The less sleep you get each night, the more your mind begins to focus on trying to sleep. This can often cause a vicious cycle of stress, worry, and sleeplessness. If that all sounds a bit like you, here’s a set of questions you can ask yourself—helping to narrow down the causes of why you’re waking up periodically throughout the night, and what you can do to improve your sleep habits.

Are you actually waking up every two hours?

First things first: are you really waking up every two hours, every night? That’s four or five times in the average sleep. You may be waking up that much, and if so, the information below should help. But evidence also suggests that we tend to overestimate how often we wake up, as described in this article by WSJ.

Especially if you’re used to sleeping soundly throughout the night, finding yourself repeatedly waking can be a stressful experience, and one that preoccupies us during the day. But it’s important to maintain objectivity, try to get to the bottom of an unrestful sleep, and keep our attention on the quality of sleep that we do get, no matter how little that may be!

Some waking during the night is completely normal

It’s actually quite rare to go a whole night without at least partially waking. If we return to sleep quickly, however, we usually don’t remember those moments of wakefulness. Waking up for more than thirty seconds is normally the point at which your body may become more aware, and you may become conscious of waking up, and retain a memory of waking in the morning.

Still, it’s not unusual to wake up fully once or twice per night. For some people, waking three or four times might be the norm, due to long-standing hereditary factors or lifestyle habits. If you regularly wake up four or more times, however, it’s definitely something you should be looking into, for the reasons suggested below.

Repeated waking at regular intervals

Environmental alarms

Like almost every mammal, we humans sleep in cycles, with certain points in the cycle being more susceptible to disturbance than others. Sometimes, intrusive elements of the environment in which we sleep can occur during these lighter parts of the sleep cycle, meaning you can be quickly and easily awoken.
For example, say you normally go to bed at 11:00 pm, and cycle through two stages of sleep in around 2.5 hours (the average sleep cycle duration, according to psychology today). Then say your neighbor, who works a night shift, leaves for his job around 1:30 am each morning, slamming his car door in the process.

While the sound of a car door slamming might not normally wake you, the fact that it occurs during stage 1 of your sleep cycle means you’re more easily woken. Add that to the fact that you may not necessarily be aware of the sound that woke you, and you’re left awake and confused at the same time each night.

It’s not just sounds that can have this effect. There are many environmental alarm clocks that might be waking you without your knowledge, especially if they occur during stage 1 or 2 of the sleep cycle. The heating being turned on in an apartment complex, sirens—or even your partner entering a particularly ‘snorey’ part of their own cycle—can all result in you being woken up on the regular.

Anxiety

If you’ve managed to rule out environmental alarms as the cause of your restlessness, internal alarms might be the culprit. Worry, stress, and anxiety can result in the brain giving itself issues to solve and problems to mull over—deciding that you need to be awake in order to fully process them.

Just as a person might suffer panic attacks according to a particular schedule or set of triggers, waking at the same time or with the same regularity can be an irrational response to an upsetting or overstimulating period of life.

Repeated waking without a clear pattern

Waking up repeatedly without an identifiable reason could also be a sign of an underlying medical condition, ranging from the quickly treatable to those requiring a visit to a doctor or sleep specialist.

Restless leg syndrome is an uncontrolled movement of the legs, sometimes accompanied by itching, tingling, or pain. While often unnoticed during the day, the syndrome can easily wake a person at night. Sleep.org suggests that repeated waking also correlates with hypertension—high blood pressure—which may be a sign of prediabetes.

According to Sleep Advisor, millions of Americans also have undiagnosed sleep apnea, where the body struggles or even briefly ceases to breathe during sleep. Our bodies are pretty good at waking us up if or when this occurs, but again, we might not know why we have woken.

What’s your bedtime routine like?

For those waking regularly during the night, it’s important to take a long, hard look at what happens before lights out.

Indigestion

The closer you eat to bedtime, the less time your body has to fully process and digest your meal. Unless you’re a vampire or an astronaut, it’s likely that you sleep lying down, which further prevents healthy digestion. As a result, heartburn and acid reflux can occur, and even a mild case is enough to wake you up. Therefore, it is suggested that you stop food intake three hours prior to bedtime.

How easy is it for you to fall asleep?

Bad habits such as time spent in front of screens, working late, or simply not taking time to relax in the evening can make it hard to fall asleep, causing a restless night from the outset. Slight hormone imbalances can cause the same effect, meaning that women may wake up more often around their periods.
On the other hand, if you’re finding it easy to go to bed early, it’s possible that you’re cycling through your deep sleep earlier in the night than most people, meaning that you start to wake up earlier, too.

What’s your morning routine like?

The things that you do during the day can have a large effect on your sleep health, even if they occur hours before your head hits the pillow.

Caffeine

Caffeine stays in your system for hours after your last cup. The exact number of hours can vary according to your metabolism and preferred roast—but it can be up to 8 hours before the drug completely leaves the body. Web MD suggests that mismanagement of caffeine, alcohol, and tobacco are the primary reasons why people wake up at night. If you’re looking to wean off caffeine, check out our step-by-step guide on how to wake up without coffee.

Exercise

Too much exercise, too close to bedtime, and your body can find it difficult to successfully enter the sleep cycle. Too little exercise during the day and the same applies. It’s not rocket science, but ensuring you get a regular 30 minutes of exercise per day is one of the most reliable ways to support healthy sleep.

Is it time to consider an insomnia diagnosis?

There’s no clear line between sleeplessness and insomnia. Medically speaking, insomnia is defined as having difficulty falling or staying asleep, even when a person has the chance to do so.

Middle insomnia

Middle insomnia refers to the condition of being able to fall asleep, but waking up in the middle of the night. Unfortunately, once middle insomnia sets in, it can be hard to break the habit. According to The Mayo Clinic, sleep aids aren’t usually too successful in providing relief, or a solution.

Nightmares/night terrors

We only remember a small proportion of our dreams. As such, it’s possible to be woken by vivid or unpleasant thoughts without realizing it. If you notice yourself waking from nightmares once or twice, the reality may be that dreams are more responsible for your sleeplessness than you think.

How much sleep do you actually need?

Circadian rhythms

The well-known recommendation of seven to nine hours of sleep per night is an average, designed to apply to the largest proportion of people. While that means the recommendation probably does apply to you, you may also fit into the minor category of people who need a greater, or fewer hours of sleep per night.

Your circadian rhythm is (broadly speaking) your biological or internal clock, and most people have a tendency towards a 24-hour rhythm or cycle. This doesn’t apply to everyone, however. So if you find yourself regularly getting less than the recommended seven hours, perhaps the truth is that you simply don’t need it. It’s really all a matter of how you feel.

Sleep-wake phases

A person with a delayed sleep-wake phase is more commonly known as a night owl. These are people whose circadian rhythms are offset to kick in later than the average person. People with an advanced sleep-wake phase are the opposite—feeling tired earlier in the evening and likewise waking earlier.

Essentially, both of these conditions are synonymous with jetlag. And as we all know how being out of sync with the standard day/night cycle can result in a disrupted night’s sleep.