Middle-of-the-night Insomnia

  • When waking up means staying up!


By Dr. Don Davis


You’ve been there. Asleep in your bed, awash in dreamland, when you turn over or get up to pee, lie back down and find that you are awake, really awake. At first you just lie there assuming that your body will take over and send you back to your sacred sleep. After all, you are tired, worn out and need some relief. But it doesn’t happen. You begin to wonder if you should apply for that open job at work, or you find yourself regretting a response you gave to a friend asking you for a loan, or a million other things.

You’re wondering why when you wake you have to start thinking about this stuff, after all it didn’t bother you when you first went to sleep? This is problem that millions of people have called Middle-of-the-night insomnia (MOTN), or maintenance insomnia.


Middle insomnia is different from onset insomnia not only because it happens at a different time but because it actually caused by different mechanisms. That’s right, mechanisms.



Sleep is a sort of machine that proceeds down the train tracks, normally in a predictable way, dependent on bunches of hormones, and dozens of chemicals and neurotransmitters. Each sequence must be followed exactly to get to the next step, and if that next step is missed, sleep won’t be coming your way. It really doesn’t matter if you are tired, haven’t slept well for the last week or that you must drive your kids to rowing workouts at 5:00am.


In a way, getting to sleep is a bit easier to understand than staying asleep. During the day, your brain slowly produces chemicals like adenosine that have a hypnotic effect over the length of the day that drive you to sleep. But there is an equal drive to stay awake that cancels the sleep urge by the hormone cortisol and the neurotransmitter acetylcholine (Ach). This way you stay awake all day without any noticeable need to sleep. Then at the end of the day, cortisol and Ach decrease with an increase in melatonin that sends you the sand land. Things can go wrong here of course, but in this article we’ll concentrate on middle insomnia.


So, let’s say that you get to sleep in short order, after a nice bath, and some light reading with your “sleepy time” tea. Then you wake around 3;30 (it could really be any time), and begin to stare at the back of your eyelids. You might decide to check on your pet hamster that hasn’t been looking so great lately, and think that you will go back to sleep. But you don’t. You think that if you could just relax and not think about it, sleep would finally come. But you DO think about it, and down the sink hole you go, and knowing that it could last for hours is dreadful.


The Stress Response and Sleep


Most scientists feel that insomnia is caused by hyper-arousal. That makes sense but what causes the hyper-arousal. Well, a few things. First, any kind of stress whether mental or physical will increase those alerting type chemicals- cortisol and Ach -that should decrease substantially at night. If they don’t, there could be a problem in the adrenal gland system – H-P-A axis. The brain, when fired up with stress or inflammation tells the adrenal gland to make cortisol, arousing you still further. Even estrogen, if imbalanced, will contribute to your waking sleep.


Low Blood Sugar?


Another big problem causing middle insomnia is a drop-in blood sugar during the night. If you have a tendency toward low blood sugar (reactive hypoglycemia), a drop in the night will signal your brain to wake up and solve the problem.


The brain needs a constant supply of blood sugar. When this doesn’t happen, it triggers a sequence of hormone and nervous system responses to increase glucose. Your brain will signal your liver to increase more glucose but it also increases the excitatory hormone epinephrine. That’s the hormone that causes a faster heartbeat, anxiety, sweating and fear. Not a good combination if you are trying to get back to sleep. But at least if your blood sugar is low you’ll be awake enough to walk to the fridge and eat something.


Low Vitamin B6 (P5P)?


And one last thing. Making sure that you have the proper co-factors for sleep is more important than you might think. Vitamin B6 (P5P) for instance will convert tryptophan to serotonin, a relaxing neurotransmitter that will actually give you a positive attitude toward sleep. This way, when you wake up in the middle of the night, you won’t be so worried about getting back to sleep.


Sometimes people will have a methylation defect that prevents the proper formation of B6. This can be tested with DNA analysis but can be circumvented by using P5P a form of B6 that is more effective in our cells.


This is not the whole story, of course, but to stay asleep at night, look at these 5 important factors of sleep.


First, there can’t be any gut infections, bacterial imbalance, leaky gut
or inflammation, otherwise you won’t absorb all the cofactors necessary for sleep. Testing the gut is a great place to start. Healthy gut bacteria can help control an over-active immune response that can hijack your metabolism and brain chemistry.


Second, you need to consume a full spectrum of nutrients that can fully support your sleep cycle. This is best done with an anti-inflammatory diet like Paleo. Inflammation produces pro-inflammatory proteins that travel to the brain affecting mood, behavior and sleep.


Third, look at the adrenal gland and the stress system closely. Testing using the DUTCH adrenal profile and comprehensive thyroid testing can give you a good look at your 24 hour adrenal cycle and other important hormones.


Fourth, make sure that you don’t have other deficiencies like Iron or anemia. Low iron can increase your chances of having Restless Leg Syndrome. This a condition where there is a feeling like you have to move your legs restlessly and a feeling of twitching sensations in the legs. Many of us have unrecognized iron deficiency that doesn’t come up on the limited blood work typical nowadays.


Fifth, look at magnesium. It has a double role in sleep. It can relax your brain before sleep – by stimulating the inhibitory GABA receptors. It also is essential for relaxing your muscles. Tight muscles and cramps are a real problem for a good nights sleep.


The good news is that there is lot you can do with functional medicine to deepen your sleep besides taking a hot bath and pretending to sleep.


Health is on the way


Leave A Comment


First Name
Email address