Why Do I Keep Waking Up at Night? What Guidelines and Research Say

Waking up in the night and having trouble getting back to sleep is one of the most common sleep complaints. This guide sets out what U.S. health agencies and clinical guidelines say about it: when it is within the usual range, what can cause it, when it counts as insomnia, and which approaches have the best support.

It is not medical advice. It was written by our editorial team, not by a clinician, and no doctor has reviewed it. If sleep trouble is persistent, talk to a healthcare provider.

The Short Answer

Waking often during the night is the most common insomnia symptom. The National Heart, Lung, and Blood Institute (NHLBI) says it affects mostly older adults.
Some waking is part of ordinary sleep. A meta-analysis of healthy adults found that time awake after falling asleep increases with age.
It counts as chronic insomnia when it happens 3 or more nights a week for 3 months or longer. NHLBI adds that it cannot be fully explained by another health problem.
Common contributors include stress, worrying about sleep and watching the clock, alcohol, caffeine, nicotine, noise, light, temperature and daytime naps. Some causes, such as sleep apnea, need a medical evaluation.
The best-supported approach for chronic insomnia is cognitive behavioral therapy for insomnia (CBT-I). The American College of Physicians and the American Academy of Sleep Medicine both give it a strong recommendation.

Is Waking at Night Normal?

Some of it is. Ohayon and colleagues analyzed 65 studies of healthy people aged 5 to 102 (3,577 people in all) whose sleep was recorded overnight. In adults, the time awake after falling asleep increased with age. The authors also found that the size of the age effects changed with how carefully the participants had been screened for mental disorders, organic disease, drug or alcohol use, sleep apnea and other sleep disorders (Ohayon et al., 2004).

A consensus panel of the National Sleep Foundation reviewed 277 studies and agreed that the number of awakenings longer than 5 minutes and the time awake after falling asleep are appropriate indicators of good sleep quality across the life span (Ohayon et al., 2017). We read only the abstract, which does not give the cut-off values. We do not quote numbers we could not read.

NHLBI describes the symptom differently. With insomnia, sleep “may be possible for only short amounts of time,” you “may wake up often during the night or be awake for most of the night,” and waking too early and not getting back to sleep is also common (NHLBI, symptoms, last updated March 2022).

What Can Cause It

NHLBI lists risk factors and things that can disturb sleep (NHLBI, causes):

Stress. Stress or worrying about school, work, relationships, money or a loss raises the risk of insomnia. It also says worrying about whether you will get enough sleep and watching the clock can raise the risk or make it worse.
Environment. Shift or night work, noise or light during the night, and uncomfortably high or low temperatures.
Lifestyle. A changing routine, interruptions such as waking to care for a baby, long naps, too little physical activity, caffeine, nicotine, alcohol or recreational drugs, and using screens close to bedtime.
Age and sex. The chance of insomnia increases with age, and it is more common in women. Hormone changes in pregnancy and menopause can cause sleep problems.

Alcohol deserves its own note, because it can make sleep feel easier to start. A review of studies in healthy volunteers found that alcohol at all doses shortened the time to fall asleep and made the first half of the night more consolidated, and it increased sleep disruption in the second half (Ebrahim et al., 2013). NHLBI says alcohol can cause a lighter sleep than normal, which makes waking during the night more likely.

Medical causes are also possible. NHLBI lists “waking up often during the night to urinate” among the symptoms of sleep apnea, along with breathing that starts and stops, frequent loud snoring, gasping for air, and daytime sleepiness (NHLBI, sleep apnea symptoms, last updated January 2025). It also advises talking to your provider about medicines that can disrupt sleep, such as some cold and allergy medicines (NHLBI, care page).

When Waking Becomes Insomnia

NHLBI says you may be diagnosed with insomnia if you have difficulty falling or staying asleep at least 3 nights a week, and that it is considered chronic when it occurs 3 or more nights a week and lasts 3 months or longer. A doctor may ask how often you wake up at night and how long it takes you to fall back asleep, how you feel during the day, and whether you snore loudly or wake up gasping. It suggests keeping a sleep diary for 1 to 2 weeks before the visit, with the times you go to sleep, wake up and nap, how sleepy you feel, and when you have caffeine, alcohol and exercise (NHLBI, diagnosis).

What the Guidelines Support

CBT-I. The American College of Physicians recommends that all adults with chronic insomnia disorder receive CBT-I as the initial therapy (strong recommendation, moderate-quality evidence) (Qaseem et al., 2016). The American Academy of Sleep Medicine’s 2021 guideline also gives multicomponent CBT-I a strong recommendation. It gives conditional recommendations to brief multicomponent therapies, stimulus control alone, sleep restriction therapy alone and relaxation therapy alone, and a conditional recommendation against sleep hygiene as the only therapy (Edinger et al., 2021).
What CBT-I involves. NHLBI describes a 6- to 8-week plan that can be delivered by a doctor, nurse or therapist, in person, by telephone or online. Its parts include cognitive therapy, relaxation or meditation, sleep education, sleep restriction therapy and stimulus control therapy. Stimulus control means going to bed only when sleepy, getting out of bed if you cannot sleep, and using the bed only for sleep and sex (NHLBI, care page). NHLBI describes these steps as parts of a program. We do not present them as a do-it-yourself program.
Habits. NHLBI lists a cool, quiet, dark bedroom, a regular sleep and wake time, avoiding caffeine, nicotine and alcohol close to bedtime, limiting how much you drink close to bedtime, which may mean fewer trips to the bathroom, regular physical activity in the daytime and avoiding naps.
Medication. The AASM’s 2017 guideline on drugs for chronic insomnia makes weak recommendations on individual drugs, some of them for sleep maintenance insomnia (Sateia et al., 2017). The American College of Physicians suggests a shared decision with a clinician, weighing benefits, harms and costs, about short-term medication for people in whom CBT-I alone did not work (weak recommendation, low-quality evidence) (Qaseem et al., 2016).

What the Evidence Says About Supplements

The same AASM guideline suggests that clinicians not use melatonin, tryptophan or valerian for sleep onset or sleep maintenance insomnia in adults. Each is a weak recommendation (Sateia et al., 2017). NHLBI says research has not proven that melatonin is effective for insomnia, and that the FDA does not review dietary supplement products for safety and effectiveness before they are marketed (NHLBI, care page). Our melatonin guide goes through the studies.

When to See a Doctor

NHLBI says to talk to your doctor if not getting enough sleep is affecting your daily activities. Based on the sources above, these are reasons to raise it:

Trouble staying asleep at least 3 nights a week, which is NHLBI’s threshold for a diagnosis of insomnia.
Loud, frequent snoring, waking up gasping or feeling out of breath, or waking often at night to urinate. These are on NHLBI’s list of sleep apnea symptoms.
Daytime sleepiness, trouble focusing, or feeling anxious, depressed or easily annoyed, which NHLBI lists as effects of poor-quality sleep.
Sleep trouble alongside a new medicine, pregnancy or menopause. Your provider will ask about all three, so mention them.

What We Do Not Know

Why any one person wakes when they do. The sources above describe risk factors and disorders. They do not tell you the cause in your case, and a clinician who knows your history has to.
The usual number of awakenings for you. We could not read the cut-offs in the National Sleep Foundation report, and the normal range depends on age and health.
Whether a particular time of night means anything. See our guide on waking up at 3 a.m..

Questions

Why do I keep waking up at night?

The sources list many contributors, including stress, worry about sleep, alcohol, caffeine, noise, light, temperature, age, hormone changes and medical problems such as sleep apnea. Which applies to you is a question for a healthcare provider, and a sleep diary makes it easier to answer.

Why can’t I go back to sleep after waking up?

NHLBI lists waking early and not getting back to sleep as a common symptom, and it says worrying about sleep and watching the clock can make insomnia worse. NHLBI describes stimulus control, one part of CBT-I that a clinician can deliver, as including getting out of bed if you cannot sleep.

How do I sleep through the night?

The sources we read do not promise that any method works for everyone. For chronic insomnia, the best-supported approach in the guidelines is CBT-I. NHLBI also lists habits meant to make it easier to fall asleep and stay asleep.

Why do I wake up at the same time every night?

We found no study explaining a specific time. A sleep diary shows whether the pattern is real, and your provider may ask when you wake and how long it takes to fall back asleep.

Sources Cited in This Guide

National Heart, Lung, and Blood Institute, NIH. “Insomnia: What Is Insomnia?”, “Symptoms”, “Diagnosis”, “Causes and Risk Factors” and “Treatment.” Last updated March 24, 2022. Read September 19, 2026. NHLBI
National Heart, Lung, and Blood Institute, NIH. “Sleep Apnea: Symptoms.” Last updated January 9, 2025. Read September 19, 2026. NHLBI
Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV. “Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan.” Sleep. 2004. Read September 19, 2026 (abstract). PMID 15586779
Ohayon M, Wickwire EM, Hirshkowitz M, et al. “National Sleep Foundation’s sleep quality recommendations: first report.” Sleep Health. 2017. Read September 19, 2026 (abstract). PMID 28346153
Ebrahim IO, Shapiro CM, Williams AJ, Fenwick PB. “Alcohol and sleep I: effects on normal sleep.” Alcohol Clin Exp Res. 2013. Read September 19, 2026 (abstract). PMID 23347102
Qaseem A, Kansagara D, Forciea MA, et al. “Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians.” Ann Intern Med. 2016. Read September 19, 2026 (abstract). PMID 27136449
Edinger JD, et al. “Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline.” J Clin Sleep Med. 2021. Read September 19, 2026 (abstract). PMID 33164742
Sateia MJ, Buysse DJ, Krystal AD, et al. “Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline.” J Clin Sleep Med. 2017. Read September 19, 2026 (abstract). PMID 27998379

This guide is for information and is not medical advice. It was written by an editorial team, not by a clinician. Talk to a healthcare provider about medication, pregnancy, medical conditions and persistent sleep problems.