Middle of the Night Insomnia

What to do if you are waking in the middle of the night

Followers of my Substack are really getting a window into the juicy stuff I usually just share with my patients when they come to see me.

However I love sharing. Its my nature; so I am going to share some today about middle of the night insomnia:

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What to “not do” about middle of the night insomnia is more important then what to “do” , but most people are looking of for things to do.

So I will share some ideas:

If you awake; have a wake plan:

• Plan for your first thought when you awake. Instead of saying “Oh 5%$%$ here we go again…” . Perhaps replace it with “ Waking in the middle of the night is normal and I am just going to get comfortable and go back to sleep”. Its not a lie; it is considered normal to awaken 2 times per night for less then 10 seconds.

• Don’t watch the clock. Turn your alarm clock to face the wall and resist the temptation to check the time on your smartphone.

• Get comfortable. Visit the bathroom to empty your bladder if it might be full. Make sure your bedroom is cool and dark and that your bedding is just right so that you don’t feel too warm or chilly.

• Relax. Try progressive muscle relaxation. Work your way through the different muscle groups in your body (e.g. arms, legs, torso, face) tensing the muscles in each group at about three-quarters strength for approximately five seconds before releasing the tension all at once. Skip any muscles that hurt and try to isolate the muscles as you contract them instead of, for example, tensing your chest muscles when you’re focusing on your arms. Take slow, deep breaths in between muscle groups.

• Don’t stay in bed longer then 20 minutes. If you’re just not dozing off, get up after about 20 minutes have gone by. (It’s fine to just guesstimate how much time has passed.) “Sit in a comfortable chair in another room, Read a boring book, with just enough lights on so that you can see the print comfortably. If your mind is racing (perhaps you’re going over a work presentation you’ll give in the morning or trying to solve a problem in your life), write your thoughts down on a notepad and then get back to it in morning. My go to book is the Psalms/Tehillim; I find them very soothing.

• Reapproach bed after 10 minutes of begin awake It’s important not to stay in bed, If you do not feel like reading or listening to music. Try this this yoga exercise:

• it is called the Non-deep sleep rest protocol ( NSDR )

• You can also do these self hypnosis that help with sleep training such as https://www.reveri.com

Ther are other things to consider if you are waking in the middle of the night:

First, let’s talk about environment: Is there light or noise you are being exposed to? How about a noisy partner?  Are you eating or drinking too close to bedtime?

Next, there are medical considerations that might wake someone in the middle of the night?

a.      Gastroesophageal Reflux (GERD)

b.     Hot flashes due to menopause

c.      Sleep apnea

d.     Restless Leg Syndrome/ Periodic Limb Movement Disorders

e.      Low blood sugar

f.      Any pain disorders

g.     Depression

h.     Grief (the lung meridian is 3:00 am-5:00 am. in Chinese Medicine)

In 2023; I revised my top 3 things that I have people take or do if they have troubles with insomnia. Here they are:

1.     Cannabinol (CBN)  is a Cannabinoid that has really worked well for sleep in my patients and has shown some benefits in trials. I am currently liking the Deep Sleep product by ECS  . I find these way better for sleep then activating cannabis strains.

2.     Dihydrohonokiol  an extract from Magnolia ; that is anti-inflammatory, anti-histamine, raises GABA, and Serotonin. The brand DHH-B max is really a great own

3.     Alpha-Stim, Vagal Stim upon awakening. Stimulating the Vagus nerve to stabilize the nervous system is very helpful in falling back a sleep. There are many vagal stim units; I happen to like Alpha-stim. Next time you are in my office I can show you my alpha-stim unit. If you didn’t know I am really into balancing the vagal nerve and offer the SSP protocol.

Of course there is good old, Melatonin, Magnesium, and Valerian root.  However, sometimes those don’t work well for various reasons for people.

Hope this gives you a window into some ideas to help your middle of the night insomnia. Of course discussing all of these options with your health care provider is a must before adopting any of these ideas.