Sleep Maintenance/Middle Insomnia: Causes, Symptoms, Treatment

Dr. Colleen Ehrnstrom, PHD
Oct 11, 20214 min read
Girl awake laying in bed

Sleep is essential as it helps you rest and recover so you can function at your best. Unfortunately, while sleep comes easy to some, many struggle every night when their head hits the pillow.

The term insomnia is often used to refer to all types of sleeping problems, but learning about the specific subtypes of insomnia can increase your ability to address these problems.

Read on to learn more about a common type of insomnia known as Sleep-maintenance Insomnia.

What is Sleep-Maintenance Insomnia?

Insomnia is defined as any or all of the following;  trouble falling asleep, staying asleep, waking too early, or feeling tired during the day. The constellation of symptoms that you struggle with will impact which treatments work best.

The term sleep maintenance insomnia, also known as middle insomnia, refers to the challenge of staying asleep throughout an entire night. This is defined as waking up during the middle of the night and finding it hard to fall back to sleep once you do wake up. This type of awakening can happen multiple times throughout the night, leading to fragmented and insufficient sleep.

Symptoms of Sleep-Maintenance Insomnia

The main symptom and indicator of sleep maintenance insomnia is waking up during the middle of the night and having a hard time going back to sleep. Other symptoms are sleep anxiety, daytime sleepiness, inability to concentrate, headaches, and irritable mood.

Impact of Sleep-Maintenance Insomnia

Living with insomnia is hard. In addition to the long, frustrating sleepless nights, it also can affect both mental and physical health.

Short-term consequences include the inability to function and perform. It lowers reaction time which means routine tasks such as driving become unsafe. Further, studies show that it can also affect balance.

Long term, it raises the risk for diseases of the heart, mind, and hormonal system. Depression and anxiety are also common in patients with persistent insomnia.

What Can Cause Sleep-Maintenance Insomnia?

Waking up during the night is normal; most of us do. However, we do expect to have the ability to fall back to sleep fairly quickly. So if you find yourself waking up and having difficulty going back to sleep, for at least three out of seven nights per week, for three months or more, you are likely struggling with sleep-maintenance insomnia.

It can be helpful to consider all the factors that may be creating this frustrating cycle such as:

  1. Physical factors such as pain, breathing or digestive problems, hormones, or a full bladder
  2. Psychological factors such as  stress, anxiety or other psychological concerns (mood disorders)
  3. Sleep Habits such as your sleep schedule, caffeine, nicotine, or alcohol intake, or technology habits

Sleep-Maintenance Insomnia Treatment

Sleep-maintenance insomnia, like other forms of insomnia, is treatable. Most people can benefit by adopting healthy lifestyle habits. such as exercising regularly and establishing a relaxing bedtime routine. Resisting daytime naps and going to bed only when sleepy is also recommended, as is avoiding stimulants such as caffeine before bed.

Sleep-maintenance insomnia often develops because we have taught our brains to respond to natural wake-ups with hyperarousal. We worry about being awake during the middle of the night. To unlearn this and train your brain not to be afraid, we can use a user-friendly behavioral techniques from CBT-I such as stimulus control.

Cognitive Behavioral Therapy for Insomnia (CBT-I) can help if insomnia persists. It is a proven therapy that directly addresses the link between thoughts, behaviors, and habits. It enables you to form healthier habits and cope with stress and the negative thoughts associated with insomnia. These, as discussed earlier, are the common causes of a chronic sleep=maintenance insomnia pattern.

Learn More

To get more information about sleep-maintenance insomnia and use Dawn’s evidence-based CBT-I to treat your sleep-maintenance insomnia, contact us today!



Dr. Colleen Ehrnstrom, PHD

Dr. Colleen Ehrnstrom is a licensed clinical psychologist with a specialty practice in Acceptance and Commitment Therapy (ACT). Areas of expertise include insomnia and other sleep disorders, anxiety, and depression.

Dr Ehrnstrom is the co-author of the book End the Insomnia Struggle: A Step by Step Guide to Help you Get to Sleep and Stay Asleep which offers a comprehensive, personalized sleep program that integrates the physiology of sleep, cognitive behavioral therapy for insomnia (CBT-I) and acceptance and commitment therapy (ACT).

It’s time to stop blaming the night monsters.
Let’s work together to transform your sleep for the better.