I Wake Up at 3 a.m. Every Night. How Do I Get Back to Sleep?

By Margaret Crandall

Dear TueNight,

I used to be a champion sleeper. I’d be out like a light when my head hit the pillow, unconscious for at least seven hours. Not anymore! For the last several months, I’ve been waking up in the middle of the night — usually around 3 a.m. — and then I can’t get back to sleep. I’m exhausted, cranky, and way too busy for daytime naps. Oh, and sleeping pills scare the hell out of me. I’m desperate for sleep — can you help me?

Sincerely,
Suddenly Sleepless

Dear Sleepless,

I am not a doctor (I have an utterly useless sociology degree). But I have been in your shoes. In fact, I am still in your shoes, and getting so comfortable in them that said shoes could probably use some Febreeze. 

Before I give you any “tricks” or advice, I’m going to assume you practice what the content farms call Good Sleep Hygiene: you live like a sober, caffeine-free, physically fit monk who has a set bedtime and doesn’t sleep next to someone who saws logs like a lumberjack (and refuses to try those nose strips and/or sleep on the couch). Those same experts also say you shouldn’t have cats or other rude nocturnal pets in your room, and you should limit sugar and all the other things we’ve been numbing ourselves with since March 2020. Oh, and you absolutely shouldn’t bring any electronics with you to bed. (TikTok and sleep are sworn enemies.)  

Are you doing all/most/some of that and still waking up in the middle of the night for no good goddamn reason? Welcome to the Hormonal Shitshow (trademark pending). Now might be a good time to make an appointment for some blood work.

When I went to my doctor for the same problem, his initial diagnosis was sleep apnea. He got very excited about this. There were sleep studies I could do! Machines I could try out! Ohhh boy, here was a project he could sink his teeth into!

I cut him off with, “Hey, doc, um, I haven’t had a period in several months. How about we test for menopause hormones first?” He made Wee Bey face and quickly put in the blood work order.

Shocker: My blood work came back saying, hormonally, I was in my 70s. (I was 47 at the time.) He referred me to the gyno in short order, and she suggested hormone replacement therapy. When I asked her about the risks of HRT, she told me to Google it. #WTAF

I weighed the pros and cons, and decided to try the meds for a few months. Things got a little better. I was sleeping longer, even had a bit more energy. Then I went off the pills to see if I was fixed. Turns out, not really. It depends on so many other things: exercise, food, stimulants, various family crises, possibly a global pandemic. A friend suggested I try some over-the-counter hormone creams, but the instructions were vague and the corporate customer service nonexistent. After a few weeks, I gave that up too. Those tubes are somewhere in the back of my bathroom cabinet, their contents expiring as I type.

Most nights, I still wake up between 3 a.m. and 4 a.m. A few nights ago I woke up soaked in sweat, heart racing from a nightmare in which I was either trying to save Keanu Reeves’ life, or he was trying to kill me. I spent a few minutes trying to remember the plot — and then fell back asleep.

But most of the time, when I wake up in the middle of the night, I lie there and ask myself questions:

1. Do I need to pee? How badly do I need to pee? Did my bladder wake me up? How is that even possible when, in my youth, my friends called me “the camel” because I never, ever needed to go? If I can force myself out of bed to use the bathroom, I can fall back asleep pretty easily.

2. Am I thirsty? Do I have the energy to reach for the water bottle next to the bed and chug as much as possible? If yes, that’s all I need for more sleep.

3. Do I have any control over this situation? If this is not a matter of fluid entering or leaving my body, and sleep is no longer an option, should I just get out of bed and start my day? I’ve done this a few times, with varying degrees of success. Sometimes I’ll have coffee at 4 a.m. and go back to sleep. The subsequent caffeine-induced anxiety dreams make me regret it.

4. What if I lie here and read something challenging and slightly boring? This is when I wish I still subscribed to the print edition of The New Yorker. I don’t want to call out any boring writers by name, but sometimes that’s all it takes.

5. Should I meditate? I paid money for that Headspace app but I never use it. Should I try it now? The thought is usually so exhausting that I fall back asleep.

By now you’re probably thinking, “I asked you for advice, not your personal life story.” So here’s the TL;DR:

• Talk to your doctor if this is a debilitating problem. There is a good chance this is hormone-related. (“Hormonal Revenge” would be a great band name.)

• Start tracking what helps and what doesn’t. Consider trying something like melatonin or CBD. But start with the tiniest amount possible. 

• Listen to your body when it wakes you up in the middle of the night. It might be trying to tell you something. 

And if there’s anything I missed, I hope readers will let me know in the comments!

Originally Published April 19, 2021. Updated May 28, 2021.