Night wakings: A guide for the science-minded parent

© 2008 - 2019 Gwen Dewar, Ph.D., all rights reserved

You might be tempted to think of night wakings as evidence that something has gone wrong. But it's normal for healthy sleepers to experience multiple arousals from sleep during the night.

Mostly, these arousals are very brief, so brief that we don't even remember them in the morning. Occasionally, we experience longer periods of waking.

But either way, night wakings are a regular feature of sleep, for adults and children alike. And they needn't be disruptive.

For instance, when researchers have monitored the sleep of babies, they've found that infants as young as three months will sometimes awaken without their parents' knowledge. The babies remain drowsy and quiet, and fall back to sleep on their own (Tikottzky and Volkovich 2019).

It's only when a child fails to self-settle -- and wakes up his or her parents -- that night wakings are perceived to be a problem.

So what's going on? Why do we wake up in the middle of the night? What causes frequent night wakings in children? And what can we do to make night wakings less disruptive?

In this article, I review the science of interrupted sleep:

  • why nobody truly "sleeps through the night"
  • why baby sleep is more fragmented than adult sleep
  • The causes of frequent or disruptive awakenings

What to do if you or your child awakens frequently at night

Night wakings: Why nobody truly "sleeps through the night"

Perhaps you’ve heard parents brag that their children are "sleeping through the night." This isn’t happening in your family, and you’re wondering what’s wrong.

Your baby seems to be a light sleeper. She’s easily aroused at night and (when things get really difficult) she seems capable of waking up every hour.

Or maybe you have an older child, and wonder why your toddler keeps waking up in the middle of the night.

Is a medical problem causing these wakings? Maybe. As I note below, there are conditions -- like gastroesophageal reflux disease and obstructive sleep apnea -- that can trigger night wakings.

But you don't need a health problem to experience night wakings. On the contrary, night wakings are a normal feature of sleep.

Nobody truly "sleeps through the night," not if we mean by this phrase "sleeping continuously in one, long bout." Babies, children, and adults all experience interruptions.

For example, when adults sleep, we cycle through a series of sleep stages (including light sleep, deep sleep, and REM, or rapid-eye movement sleep). Arousals are common during transitions between stages, and also during REM.

How common?

In a study conducted in the United States, researchers used electroencephalograms (EEGs) to measure the sleep behavior of 76 healthy adults between the ages of 18 and 70. Across all age groups, sleepers averaged 80 to 130 arousals in a single night (Bonnet and Arand 2007).

And other studies -- of people living in traditional cultures that lack electricity -- suggest that adult sleep is marked by frequent interruptions (Samson et al 2017a; Samson et al 2017b).

If we aren't aware of these frequent arousals, it's because we sink back into sleep very quickly and don't remember the disruption in the morning.

But of course some people do remember. They may have trouble getting back to sleep, and view their trouble as a pathology. A sleep specialist might diagnose them with a medical disorder: "secondary insomnia" (Dement and Vaughan 1999).

But are night wakings necessarily a bad thing -- a sign that something is medically or psychologically wrong? The cross-cultural evidence suggests otherwise.

Night wakings in anthropological perspective

Ethnographic and historical research indicates that "sleeping through the night" is not a universal expectation.

For instance, in pre-industrial Europe, people met their sleep needs in at least two distinct sleep sessions (sometimes called "first sleep" and "second sleep"). They may have also taken naps during the day (Ekirch 2005)

Similarly, people living in a variety of non-Western, traditional cultures have been known to take their sleep in multiple sessions (Worthman and Melby 2002; Samson et al 2017b).

And it's clear that night wakings serve a protective function. They help us monitor changes in the environment, so that we can awaken more quickly in the event of an emergency. They may also protect us from falling into too deep a sleep -- a dangerous prospect if you experience a bout of sleep-disordered breathing (Halász et al 2004).

This doesn’t mean that night wakings don’t present a problem to sleepless parents. But it does suggest that sleep is more variable and flexible than we sometimes assume. And the better we understand this variation, the better we can cope with night wakings in babies and children.

Why do babies experience frequent night wakings?

When they're young, babies need to feed during the night. That's obvious enough. But babies have additional reason to awaken.

During the first three months postpartum, babies spend most of their sleep-time in a stage called "active sleep." It's the infant counterpart to REM, and it's especially restless. Babies twitch, thrash around, and even vocalize.

This can fool us into thinking our infants are awake. So we intervene, and, in doing so, we rouse our babies from sleep. We've caused a night waking! Alternatively, all that thrashing around can sometimes cause an infant to awaken himself.

What's all this about?

One interesting theory is that babies twitch and move during sleep because their brains are busy testing and mapping out the connections between nerves and skeletal muscles. But it's also evident that young infants are at special risk for sleep-related breathing emergencies -- emergencies believed to cause SIDS, or sudden infant death syndrome. So spending time in active sleep -- being easily awakened -- may benefit babies in multiple ways.

No wonder, then, if babies wake us up at night. In a study that recorded the sleep patterns of healthy 2- and 9-month old infants, babies averaged 3 major awakenings each night (Anders 1978).

Why, then, do some parents claim their babies sleep through the night? Most likely, they are simply unaware of their infants' brief night wakings. The issue, then, isn't whether or not your baby wakes up during the night. It's whether he also wakes you up.

For tips on coping with baby night wakings, see this article on baby sleep patterns.

And what about big kids?

Many people expect children to sleep soundly throughout the night. But as we've seen, interrupted sleep is normal for adults and infants. It's also normal for big kids.

In fact, if you think your child doesn't wake up, you are mistaken. That's the implication of studies that monitor children's sleep with actigraphs. When researchers compared objective data with subjective, parental reports, they found that parents consistently underestimated how frequently their kids awakened during the night (e.g., Holley et al 2010; Kushnir and Sadeh 2013).  

So waking up doesn't mean your child is unhealthy, immature for his age, or maladjusted. But some night wakings are symptomatic of real problems, and these problems should be addressed.

Here are some common causes of night wakings—and advice for coping with them.

Nighttime fears and separation anxiety. Worried, frightened kids have more sleep problems, including disruptive night wakings (Petit et al 2006; Gregory et al 2005; Kushnir and Sadeh 2011; Meltzer et al 2013). There is no evidence that nighttime fears or separation anxiety will diminish as a result of sleep training. In fact, research suggests that ignoring your child’s fears may lead to nightmares and emotional problems. So it’s important to take an active role in teaching your child to overcome her fears. For more information, see this article on nighttime fears in children.

Nightmares. Nightmares are frightening dreams associated with REM sleep, and they are more likely to occur after a child has been sleeping for several hours. When a child wakes up immediately after a nightmare, she is likely to remember it. Triggers for nightmares include stress, anxiety, traumatic events, and medications that interfere with REM sleep (Moore et al 2007). Kids who awaken from nightmares need to be reassured that their dreams weren’t real. To help kids cope with emotions associated with nightmares, see my article on nighttime fears in children.

Night terrors. Like nightmares, night terrors are distressing, disruptive, and cause night wakings. But night terrors differ from nightmares in several key respects. A child may move--even sleep walk--during a night terror, which puts him at risk of hurting himself. For help distinguishing night terrors from nightmares--and for tips on treatment--see this article on night terrors in children.

Overtiredness. When people are overtired, their sleep may become more restless and they suffer more frequent night wakings. If your child is overtired, he needs more sleep. For tips on getting him to get to sleep earlier at night, see this article on bedtime problems in children.

Snoring and other forms of sleep-disordered breathing. Sleep disordered breathing (SDB) includes snoring, loud breathing, troubled breathing and interrupted breathing (apnea) during sleep. SDB can restrict the oxygen supply to a child’s brain and cause serious health problems. It is also associated with poor sleep quality, nighttime crying, daytime sleepiness, attention problems, hyperactivity, and frequent night wakings (e.g., Fukumizu et al 2005; Hiscock et al 2007; Shur-Fen Gau 2006). If you suspect your child suffers from sleep-disordered breathing, consult your physician.

Full or irritable bladders. Kids may be awakened during the night be the urge to urinate, so it’s wise to avoid drinking fluids before bedtime. But some children may have urinary tract problems that awaken them even when their bladders aren’t full. Girls are especially prone to urinary tract infections because the female urethra is very short—making it easier for germs to enter the body. If your child has frequent night wakings, try to find out if bathroom trips are contributing to the problem.

GER (gastroesophageal reflux). Kids who suffer from gastroesophageal reflux (stomach acid in the esophagus, also known as heartburn) may experience frequent night wakings. GER is associated with sleep-disordered breathing and can be—in some cases—dangerous. If you think your child may suffer from GER, consult your physician for treatment options. Meanwhile, avoid acidic and hard-to-digest foods before bedtime.

Headaches. A recent Polish study of 284 kindergarten and school-aged children reports that kids who suffered from headaches were more likely to suffer from frequent night wakings (Zarowski et al 2007). Similar results have been reported for kids in the United States (Long et al 2010) and Italy (Carotenuto et al 2005). It’s not clear if the headaches are causing the sleep problems, or the sleep problems are causing the headaches. Either way, it’s a good idea to have your child’s headaches investigated by a physician.

Stress. Like adults, kids experience sleep problems when they are under stress. Children who’ve experienced traumatic events are likely to suffer from nightmares and other sleep disturbances (Sadeh 1996). But everyday stressors disturb sleep, too. For instance, kids experiencing family stress suffer more night wakings and get less sleep overall (El Shaik et al 2006; Sadeh et al 1999). And these sleep problems are associated with elevated stress hormone levels (El Shaik et al 2008).

Sleep-onset associations. According to a prevailing theory among Western sleep researchers, kids often learn to associate falling asleep with certain forms of stimulation—like parental soothing or a particular sleep environment. These sleep aids may be very effective, but if kids become dependent on them, they fail to learn how to fall asleep on their own. So if your child is used to falling asleep in your presence, but wakes up alone, he may not be able to settle himself back to sleep (Moore et al 2006). If you want your child to develop self-soothing skills, you may want to consider sleep training. For more information, see these articles on "no cry" sleep training and the Ferber method.

References: Night wakings

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