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Sleep Disorders

Waking Up too Early



Whether I go to sleep at 8:00 pm or midnight, I wake at 4 am. Then by late afternoon I am so tired it`s hard to fuction.  Should I see a doctor? 



This can be a very frustrating problem and could be due to a wide range of causes. Most likely, this may represent a problem with your underlying internal clock. Our sleep cycle (when we sleep) is controlled by 2 main factors. The first is called our homeostatic drive to sleep - in lay terms this means the longer we are awake, and the more sleep deprived we become, the sleepier we get. The second factor is our internal clock, or circadian rhythm. The underlying circadian rhythm is what tells us to sleep at night and to stay awake during the day. It runs on about a 24 hour cycle and can be effected by several factors with the strongest being light exposure and melatonin secretion.

The combination of the homeostatic drive to sleep and the circadian rhythm usually ensures we sleep at night. However, in some individuals, these factors can be altered, shifting the time we might normally sleep. For example, in teenagers, the circadian clock tends to be delayed, leading them to stay awake later into the night but also want to sleep in later in the morning. Conversely, as we age, the circadian clock tends to advance and it is not uncommon for elderly people to get sleepier earlier in the evening and then awaken earlier in the morning.

It sounds as though you likely have an "advanced sleep phase" (tendency to awaken in the early morning hours) and thus, when you go to bed late, do not get adequate sleep resulting in daytime tiredness. If this is indeed the case, there are maneuvers that can be under taken to help you delay your circadian rhythm, allowing you to sleep later in the day. Specific prescriptions for late evening light exposure may be beneficial. Alternatively, late morning melatonin may be of benefit, though light exposure is probably going to be more effective.

There are other possibilities to consider as well. These may range from depression, sleep-related breathing disorders (tend to be worse during dream or REM sleep, which occurs in the early morning hours), medical problems (such as asthma, reflux disease, heart failure, painful syndromes) and medications.

To fully assess and treat your problem, a full history and physical need to be done. I recommend you see a doctor to help solve this. It's likely a visit to a Sleep Specialist would be helpful.

If you would like further information about awakenings from sleep, I recommend the American Academy of Sleep Medicine website. In addition to information about sleep medicine, the website also contains a list of accredited Sleep Centers and may help you to locate one nearest you.

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Response by:

Aneesa M Das, MD Aneesa M Das, MD
Assistant Clinical Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University