Waking at 3 a.m. and waking at 5 a.m. are different

What time you wake up is the fork in the road

Key points in 30 seconds

1. Falling asleep is fine, but waking before dawn and not getting back to sleep is also insomnia. It has its own name.
2. If you wake at 2–3 a.m., we look for something that's breaking up your deep sleep. It could be snoring, pain, reflux, or needing the bathroom.
3. Waking at 4–5 a.m. and not getting back to sleep is a different kind. We also look at how you've been feeling lately.
4. Different causes call for different steps. Just changing your "ways to get sleepy" leaves your nights the same.
5. Don't stop your sleeping pills on your own. Any adjustment should be decided together with the doctor who prescribed them.

What we often hear

• "Every night at 3 a.m., my eyes just pop open."
• "Is waking up at five okay?"
• "I always wake up at about the same time."

It's 3 a.m. again

You check the clock, close your eyes, check again: 3:40. Falling asleep was no problem. The problem is always this hour. And when morning comes, you start the day more tired than you were last night.

A great many people with nights like this come to our clinic. And most of them say something similar.

"I fall asleep just fine. Is this insomnia too?"

Yes, it is. Insomnia isn't only having trouble falling asleep. Waking during the night and not being able to get back to sleep is a type of insomnia with its own name (sleep maintenance insomnia). In a study of about 9,000 adults, more than one in three said they woke during the night more than three times a week, and for over 90% of them, the problem had lasted more than six months.

In other words, it's common, but because people don't think of it as an illness, they put up with it for a long time.

So what time do you wake up?

There's one thing we need to separate here: the time you wake up.

Waking at 2–3 a.m., just a couple of hours after falling asleep. This stretch of the night is normally when deep sleep should continue. If you keep waking here, we suspect something is breaking up your deep sleep. It may be that your body's alertness doesn't switch off well even at night, or it may be a signal from your body, such as snoring or sleep apnea, pain, reflux, or needing the bathroom.

In fact, there is research showing that in people with insomnia, stress hormones stay high in the early part of the night. The body can't come off standby even while you sleep.

Waking at 4–5 a.m., an hour or two earlier than you want to get up, and not being able to get back to sleep. This has a separate name of its own (early morning awakening). It may look like the same "waking during the night," but it's a different kind. This type sometimes appears together with changes in mood, especially low mood or depression, so we need to look not only at sleep but also at how you've been feeling lately.

Why separate them like this?

Because different causes call for different steps.

When we listen to people who say they've tried everything that's supposed to help and none of it worked, most of them have been changing their "ways to get sleepy" without knowing which type they are. Going to bed early, warm milk, a half-body bath. These aren't bad things. But even the clinical guidelines of the American Academy of Sleep Medicine do not recommend sleep hygiene education like this on its own.

If you leave the cause alone and only change methods, your nights stay the same.

Here's the order we follow

First, we look for the cause. We start by checking what time you wake up, whether you snore, whether anything hurts, and whether you take any medications. When an herbal prescription is needed, we do a blood test and body composition test, and also gently press on your belly and check your pulse. If sleep apnea is suspected, we first refer you to a place that can do a detailed sleep study.

Second, we work on switching off alertness. We use acupuncture and pharmacopuncture (herbal acupuncture) to release tension that built up during the day, and herbal medicine suited to your condition to help restore a daily rhythm that has fallen apart. It's not about forcing you to sleep, but about helping the switch that should turn off at night actually turn off. For acupuncture, when trials comparing it with sham acupuncture were pooled together, results have been reported showing better sleep quality scores.

Third, we check again. At your follow-up visit, we compare what we checked before treatment, using the same method. Not "I think it's a bit better," but what changed and by how much — we look at it together.

We've written more about why we press on the belly and what we check during the exam in When we hear "I wake up at 3 a.m.," what do we look at first?.

If you're taking sleeping pills

There's one thing we must ask of you. If you're currently taking sleeping pills, never stop them on your own. Stopping suddenly can actually make insomnia worse. Any adjustment must be decided together with the doctor who prescribed them.

We are not a place that promises to get you off medication. We work on creating the conditions in your body that let you sleep without medication.

What changes

A morning when you don't wake before dawn, and the first thing that opens your eyes is the alarm. A day when you don't have to count how many times you woke up last night.

What we aim for is that ordinary morning.

How things progress, and how quickly they improve, differs from person to person depending on the cause, how long you've had the problem, and the medications you take.

Who should come see us

• People who fall asleep easily but wake before dawn and can't get back to sleep
• People who wake at almost the same time every night
• People who wake an hour or two earlier than they want to
• People who've tried several methods that are supposed to help, with no change

When you come in, we start by sorting out what time you wake up and why. Once you know your type, the next steps get much easier. If you're taking any medication, we start while you keep taking it as is, so you don't need to worry about that.

You can read about how much acupuncture helps with insomnia, along with the research, in Is there evidence that acupuncture helps insomnia?.