Waking up in the middle of the night is common, but for some, it leads to a frustrating cycle of sleeplessness. Known as maintenance insomnia, this condition affects nearly 20% of those with insomnia symptoms, according to a 2014 study. Experts say stress and anxiety are often the culprits, triggering a surge of stress hormones that keep the mind racing.
Dr Julia Kogan, a health psychologist and insomnia specialist based in Chicago, explains that while waking at night is normal, people with maintenance insomnia struggle to get back to sleep. “People wake and cannot shut their mind off, which interferes with their ability to fall back asleep,” she says. This can lead to impaired daytime performance, anxiety, headaches, and even long-term health risks such as obesity, diabetes, and cardiovascular disease.
Dr Jamie Zeitzer, professor of psychiatry and behavioral sciences at Stanford University, notes that maintenance insomnia is distinct from other forms like sleep onset insomnia or early waking insomnia. It often involves waking at the end of a sleep cycle, when sleep is lightest, but the key factor is what happens next. “It’s not necessarily what wakes people up, but what happens after with their mind that keeps them up,” Kogan adds.
Other contributing factors include a lack of sleep drive—often due to napping or spending too much time in bed—and physical pain or discomfort. Chronic conditions like migraines, inflammatory diseases, and breathing disorders can also disrupt sleep. Dr Olabimpe Fashanu, a sleep physician based in Maryland, warns that untreated maintenance insomnia can increase the risk of serious health issues, but effective treatments are available, including cognitive behavioural therapy and stress management techniques.
