The 3 a.m. wake-up: Why it happens to women more often after 55

It happens like, well, clockwork: you have little trouble falling asleep each night, but your eyes seem to pop wide open in the wee hours. A glance at the clock tells you it’s 3 a.m. — seemingly every time.

You’re not imagining it. Waking up at 3 a.m. is a familiar phenomenon for women 55 and up because of biological and lifestyle factors. “Based on my own practice, I’d say sleep disturbances at that time of life are really common,” says Dr. Kathryn Corelli, an internist and menopause specialist at Harvard-affiliated Brigham and Women’s Hospital.

But just because many women face it doesn’t mean you have to accept it, Dr. Corelli says. There are ways to take control and improve your sleep.

The role of menopause and hormonal changes

Topping the list of reasons for older women’s 3 a.m. wake-ups are drastic drops in estrogen and progesterone that accompany menopause. These hormonal shifts spur many changes throughout the body, but one of the most noticeable is disrupted sleep cycles.

Vasomotor symptoms, which include hot flashes and night sweats, often strike in the early morning hours as well. “Those will wake you up, of course,” Dr. Corelli says.

For both sexes, aging typically also changes our “sleep architecture,” the pattern and sequence of sleep stages throughout the night. There’s a natural shift toward lighter sleep as the years pass, with less time spent in restorative, deep sleep. At the same time, our circadian rhythm tends to swing, driving us toward earlier bedtimes as well as wake-ups.

“Older people often need less sleep and find themselves waking up earlier as they age,” Dr. Corelli says. “That’s not something we can actually help correct.”

Other common causes of middle-of-the-night waking

Hormones and sleep patterns are just part of the picture. “There are several different components that lead to waking up in the middle of the night, which is much more common than having trouble falling asleep,” Dr. Corelli says. The following are chief among them:

Stress and anxiety. It’s maddening, but racing thoughts have a way of turning on during the wee hours. “Being more anxious is very common around menopause,” she says.

Bladder changes. “Urinary urgency and frequency are common reasons women wake up at 3 a.m. after 55,” she says. “Getting up once a night to use the bathroom is considered normal; twice or three times can really disrupt sleep.”

Medications. Some drugs can fragment sleep, especially those for high blood pressure or mood issues. “You always have to balance effectively treating your condition with how your medications are affecting your sleep,” Dr. Corelli says.

Chronic pain. Natural declines in body temperature, blood flow, and production of the anti-inflammatory hormone cortisol at night can encourage flares in back pain, arthritis, and neuropathy just when we ought to be sleeping.

Alcohol, caffeine, or late eating. All can disrupt deeper sleep stages. In particular, “alcohol definitely changes our sleep architecture and makes us get less deep, restorative sleep,” Dr. Corelli says.

Tips to improve sleep and reduce nighttime wake-ups

It’s one thing to be fatigued or cranky here and there, but when should you be concerned that 3 a.m. awakenings are affecting your health? Talk to your doctor if you’re sleeping poorly many nights a week or you’re chronically exhausted.

Dr. Corelli also suggests these strategies to help break the cycle:

Practice good sleep hygiene. Keeping consistent sleep and wake times and maintaining a cool, dark bedroom beckon your brain and body toward more consistent rest. And be strict about cellphone use. “If you pick it up in the middle of the night, even to check the time, that can absolutely keep you awake,” she says.

Address medical issues. Talk to your doctor about menopause-related symptoms, bladder issues, or medications that appear to contribute to broken sleep. She may be able to prescribe effective therapies or fine-tune doses or timing.

Try mind-body techniques. Deep breathing or meditation can quickly move you back toward slumber.

Tweak your lifestyle. Limiting caffeine, alcohol, and heavy evening meals can avert the problem before it starts.

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