Why Am I Up at 3 am?

I find the overwhelming majority of my patients that wake in the wee hours of the morning share one of a couple of common sentiments. Either they feel like they never slept deeply for the few hours they did manage to sleep, or that their mind is racing almost immediately.

Patients that report issues with sleep maintenance, i.e. the difficulty staying asleep, with or without difficulty falling asleep, often appear to have never really fallen into a deep sleep on some level. Therapeutically, there are two weaknesses in physiological functioning that I see most often: low blood sugar and/or anxiety.

First, to discuss low blood sugar, as patients may not consciously feel hungry when they awaken in the early hours. On some level, their body is starting to experience a drop in blood sugar and from a primitive standpoint, this is stressful for the body and can be associated with restless sleep. Often these patients will report poor eating habits in the evening and can benefit from a healthy bedtime snack, usually with protein and healthy fats being centrepoints, or they find they are indulging in sweets or alcohol too often. Alcohol can be particularly sneaky as many patients develop a habit of using a bit of alcohol to help induce sleepiness, unknowingly contributing to early waking and poor sleep quality, so the cycle continues.

With anxiety, this may not be a clinically diagnosed Generalized Anxiety Disorder, but perhaps a low level “over-active mind” that the patient describes as an issue at bedtime, and also upon early waking. It is no surprise to imagine that the brain doesn’t really allow the body to fully relax into a restful sleep.

The science behind sleep cycles is still being explored and the old beliefs of 4 stages of NREM sleep have recently been re-classified by scientists. Scientists are also studying the effect of what hour of bedtime has on your REM sleep. We know that cortisol, melatonin, and even our female hormones all play a part in wakefulness, relaxation, and feelings of calm, so that is a big area of treatment for a naturopathic doctor. Generally, I find melatonin only helpful for occasional insomnia or jet-lag, though its role in bolstering our systems through its anti-oxidant effects is also very interesting at present. Sleep treatments should be individualised based on the nutrition, hormonal, stress, and Chinese medicine (yes, acupuncture is a wonderful tool!) history of a patient.