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Sleep maintenance insomnia happens when you can’t stay asleep. You may experience it because of health conditions including illness, some medications, or other causes like stress.

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Not being able to sleep through the night is the worst.

You wake up — who knows why — and immediately stress about how cruddy you’re going to feel the next day if you can’t fall back asleep fast enough.

Having just one episode is bad enough, but if it keeps happening, you’ll probably want to figure out why and what to do about your insomnia. Yes, not being able to stay asleep is actually a type of insomnia, and various factors, from your lifestyle to an underlying condition, could be to blame.

Insomnia’s commonly thought of as simply staying up all night and not being able to get to sleep, but that’s just one type of insomnia.

Being unable to stay asleep is a type of insomnia, too.

It’s referred to as maintenance insomnia, sleep maintenance insomnia, and, sometimes, middle-of-the-night insomnia.

Most people experience some type of insomnia on occasion, usually because of stress. If you can’t stay asleep at least 3 nights per week for 3 months or longer, it’s considered chronic.

In a word: stress.

The cause of said stress can be all kinds of things, from lifestyle to medical conditions.

The real kicker with maintenance insomnia is that stress from not being able to stay asleep can keep the cycle going, making your insomnia worse and leaving you feeling pretty lousy.

Here are the many things that could be preventing you from staying asleep.

Sleep apnea, asthma, or other breathing problems

Respiratory disturbances at night are par for the course if you have asthma, sleep apnea, or any other breathing problem, like allergies or even a cold.

If anything disrupts your breathing, even just for a second, it can wake you up and make it hard to fall back asleep.


With some conditions, like fibromyalgia and arthritis, pain can flare up at night and wake you up.

If you have an injury or pain that’s worse with movement, turning over can hurt and wake you up, too.


There are several illnesses associated with sleep issues. While not an exhaustive list by any stretch, some common ones include:

Mental health disorders like depression or schizophrenia

Research from 2018 showed that mental health conditions and insomnia go hand-in-hand.

Trouble falling asleep or staying asleep is a common side effect of mental health conditions, like anxiety, depression, and schizophrenia. On the flip side, poor sleep can also worsen symptoms of these conditions.

Certain medications

Some over-the-counter (OTC) and prescription medications can cause side effects that wake you up at night, like excitability, frequent urination, and vivid dreams.

These some possible culprits:

External issues, like worries about work or your social life

Got stuff on your mind?

Worries about things like work or relationships can impact a full night’s sleep. You can even experience nocturnal panic attacks if you’re under a lot of stress or feeling anxious.

Hot flashes or hormone fluctuations

While anyone can experience hormone fluctuations that can mess with sleep, people with uteri are more prone to hormone-induced sleep issues, because they may experience fluctuations during periods, pregnancy, perimenopause, and menopause.

Hormone fluctuations can trigger sleep-disrupting symptoms, like anxiety, hot flashes, and night sweats.

Acid reflux

There’s nothing quite like stomach acid and other contents making their way up into your esophagus and mouth to wake you up.

Lying flat can make acid reflux worse and even lead to choking.

Jet lag

Jet lag happens when there’s a mismatch between your circadian rhythm and the time of day.

While your body’s clock is still anchored to another time zone, you can have trouble falling asleep and staying asleep.

Poor sleep environment

Yep, your environment could be to blame for your inability to sleep through the night.

As comfy and cozy as your bed may be, environmental factors, like bright lights outside your bedroom window, street noise, or the incessant humming of an air conditioner, can wake you up throughout the night.

Blue light

Like to scroll your social feeds in bed? Your screen time and exposure to blue light could be the reason why you can’t stay asleep.

Blue light suppresses melatonin secretion, affecting sleep. It can also increase alertness, which is the last thing you need when it’s time for sleep.


As we get older, our sleep patterns change. For older adults, nighttime arousal, shorter periods of deep sleep, and fragmented sleep become very common.

The risk for chronic conditions also increases with age, adding to the stress that makes it even harder to stay asleep.

Here are some common suggestions for making sure your sleep is restful.


No duh, right? Relaxation may be hard to come by when you’ve got a lot on your mind and are stressed about your sleep issues to boot.

Here are some relaxation techniques that can help:

  • meditation
  • deep yoga
  • soaking in a hot bath before bed

Talk with your doctor about your medication

If you’re taking meds, ask your doctor if insomnia is a known side effect.

They may recommend taking your medication at a different time or swapping it out for another one that won’t interfere with sleep.

Give yourself a bedtime

Strict bedtimes work for toddlers and can work for you, too. Aim to go to bed around the same time every night, so you can get your body used to sleeping at that time.

Avoid caffeine later in the day

Caffeine later in the day could sabotage a good night’s sleep, so it’s best to avoid it after 2 p.m. or so.

Here are some common caffeinated beverages to avoid:

  • coffee
  • black tea
  • energy drinks
  • soda

Avoid alcohol

You might find that alcohol helps you unwind and can make you drowsy enough to fall asleep. But it won’t help you stay asleep.

According to 2013 research, drinking before bed causes frequent waking and fragmented sleep.

Avoid smoking

Kicking the habit means ending the cravings for a smoke that could actually wake you up at night.

Exercise, just not before bedtime

Exercise can improve your sleep and reduce stress and anxiety that can be messing with your slumber.

Just don’t do it too close to bedtime, or you’ll risk perking yourself up when you should be winding down.

Don’t eat or drink before bedtime

Limit eating or drinking 2 to 3 hours before going to sleep.

Going to bed on a full stomach can interfere with sleep and cause nocturnal heartburn and reflux. Drinking too much or drinking too close to bedtime will make you more likely to have to get up to pee.

Limit blue light exposure

This means no screen time 2 to 3 hours before bedtime. Swapping out a nightlight for a red bulb and investing in some room darkening curtains can help, too.

Improve your sleep environment

Keeping your room a comfortable temperature or investing in some ear plugs, a good mattress, and bedding can all contribute to a full night’s sleep.

Don’t nap during the day

Napping can feel oh-so good on a lazy afternoon, but even a short nap can keep you from staying asleep all night.

If you really want to lie down during the day, make it earlier in the day and keep it under 20 minutes.

Change your sheets weekly

Dirty sheets can trigger or worsen symptoms if you have allergies or asthma. Change your sheets weekly to prevent a stuffy nose and other sleep-busting symptoms.

There are lots of reasons why you might not be able to sleep. The good news: There are lots of potential solutions.

A few tweaks to your lifestyle might do the trick. If not, talk with a healthcare professional to find out why you’re not sleeping and how to treat it.

Adrienne Santos-Longhurst is a Canada-based freelance writer and author who has written extensively on all things health and lifestyle for more than a decade. When she’s not holed-up in her writing shed researching an article or off interviewing health professionals, she can be found frolicking around her beach town with husband and dogs in tow or splashing about the lake trying to master the stand-up paddle board.