Nighttime awakenings

Nighttime awakenings are episodes of waking after sleep has begun, whether brief and forgotten or long enough to notice and remember.

Brief arousals are a normal part of the sleep cycle, and most adults wake several times a night without recalling it. Awakenings become a problem when they are frequent, prolonged or leave a person unrefreshed the next day. Common causes include sleep apnea, pain, nocturia, hot flashes, alcohol, anxiety, environmental noise and the lighter sleep that comes with aging. Difficulty returning to sleep is a defining feature of sleep-maintenance insomnia.

Assessment starts with a sleep diary and questionnaires, and sleep specialists may use actigraphy or overnight polysomnography to count awakenings and measure wake after sleep onset. Identifying the underlying cause guides care. Cannabinoids have been studied for sleep in small trials, and effects on awakenings have not been consistent.