Dr Amir Khan, an NHS GP with a large social media following, has explained why many people wake up between 2am and 4am. In a video, he said it is 'common and normal' and there is a 'biological reason' behind it.
According to Dr Khan, the phenomenon is linked to a rise in cortisol, the body's natural stress hormone, which begins to increase in preparation for waking. This hormonal shift, combined with a dip in blood sugar levels, can trigger wakefulness. He noted that factors such as alcohol, late eating, or chronic stress can exacerbate the effect.
Dr Khan also highlighted psychological factors: 'At 3am there are no distractions, no emails, no noise, just you and your thoughts, and your brain's threat system becomes louder.' The amygdala, which processes fear, is more reactive when sleep-deprived, making worries feel more intense.
Hormonal changes during perimenopause and menopause can also contribute. Dr Khan explained that fluctuating oestrogen affects temperature regulation and sleep stability, leading to early morning awakenings. He advised gentle breathing, avoiding clock-watching and screens, and keeping evenings calm.
The NHS recommends 7-9 hours of sleep for healthy adults and emphasises good sleep hygiene, such as consistent bedtimes and wind-down routines. While occasional sleepless nights are normal, persistent sleep deprivation should be addressed if it affects daily life.
