What to Do About those "2 AM Wake-Up Calls"

Does it seem like every night at 2–4 AM your internal alarm clock goes off? Or perhaps you have patients who experience this disruptive nightly routine.2 am It is one of the most common problems affecting people with fibromyalgia, and is increasingly common in the general population as well.

But what if it was optional?

While it might not be as easy as hitting the keypad and getting on a “do not call” list, these annoying and often debilitating nightly sleep disruptions are preventable in many cases.

Here are some of the major causes:

Drops in Blood Sugar: This is a major problem in people with adrenal fatigue. It can be especially common in people who are exhausted and “hangry” (angry when hungry), all day and whose minds suddenly go wide awake at bedtime. The drop in blood sugar triggers an adrenaline rush, and they are suddenly wide-awake.

The solution? Have a 1-2 oz high-protein snack at bedtime such as a hard-boiled egg or some cheese, meat, or fish. But definitely avoid sugary or high-carbohydrate snacks at all costs--they will actually make the problem worse. You’ll know if the high-protein remedy is helping after one or two nights.

Frequent Urination: In a number of conditions, such as fibromyalgia, people often have a drop in antidiuretic hormone (ADH or vasopressin). This makes it hard to hold onto water so they “drink like a fish and pee like a racehorse.” This can keep them up at night as well.

To solve this problem, one needs to understand a bit of physiology.

  • Because we are an upright species, gravity pools fluid in our legs. As much as a quart or two. When we lie down, it goes back into the rest of our body. Kind of like drinking a quart or two of water while sleeping. To prevent this, prop your feet up for a few hours before bedtime when you are sitting around reading, watching TV, or checking the computer. This way the legs can drain and you’ll urinate the fluid out before you go to bed.
  • A simple prescription nose spray or tablet called DDAVP (desmopressin acetate) supplies antidiuretic hormone, which makes someone better able to hold water This is the same treatment that is given to kids who wet their beds. The dose is 1/10 mg, one or two sprays or tablets at bedtime.
  • Avoid drinking a lot of fluids, especially with caffeine, for a few hours before bedtime.
  • If the typical pattern is a wake-up followed by urinating only small volumes, try holding off on going to the bathroom for five minutes. In most cases, the person will have fallen back asleep by then, and this will retrain their bladder to sleep through the nightIf there is urinary urgency (including incontinence during the day), try the herb Angelica. It often helps people more easily sleep all night.

Night Sweats & Acid Reflux: Though this is more common in women, night sweats are definitely not exclusively a “women’s issue.” It can come from a number of problems. Especially common ones are hormonal deficiencies (estrogen and testosterone), and infections (especially Candida). If night sweats are frequent and persistent, you need to dig a bit to find the underlying factor(s). There are no one-size-fits-all recommendations for this issue.

In some people, night sweats are secondary to acid reflux. These patients may notice the heartburn when they wake up, but other times they won’t and they’ll just wake up in a sweat after inhaling the stomach acid. This is especially likely to be a problem if the person has daytime indigestion as well. Several things can help in these cases:

Start by taking an acid-blocker such as Prilosec or Nexium an hour before bedtime for three to four nights. If this helps, you’ve identified the underlying driver of the night sweats.

Once the problem is apparent, stop the acid blocker as soon as possible. These drugs are quite addictive and toxic when used long-term. Though it's a bad idea to keep stomach acid "turned off" during the day (you need it to digest food), you don’t need stomach acid at bedtime while sleeping. But there are much safer ways to control it than by relying on prescription acid blockers.

Try the following:

  • Try bicarbonate of soda (e.g., Arm & Hammer) ½ teaspoon in 4 oz of water at bedtime to neutralize the stomach acid(not for children under 16 years old).
  • Don't eat within two hours before bedtime and take 2 caps of a plant based digestive enzyme an hour before sleep. This will ensure your stomach is empty when you sleep.
  • Sleep with your upper body elevated. Raise your upper body at least 6-8 inches when in bed (just raising your head with pillows won’t work). One way to do this is to place a 6-8” brick or phone book under the legs of the bed (just the two legs by the end of the bed where your head is). Another wonderful solution is to use a sleep wedge pillow (you can find one online at www.Hammacher.com.
  • Take 5-6 mg at bedtime. This may decrease reflux
  • Immediate Heartburn Relief chewable antacids. Keep a few at bedside to take if needed.

Pain: If pain is keeping the person awake at night, it absolutely should be eliminated. Getting sleep will then actually help the pain to decrease over time. There are a number of helpful natural treatments, all of which can all be used in combination with any prescription pain medications. Give them six weeks to see the full effect:

  • Curaphen (EuroMedica): This combination of curcumin (turmeric) and Boswellia has been a pain relief miracle for many people, and can be taken one or two capsules three
  • 5-HTP: 300 mg usually does the trick. It helps sleep, decreases pain, and even improves mood.
  • End Fatigue Pain Formula (Integrative Therapeutics): A product I formulated containing Sweet Cherry, Boswellia, and White Willow.

Stress: Insomnia and disrupted sleep is sometimes caused simply by stress. My favorite herbal mixes to optimize a good night sleep include (all three can be used together, and the effects are seen first night)

  • Revitalizing Sleep Formula (Integrative Therapeutics): 2 – 4 Capsules at bedtime
  • Terrific ZZZZ (EuroPharma). This is an excellent mix of four sleep-promoting essential oils: Lemon balm, Lavender, Mandarin orange, and Ravensara

Getting eight hours of solid sleep a night is essential not only for energy and immune function, but also to eliminate pain and to help people to lose weight.


Jacob Teitelbaum, MD is author of the popular free phone app “Cures A-Z”

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