I wake up several times during the night: why this happens and when to seek advice
Waking up briefly during the night can be part of normal sleep. When these awakenings become frequent, last for a long time, make it difficult to get back to sleep or affect the following day, it is worth investigating what might be causing them.
Some people fall asleep easily but wake up several times throughout the night. Some fall back asleep almost immediately; others remain awake for long periods, keep checking the clock or start to worry as the night wears on and they are unable to get any rest.
These night-time awakenings may occur during a period of stress, due to changes in routine, or as a result of a temporary circumstance. They may also be linked to physical symptoms, certain habits, medication or conditions that disrupt sleep.
To understand their significance, it is not enough simply to count how often they occur. It is also necessary to know how long they last, whether it is difficult to get back to sleep, what happens before or after each time they wake up, and how the person feels during the day.
The essentials
During a normal night, brief awakenings may occur that are not always remembered.
The problem becomes significant when these awakenings are frequent, prolonged or make it difficult to get back to sleep.
Stress, habits, certain physical symptoms and various disorders can disrupt sleep.
Overnight polysomnography is not carried out as a matter of routine: it is recommended when it can help answer a specific diagnostic question.
Is it normal to wake up during the night?
Yes. During a normal night, brief awakenings may occur, many of which go unnoticed and are not remembered the following day.
Therefore, opening your eyes occasionally or changing position does not necessarily mean there is a disorder. What matters is whether the waking lasts for a long time, occurs frequently, causes discomfort or prevents sleep from continuing normally.
As Dr Alejandro Melcón Villalibre, head of the Neurological Sleep Disorders Unit at the Publio Cordón Memorial Hospital, explains, ‘Waking briefly during the night can be part of normal sleep. What we need to assess is whether these awakenings recur, last for a long time or make it difficult to get back to sleep’.
A person who wakes up for a few moments and falls back asleep effortlessly is not in the same situation as someone who stays awake for an hour and starts the day feeling tired or irritable.
When do night-time awakenings become a problem?
Waking episodes warrant attention when they are recurrent, last too long or have consequences during the day.
Difficulty getting back to sleep is particularly significant. A population-based study published in *Sleep Medicine* found that people who had trouble getting back to sleep after waking up reported poorer subjective sleep quality, greater daytime impact and were more likely to seek medical attention. Simply waking up, when not accompanied by other symptoms of insomnia, did not show the same association.
When repeated awakenings and difficulty getting back to sleep persist despite having sufficient time and suitable conditions for rest, a pattern of maintenance insomnia may be present. However, the symptom on its own is not sufficient to establish a diagnosis: its frequency, duration, the distress it causes and its impact on daily life must also be assessed.
It is also important to distinguish between waking up during the night and early morning awakening. In the latter case, the person wakes up before their usual time and is unable to get back to sleep. Both patterns can occur in insomnia, but they are not exactly the same.
Why might I wake up several times during the night?
There is no single cause. Waking up may be linked to the environment, habits, emotional state, physical symptoms or specific sleep disorders.
The environment and habits
Noise, light, an uncomfortable temperature or disturbances caused by other people can disrupt sleep. Frequent changes to one’s schedule, long naps or going to bed and getting up at very different times depending on the day can also have an impact.
Caffeine can make it difficult both to fall asleep and to stay asleep. A systematic review and meta-analysis of 24 studies concluded that caffeine consumption reduced total sleep time and sleep efficiency, and increased the time spent awake after falling asleep. The effect varies depending on the dose, the time of consumption and individual sensitivity.
Alcohol does not guarantee a good night’s sleep either. Although it may cause drowsiness at first, evidence shows that it tends to disrupt sleep structure and lead to greater fragmentation later on, particularly in the second half of the night.
This does not mean that a single habit necessarily explains why one wakes up, but it does suggest that it is worth checking whether there is a temporal relationship between certain behaviours and the deterioration in sleep quality.
Stress and mental arousal
Worries do not always prevent you from falling asleep at the start of the night. For some people, the mind becomes active after waking up: thoughts about the following day arise, they calculate how long is left before they have to get up, or they fear they will not be able to get back to sleep.
Such worry can increase alertness and prolong wakefulness. The greater the effort to force sleep, the more difficult it can be to regain the calm needed to fall asleep.
This mechanism does not explain all instances of waking up, but it may contribute to them persisting when the problem continues for weeks or months.
Physical symptoms and medication
Pain, a cough, acid reflux, hot flushes, breathing difficulties or the frequent need to urinate can disrupt sleep. In these situations, waking up may be a consequence of another symptom rather than a separate disorder.
Certain medicines may also affect the continuity of sleep or cause a person to have to get up during the night. They should not be stopped or altered without medical advice, but it is important to inform your specialist of all the treatments you are taking.
Disorders that fragment sleep
Repeated awakenings can occur in insomnia, sleep-related breathing disorders, periodic limb movements and certain nocturnal behaviours.
For example, respiratory disturbances can cause brief periods of brain arousal that interrupt the continuity of sleep, even if the person does not remember each episode. Loud snoring, observable pauses in breathing, a feeling of suffocation or marked daytime sleepiness are signs that should be discussed during a consultation.
Repeated movements or certain behaviours during sleep can also fragment rest. Their presence cannot be confirmed simply because the person wakes up: it is necessary to assess the full range of symptoms and, in some cases, carry out a night-time examination.
What happens after waking up also matters
Dr Melcón Villalibre points out that the number of times a person wakes up is not enough to assess the problem: the duration of these awakenings, the difficulty in getting back to sleep, and the person’s condition the following day are also important.
Constantly checking the time can increase anxiety. Using a mobile phone exposes you to light and content that promote wakefulness. Staying in bed for a long time trying to force yourself to sleep can also gradually lead to the bedroom being associated with wakefulness and frustration.
When waking up is occasional, it is best not to interpret it as a cause for alarm. If wakefulness persists and stress levels rise, as part of the treatment for insomnia it may be recommended to get out of bed temporarily, engage in a quiet activity, and return to bed when drowsiness returns. This strategy, known as stimulus control, forms part of broader clinical interventions and must be tailored to each individual.
The European Insomnia Guidelines recommend cognitive-behavioural therapy as the first-line treatment for adults with chronic insomnia. This approach combines techniques aimed at regulating sleep schedules, reducing arousal associated with sleep, and re-establishing a stable association between the bed and rest.
These general recommendations are no substitute for a proper assessment. When waking episodes have a medical, respiratory, motor or pharmacological cause, treatment must address the underlying problem.
When should you seek advice, and how is the problem assessed?
It is advisable to seek an assessment when episodes of waking persist, make it difficult to get back to sleep, or affect performance, mood or the ability to concentrate.
It is also advisable to seek advice when they are accompanied by:
Drowsiness whilst driving or during high-risk activities.
Loud snoring, pauses in breathing or a feeling of suffocation.
Repetitive movements or unusual behaviour during the night.
Pain, acid reflux, urinary symptoms or other persistent discomfort.
A worsening of symptoms coinciding with the start or change of a course of treatment.
There is no need to wait until the situation becomes serious. It is also advisable to seek help when no clear cause can be identified, but sleep quality has deteriorated or concerns about sleep are taking up an increasing amount of space in daily life.
The assessment begins with a clinical interview. The specialist asks when the problem first appeared, how many nights it occurs, how long the awakenings last and what symptoms accompany them. They also review sleep schedules, naps, habits, medical history, medication and the impact on daily life.
Information from a partner or other household members can be useful in identifying snoring, breathing pauses, movements or behaviours that the patient does not recall.
In some cases, it is recommended to keep a sleep diary for one or two weeks. Recording the time of going to bed, the approximate time taken to fall asleep, periods of wakefulness and how one feels the following day helps to identify patterns and guides the consultation.
The European Insomnia Guidelines state that the clinical interview, medical and sleep history, questionnaires and diaries form the basis of the assessment. Additional tests are reserved for cases where they are justified.
When might an overnight polysomnography be necessary?
Not everyone who wakes up several times needs a sleep study.
In many cases, the clinical history allows the problem to be pinpointed and the first steps to be determined. Polysomnography is reserved for situations where there are symptoms consistent with other sleep disorders, an unusual course of the condition, or a specific diagnostic question.
“Polysomnography can help us when we suspect that awakenings are caused by a disturbance occurring during sleep, but it is not a routine test for everyone who wakes up at night,” explains Dr Melcón Villalibre.
When indicated, the test records various physiological signals whilst the person is asleep, such as brain activity, eye and muscle movements, breathing, oxygenation and heart rate.
Its purpose is not simply to demonstrate that awakenings have occurred, but to help identify what may be disrupting sleep. The results must be interpreted in conjunction with the patient’s symptoms and medical history.
Understanding the cause helps restore uninterrupted sleep
Waking up once during the night can be part of normal sleep. The problem arises when these awakenings are frequent, prolonged or prevent the person from feeling refreshed the following day.
It is not advisable to automatically assume that these are due to age, stress or a supposed inability to sleep. Nor is there a single solution that works for every case. Some people need to review their schedules or certain habits; others require treatment for a medical condition, a sleep disorder or the mechanisms that are perpetuating their insomnia.
Understanding what happens before, during and after each time you wake up allows us to tailor an approach to each patient’s specific situation.
Do you wake up several times and find it difficult to get back to sleep?
The Insomnia and Restorative Sleep Clinic at the Neurological Sleep Disorders Unit of the Publio Cordón Memorial Hospital enables us to examine the characteristics of night-time awakenings, their possible causes and their impact during the day.
Based on the clinical assessment, the specialist can guide the diagnosis and decide whether a specific sleep study is necessary.
Frequently asked questions
Is it normal to wake up several times during the night?
Brief awakenings can occur during a normal night and many are not remembered. It is worth paying attention to them when they are frequent, last too long, make it difficult to get back to sleep or cause tiredness and disruption during the day.
Why do I always wake up at the same time?
This may be linked to your daily routine, your environment, stress, physical symptoms or a pattern of early waking. The time of day alone is not enough to determine the cause and should be interpreted alongside your other symptoms.
Does waking up at night mean I have insomnia?
Not necessarily. Insomnia involves persistent difficulties in falling asleep or staying asleep, despite having sufficient time and suitable conditions, accompanied by discomfort or disruption during the day.
What can I do if I can’t get back to sleep?
Avoid repeatedly checking the clock or using your mobile phone. If you find yourself lying awake for a long time and your anxiety is increasing, as part of a strategy to manage insomnia, it may be advisable to get up briefly and do a quiet activity until you feel sleepy again. If this happens frequently, it is advisable to seek medical advice.
When do I need a sleep study?
A polysomnography may be recommended when there are signs of a respiratory, motor, neurological or behavioural disorder that needs to be monitored overnight. It is not a routine test for all instances of waking during the night.
The information in this article is provided for general awareness and does not replace an individualised medical assessment.
