Middle-of-the-night insomnia (MOTN) is characterized by having difficulty returning to sleep after waking up during the night or very early in the morning. This kind of
insomnia (sleeplessness) is different from initial or sleep-onset insomnia, which consists of having difficulty falling asleep at the beginning of sleep.
The disrupted sleep patterns caused by middle-of-the-night insomnia make many sufferers of the condition complain of fatigue the following day.
Excessive daytime sleepiness is reported nearly two times higher by individuals with nocturnal awakenings than by people who sleep through the night.
Sleep research conducted in the 1990s showed that such waking up during the night may be a natural sleep pattern, rather than a form of insomnia.
If interrupted sleep (called "biphasic sleeping" or "
bimodal sleep
Biphasic sleep (or ''diphasic'', ''bifurcated'', or bimodal sleep) is the practice of sleeping during two periods over the course of 24 hours, while polyphasic sleep refers to sleeping multiple times—usually more than two. Each of these is in ...
") is perceived as normal and not referred to as "insomnia", less distress is caused and a return to sleep usually occurs after about one hour.
Causes
*
Pain
Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ...
*
Pregnancy
*
Anxiety
* Difficulty breathing /
sleep apnea
* Urge to urinate or defecate
* Hunger or thirst
* Illness
* Shift work
* Erratic sleep schedule
Nocturnal awakenings are more common in older patients and have been associated with
depressive disorders,
chronic pain,
obstructive sleep apnea
Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is characterized by recurrent episodes of complete or partial obstruction of the upper airway leading to reduced or absent breathing during sleep. These episod ...
,
obesity,
alcohol
Alcohol most commonly refers to:
* Alcohol (chemistry), an organic compound in which a hydroxyl group is bound to a carbon atom
* Alcohol (drug), an intoxicant found in alcoholic drinks
Alcohol may also refer to:
Chemicals
* Ethanol, one of sev ...
consumption,
hypertension
Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long-term high bl ...
,
gastroesophageal reflux disease,
heart disease
Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include stroke, hea ...
,
menopause,
prostate problems, and
bipolar disorders.
Gastro-intestinal discomfort arising from food that has not been fully cooked, is also a contributor to middle of the night insomnia.
Nocturnal awakenings can be mistaken as
shift work disorder
Shift work sleep disorder (SWSD) is a circadian rhythm sleep disorder characterized by insomnia, excessive sleepiness, or both affecting people whose work hours overlap with the typical sleep period. Insomnia can be the difficulty to fall asleep o ...
.
Treatment
Middle-of-the-night insomnia is often treated with medication, although currently Intermezzo (
zolpidem tartrate sublingual tablets) is the only
Food and Drug Administration-approved medication specifically for treating MOTN awakening. Because most medications usually require 6–8 hours of sleep to avoid lingering effects the next day, these are often used every night at bedtime to prevent awakenings. Medication may not be prescribed in some cases, especially if the cause turns out to be the patient ingesting too much fluid during the day or just before they go to sleep.
Sleep restriction therapy and stimulus control therapy as described in
insomnia have shown significance in treating middle of night insomnia.
Some studies have shown that
zaleplon, which has a short elimination
half-life, may be suitable for middle-of-the-night administration because it does not impair next day performance.
Prevalence
Waking up in the middle of the night, or nocturnal awakening, is the most frequently reported insomnia symptom, with approximately 35% of Americans over 18 reporting waking up three or more times per week.
Of those who experience nocturnal awakenings, 43% report difficulty in resuming sleep after waking, while over 90% report the condition persisting for more than six months. Greater than 50% contend with MOTN conditions for more than five years.
A 2008 "Sleep in America" poll conducted by the
National Sleep Foundation found that 42% of respondents awakened during the night at least a few nights a week, and 29% said they woke up too early and couldn’t get back to sleep. Other clinical studies have reported between 25% and 35% of people experience nocturnal awakenings at least three nights a week.
See also
*
Biphasic and polyphasic sleep
References
{{DEFAULTSORT:Middle-Of-The-Night Insomnia
Insomnia