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Sleep issues have multiple causes

DEAR DOCTOR K: I fall asleep just fine, but then I wake up around 4 a.m. It’s too early to get up, but I can’t fall back asleep. Help!

DEAR READER: Practically everyone has sleep problems occasionally. And a lot of people have sleep problems often. Sometimes it’s trouble falling asleep. Sometimes, as in your case, it’s trouble staying asleep. And sometimes it’s just waking up unrefreshed, even though you think you’ve slept soundly.

Sleep doctors call waking up in the middle of the night “sleep-maintenance insomnia.” That’s difficulty staying asleep, particularly waking too early and struggling to get back to sleep.

When my patients tell me they keep waking up at night for no good reason, I ask them if they wake up once or repeatedly. Sometimes they wake up just once, a few hours before they want to wake up – as seems to be the case with you. That can be a sign of depression, even in people who aren’t aware that they are depressed.

At least as often, patients say they wake up multiple times at night, not just early in the morning.

Sometimes the problem is a stressful day. You lay your head on the pillow, and events from the day keep streaming through your brain. Consider meditation, deep breathing, progressive muscle relaxation or biofeedback.

Sometimes the problem is stimulants – stimulant medicines or an alcoholic “nightcap” before bed.

Sometimes the problem is pain.

When depression, life stresses, stimulants or pain are not the cause, cognitive behavioral therapy can be helpful. Working with a therapist, you’ll learn new ways to think about your sleep problems and develop better strategies for dealing with those problems.

For example, you may believe that you need eight hours of sleep and that you won’t be able to function the next day if you don’t get that much. Some people do need an average of eight hours a night, but still can function fine after one or two nights of less sleep. CBT can help change such beliefs, making it easier to relax and fall back asleep.