Waking up at 3 a.m.

It's three o'clock, maybe half past. There was no noise. Your eyes open and the body is already awake, as if someone had switched on a light inside.

Many people describe the same thing. The heart a little fast, some heat, the mind going over the day, the to-do list, a conversation from years ago. Sleep doesn't come back (or it comes back half an hour before the alarm).

If it happens often, there is a logic to it. And that logic almost always runs through the nervous system.

Why does the body wake up at that hour?

Sleep isn't even. Deep sleep, the kind that repairs, is concentrated in the first half of the night; in the second half sleep gets lighter, and the brain comes up to the surface several times without our noticing.

At the same time cortisol, which was at its lowest around midnight, starts to rise to get you ready for the morning. That is a normal rhythm.

In a rested body, both things pass without consequence: a brief waking, and sleep goes on. In a body that lives on alert, that small rise is enough to cross the threshold, and the system, which picks up the activation and reads it as a sign that something is wrong, wakes up all the way.

Sleep needs the brake

To sleep deeply you need the brake: the parasympathetic system, the branch that slows the pulse, loosens the muscles, moves the gut and lets tissue repair. (On the somatic therapy page I explain the accelerator and the brake more slowly.)

When the day's activation hasn't finished discharging, the foot stays on the accelerator even while the body lies down. Still on the outside; on the inside, the engine is running.

That is why so many people say they go to bed exhausted and wake up alert: the two live together, and a nervous system can be worn out and on watch at the same time.

Why won't my mind stop at 3 a.m.?

The thoughts of three in the morning almost always arrive after the activation. First the body switches on. Then the mind goes looking for a reason, and it finds one: money, the kids, work, something someone said.

So arguing with those thoughts rarely works. You answer the content. What keeps you awake is the state.

At that hour, too, the part of the brain that keeps things in proportion is barely available, and what looks manageable in daylight looks enormous at night. By morning it's almost always back to its real size.

What makes it worse

Some causes are physical, and those are worth checking first: alcohol at night, which helps you fall asleep and breaks up the second half of the night; coffee in the afternoon; late or heavy dinners; reflux; the hot flashes of perimenopause. Some medications too: if you suspect one, talk to whoever prescribed it, and don't stop it on your own.

Others are about rhythm. Days without a pause, the phone until the last minute, going to bed at a different time every night.

And sometimes there is a history. Some bodies learned to keep watch exactly when everything goes quiet. You don't need a history like that to wake up at three, and the symptom alone doesn't tell whether there is one. If something stirs as you read this, the page on trauma may give you some context.

Once you're awake

First, don't fight it. Looking at the clock and counting the hours left usually switches you on even more.

It helps more to give the body signals that there is no danger. Feel your weight on the mattress (heels, back, the back of the neck), and let the out-breath last a little longer than the in-breath, without forcing it. Find something comfortable, even something small. The warmth of the blanket. A warm hand resting on your belly.

If after a while the body is still switched on, many people find it works to get up, with low light and no screen, and go back to bed when sleep shows up.

None of these things can make sleep come: they turn the volume down, and sleep arrives when it arrives.

What we do in session

As a doctor, I first look at what needs to be ruled out: sleep apnea, thyroid, anemia, pain, depression, whatever you already take. If something needs testing, medication or another specialist, I'll tell you.

Then we work with the state of the body. With somatic therapy, the body learns, little by little, to finish an activation that was left halfway and to find the brake again; with Gestalt we look at what is going on in your life today that keeps the foot on the accelerator.

Sessions last 60 minutes, in Tepoztlán or online. I won't promise you'll sleep through the night after a certain number of sessions; the goal is for the body to get its rhythm back, and that takes the time it takes.

When not to start here

If you snore loudly, wake up gasping for air, or someone has seen you stop breathing in your sleep, the first step is a sleep study with a doctor, not therapy.

If the insomnia arrived together with a sadness that doesn't lift during the day either, the first step is a medical or psychiatric evaluation, soon.

If you take medication to sleep, this doesn't replace it. It can go alongside it, and any change is something you decide with whoever prescribed it.

If you want to sleep well by next week, this is probably not what you need: this work goes slowly, because the nervous system doesn't change on command.

And if, reading this, you feel it isn't the moment, that's fine too. Not booking is also a good decision.

Frequently asked questions

Is it normal to wake up at the same time every night?

Waking briefly several times a night is normal, and you almost never remember it. What isn't part of a healthy rhythm is waking all the way up, alert, and not being able to get back to sleep night after night. That almost always points to a nervous system that doesn't finish coming down.

Is waking up at 3 a.m. a sign of anxiety?

It can be, but not always. Activation in the early morning shows up with anxiety, and also with alcohol, reflux, hormonal changes, pain or sleep apnea. That's why, as a doctor, I rule out the physical causes first.

Should I take something to sleep?

That's a decision to make with a doctor who knows your case. There are situations where a medication helps. This work can go alongside it, and I never suggest stopping or changing a medication.

Are sessions online or in person?

Both. I see people in person in Tepoztlán, Morelos, and online by video call. Each session lasts 60 minutes, in English or Spanish.

If you want to start

If any of this sounds familiar, we can talk. The first session is for looking together at what is happening to your sleep and what makes sense to do. No rush.

Book a first session or message me on WhatsApp.

You may also want to read: anxiety you feel in your body.