NHS Doctor Explains Three Key Triggers That Wake You at 3am
NHS GP Dr Amir Khan has provided a detailed explanation for why countless individuals find themselves abruptly awake in the early hours of the morning, particularly around 3am. The doctor, who maintains a significant social media following, emphasised that this phenomenon is "common and normal", stemming from a combination of biological processes and psychological factors.
The Biological Basis for Early Morning Awakenings
Dr Khan highlighted that waking between 2am and 4am has a clear biological reason. During this period, the body enters a specific phase of the sleep cycle where cortisol, the body's primary stress hormone, begins to rise in preparation for waking. This hormonal shift is a natural part of the circadian rhythm, but it can be amplified by existing stress or anxiety, leading to full wakefulness.
Additionally, blood sugar levels often dip slightly during the night. If these levels drop too low—due to factors like late-night eating, alcohol consumption, or chronic stress—the body may release adrenaline to compensate. This surge can cause sudden awakening with symptoms such as a racing heart or heightened alertness.
Psychological Factors and the Absence of Distractions
Beyond biology, psychological elements play a crucial role. Dr Khan noted that at 3am, the lack of distractions—no emails, noise, or daily tasks—means the brain's threat system becomes more pronounced. The amygdala, which processes fear, is particularly reactive when sleep-deprived, causing worries that seem manageable during the day to feel overwhelming in the quiet of the night.
He explained: "Have you ever noticed that you fall asleep just fine and then suddenly you're awake at 3am staring at the ceiling overthinking your entire life? Well, there's actually a biological reason for that."
Hormonal Influences and Life Stages
Hormonal changes, especially during perimenopause and menopause, can also contribute to sleep disruptions. Fluctuating oestrogen levels affect temperature regulation, cortisol sensitivity, and overall sleep stability, leading many women to report early morning awakenings. Dr Khan pointed out that this can create a cycle where anxiety about sleep itself exacerbates the problem.
NHS Perspective on Sleep Difficulties
The NHS acknowledges that sleep problems are common and can arise from various causes, including illness, work stress, or life events like having a baby. While a few sleepless nights are generally not a concern, persistent sleep deprivation can impact daily life. The health service recommends that most adults aim for 7-9 hours of sleep per night, though this varies by age and health status.
Practical Tips for Returning to Sleep
Dr Khan advised that waking briefly during the night is normal, as sleep cycles include lighter phases every 90 minutes. The key is to manage the anxiety associated with being awake. He suggested:
- Practicing gentle breathing exercises
- Avoiding clock-watching and screen use
- Maintaining calm evenings with limited alcohol
The NHS also promotes good sleep hygiene, such as:
- Establishing consistent bedtimes and wake-up times, even on weekends
- Turning off electronic devices at least an hour before bed to avoid blue light disruption
- Creating a bedroom environment that is quiet, dark, and cool
- Engaging in relaxation techniques like reading, listening to calming music, or meditation
- Maintaining a nutritious diet and regular exercise, while avoiding workouts within 90 minutes of bedtime
Dr Khan reassured: "So if you're awake at 3am, it doesn't mean you're broken, it just means your biology is doing what biology does, and we just need to help it along a little bit." By understanding these triggers and adopting healthy sleep practices, individuals can better manage nighttime awakenings and improve overall sleep quality.
