Why Can’t I Stay Asleep? 12 Reasons You Keep Waking Up at Night

Quick Answer: If you can fall asleep but keep waking up at night, something may be interrupting your sleep after it begins. Occasional wake-ups can be normal, but repeated difficulty staying asleep may be related to insomnia, a sleep disorder, medication, another health condition, or factors in your sleep environment.

We all know sleep matters, but sometimes the harder you try to get it, the more elusive it becomes. You may fall asleep normally, wake up a few hours later, and suddenly find yourself staring at the ceiling, checking the time, and growing increasingly annoyed because you cannot fall back asleep.

Difficulty staying asleep can have many causes. Sometimes something as simple as noise, room temperature, or stress is enough to disrupt your sleep. In other cases, repeatedly waking up could be related to a sleep disorder or another health problem you may not be aware of.

If this keeps happening to you, understanding why you cannot sleep through the night is a good place to start.

Is it normal to wake up during the night?

Yes, it is normal to wake up during the night. Sleep is not one continuous state from the moment you fall asleep until morning. Instead, you move through different stages of non-REM and REM sleep in cycles throughout the night.

A typical sleep cycle lasts about 80 to 100 minutes, and most adults go through four to six cycles each night. Non-REM sleep includes lighter sleep and deep sleep, while REM sleep is the stage most closely associated with vivid dreaming.

Brief wake-ups can happen as you move between sleep cycles or spend more time in lighter sleep. You may roll over, adjust your position, or briefly become aware of a sound before falling back asleep. 

Many of these wake-ups are so short that you do not remember them the next morning.

Also Read: Waking Up at 3 AM: Is It Bad, and Why It Keeps Happening

If I can’t stay asleep through the night, do I have insomnia?

Insomnia can involve difficulty falling asleep, staying asleep, or waking up too early and being unable to go back to sleep. An occasional night of poor sleep does not automatically mean you have insomnia.

Difficulty staying asleep through the night is known as maintenance insomnia, or sleep maintenance insomnia, whereas chronic insomnia generally involves difficulty falling or staying asleep at least three nights a week for three months or longer.

There is also a difference between insomnia and simply not getting enough sleep. If repeated awakenings reduce your sleep over several nights, you may start building sleep debt, which is the difference between how much sleep your body needs and how much you actually get.

12 reasons you may have trouble staying asleep

Poor sleep habits can affect how well you sleep, but they are not the only reason you may wake up during the night. Below are 12 other factors that can interrupt sleep after you fall asleep.

1. Stress can keep you more alert at night

Stress can affect sleep even when you have no trouble falling asleep. When you are stressed, your body releases hormones such as cortisol that help keep you alert. This response is partly regulated by the hypothalamic-pituitary-adrenal (HPA) axis, which normally becomes less active during the early stages of sleep.

Ongoing stress can keep this alert state active longer than usual, making sleep lighter and more easily interrupted. Once you wake up, thoughts about work, finances, relationships, or the next day can also make it harder to fall back asleep. (1)

2. Sleep apnea can repeatedly interrupt your breathing

Obstructive sleep apnea (OSA) occurs when the upper airway repeatedly narrows or closes during sleep. When airflow becomes restricted or stops, the brain briefly wakes you so breathing can restart. These interruptions can occur many times during the night without you remembering each one.

Certain physical features and health factors can increase the risk of OSA. Overweight or obesity can increase fatty tissue around the neck and upper airway, and a larger neck, a large tongue, or enlarged tonsils can also reduce the space available for airflow during sleep. 

Common signs include:

• Loud, frequent snoring

• Breathing that stops and starts during sleep

• Gasping or choking

• Morning headaches

• Dry mouth

• Daytime sleepiness or fatigue

• Frequent nighttime bathroom trips

Many adults with OSA do not know they have it because some of the most noticeable symptoms happen while they are asleep. If you suspect you may have sleep apnea, talk with your healthcare provider. A sleep study may be needed to confirm the diagnosis. 

3. Restless legs syndrome can make it difficult to stay settled

Restless legs syndrome (RLS) is a neurological condition that causes a strong urge to move the legs, often accompanied by uncomfortable sensations such as aching, tingling, pulling, crawling, or creeping.

Symptoms usually worsen while resting and are often more noticeable in the evening or at night. Moving or walking may temporarily relieve the discomfort, but the sensations can return once you lie down again.

Some people with RLS also experience periodic limb movements during sleep (PLMS). These repeated, involuntary leg movements can disrupt sleep even when you do not fully wake up or remember them the next morning. 

4. Acid reflux and other digestive problems can interrupt sleep

Acid reflux happens when stomach contents move back into the esophagus. When it happens regularly, it may be diagnosed as gastroesophageal reflux disease (GERD).

Heartburn, regurgitation, coughing, or chest discomfort can become uncomfortable enough to wake you up. A hiatal hernia, where part of the stomach moves upward through the diaphragm, can also increase the likelihood of GERD or make reflux symptoms worse. 

Gastritis is different from GERD, but it can cause upper-abdominal pain, nausea, vomiting, or indigestion that may also interfere with sleep. 

5. Pain can interrupt sleep throughout the night

Pain can make it difficult to stay comfortable for several hours. Turning over, putting pressure on a painful area, or moving an irritated joint or nerve may be enough to wake you up.

Conditions that can interfere with sleep include:

• Arthritis

• Chronic back or neck pain

• Sciatica

• Fibromyalgia

• Migraines or recurring headaches

• Injuries

• Other chronic musculoskeletal pain

Pain and sleep can also affect each other. Chronic pain may interrupt sleep, while poor sleep has been associated with greater pain sensitivity the following day. (2)

6. Hormonal changes can affect sleep

Hormonal changes can affect sleep in both women and men, but the effects are often more noticeable in women because hormone levels fluctuate across the menstrual cycle, pregnancy, perimenopause, and menopause.

During perimenopause and menopause, fluctuations in estrogen and progesterone can occur alongside hot flashes, night sweats, and mood changes that disrupt sleep. Night sweats, in particular, can cause repeated awakenings during the night. 

The menstrual cycle can affect sleep as well. Some women experience dysmenorrhea, or painful menstrual cramps, along with lower-back pain, headaches, nausea, and other symptoms. Period pain is often strongest during the first day or two of menstruation and can make it harder to stay asleep, especially when cramps or discomfort wake you at night. 

In men, testosterone levels normally rise during sleep, and poorer sleep quality has been linked to lower testosterone levels. Sleep loss can also reduce testosterone, particularly when sleep is severely restricted. (3)

7. Frequent bathroom trips can fragment your sleep

Getting up to pee occasionally during the night is common. When it happens several times, the repeated bathroom trips can fragment your sleep and make it harder to go back to sleep.

Frequent nighttime urination is called nocturia. (4) Possible causes include:

• Drinking a large amount of fluid in the evening

• An enlarged prostate

• Overactive bladder

• Diabetes

• A urinary tract infection (UTI)

• Kidney or heart problems

• Sleep apnea

An overactive bladder can cause urinary urgency and frequent urination, while a UTI may cause a strong urge to pee even when there is only a small amount of urine to pass. 

8. Some medications can interfere with sleep

Prescription and OTC medications can affect sleep in different ways. Some increase alertness, while others may cause restlessness, headaches, vivid dreams, or frequent urination.

Examples include:

• Pseudoephedrine, found in some decongestants, can cause nervousness, restlessness, headaches, and difficulty sleeping. (5)

• Stimulants such as methylphenidate and lisdexamfetamine, commonly used for ADHD, can interfere with sleep, particularly when taken later in the day. (6)

• Prednisone and other corticosteroids can cause headaches and difficulty falling asleep or staying asleep. (7)

• Some antidepressants can affect sleep. Missing doses, reducing the dose too quickly, or abruptly stopping an SSRI or SNRI can also cause withdrawal symptoms such as insomnia, vivid dreams, dizziness, headaches, and electric-shock-like sensations often called brain zaps. 

• Bupropion may cause agitation, headaches, or difficulty sleeping in some people. (8)

• Albuterol can cause nervousness, headaches, and difficulty sleeping. (9)

• Diuretics such as furosemide increase urination and may lead to more nighttime bathroom trips depending on when they are taken. (10)

Side effects vary from person to person, and medication timing can matter. Do not stop or change a prescribed medication on your own. Talk with your healthcare provider or pharmacist if your sleep changed after starting a medication or adjusting the dose.

9. Anxiety, depression, and PTSD can change sleep

Mental health conditions can affect the brain activity involved in sleep and alertness, not just the thoughts running through your mind at bedtime.

Anxiety disorders and PTSD can keep the brain in a heightened state of alertness, sometimes called hyperarousal. This can make sleep lighter and more easily interrupted. PTSD may also cause nightmares or sudden awakenings during the night. 

Depression can also affect normal sleep patterns, including REM sleep and deep sleep, and may be associated with waking up frequently or earlier than intended. (11)

10. Your circadian rhythm may be out of sync

Your circadian rhythm is the roughly 24-hour internal clock that helps regulate when you feel sleepy and when you feel alert. Light and darkness are major signals that help keep this rhythm aligned with the time of day.

When your internal clock and sleep schedule do not match, your brain may promote wakefulness when you are trying to sleep.

Jet lag is one example. After traveling across time zones, your internal clock may still be following the timing of your previous location, leaving you sleepy or alert at the wrong times.

Night shifts and rotating schedules can create a similar mismatch. People with shift work disorder may have difficulty getting uninterrupted sleep because they are trying to sleep during hours when their circadian rhythm normally promotes wakefulness. 

11. Sleep changes as you get older

As you get older, you may notice that your sleep changes compared with when you were younger. You may start feeling sleepy earlier in the evening, wake up earlier in the morning, or wake up more often during the night.

Sleep also tends to become lighter and more fragmented with age. Older adults generally spend less time in deep sleep, and conditions such as pain, sleep apnea, medication use, and nighttime bathroom trips can further disrupt sleep.

Getting older does not mean you suddenly need much less sleep. Adults 65 and older still generally need about 7 to 8 hours of sleep each night. 

12. Your sleep environment may be interrupting you

Sometimes the problem is in the bedroom itself. Light, noise, temperature, an uncomfortable mattress, a partner who snores or moves frequently, or pets moving around at night can all cause brief wake-ups.

These disturbances may be more noticeable during lighter stages of sleep. Keeping the bedroom dark, quiet, and comfortably cool can reduce unnecessary interruptions.

Also Read: Is Bed Rotting Good for Your Sleep? Here's What You Need to Know

Frequently asked questions

Why do I wake up every 2 hours?

Brief wake-ups can happen as you move through different sleep stages, but regularly becoming fully awake every couple of hours may mean something is repeatedly interrupting your sleep. This could be related to a sleep disorder, another health condition, stress, or your sleep environment.

Why can I only stay asleep for 4 hours?

Regularly waking up after four hours can happen when your sleep is interrupted by insomnia, a sleep disorder, a health condition, or changes in your sleep-wake schedule. Most adults need more than four hours of sleep, so if this happens often and you cannot go back to sleep, consider discussing it with your healthcare provider.

So, how can I stay asleep longer?

Sleep can be elusive, especially when stress, your health, or even your surroundings keep interrupting it. If you wake up in the middle of the night and cannot fall back asleep, give yourself time to settle instead of immediately trying to force it.

• Stop checking the clock. Watching the time can quickly turn into counting how many hours you have left until morning. That can add pressure and make it harder to relax and fall back asleep.

• Take the pressure off falling asleep. You may have noticed that the harder you try to force yourself to sleep, the more awake you feel. Instead, rest quietly for a while rather than treating sleep as something you need to make happen right away.

• If you are still wide awake, get out of bed for a while. Keep the lights low and do something quiet, such as reading a few pages of a book or listening to soft music, pink noise, white noise, or another steady sound. Return to bed once you start feeling sleepy again.

• Remind yourself that briefly waking up during the night is normal. Getting frustrated about being awake can make it harder to fall back asleep.

• Try slow breathing or write down what is on your mind. If the same thought keeps coming back, jotting it down in a journal can help you set it aside for the morning instead of continuing to think about it in bed.

If you need help falling asleep or staying asleep, Sip2Sleep® is a melatonin-free liquid sleep aid made with Montmorency tart cherry extract and Rafuma leaf (Venetron®). Take 1 to 3 full droppers 30 to 60 minutes before bed. If you wake up during the night, you can also take 1 full dropper to help you fall back asleep.

If trouble staying asleep persists for several weeks or begins to affect how you feel during the day, talk to your healthcare provider.

About the author

Dr. Ruchir P. Patel, MD, FACP, is the Medical Director of the Insomnia and Sleep Institute of Arizona and the founder of Sip2Sleep. He is triple board-certified in sleep medicine, obesity medicine, and internal medicine. Dr. Patel is a multi-year Phoenix Magazine Top Doctor and holds the Inspire Excellence designation.

References:

1. van Dalfsen, J. H., & Markus, C. R. (2018). The influence of sleep on human hypothalamic-pituitary-adrenal (HPA) axis reactivity: A systematic review. Sleep medicine reviews, 39, 187–194. https://doi.org/10.1016/j.smrv.2017.10.002

2. Runge, N., Ahmed, I., Saueressig, T., Perea, J., Labie, C., Mairesse, O., Nijs, J., Malfliet, A., Verschueren, S., Van Assche, D., de Vlam, K., Van Waeyenberg, T., Van Haute, J., & De Baets, L. (2024). The bidirectional relationship between sleep problems and chronic musculoskeletal pain: a systematic review with meta-analysis. Pain, 165(11), 2455–2467. https://doi.org/10.1097/j.pain.0000000000003279

3. Lord, C., Sekerovic, Z., & Carrier, J. (2014). Sleep regulation and sex hormones exposure in men and women across adulthood. Pathologie-biologie, 62(5), 302–310. https://doi.org/10.1016/j.patbio.2014.07.005 

4. Leslie SW, Sajjad H, Singh S. Nocturia. [Updated 2024 Feb 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/sites/books/NBK518987/

5. American Society of Health-System Pharmacists. (2025, June 15). Pseudoephedrine. MedlinePlus. https://medlineplus.gov/druginfo/meds/a682619.html

6. American Society of Health-System Pharmacists. (2021, October 15). Lisdexamfetamine. MedlinePlus. https://medlineplus.gov/druginfo/meds/a607047.html

7. American Society of Health-System Pharmacists. (2024, June 20). Prednisone. MedlinePlus. https://medlineplus.gov/druginfo/meds/a601102.html

8. American Society of Health-System Pharmacists. (2025, November 15). Bupropion. MedlinePlus. https://medlineplus.gov/druginfo/meds/a695033.html

9. American Society of Health-System Pharmacists. (2023, October 15). Albuterol. MedlinePlus. https://medlineplus.gov/druginfo/meds/a607004.html 

10. American Society of Health-System Pharmacists. (2025, April 15). Furosemide. MedlinePlus. https://www.medlineplus.gov/druginfo/meds/a682858.html 

11. Palagini, L., Baglioni, C., Ciapparelli, A., Gemignani, A., & Riemann, D. (2013). REM sleep dysregulation in depression: state of the art. Sleep medicine reviews, 17(5), 377–390. https://doi.org/10.1016/j.smrv.2012.11.001