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Sleep Disorders

Waking Up Several Times Per Night

02/09/2009

Question:

I have no problem falling asleep, but I wake up several times a night. I actually sit up sometimes walk around. Then I go back to sleep for about a hour and wake up again. Most times I am very stiff when I wake up. What could this be and what type of specialist should I see for evaluation?

Answer:

Waking up in the middle of the night and experiencing difficulty getting back to sleep can be troublesome. This is a form of insomnia known as "sleep maintenance insomnia" and may result from a number of varied causes. Some of the more common conditions or problems that may result in sleep maintenance insomnia include breathing disorders in sleep (such as sleep apnea, asthma, or heart failure), leg jerks during sleep or wakefulness (known as periodic limb movement disorder or restless legs syndrome, respectively), depression, anxiety, conditions associated with pain, heartburn, side effects from medications or substances (such as caffeine, alcohol, or nicotine), circadian rhythm disturbances, and a poor sleep environment.

Sometimes, simply improving sleep hygiene and sleep-related behaviors can help. This may include simple measures such as keeping a regular sleep schedule, avoiding caffeine and alcohol within 4-6 hours of bedtime, avoiding exercise and/or hot showers near bedtime, and making sure the bedroom is quite, dark and comfortable. In addition, how you behave once you awaken can be a significant cause of trouble getting back to sleep. Behaviors such as lying in bed when you can’t sleep, clock watching or getting up and doing something stimulating (such as smoking, watching TV, etc.) can all be counterproductive for returning to sleep.

If you already practice good sleep hygiene, or you try these maneuvers without success, then you should probably be referred to a Sleep Specialist for additional evaluation. All of the above mentioned conditions can be treated to some degree of success and the key lies to sorting what factors in your specific case need to be addressed.

The issue of feeling stiff upon awakening in the morning is likely a separate problem altogether. How best to sort this out will depend on a number of factors in your specific history and may require additional evaluation. Things to consider range from as simple as sleeping on a mattress that is too firm to more complicated conditions, such as having an autoimmune disease. So, in order to comment on this in more detail will require additional information.

To learn more about insomnia or other sleep disorders, please visit the American Academy of Sleep Medicine website. In addition to information, the website contains a list of Sleep Centers across the country so that you may locate one near you. 

Good luck and here's to better sleep!

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Response by:

Dennis   Auckley, MD Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University