The 4am wake-up call

Why do so many of us fall asleep only to wake up at 4am tossing and turning for the rest of the night, asks ELEANOR FITZSIMONS

IT’S NOT just tortured poets who are prone to nocturnal wakefulness. This well-documented phenomenon often occurs when we’re feeling a bit low or something is preying on our minds.

The inconvenient and exhausting irritation of waking up in the middle of the night, officially termed sleep maintenance insomnia, is commonly experienced during periods of stress and depression, although physiological conditions such as sleep apnoea or restless leg syndrome are also factors.

Many of us find it difficult to sleep soundly. What is odd is that anecdotally it would seem that sleep maintenance insomnia often strikes at precisely 4am. Try Googling “waking at 4am” to discover just how prevalent this problem actually is.

The constancy of a phenomenon estimated by sleep experts to affect one in four of us surely can’t be coincidental. While it’s easy to accept that anxiety interferes with our sleep patterns, what is less obvious is why we wake, feeling anxious and with thoughts racing, at precisely the same time every night.

It seems that this tendency is most commonly observed among those of us who typically fall asleep at around midnight. A decent night’s sleep should contain four to five sleep cycles, each lasting 90-120 minutes.

During that time, we progress from a stage of light sleep through deeper sleep before entering a period of rapid eye movement (REM) sleep at the end of each cycle.

While it’s usual to re-enter a period of lighter non-REM sleep after each phase of REM sleep, we shouldn’t actually reach full consciousness but should slip back under without even being aware of the change.

The problem arises when we are too tense, which renders our bodies more responsive during the phase of lighter sleep that tends to occur at precisely the same time every night. The slightest noise, variation in light or change in temperature is enough to render us fully awake and fretful.

By 4am, the room may be slightly warmer, weak light may be filtering through the curtains and the birds may have commenced their dawn chorus. These factors can be sufficient to render us wide awake. The four hours’ sleep we have managed by then fools our body into believing that this is sufficient to start the day. It’s not.

Clinicians previously associated early morning waking with depression. Psychology Today has stated that “at least 80 per cent of depressed people experience insomnia difficulty in falling asleep or, most often, staying asleep. Indeed, early morning awakening is a virtual giveaway of depression”.

However, the increasingly stressful nature of modern life is boosting its prevalence. Considering the overwhelming burden of national and personal debt and the natural disasters and conflicts that are beamed into our living rooms nightly, leaving us feeling powerless to resolve them, it’s little wonder that we increasingly feel down.

Research findings documenting the nature and incidence of insomnia among Irish adults were recently published on the website glotosleep.ie and state that one-third of Irish adults are currently suffering from insomnia. It’s hardly surprising that 25 per cent of insomniacs cited work and insecurity as the main cause. One in 10 specifically mentioned money worries, with 14 per cent blaming current economic conditions for regular sleep disruption.

The prospect of facing into an indefinite future of waking with the proverbial lark is enough in itself to disrupt the sleep we crave. So what can we do to combat early wakefulness?

The National Sleep Foundation of America recommends the following:

A quiet bedtime routine incorporating a relaxing bath or soft music;

Avoiding stimulants such as caffeine;

Exercising during the day to induce physical as well as mental exhaustion;

Going to bed only when we actually feel sleepy.

Once we are awake, our anxious state is not helped by feeling the need to lie still and quietly in the dark with only our thoughts for company. Anxieties are amplified and any possibility of recapturing that elusive somnolence slips further and further from reach.

But there’s really no point in lying there indefinitely. The National Sleep Foundation suggests: “If you can’t go to sleep after 30 minutes, don’t stay in bed tossing and turning. Get up and involve yourself in a relaxing activity, such as listening to soothing music or reading, until you feel sleepy. Remember: try to clear your mind; don’t use this time to solve your daily problems.”

Mayo Clinic sleep specialist Timothy Morgenthaler suggests hiding the clocks, saying “clock-watching causes stress and makes it harder to fall asleep”.

It has been theorised that insomnia is linked with creativity. Acquainted with the Night: Insomnia Poems is a collection of more than 80 poems including several by Walt Whitman, Emily Bronté and Robert Frost, all inspired by sleepless nights. Also, Marcel Proust wrote much of À la Recherche du Temps Perdu while kept awake by chronic illness.

Contemporary evidence of night-time creativity can be found at 4amproject.org, a collection of photos from around the world all taken at this magical time.

" I work all day, and get half drunk at night. Waking at four to soundless dark, I stare. In time the curtain edges will grow light. Till then I see what's really always there: Unresting death, a whole day nearer now, making all thought impossible but how and where and when I shall myself die"

– From ‘Aubade’ by Philip Larkin