Early Morning Awakening Insomnia: Causes and Treatment Option

There are different types of insomnia.

Some people find it hard to fall asleep, while others wake up frequently (sleep maintenance insomnia).

Here, we'll look at the type refers to people who wake early and can’t get back to sleep - i.e. early morning awakenings.

This is increasingly common as people get older (1).

In this post, I’ve summed up all the current research available on early morning awakening insomnia, which includes both underlying causes and treatment methods.

Potential Causes of Early Morning Awakening

Even if you don’t have chronic insomnia, you still might be waking up a bit earlier than you’d like.

Very few cases of sleep issues are the same, there’s always different individual factors that need to be considered.

When it comes to waking up early, I’ve identified the 4 main underlying causes that have been studied by researchers.:

1. An advanced circadian rhythm - While we’re not sure why, some people develop or naturally have a circadian rhythm that makes them want to wake up early.
2. Sleep hygiene - Early morning noise or light can impact sleep in the morning.
3. Co-existing health conditions - Having other conditions like sleep apnea, arthritis, and others can affect sleep (especially during lighter sleep stages of the morning).
4. Behavioral habits - It’s possible to develop certain thinking patterns and habits that interfere with morning sleep in particular.

The good news is that there are effective treatment options for all of these potential issues.

I’ve gone into more detail on the research for each issue in the rest of this post.

1. An Advanced Circadian Rhythm

One team of researchers put out an ad for subjects who woke up early and couldn’t return to sleep .

After screening 100 calls from interested people, they found that 70 of them had other sleep issues, not early morning waking insomnia (2).

Those 70 other people likely had one or more of the 3 other main reasons that we’ll look at later.

Back to the study...The 30 people that actually had insomnia were brought in for a sleep study (along with a control group).

They found that early wakers had a circadian rhythm that was shifted earlier by about 2 hours. This was discovered by looking at their melatonin levels and body temperature:

...EMA (early morning awakenings) group had earlier timed temperature and melatonin circadian rhythms than the good sleepers.

They made the same total melatonin over a 24 hour period, just at the “wrong” times for what most people expect.

Even though they were sleepier earlier at night than the “good” sleepers in the control group, the early risers went to bed only a little bit earlier.

However, because of their circadian rhythms (mainly the body temperature for waking up), they woke up after about just 5.5 hours of sleep.

This is referred to as advanced sleep phase syndrome.

Treatment Options for an Early Circadian Rhythm

There are 2 options available for people with actual early morning awakening insomnia, neither involve sleep medicine.

The first is to simply go to bed earlier. That will result in a normal amount of total sleep, but they’ll still be waking up super early.

That’s not ideal for most, as it interferes with social events and personal preferences. It can also make it difficult to fall asleep in the first place.

The second option is to retrain your circadian rhythm using bright light therapy.

There’s quite a bit of research that shows this approach is effective. A person is exposed to (a particular kind of) light to inhibit melatonin production until the ideal sleep time. This delays the circadian rhythm and sleep cycle (3).

Note that your diagnosis should be confirmed by a doctor and treatment should be done with their guidance.

SummaryPeople that truly have early morning insomnia typically have an advanced circadian rhythm. Sleep quality can be improved by either going to bed earlier or using bright light therapy.

2. Poor Sleep Hygiene

While bad sleep practices (think "habits" and environment) can cause difficulty falling asleep, it can also affect your sleep later on in the night.

Some habits affect how easy it is to get to sleep, and others affect when you wake up.

The most obvious aspects that affect early morning awakenings are:

• Light - As your body senses light, it starts to get ready for the day and wakes up shortly after.
• Noise - Sleep disturbances like loud noises can startle you awake and make it hard to fall asleep again.
• Heat - A rise in body temperature can affect your circadian rhythm and essentially tells your body to wake up, leading to difficulty staying asleep.

Light can be dealt with by getting blackout curtains or wearing a sleep eye mask.

Noise is often out of your control, but earplugs can make a significant difference. They’re uncomfortable at first, but feel normal after a few days. Soundproofing bedrooms is also possible, but not easy and can be expensive.

Heat is not usually an issue, but it is possible if someone else wakes up before you and changes the thermostat.

SummarySee my guide to insomnia sleep hygiene for more detailed explanations of these and more.

3. Co-Existing Health Conditions

Research has shown that some people wake up early because of other existing conditions - not insomnia (4).

For example, people with arthritis can experience pain during the night that affects sleep.

Because insomnia related to waking up occurs in light sleep stages (REM, stage 1), disruptions are more likely to occur in the early morning when your brain shifts more from periods of deep sleep to light sleep.

At that point, it can be difficult to get back to sleep.

SummaryIf you have any other condition that can cause pain or sleep disruption (i.e. sleep apnea), you will need to get treatment from your doctor for that condition in order to sleep better in the mornings. Note that this may not be the sole cause of your early awakenings.

4. Behavioral Habits

Finally, people often develop bad habits when it comes to sleep (there’s some overlap with sleeping practices).

Patterns of thoughts or actions can lead you to waking up early and not being able to sleep more.

For example, some people start off the day thinking about everything they need to do, and often stressing about it. It’s not surprising that any time they wake up during the night, their brain automatically starts thinking about these things.

These issues can develop over time, and the symptoms may “suddenly” appear out of nowhere.

Treating Behavioral Habits That Cause Early Awakenings

The most effective and safest treatment option for people with this type of sleep issue is cognitive behavioral therapy (CBT) (5).

CBT often improves sleep quality even in those without major sleep issues, because we all have some degree of thoughts that get in our way.

If your symptoms are minor, there are some online courses on CBT for insomnia that are available. However, the proper treatment procedure is to see a professional for 4-8 sessions, which typically results in significant sleep quality improvements.

Summary of Early Morning Awakening Insomnia Causes and Treatment

There are 4 main causes of early awakening insomnia:

• An early shifted circadian rhythm
• Poor sleep hygiene
• Co-existing sleep disorders
• Disruptive behavioral habits

We’ve looked at treatment options for all of these, ranging from bright light therapy, to simple sleep habit improvements, to CBT.

One treatment method that I didn’t mention was the use of sleep medication. There are sleep medications out there, but they often come with significant side effects. Sleep medication is usually a short term fix, and not a long term solution.

That doesn’t mean that sleep medication doesn’t have its place in treatment. Listen to your doctor and follow your prescribed treatment procedure. Hopefully this post has helped you understand why your doctor is approaching your sleep issues in a particular way.

References

1. Epidemiology of Sleep: Age, Gender, and Ethnicity
2. Circadian rhythms of early morning awakening insomniacs
3. The Treatment of Early-Morning Awakening Insomnia With 2 Evenings of Bright Light
4. Awake at 4 a.m.: Treatment of Insomnia With Early Morning Awakenings Among Older Adults
5. Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age