Why Do I Wake Up Each Two Hours? Causes and Sleep Ideas

First of all, know that it’s common to wake up throughout the night. In fact, it’s natural to do so, says Christopher Winter, MD, a sleep medicine specialist and author of The Sleep Solution. How much you notice those awakenings is another thing entirely. Most of the time, you’ll fall back to sleep quickly, and won’t remember it happened by morning. But if you’re waking up in the middle of the night (or waking up every hour and staying awake) it’s absolutely frustrating, and you probably want to figure out how to stay asleep all night.

We talked to two sleep experts to help us understand why we’re waking up so often every night, and what to do about it.

9 reasons you’re waking up every two hours at night

“The number of things that can lead to nighttime awakenings is a huge list,” says Dr. Winter. When you’re trying to suss out your sleep struggles, here’s what may be going on:

1. Your sleep environment isn’t right

The most common reason you might wake up: Something about your sleep environment is off, says Orlando Ruiz-Rodriguez, MD, a pulmonologist and sleep medicine specialist with Orlando Health Medical Group Pulmonology and Sleep Medicine. “Things that are not conducive to sleep include a room that is too hot, too cold, too noisy, and one that has too much light. Those factors can interrupt our sleep,” he says.

2. You have restless legs syndrome

Restless legs syndrome (RLS) is a neurological disorder that causes uncomfortable feelings in your legs, giving you the urge to move them, per the National Institute of Neurological Disorders and Stroke. RLS can make it difficult to stay asleep, and once you wake up in the middle of the night, these must-move urges make it tough to drift off again. “Patients will say that they’re waking up a lot, but they’re not aware of this restlessness. When a doctor asks if they find it difficult to sit still at night or are restless, they might say “yes,” and mention that this happens to another person in their family,” says Dr. Winter. (RLS can be inherited.)

3. You have acid reflux

Having GERD (aka, gastroesophageal reflux disease) means your stomach contents flow back up to your esophagus, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms include heartburn, chest pain, and nausea, and can happen at night when you lay down (because your stomach contents don’t have to fight gravity as much). Having reflux symptoms is associated with a higher risk of poor sleep quality, according to a July 2023 study in JAMA Network Open. In fact, a 2009 survey in Clinical Gastroenterology and Hepatology found that out of nearly 12,000 people with GERD, more than 1 in 2 had difficulty staying asleep at night.

4. You’re in pain

Even when asleep, your brain can still detect discomfort. “If you have pain that causes arousals from sleep, you may wake up more fully during the night,” says Dr. Ruiz-Rodriguez. Indeed, people with chronic pain struggle to fall asleep and wake up more often and for longer throughout the night, according to a December 2018 review in Sleep Medicine.

5. It’s your medication

Unfortunately, not all meds are compatible with good sleep. “Some medications can interrupt sleep and alter normal sleep patterns,” says Dr. Ruiz-Rodriguez. That includes some blood pressure medications, anticonvulsants, antidepressants, diuretics, and decongestants, according to the National Council on Aging.

6. You’re drinking alcohol or caffeine

A nightcap may help you fall asleep, but it’s not great at keeping you asleep. “Drinking alcohol before bed can make your sleep more interrupted in the later parts of the night,” says Dr. Ruiz-Rodriguez. Likewise, caffeine is a stimulant. “It works in parts of the brain that interrupt sleep,” he adds. Drinking caffeinated tea, coffee, soda, and energy drinks in the afternoon or at night can all have this effect.

7. You have insomnia

We often associate insomnia with trouble falling asleep, but the disorder can also cause trouble staying asleep throughout the night. According to Dr. Ruiz-Rodriguez, the reality is that even worrying about your sleep can lead to the development of insomnia. The anxiety or expectation of waking up exacerbates those nighttime arousals, adds Dr. Winter.

8. You are stressed

Stress is ubiquitous. (Who among us can name at least a dozen things we’re stressed about right now?) And if you’ve ever had a stress dream, you know these feelings can make their way into your sleep. “Stress and anxiety can send us into a hyper-aroused state that interrupts not only the process of falling asleep, but maintaining sleep, too,” says Dr. Ruiz-Rodriguez.

9. You’re staring at screens before bed

It’s a great feeling to slip into bed and finally have nothing to do but wind down by watching TikToks or Instagram reels. But your screen emits blue light that tells your brain to stay awake, which may also cause middle-of-the-night problems. “When you expose your brain to blue light up to the last minutes of sleep, that will affect the spike in levels of melatonin in the brain that are part of our internal clock,” says Dr. Ruiz-Rodriguez. This internal clock is what helps us go to sleep and stay asleep, he explains. When it’s disrupted, you may find yourself waking up every two hours (or more).

How to stop waking up multiple times per night

Want to sleep more soundly? Here’s what to do to stop waking up so much.

Create a relaxing sleep environment

Quick room check: What do you need to make this the best place to sleep? Try turning down your thermostat a degree or two cooler at night, or maybe invest in a cozy weighted blanket—one of Dr. Winter’s go-tos for calming, restful sleep. You could also try using a cooling pillow or sheets, or putting shades or curtains on your windows to block light from coming in. And if you need some background sounds, a white noise machine (or app) can do the trick.

Put away your phone

This one is easier said than done, we know. But ideally, you’ll want to turn off any screen a couple hours before bed. If you do go on your phone or watch TV, aim for no more than 30 minutes before bed, suggests September 2021 research in Healthcare.

Incorporate go-to stress reducers

Finding ways to reduce your stress can be helpful for getting quality zzzs. “If you’re experiencing stress, what are your methods for getting that down?” poses Dr. Winter. Maybe that’s going to the gym to relieve some anxiety, starting a text thread with friends, using a meditation app before bed, setting up boundaries in your personal life, or recalibrating how you view the things that are bringing you stress.

Get some daily exercise

Physical activity—be it a walk around the neighborhood, a sweaty bike ride, or a muscle-burning barre class—is connected to reduced stress and more positive emotions, according to a small May 2019 study in the British Journal of Health Psychology. This de-stressing through exercise can help you feel more relaxed before bed, which may help you fall asleep, according to Dr. Winter.

Practice breathwork

Another way to relax? Practicing breathwork. It’s a free and accessible strategy that you can do at any time of day, including before bed. “Studies show that when people meditate or do breathwork before bed, their sleep is significantly deeper—deeper being a code word for sleep that’s less likely to be fragmented with awakenings,” says Dr. Winter. Because we tend to wake up during lighter stages of sleep, increasing the depth of your sleep can help you stay asleep.

Drink alcohol or caffeine earlier in the day

Both alcohol and caffeine are not great for your sleep, says Dr. Winter. Of course, the choice to drink a cocktail or a cup of coffee late in the day is completely yours—especially if you are celebrating a special occasion. But if you’re wanting to protect your sleep, you’ll have to be a little more conservative with both alcohol and caffeine. Cutting them off about three hours before bed is ideal, per Michigan Medicine.

Treat any underlying conditions

If you’re feeling especially tired during the day or wake up frequently at night (especially coughing or gasping for air), this may mean you have an underlying sleep disorder that needs to be treated. Things like sleep apnea, restless legs, etc. can keep you from getting a good night’s sleep. Let your doctor know about your symptoms—they can diagnose any potential health issue and help you decide on proper treatment.

Similarly, if you’ve started a new medication and you notice it’s affecting your sleep, reach out to your doctor. They can help adjust your dose or find another med that will allow for more restful shut-eye.

When to see a doctor about frequent nighttime awakenings

If there’s been a change in your sleep habits—for example, you felt as if you were sleeping through the night and now you wake up constantly—that might mean something, says Dr. Winter. Consider talking to your doctor to see if there’s a health-related reason you’re waking up so often. If you’ve gone through the list of things to do to get better sleep (like improving your sleep environment and practicing good sleep hygiene) and it hasn’t helped, it may be time to see your doctor, he adds.