Why do I always wake up at 3 am?

As a therapist specialized in insomnia and sleep disorders, I often hear about 3am and, less frequently, 4am or 5am wakeups.

I frequently hear from clients who say things like:

• “3am is my witching hour”

• “I consistently wake up at 3 in the morning, for no reason.”

• “I think I’m having cortisol spikes in the middle of the night at 3am because I’m always getting up.”

There’s an expectation that “good sleepers” sleep soundly with no brief awakenings, but the reality is that many people with healthy sleep have brief awakenings, even if it’s as quick and simple as waking up to roll over and going back to sleep. 

Many people are shocked to hear that waking up in the night isn’t necessarily a problem. It’s the trouble falling back asleep that is the problem.

Brief awakenings are perfectly healthy and can be helpful for making sure all is sound in the house, there’s no danger and it’s safe to return to a deeper sleep. 

There are a number of reasons why someone might wake up at 3am in particular as opposed to another time of night. Sleep tends to be lighter and there are more likely to be recalled awakenings in the latter portion of the night because we’ve met some of our sleep “appetite”
Earlier in the night there’s more sleep drive (like “hunger” for sleep) so it may be easier to return to sleep and awakenings may be less likely. 

I’m going to walk through the most common example of a persistent 3am wakeup but keep in mind, I’m not evaluating you in particular, so please speak to a licensed healthcare provider if you have questions or want to talk through your specific situation.

As an example, let’s suppose that two very similar people both wake up at 3am.

Person A wakes up at 3am, but doesn’t keep a clock in their room and keeps their phone in another room. They’re naturally not too worried about sleep in general so they just relax for a minute, get bored, and fall back asleep.

Person B wakes up at 3am and sees the backlight clock in their room that says 3:05. They think “Oh no, not again” and worry that they won’t be able to get back to sleep, they know that worry and stress make it harder to sleep so they try to relax but after a minute, they feel the need to use the restroom and get up even more worried about sleep than before. They try to listen to a sleepy podcast and try to take their mind off the worry but then grow concerned that the relaxation exercises aren’t working. They drift in and out of a very light sleep and hours later they wake up for the day and feel run-down and groggy.

In this example, you can see that person B is trying to relax and not worry with distractions, but there’s a fear underneath that keeps brewing. 

There are many similarities between insomnia and a phobia of sleeplessness. We can try to ignore a phobia but it tends to be very persistent and distraction techniques tend not to work very well.

Instead, taking an exposure based approach can be much more effective.

Let’s continue the example of Person B.

Person B experiences this same issue of waking up at 3am night after night and eventually gets fed up and learns about CBT-I, the first line recommended treatment for insomnia, from their doctor. They decide to give it a try.

In treatment they learn that one cannot force sleep to come. It is an involuntary process and trying to make sleep happen tends to backfire.
It’s like trying to force yourself to stop sweating on a hot day by sheer will-power. The stress of trying to do that might make one sweat even more.

With the support of their therapist, they build a structured sleep plan that allows them to get the amount of sleep they had been getting (with a little room for a buffer) and slowly work on exposure therapy to the fear of sleeplessness.
It’s difficult at first but they start to notice feeling more relaxed in the bed over time.
Eventually, their body starts allowing them to sleep longer. They no longer have a clock in the bedroom (and they also lose the urge to check their phone). They may still have a brief 3am awakening, but they just roll over and go back to sleep without trying (which previously felt impossible). 

If you’re curious to learn more about CBT-I, or if you just want to talk through your unique concerns about sleep, schedule a free consultation.