What causes waking up in the middle of the night and being unable to fall back asleep?

Generally, waking up in the middle of the night and being unable to fall back asleep may be caused by pre-sleep stimulation, psychological anxiety, poor sleep environment, cervical spondylosis, gastroesophageal reflux disease (GERD), or other reasons. If discomfort occurs, it is recommended to seek medical attention promptly. Specific causes are analyzed as follows:

1. Pre-sleep stimulation

Engaging in intense exercise, watching highly stimulating TV programs, or using mobile phones before bedtime are bad habits that may excite the brain, leading to awakening during the night and difficulty returning to sleep. It is advisable to relax appropriately before bed and avoid vigorous activities or viewing stimulating content.

2. Psychological anxiety

Stress and anxiety can activate the body's stress response system, increase cortisol levels, and disrupt normal sleep cycles, resulting in nighttime awakenings and difficulty falling back asleep. Stress can be relieved before bedtime through reading, listening to soft music, deep breathing, or similar methods.

3. Poor sleep environment

Noise, light, and room temperature can affect sleep quality, causing one to wake up at night and be unable to fall back asleep. Tools such as blackout curtains, earplugs, or white noise machines can be used to improve the sleep environment.

4. Cervical spondylosis

Cervical spondylosis may result from aging, unhealthy lifestyle habits, or acute and chronic injuries. Herniated cervical discs or bone spurs may compress surrounding nerves during sleep, increasing pain and causing the aforementioned symptoms, which may be accompanied by dizziness and fatigue. Medications such as ibuprofen gel, Jingkang capsules, or eperisone hydrochloride tablets may be used under medical guidance for treatment.

5. Gastroesophageal reflux disease (GERD)

GERD is primarily caused by obesity, poor dietary habits, and lack of physical activity. When lying down, gastric contents may reflux into the esophagus, causing awakening during the night. The resulting strong discomfort makes it difficult for patients to fall back asleep, often accompanied by heartburn and acid regurgitation. Medications such as rabeprazole sodium enteric-coated tablets, omeprazole enteric-coated capsules, or domperidone tablets may be used under a doctor’s guidance for treatment.

Engaging in relaxing activities before bedtime—such as soaking feet or reading—can help the body and mind transition into a sleep-ready state. Creating a quiet and comfortable sleep environment also contributes to improved sleep quality.