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Changing routine may yield better night’s sleep

By Jill U. Adams

Special to Washington Post

I woke up at 3:43 one morning. After an hour of lying awake in the dark, I moved to the sofa and read my book for an hour. Then I turned off the light and went back to sleep.

Middle-of-the-night awakenings are common for many people, and how we deal with this habit is key to getting a good sleep, says sleep expert Michael Grandner, a psychologist at the Center for Sleep and Circadian Neurobiology at the University of Pennsylvania. It turns out that I made a couple of mistakes that might have kept me from going back to sleep more quickly: I shouldn’t have looked at my clock, and I shouldn’t have waited so long to get out of bed.

Looking at the clock leads to two things antithetical to sleep, Grandner says – math and worry. You are bound to calculate how many hours of sleep you’ve gotten and how many are left, thereby triggering daytime brain functions. You are likely to then start worrying about being tired tomorrow as you tackle a long to-do list, thereby activating stress.

Staying in bed while awake trains you to associate your bed with wakefulness rather than sleep, Grandner says.

Those are just two bits of sound sleep advice, but why did I wake up in the first place? That’s a question in sleep research that remains largely unanswered.

The vast majority of patients seeking treatment for insomnia have some kind of sleep breathing problems, at least according to a recent study. In that study, published online in the journal Sleep & Breathing, researchers conducted a chart review of 1,035 patients and found that 81 percent had breathing issues.

The study’s lead author, Barry Krakow, medical director of Maimonides Sleep Arts and Sciences in Albuquerque, N.M., designed a subsequent study to better understand insomniacs without obvious breathing issues – the 19 percent in his chart review study.

Twenty such people were asked whether they could identify what made them wake up. They reported such causes as nightmares, noises, needing to urinate and pain; many said they didn’t know.

Next, the participants spent one night in a sleep research facility. Researchers recorded a combined total of 531 awakenings and found that 478 of them followed a “breathing event” such as an episode of apnea or labored breathing. Thirty awakenings lasted at least five minutes, and all of these were preceded by a breathing event. These findings, published last year in the journal Sleep, reveal that breathing issues are the cause for even more middle-of-the-night awakenings than previously appreciated.

Krakow says studies have tended to focus on getting people back to sleep, not on why they wake up.

“I believe … that in people without known causes of insomnia” – such as stress, depression or other medical conditions – “90 percent of waking events are due to breathing issues,” Krakow says.

Disorders that affect chronic insomniacs may not carry over to people with less severe sleep problems, Krakow says. Still, he advises people to take care of their noses before taking sleep medication. Treat any allergies, clear your nasal passages with a saline flush or a neti pot, or try nasal strips.