10 Causes of Middle-of-the-Night Insomnia

Doctor William C Lloyd Healthgrades Medical Reviewer
Medically Reviewed By William C. Lloyd III, MD, FACS
Written By Paige Greenfield Fowler on February 5, 2022

Everyone encounters a bad night of sleep now and again. However, frequently waking up in the middle of the night can affect every aspect of your life: your ability to think clearly, your performance at work, your relationships, your mood—even your overall health.

That's why it's so important to work with your doctor and find out what's keeping you up. Read on for 10 common causes of middle-of-the-night insomnia. 

  • Sleep apnea
    1. Obstructive Sleep Apnea
    People with obstructive sleep apnea (OSA) stop breathing for 10 to 60 seconds at a time during the night. This jolts your brain into waking you up and may cause you to gasp for air. You may then fall back asleep, only to have this happen again and again—even hundreds of times per night!

    Of course, these multiple awakenings disrupt your sleep and can make you tired during the day. They may also lead to even more severe issues, such as high blood pressure and an increased risk for heart attack and stroke. Talk with your doctor if you experience symptoms such as loud snoring, snorting, or gasping at night. There are many ways to treat OSA.
  • Restless legs syndrome
    2. Restless Legs Syndrome
    If you have restless legs syndrome (RLS), you may feel uncomfortable crawling or tingling sensations in your legs and experience an urge to move them. RLS is one of the most common sleep disorders. It affects about 12 million Americans today.
  • Periodic limb movement disorder
    3. Periodic Limb Movement Disorder
    It's common for people with RLS to experience periodic limb movement disorder as well. The condition causes jerking movements in the limbs, especially in your legs, and can occur every 20 to 40 seconds, making it extremely difficult to stay asleep.
  • cup-of-coffee
    4. Caffeine
    It can take as long as eight hours for the stimulating effects of caffeine to wear off. Caffeine may also interfere with adenosine, a brain chemical that triggers sleep. That's why the cup of coffee that helped you power through the afternoon may make you toss and turn late into the night.
  • Alcohol
    5. Alcohol
    Anyone who's ever enjoyed a nightcap knows that alcohol can make you feel sleepy, but that doesn't mean it's a good idea before bed. Why? As the effects of the alcohol wear off, it can cause you to wake at night, ultimately disturbing the overall quality of your sleep.
  • Woman taking pill
    6. Over-the-Counter and Prescription Medications
    Did you know that many headache medications contain caffeine? Decongestants, steroids, and beta-blockers—medications for the heart and blood pressure—can also cause nighttime awakenings. So can treatments for asthma and bronchitis. If you're having difficulty sleeping, ask your doctor whether any of your medications may be to blame.
  • Smoking-cigarette
    7. Nicotine
    Many people may not realize that nicotine is a stimulant that can keep you up at night. Nicotine can also make you a light sleeper. If you're a heavy smoker, you may wake during the night because of nicotine withdrawal.
  • Stress
    8. Stress
    If you suspect that stress and anxiety are keeping you up at night, it's not all in your head. A restless mind can make it more difficult to stay asleep and may cause you to spend less time in the deep sleep stages. Depression can also contribute to insomnia.
  • woman cooling off
    9. Drop in Progesterone
    In women, levels of the hormone progesterone drop right before the start of menstruation. This decrease in progesterone concentrations can make it more difficult to sleep. Menopause is also associated with insomnia, perhaps because progesterone levels drop during menopause, too. Hot flashes can also disrupt your Z's.
  • woman-rubbing-aching-stomach
    10. Medical Conditions
    Many medical conditions, including arthritis, acid reflux, and congestive heart failure, can cause physical discomfort or pain that make it difficult to sleep soundly through the night.

    Key Takeaways

    • It's important to understand what's behind your middle-of-the-night insomnia. Common causes include medical conditions such as sleep apnea, restless leg syndrome, and arthritis.

    • What you consume during the day, such as caffeine, alcohol, and nicotine, can affect how you sleep at night.

    • Stress and certain medications are common culprits as well.

10 Causes of Middle-of-the-Night Insomnia
  1. Your Guide to Healthy Sleep. National Heart, Lung, and Blood Institute. National Institutes of Health. http://www.nhlbi.nih.gov/health/public/sleep/healthy_sleep.pdf
  2. Brain Basics: Understanding Sleep. National Institute of Neurological Disorders and Stroke. National Institutes of Health.  http://www.ninds.nih.gov/disorders/brain_basics/understanding_sleep.htm
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Last Review Date: 2022 Feb 5
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.