Sleep maintenance

Sleep maintenance is the ability to stay asleep through the night after falling asleep, without prolonged or frequent awakenings.

Difficulty with sleep maintenance is one of the two main patterns of insomnia, alongside difficulty with sleep onset, and it becomes more common with age. Waking in the middle of the night or well before the intended time and then struggling to return to sleep are its hallmarks. Contributors include sleep apnea, pain, nocturia, hot flashes, alcohol, depression and an irregular schedule, as well as the lighter, more fragmented sleep that accompanies aging.

Clinicians assess it with a sleep diary that records awakenings and time awake, questionnaires, and objective measures such as wake after sleep onset from actigraphy or polysomnography. Cognitive behavioral therapy for insomnia is the established first-line approach. Cannabinoids have been studied for sleep in small trials, and effects on sleep maintenance measures have been inconsistent.