Dr Grant replies: Early morning awakening is a very common complaint in the Western world. It’s well- known that sleep quality deteriorates with age.
Another fact is that people who complain about being ‘bad sleepers’ are usually not that poor at all. It is normal to take 10-20 minutes to fall sleep.
As we get older, it is also normal to wake a few times during the night. Ideally you should be able to get back to sleep within 20 minutes upon awaking during the night.
The first three to four hours of sleep are predominantly deep sleep and the second three to four hours of sleep are predominantly REM sleep.
All forms of deep, light and REM sleep are important. It is often during this transition from the deep to REM sleep that people can spend hours awake at night.
Few things will ruin your day more than waking up in the middle of the night a few times a week. Photo: Getty
News in 90 seconds – Wednesday 4th February
From what you told me above, it appears you’ve already researched the rules of good sleep hygiene and are pretty good at abiding by them.
These rules are:
1. Sleep only as much as you need to feel rested and then get out of bed. This ranges from seven to right hours, sometimes up to nine hours for most adults.
2. Keep a regular sleep schedule, bedtime and get-up time, ideally seven days per week.
3. Do not try to initiate sleep until you feel sleepy.
4. Exercise regularly, preferably at least four to five hours before bedtime.
5. Aim to get 10 minutes of dusk light and dawn light exposure daily. This helps set circadian rhythm.
6. Avoid caffeinated drinks after 1pm and ideally only have one to three caffeinated drinks per day. The first caffeine hit should be after one-and-a-half hours of waking in the morning.
7. Avoid alcohol, especially near bedtime, as it disturbs sleep.
8. Avoid smoking, especially near bedtime, as nicotine is a stimulant.
9. Do not eat too late in the evening, ideally stop eating four to five hours before bedtime.
10. Make the bedroom environment conducive to sleep, especially try to have a room temperature between 16-19C. Sleep with a light duvet as body temperature naturally rises during the night and a common cause of early morning awakening is too much bed clothes or too much bed linen. If you read/listen to a podcast or watch screens to fall asleep, you should do this in a sitting room not in the bedroom. Your brain need to learn that the bedroom is for sleep, not rest and relaxation.
11. Deal with your worries (as much as possible) before bedtime. One of the best way to do this is by handwriting in a journal for 10 minutes every evening. Try to do 10 minutes of yoga or meditation in the evening to aid sleep.
Learning to stop worrying about your temporary sleep disturbance and knowing that you can overcome this in time is reassuring. Try to manage any sources of stress in your life.
Consider your mental wellbeing as depression and anxiety are common underlying causes for sleep disturbance. Early morning awakening (EMA) is defined as termination of sleep at least 30 minutes prior to the desired wake-up time.
You possibly also hit the diagnosis of chronic insomnia as I assume you have been suffering with EMA at least three times per week over the past three (or more) months.
Some medical conditions like heart failure, arthritis, fibromyalgia, lung disease, hyperthyroidism and high blood pressure may also disturb sleep
However, for a true diagnosis of insomnia you must have ‘associated daytime dysfunction’ as well as persistent sleep difficulty despite adequate sleep opportunity.
Daytime dysfunction is defined as one or more of the following: fatigue, irritable mood, poor concentration, reduced motivation, daytime sleepiness, ongoing worry about sleep or increased errors/accidents.
Some medications like steroids, beta-blockers, diuretics, or drugs of misuse, alcohol, nicotine and caffeine (as alluded to above) can cause sleep disturbance as a side-effect.
Some medical conditions like heart failure, arthritis, fibromyalgia, lung disease, hyperthyroidism and high blood pressure may also disturb sleep. Your GP can help assess you.
The American and European sleep medicine guidelines prefer initial treatment of insomnia to encompass eight sessions of behavioural therapy, usually in form of cognitive behavioural therapy for insomnia (CBTi). Occasionally patients opt for both short-term sleep-aid medication and behavioural therapy.
During therapy, several strategies are tailored to the individual and typically involve stimulus control, sleep restriction, education on sleep hygiene, and relaxation techniques.
Anxiety might be dealt with and realistic expectations related to insomnia and the need for sleep are established.
Dr Jennifer Grant is a GP with Beacon HealthCheck
