A Blood Sugar Crash + 4 Other Reasons You're Waking Up In The Middle Of The Night

Holistic Psychiatrist By Ellen Vora, M.D.
Holistic Psychiatrist
Ellen Vora is a holistic psychiatrist practicing in NYC. She graduated from Columbia University Medical School, is boarded in psychiatry and integrative and holistic medicine, and she's also a licensed medical acupuncturist and certified yoga teacher.

Photo by Michela Ravasio

Waking up in the middle of the night, aka "middle insomnia," is an extremely common type of insomnia and extremely frustrating for those who suffer from it. This is especially true for those who really try to prioritize sleep and good sleep hygiene; those who did the responsible thing and brushed their teeth, got in bed, fell asleep by 10 p.m.—but now it’s 2 a.m. and they're wide-awake and wired. What gives?

Insomnia of any kind is a multifactorial issue, deeply related to underlying health issues, and typically can't be attributed to just one thing. Before you turn to over-the-counter medications or talk to your doctor about a prescription sleep aid, consider these five common causes of middle insomnia:

1. Blood sugar crashes

The standard American diet (built on a bedrock of sugar and refined carbs) promotes a blood sugar roller coaster. With each blood sugar crash, your body is tripped into a stress response. When your blood sugar crashes in the middle of the night, the resulting stress response disrupts your sleep. If you wake up in the middle of the night in a wired state of panic, I'd consider this a blood sugar crash until proven otherwise. The definitive solution is to transition to a real-food diet comprised of vegetables, healthy fats, starchy tubers, well-sourced protein, fruit, nuts, and seeds. The quick hack for tonight is to eat a handful of almonds or take a spoonful of almond butter or coconut oil before bed. Take another spoonful anytime you wake up in the middle of the night.

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2. A haywire stress response

I’m not telling you anything new here: Waking up in the middle of the night can be intricately connected to daily stress levels. The hard part isn't learning this; it's actually doing something proactive to fix it. Here are a few realistic, actionable tips for managing middle insomnia caused by stress:

Write down your to-do list before bed.

Photo: Briana Morrison

With pen and paper, write a list each night of what’s on your mind, what you need to do tomorrow, what you need to remember. If you still find yourself lying in bed with your mind swirling with thoughts and ideas, get up and write it down. This practice outsources the emotional labor of keeping track of everything to the piece of paper so your mind can relax and you can fall asleep and stay asleep.

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Protect some amount of time in the evenings, maybe an hour, maybe just 20 minutes, when you intentionally power down and check in with yourself. When we go straight from Netflix and Instagram to sleep, our sleep is perturbed by the stimulating nature of these activities, and we can often wake up not long after we've fallen asleep.

Do less.

I’ve tried to convince the masses (and all of my patients) to meditate, but I've learned that people will come to meditation when they’re ready. A more accessible goal is to do less. Say "no" to some projects, some promotions, some brunches and birthday parties. Give yourself time for the simple things in life: reading a book, taking a bath, napping, walking without multitasking, staring out the window, sitting in the grass.

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3. Missing your ideal sleep window

Photo: Bisual Studio

I used to think that all versions of eight hours of sleep were created equal, no matter if I slept from 10 p.m. to 6 a.m. or 2 a.m. to 10 a.m. (and I tended more toward the 2-to-10 version). What I've since learned is that the body wants to be in rhythm with the sun and the moon (as "woo-woo" as it might sound). There’s a sweet spot around three hours after sunset when we’re perfectly tired. If we fall asleep then, we sleep our deepest and we're less likely to wake up throughout the night. If we miss that window, our body releases the stress hormone cortisol, and we become "overtired." This can feel like a second wind, or we can feel tired but wired. I recognize my overtired state because, even though I was falling asleep on the couch a few hours earlier, now I’m jazzed up and ready to clean the kitchen. On these nights, it’s a struggle to fall and stay asleep because my bloodstream is coursing with cortisol. Get to bed earlier to avoid getting this feeling and the consequences that come with it.

4. Alcohol

It's no fun to think about, but when we're talking about sleep quality, I'd be remiss if I didn't mention alcohol. Notorious for making it easier to fall asleep (think: nightcap), alcohol disrupts sleep architecture. When you drink, you don’t sleep as deeply, and you’re more likely to wake up in the middle of the night. It’s worse with more alcohol, but any amount makes a difference. Start observing your body’s sleep quality after drinking. If you notice an impact, consider limiting your alcohol consumption to weekends or even try cutting out alcohol completely for a certain amount of time. You might just find that alcohol dulls your experiences anyway.

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5. Medications

I’ve had patients do everything under the sun to improve their sleep, only to discover the real culprit was a medication. Several prescription and over-the-counter medications affect sleep architecture, making it harder to sleep through the night. If you take benzodiazepines (e.g., Xanax, Klonopin), stimulants (e.g., Adderall, Vyvanse), SSRIs, over-the-counter cold medicine, or even sleep aids like Ambien, they may be negatively affecting your sleep. If you want to make changes, always work closely with your health care provider to taper off your medication safely.

A final thought on middle insomnia: Some versions of middle insomnia are perfectly normal and healthy. Recent research points to the idea that humans used to sleep in two four-hour chunks, with a period of wakefulness in the middle of the night called middle sleep. Supposedly we only started sleeping in consolidated eight-hour blocks with the Industrial Revolution, when time became our most precious resource. If you suspect that your middle insomnia is normal, embrace it, but use it wisely. Use this time to meditate, journal, do a breathing exercise, have sex, or read a book by candlelight. Avoid letting your eyes see artificial light, and, whatever you do, don’t taint this sacred time with the phone. The light from the phone will trick your brain into thinking the sun is rising, and this can disrupt your circadian rhythm.

Ready for it? Here's a crash course for improving your sleep.

Ellen Vora, M.D.
Ellen Vora, M.D.
Dr. Ellen Vora is a holistic psychiatrist practicing in NYC. She graduated from Columbia University...
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Ellen Vora, M.D.
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Dr. Ellen Vora is a holistic psychiatrist practicing in NYC. She...
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