Waking up in the middle of the night, especially around 2 a.m., is more common than most people realize.
But when it starts happening several times a week and getting back to sleep feels impossible, it might point to something deeper than a bad night’s rest.
This pattern — known as maintenance insomnia — can leave people groggy, frustrated, and even anxious the following day.
In a recent Guardian article, health psychologist Dr. Julia Kogan explains how anxiety, environment, and even age can impact sleep quality — and most importantly, shares proven treatments that actually help.
Here’s what’s really going on when you wake up at 2 a.m., and how to finally stop the cycle.
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What is Maintenance Insomnia?
Unlike trouble falling asleep, maintenance insomnia refers to difficulty staying asleep through the night.
Dr. Jamie Zeitzer, a professor of psychiatry and behavioral sciences at Stanford University, explains that there are different forms of insomnia — including sleep onset insomnia (trouble falling asleep), early waking insomnia (waking up too early), and middle-of-the-night wakings, which are typically classified as maintenance insomnia.
According to a 2014 study published in the journal Nature and Science of Sleep, nearly 20% of people with insomnia symptoms experience regular nighttime awakenings.
“It’s not necessarily what wakes people up, but what happens after with their mind that keeps them up,” says Dr. Kogan. Racing thoughts, stress about the next day, or anxiety about not getting enough sleep can all prevent the brain from settling.
Common Causes of Waking in the Night
1. Mental and Emotional Stress
Stress and anxiety are the top contributors, according to Kogan. For many people, 2 a.m. brings a flood of unresolved thoughts — from unfinished work tasks to family concerns.
Even worrying about not sleeping enough can trigger more wakefulness. For some, nightmares or PTSD episodes further disrupt the night.
2. Not Tired Enough
This is referred to as a low “sleep drive.” If your body doesn’t feel tired, you might wake up in the night and struggle to return to sleep.
“People with maintenance insomnia think that spending more time in bed will help them get more sleep, but it usually leads to less sleep overall,” says Kogan. Naps or oversleeping can reduce the body’s natural sleep pressure.
3. Physical Discomfort or Health Issues
Pain, even temporary like a pulled muscle or sunburn, can wake someone and make it difficult to return to sleep.
Chronic conditions — such as migraines, arthritis, cardiovascular disease, or nighttime breathing issues — also commonly interfere with sleep continuity.
Medications for many of these conditions can interrupt sleep as well.
4. Age and Hormonal Changes
As people age, sleep becomes lighter, and disruptions more frequent. Dr. Zeitzer notes that older adults are more prone to nighttime wakings due to neuropathy, reflux, and urinary issues.
Additionally, a 2015 study found that women, particularly during perimenopause and menopause, are more likely to experience maintenance insomnia due to fluctuating hormones.
5. Environmental Factors
Noisy streets, a snoring partner, room temperature, or even an uncomfortable mattress can all break up sleep.
Dr. Olabimpe Fashanu, a Maryland-based sleep physician, adds that people have different thresholds for reacting to disturbances.
What Happens If It’s Left Untreated?
Maintenance insomnia doesn’t just ruin your night — it affects your days, too.
People with chronic nightly wakefulness often struggle with:
- Poor focus and memory
- Mood swings and anxiety
- Increased sensitivity to pain
- Higher risks of metabolic diseases like obesity and type 2 diabetes
- Elevated risk for cardiovascular complications
The longer maintenance insomnia persists, the harder it can become to treat, as people develop poor sleep habits like lying in bed awake or obsessively checking the clock.
How to Treat Maintenance Insomnia
The good news: Treatment is available — and effective.
1. Start with the Source
If physical discomfort or environmental disruptions seem to be the cause, address those first.
- Adjust room temperature
- Use blackout curtains or white noise machines
- Assess mattress and pillow comfort
- Speak to a doctor about pain management or medication side effects
2. Cognitive Behavioral Therapy for Insomnia (CBT-I)
CBT-I is widely considered the gold standard for treating insomnia. Dr. Zeitzer explains that it teaches people to reframe their thoughts around sleep — letting go of anxiety and urgency.
A standard CBT-I protocol consists of six to eight therapy sessions that help restructure sleep-related behaviors and thinking patterns.
“CBT-I essentially teaches you not to care about your insomnia, which enables you to go back to sleep much faster,” he says.
3. Medication, Only When Necessary
Dr. Kogan cautions that sleep medications should not be a first-line treatment.
“Insomnia is often related to cognitive and behavioral factors, so sleep meds are often a band-aid if those factors are not addressed,” she says.
For short-term relief, prescriptions like Ambien or Lunesta might help, but they’re not a long-term fix.
Melatonin supplements are typically not effective for maintenance insomnia, since it’s more about sleep continuity than falling asleep initially.
4. Build a Consistent Sleep Routine
Kogan recommends creating a buffer period of 30 to 60 minutes before bed, free from screens or stimulating content. Use this window for calming activities:
- Deep breathing or progressive muscle relaxation
- Journaling earlier in the day to “offload” mental clutter
- Gentle stretching or warm baths
Importantly, avoid lying in bed awake. If you’re up for more than 20 minutes, get out of bed and do something low-stimulation (like reading) in dim lighting until sleepiness returns.
When to Seek Help
If symptoms persist for more than a few weeks or begin impacting your quality of life, reaching out for a professional evaluation is crucial.
“Chronic insomnia is harder to treat the longer it’s been going on,” warns Dr. Fashanu. Early intervention helps prevent long-term patterns from solidifying.
If you’re routinely waking up at 2 a.m. and struggling to fall back asleep, you’re not alone — and it’s not something you have to just accept.
With lifestyle tweaks, therapeutic support, and guidance from a sleep specialist, restful nights can become a reality again.
