FAQ: Why do I wake up at 3am?
Insomnia—difficulty sleeping—comes in several flavors: trouble falling asleep initially, waking up too early, and waking up in the middle of the night. Often, the “middle of the night” type of insomnia happens around 3am… the most anxious and miserable time for a lot of people. If you wake up at 3am, you are not alone!
[Also see: What NOT to do if you wake up at 3am.]
When a patient comes to me for 3am awakenings, we first look for clues for the underlying cause or causes (there are often a combination of factors). Treating the correct underlying problem makes a huge difference in treatment success for insomnia. So rather than jumping to sedating medicines, it’s important to pinpoint and treat the specific causes of insomnia for effective, individualized treatment.
Here are 10 reasons you might be waking up at 3am, with clues and what to do for each one.
1. Your circadian rhythm (internal clock) is early
While your sleep drive puts you to sleep, your circadian rhythm—which is separate—keeps you asleep. If your circadian rhythm is early, it thinks 3am is morning time and time to get up for the day.
Clues you have an early circadian rhythm:
You get tired and drowsy in the evening, and might even drift off to sleep on the couch before your official “bedtime.”
You are a “morning lark” to start with, certainly never a “night owl.” You may come from the kind of family that enjoys breakfasting together.
You’re middle or older age. This is when there is a normal shift in circadian rhythms, so especially if you’re early to start with.
If you went to bed early enough, you feel refreshed even if you wake up at 3am.
What to do about an early circadian rhythm:
If going to bed early and getting up early don’t interfere with your social life, family time, work, school or other activities, you don’t have to do anything! Enjoy the quiet hours in the morning. Just make sure you go to bed early enough so that you are getting enough sleep.
Avoid melatonin in the evening which will make your circadian rhythm even earlier.
If you do want to push your circadian clock later, light therapy is the strongest way to move your circadian rhythm. Use a light box, at least 5000 lux (the measurement of brightness), at arm’s length, for 30-60 minutes in the evening.
2. You have sleep apnea:
Obstructive sleep apnea is very, very common, estimated about 20% of the population. Men have roughly twice the rates of OSA as women until menopause. Then around menopause, women catch up to men in terms of OSA prevalence. This means that around the time of menopause, a lot of women get OSA. OSA is caused by collapse of the airway at the back of the mouth collapsing during sleep. This tends to be worse during REM (dreaming) sleep, and since there is relatively more REM sleep in the second part of the night, people with OSA will have more abnormal breathing in the second half of the night that might wake them up.
Clues you have obstructive sleep apnea (OSA) causing your 3am awakenings:
You snore and/or wake up gasping, choking, or snorting. If someone else has seen you stop breathing in your sleep, pause your breathing/snoring, or breathe irregularly… this is a very strong sign you have OSA, even if it was just one time.
You tend to wake up from a dream that you were drowning or suffocating, wake up covered in sweat, or wake feeling like you were struggling.
You wake up with a sour metallic taste in your mouth, or with heartburn. This is the taste of acid reflux: when someone with OSA is trying to inhale against a closed airway, the negative pressure in the chest essentially sucks stomach acid up into the esophagus.
You wake up with a headache that goes away after a little while.
What to do if you think you have obstructive sleep apnea (OSA)
See a sleep medicine doctor for a sleep study. If you have sleep apnea, get it treated. (Find an accredited sleep center here.)
3. Alcohol
Alcohol is terrible for sleep. It suppresses REM sleep, so while there is alcohol in your system in the first few hours of the night, you end up with REM deprivation. Once the alcohol gets metabolized, there is REM rebound where there is a lot of REM in the second part of the night. So this might make any OSA worse (see #2) that wakes you up. When you do wake up in the middle of the night after drinking, you will often wake from an intense, anxious dream.
Alcohol fragments sleep, meaning you will have lots of awakenings, for no other reason. When this happens as the alcohol is wearing off, ie around 3am, people often have anxiety (aka hangxiety) from the withdrawal of the sedative effects of alcohol.
Lastly, alcohol makes you have to urinate more, so you might also be waking to use to the bathroom at 3am.
Clues alcohol is causing you to wake up at 3am.
You drink alcohol. Even one drink can disrupt sleep, especially in the second half of the night.
The 3am wakeup is more likely or more severe if you have more alcohol than usual.
What to do:
Don’t drink alcohol. Seriously, just try it for a month and see how your sleep changes.
If you drink on most days, you may have withdrawal if you stop abruptly. Talk to your doctor and/or seek assistance to quit safely.
4. Mood and anxiety disorders
Sleep changes are a common symptom of mood disorders like depression or bipolar disorder, or anxiety disorders. In fact, insomnia may be the first sign of depression: in a large meta-analysis (Pubmed link), insomnia signaled over twice the chance that someone would be diagnosed with depression.
Clues depression is causing 3am awakenings:
The 3am awakenings are new, or similar to a prior bout of insomnia you had with a mood disorder
Your mood is different: blue, apathetic, anhedonic (nothing brings pleasure), numb; or the opposite – euphoric
You have other symptoms of depression: low energy or fatigue, change in sex drive, feeling of worthlessness, change in appetite
What to do:
See a doctor or mental health professional for treatment ASAP.
Don’t do nothing. Poor sleep puts people at higher risk of depression.
5. Bed partner
Someone or someones in your bed is waking you up. This may be your partner (a snoring spouse is a common cause of 3am awakenings), kids, pets, etc.
Clues it’s not you, it’s them:
You can pinpoint the noise, snoring, kicking, thrashing, or whatever someone did to wake you up.
You would strangle your partner, if only you had the energy.
What to do if someone else if waking you up in the middle of the night:
Use your words, in the daytime. Explain to your bed partner that they are causing you to wake up, and encourage them to seek appropriate help. Getting good sleep is important for our physical, mental, and emotional health.
If it’s noise waking you, you can try earplugs, or a white noise machine or fan.
You can try sleeping in separate beds, rooms, or abodes. In a 2025 survey by the American Academy of Sleep Medicine of >2000 people, a third of adults slept apart from their partner. Sleeping separately was even more common among Millenials (age 35-44 in the survey). In my experience, this is an underestimate because some people technically have a shared bedroom, but in practice sleep apart. Also, please don’t call it a “sleep divorce!” Many loving couples sleep apart… and are more loving that way.
For pets and children: If you want them in your room, try having a separate bed for them within the room. Or, if you prefer to fall asleep with them, you can migrate to another location to sleep in the middle of the night.
What NOT to do: suffer in silence and seethe with resentment, wake your partner in the middle of the night, take sedatives, drag them to the doctor yourself (this doesn’t work, I know, I’ve been that doctor many times).
6. Wearing off of sedatives may be waking you up at 3am.
If you take over-the-counter or prescription medications that makes you drowsy at bedtime, it will obviously help you fall asleep. But, as your body metabolizes the medication, the sedative effect will wear off, waking you up.
Clues: You take sedating medications or substances.
What to do:
If you take a prescription medication, talk to your doctor about changing the medication or alternative treatments.
If you take over-the-counter medication, please see a sleep doctor to evaluate the cause of your insomnia rather than masking it with a sedative.
If the sedative is a recreational drug, stop it or get help to stop.
7. Hot flashes and other menopausal symptoms
Hot flashes are a sensation of extreme heat often accompanied by sweating or heart racing. Hot flashes are very, very common—they occur in about 80% of women eventually. They can occur at any time of night, but more so in the second half of the night. Interestingly (or annoyingly), hormone changes during (peri)menopause lead to more fragmented sleep, and awakenings actually precede the hot flashes, rather than the hot flash causing the awakening.
Clues menopause or perimenopause is waking you up:
You are a woman in your 40’s or 50’s
You feel hot and sweaty.
Your periods have changed or you’ve noticed other symptoms of perimenopause.
What to do:
Talk to your gynecologist. Hormone replacement therapy may be helpful but requires an individualized discussion of risks and benefits.
Medications: there are two new medications specifically for hot flashes (fezolinetant and elinzanetant) which block neurokinins. Additionally, other medications like gabapentin, clonidine, or certain SSRIs can be helpful for hot flashes.
If you smoke, quit! Hot flashes are more common in smokers.
If you wear pajamas, select loose and cool pieces that you can change out of easily. (Have extras). Natural fibers such as cotton or linen for pajamas and sheets will help wick moisture and allow for air circulation.
8. Spiritual window or witching hour
Some religious and spiritual traditions believe that the 2-4am zone is a time associated with supernatural events, a time of spiritual awakening, or time to receive messages from spiritual guides or angels.
Clues: This resonates with you.
What to do:
Nothing! If you want, you can pray, meditate, or otherwise take advantage of this opportunity. If this is a regular and prolonged occurrence that is cutting in to your sleep time, you may need to get to bed earlier or take an early-afternoon nap to make up for the sleep.
9. Normal awakenings
In normal sleep, people cycle through non-REM and REM, 4-5 times over the course of each night. At the end of each REM, most people wake up briefly. This is completely normal. Because each cycle is about the same length each night, normal awakenings will be at about the same time every night (12-1am and 3am being very common). If you wake up at the same time each night, you are normal and your brain is cycling normally through sleep cycles!
Clues you are having normal awakenings:
You wake up at the same time(s) a lot.
You often wake up during or at the end of a dream.
You get back to sleep within 15-30 minutes (often within a couple minutes), and you feel refreshed in the morning if you get a full night of sleep.
What to do: Nothing! You are normal! Enjoy your good and normal sleep!
10. Insomnia
Some people wake up at 3am, either as part of normal sleep cycles (as in #9) or due to other factors (e.g. pain, bathroom, blood sugar changes, anxiety, etc), and have trouble getting back to sleep. In general, taking more than 30 minutes to get back to sleep is considered abnormal, although the critical factor is whether your daytime functioning is affected.
If you are waking up and having trouble getting back to sleep, you should seek help from a sleep specialist, sooner rather than later. Insomnia may get worse the longer it goes untreated, especially if you are staying in bed awake for long periods.
This is listed last because a sleep doctor will assess for the other above causes of awakenings first, because they are so common and need to be addressed specifically.
If you do have true insomnia: it is treatable! The first-line treatment is not medication but cognitive behavioral therapy for insomnia (CBTI or CBT-I). In some cases medication is used, but in general CBTI should be the first-line treatment because studies show it is as effective as medications and the effects last longer.
Takeaway: There are lots of potential reasons why you may be waking at 3am. If it’s once in a while, and you don’t have any red-flag symptoms of sleep apnea, you can leave it alone. If it’s frequent—a couple times per week or more—you DO need to do something about it. See a sleep doctor, quit drinking, sleep separately, etc… now you know what you need to do. No matter what, do NOT linger in bed for long periods or do other things that you shouldn’t do at 3am, so that things don’t get worse!
