© 2019 Gwen Dewar, Ph.D., all rights reserved
Night wakings have a bad reputation, and no wonder. Just about everybody has experienced it: awakening spontaneously in the middle of the night, unable to fall back to sleep.
If you are a parent, you also know what it’s like when somebody else keeps waking you up. A hungry baby, a crying toddler, a worried child.
When morning arrives, you don’t feel restored and energetic. Not if your sleep has been too fragmented. Not if you spent too much time awake.
So you might conclude that night wakings are unnatural, unhealthy — a sign that something has gone wrong. But science doesn’t support this idea.
Yes, night wakings can be associated with sleep deprivation and other health issues. If night wakings are causing strife and distress, you need to find ways to improve the situation.
But night wakings aren’t — by themselves — unnatural or unhealthy.
On the contrary, it’s normal for healthy sleepers to experience many arousals from sleep during the night. An adult or child who didn’t experience these arousals would be a freak of nature. Or a patient in a coma.
Night wakings are a bit like those unconscious movements we experience at night. If you move around too much, it can become disruptive. But if you don’t move enough, you put yourself at risk for serious problems. Muscle and tendon strains from remaining in the same position too long. Compressed and damaged nerves. Bedsores.
In the case of night wakings, they protect the brain from sinking too far into deep sleep: They help ensure that sleep is reversible.
They also allow us to keep tabs on the environment, so we can react more quickly in the event of an emergency. What’s that sound?
And they make us more responsive to urgent, internal threats — like a breathing problem (Halász et al 2004; Eckert and Younes 2014).
Thus, night wakings aren’t the enemy of a good night’s sleep. Our goal shouldn’t be to eliminate them. Instead, we should focus on making night wakings less disruptive, and addressing the problems that prevent us from falling back to sleep.
How do we do this? It isn’t easy, especially if you’ve learned to dread or resent night wakings. It pumps up your stress levels, which makes it harder to sleep. The result is what doctors call psychophysiological insomnia. You’ve (inadvertently) taught your brain to respond to night wakings by becoming more alert and vigilant.
But understanding the science of sleep can help. It can provide you with a more realistic, reassuring view of night wakings. And it offers practical insights for improving sleep quality.
In the remainder of this article, I review the following:
- Why nobody truly “sleeps through the night”
- Why spending time awake at night isn’t intrinsically bad, or against human nature
- Why babies wake up so often
- How to manage night wakings in young infants
- More tips for coping with disruptive night wakings in children and adults
Night wakings: Why nobody truly “sleeps through the night”
Perhaps you’ve heard parents brag that their children are “sleeping through the night.” This isn’t happening in your family, and you’re wondering what’s wrong.
Your baby seems to be a light sleeper. She’s easily aroused at night and (when things get really difficult) she seems capable of waking up every hour.
Or maybe you have an older child, and wonder why he keeps waking up in the middle of the night.
Is a medical condition causing these wakings? It’s possible. As I note below, there are conditions — like obstructive sleep apnea and gastroesophageal reflux disease — that can trigger night wakings.
Does your child suffer from a sleep disorder? That’s possible too.
But it’s important to understand that night wakings are a regular feature of normal, healthy sleep.
Nobody truly “sleeps through the night,” not if we mean by this phrase “sleeping continuously in one, long, uninterrupted bout.”
When scientists monitor people sleeping in the laboratory — using electroencephalograms (EEGs) — they confirm that sleep isn’t a monolithic state.
Instead, we cycle through a series of sleep stages (including light sleep, deep sleep, and REM, or rapid-eye movement sleep). And cortical arousals — transitions into increased wakefulness — are common.
In a study conducted in the United States, researchers used electroencephalograms (EEGs) to measure the sleep behavior of 76 healthy adults between the ages of 18 and 70. Across all age groups, sleepers averaged 80 to 130 arousals in a single night (Bonnet and Arand 2007).
To be clear, people aren’t waking up “all the way” every time they experience a cortical arousal. Often, they are shifting from deep sleep into light sleep. Or from REM into light sleep.
But once we’re in light sleep, we’re easily awakened. And EEG studies confirm that many arousals do result in our waking up “all the way.”
The average adult may experience more than 20 such awakenings each night — and more 40 nightly awakenings after the age of 50 (Bonnet and Arand 2007).
We don’t remember all these awakenings because most are very brief. We quickly resume sleeping, and form no memory trace.
But what if something attracts our attention during these fleeting moments of consciousness? What if we hear something? What if think of something that worries or stimulates us?
Instead of drowsing off, we become more vigilant, more alert. Voluntarily or involuntarily, we end up spending a considerable stretch of time awake.
So every normal, momentary shift into waking has the potential to become a lengthy episode of sleeplessness. And it’s this scenario — becoming alert for an extended period at night — that you may want to avoid.
Yet even here not everybody agrees.
You might take it for granted that you are supposed to sleep in one, long, continuous, nocturnal bout. Failure to do so is undesirable. Perhaps even pathological. This is a common folk belief in modern, Western societies.
But in other cultural settings, people take a very different view. They accept that sleep will include interruptions, and they don’t perceive these interruptions to be unhealthy or pathological (Worthman and Melby 2002).
I think it’s helpful to understand this, even if you embrace minimal sleep interruption as a goal. Because it’s harder to minimize interruptions when you’re convinced that time spent awake is a pathology.
If you believe that night wakings are intrinsically bad, you’re more likely to feel stressed when you realize that you’ve awakened at night. This makes it harder to fall back to sleep.
You’re also more likely to transmit negative feelings to your child — making it harder for your child to fall back to sleep.
And, in the long run, you’re more likely to chronic sleep difficulties — the learned, psychophysiological insomnia that I mentioned earlier.
So let’s take a closer look. How do people outside the bubble of Western, industrialized societies conceptualize sleep?
The anthropology of night wakings: Why spending time awake at night isn’t intrinsically bad (or against human nature)
There’s no doubt about it. We’re basically diurnal creatures — adapted for maximizing activity during the daytime.
But that doesn’t mean we need to sleep continuously from dusk to dawn. You already know that. And cross-cultural research demonstrates that human sleep patterns are flexible and variable.
For example, consider the work of Roger Ekirch. He has uncovered fascinating historical evidence about sleep habits in pre-industrial Europe. People didn’t lie down at night and expect to get all their sleeping done in a single bout. Instead, they went to sleep in the evening for a few hours, woke up, and engaged in activities. Then, an hour or two later, they resumed sleeping until morning (Ekirch 2005).
Did people think they were suffering from insomnia? Far from it. They took it for granted that this was a good way to cope with long nights (Ekirch 2005).
Similarly, people living in a variety of non-Western, traditional cultures have been known to take their sleep in multiple sessions (Worthman and Melby 2002; Samson et al 2017b). And they don’t pathologize night wakings. Even if they end up spending a considerable amount of time awake, they view their sleep habits as normal.
For instance, when anthropologists measured sleep in three traditional foraging societies, they confirmed that adults woke up multiple times during the night. The total duration of this waking time — what researchers call “wake after sleep onset” – averaged 80 minutes or longer (Yetish et al 2015).
Yet when anthropologists asked these same people if they experienced problematic night wakings, very few individuals saw it that way (Yetish et al 2015). Less than 3% of adults reported having sleep maintenance problems more than once per year.
Or take a recent sleep study conducted on Hadza hunter-gatherers in East Africa.
Parents and other caregivers averaged approximately two hours of “wake after sleep onset” each night (Crittenden et al 2018).
But none of these adults — each of whom shared a sleeping space with at least one infant or child — viewed themselves as sleep-deprived.
When asked, all of them said they were getting enough sleep at night (Crittenden et al 2018).
Remarkably, this was true even for breastfeeding mothers. Simply having a baby — spending the night with a baby — didn’t, by itself, cause sleep problems.
And while things might be different for you, it’s worth noting: Even in modern, industrialized societies, infant night wakings don’t always cause trouble.
Night wakings without strife: Babies can awaken without making you miserable
Remember those boasting parents we mentioned earlier? The ones who claim their babies sleep through the night?
Strictly speaking, they’re mistaken. Their babies are waking up at night, just like everyone else’s. But there is an important difference.
These babies aren’t waking up their parents.
Thus, parents are wrong to believe their babies don’t wake up. But they may be accurate when they report a lack of sleep disruption.
And if you’re thinking, “this isn’t me — I always know when my baby awakens!” think again. A recent study — conducted in an urban, Westernized population — suggests that “under the radar” night wakings are pretty common.
The researchers measured sleep two ways — (1) by fitting infants with sensors, and (2) by asking parents for their subjective impressions. There were more than 200 babies total, and data was collected in the infants’ own homes, for five nights.
Did the researchers document lots of night wakings overall? You bet. But when researchers compared their objective measurements against the subjective, parental reports, there was a big mismatch.
Babies were waking up more often than their parents realized. The infants awoke spontaneously, remained relatively quiet, and fell back to sleep on their own — their parents none the wiser (Tikottzky and Volkovich 2019).
The pattern was evident when the babies were just 3 months old. And in subsequent tests — when the babies were older — the gulf between objective and subjective measurements widened. Over time, parents became increasingly unaware of their children’s night wakings.
So night wakings don’t inevitably trigger sleep problems. People can feel well-rested despite awakening during the night. And parents aren’t always bothered by their children’s wakings. It’s only when a child fails to self-settle — and parents experience serious sleep disruptions — that we perceive night wakings to be problematic.
But babies are unusually difficult, right? Why do babies wake up so frequently?
First, there’s the baby’s “inner clock.”
Immediately after birth, babies lack strong circadian rhythms. Their sleep schedules can be out of sync with the natural cycle of day and night.
Second, young babies need to feed during the night.
They are born hungry. Their stomachs are small. They need to refill their tanks frequently to achieve the normal pattern of rapidly growth during the first 8-12 weeks.
Third, babies have their own, distinctive sleep stages.
During the first three months postpartum, babies spend most of their sleep-time in a stage called “active sleep.” It’s the infant counterpart to REM, and it’s especially restless. Babies twitch, thrash around, and even vocalize.
This can fool us into thinking our infants are awake. So we intervene, and, in doing so, we rouse our babies from sleep. We’ve caused a night waking! Alternatively, all that thrashing around can sometimes cause an infant to awaken himself.
Put these three factors together, and we get a whole lot of wakefulness during the night.
For example, in a study that recorded the sleep patterns of healthy 2- and 9-month old infants, babies averaged 3 major awakenings each night (Anders 1978).
And another study found that approximately 50% of 4-month-old babies were waking their parents up at least once between the hours of midnight and five a.m. (Henderson et al 2010).
What’s the solution? How can we manage night wakings in young babies?
To some degree, we simply have to be patient. These are developmental issues. But there are some things we can do to help.
For instance, when it comes to circadian rhythms, we can expose babies to powerful environmental cues. These will help babies attune their “inner clocks” more quickly. Read more about it in my article about newborn sleep.
In addition, you might find it easier to cope with nighttime meals if you try “dream feeding.” For more about this approach, see this Parenting Science guide.
What about active sleep? Dealing with all that noise, restlessness, thrashing?
Just learning about it is helpful. Once you know the signs of active sleep, you can avoid swooping in too soon, and inadvertently waking your sleeping baby.
It’s also possible that swaddling — practiced safely — can reduce the chances that your baby wakes him or herself up (Gerard et al 2002; Franco et al 2005; Meyer and Erler 2001). For the details, see tip #4 in my article about infant sleep aids.
And when your baby’s sleep patterns are driving you crazy, console yourself. Active sleep is probably doing something important for your baby.
One interesting theory is that babies twitch and move during sleep because their brains are busy testing and mapping out the connections between nerves and skeletal muscles (Peever and Fuller 2017).
Another idea is that active sleep is protective. Young infants are at special risk for sleep-related breathing emergencies — emergencies believed to cause SIDS, or sudden infant death syndrome. So spending time in active sleep — a state in which babies are easily awakened — may help reduce this risk.
And what else? What if a baby wakes frequently, and fails to self-settle? What if an older child keeps waking up?
There are indeed other measures to take. Here are some evidence-based tips.
1. Make sure you aren’t training your child to awaken.
If your child wakes you up in the middle of the night, try to keep things dark, quiet, and calm.
You don’t want it to turn into a social event — or a scolding session. Either scenario will heighten your child’s alertness. And if it happens repeatedly, your child may learn to associate awakening with these outcomes. You are training your child to become active and alert in response to night wakings!
2. Watch out for nightlights and other sources of illumination — they can counteract a child’s natural drowsiness
As I note in this article, electric lights and electronic devices emit wavelengths that interfere with the body’s production of melatonin, the hormone of drowsiness.
3. Use bedtime routines, and other tactics to help your child relax.
If you teach children to associate their beds with drowsiness and security, they will have an easier time settling themselves to sleep after a night waking. For help, see my article about gentle sleep training.
In addition, check out these 15 tips for better baby sleep, and my trouble-shooting guide to handling bedtime problems in infants and older children.
4. Talk to your doctor about any medical concerns.
A variety of medical conditions can cause night wakings. These include
- asthma (Fagnano et al 2011),
- atopic dermatitis or eczema (Fishbein et al 2015),
- bladder problems and bed-wetting,
- gastric reflux, or heartburn (Lim et al 2018),
- headaches (Tran and Spierings 2013; Long et al 2010; Zarowski et al 2007; Carotenuto et al 2005), and
- sleep apnea.
If you observe signs of these problems, or otherwise suspect that your child is in pain, be sure to consult with your doctor. For more information about bed-wetting, see this Parenting Science guide.
5. Don’t ignore snoring.
Not every snore or snuffle is a sign of trouble. But in many cases, snoring is a symptom of obstructive sleep apnea, one the conditions mentioned above. And sleep apnea doesn’t just cause frequent night wakings. It can also restrict the oxygen supply to the brain and cause serious health problems (e.g., Fukumizu et al 2005; Hiscock et al 2007; Shur-Fen Gau 2006).
So if you notice snoring — or other types of disordered breathing during sleep — talk to your doctor.
6. Address nighttime fears and separation anxiety.
Not surprisingly, kids with nighttime fears are more likely to experience sleep disruptions (Petit et al 2006; Gregory et al 2005; Kushnir and Sadeh 2011; Meltzer et al 2013).
Some people think that sleep training is the answer, but there is no evidence that nighttime fears or separation anxiety will diminish as a result of sleep training.
In fact, sleep training (like the Ferber method) isn’t designed to treat fear and anxiety. So if you implement sleep training alone, you are effectively ignoring your child’s fears. And that can make things worse.
Thus, it’s important to take an active role in teaching your child to overcome his or her fears. For more information, see this article on nighttime fears in children.
7. Pay attention to other sources of stress.
You don’t have to suffer from nighttime anxieties to experience sleep disruption. The stresses and anxieties that you experience during the daytime can have also have an impact.
For instance, children sleep more poorly when their parents are depressed (Ystrom et al 2017).
They experience more sleep disruptions when their parents fight (Rhoades et al 2012; El-Sheikh et al 2015).
And babies wake up more frequently at night when they live in socioeconomically deprived neighborhoods (Grimes et al 2019).
The takeaway? Kids are like us. Being stressed-out during the day causes sleep problems at night. So pay attention to your child’s stressors. Reduce sources of stress, and help your child cope. For tips, see these Parenting Science articles:
8. Learn how to handle nightmares and night terrors.
Both nightmares and night terrors can cause sleep disruption. But they are very distinct phenomena.
Children having nightmares usually appear to be asleep. They might twitch; they might sigh. But they are usually lying in bed, eyes closed. And they are relatively quiet. When they wake up, they may remember the nightmare.
By contrast, children having night terrors often appear to be awake. They might scream, cry, or talk. The might open their eyes. They might sit up, or walk around. But they aren’t fully conscious, and they rarely remember these experiences later.
If nightmares or night terrors are the problem, you need to learn more about them. For more information, see this Parenting Science article on nightmares and night terrors in children.
For more evidence-based information, see this index to Parenting Science articles about sleep.
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