Need a Strategy to Stay Asleep?

I don’t have any trouble falling asleep. My problem is staying asleep. I wake up in the early morning hours and watch the clock for two hours or more before being able to fall back asleep. What can I do?

– April 2, 2002

Updated 6/06/2007

Your problem is a very common variation of insomnia. In fact, it is even more common than having trouble falling asleep in the first place, particularly among older people. To change it, the first thing you have to do is try to determine the cause.

Consider these possibilities:

  • Are you physically uncomfortable? The condition of your bed, mattress or pillow can be an impediment to a good night’s sleep. Your mattress might be too soft or too firm and your pillow might not be the right kind. Replacing a worn mattress can help – check yours for signs of wear at least twice a year. If your bedding isn’t the problem, see an osteopathic physician who specializes in OMT, osteopathic manipulative therapy. A session or two of this safe and effective treatment can be life-changing.
  • Is your bedroom noisy? You can overcome this by purchasing a "white noise" generator, an inexpensive but effective device for making soothing sounds (ocean waves, waterfalls, tropical rain, for example) to mask jangling ones.
  • Is your mind overactive? If you can’t sleep because of thoughts whirling through your head, try the Relaxing Breath which can help you put aside the thoughts that are keeping you awake. A few stretches can help, too.
  • Are you getting up to urinate and then not able to get back to sleep? Both caffeine and alcohol can increase nighttime urination. They can also disturb sleep in other ways.

Two supplements, melatonin and valerian, can help you sleep, but I don’t recommend taking either one for sleeplessness that occurs in the early morning – they could make you too drowsy to get up when the time comes. I suggest using 2.5 mg of melatonin to overcome jet lag, but only for one or two nights, and only when taken at bedtime. A lower dose, 0.25 to 0.3 mg, is more effective for regular use, but again, it should only be taken at bedtime. The same is true for valerian (Valeriana officinalis). It is an effective natural sleep aid, but you should take it only before you initially fall asleep.

If you eliminate all these possibilities and still wake in the early morning hours, I would suggest getting up and reading or doing something else useful rather than watching the clock and worrying about the sleep you’re losing. Taking your mind off the problem may relax you and enable you to fall asleep again.

Andrew Weil, M.D.

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