the bedroom dark and cool
  • No screen time for two hours before bed
  • Keep the bedroom only for sleep and physical intimacy

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