Middle-of-the-night insomnia (MOTN) is insomnia

Insomnia

Insomnia is most often defined by an individual's report of sleeping difficulties. While the term is sometimes used in sleep literature to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, insomnia is often defined as a positive response to either of two questions:...

 characterized by difficulty returning to sleep after awakening either in the middle of the night, or too early in the morning. Also referred to as nocturnal awakenings, middle of the night awakenings and middle insomnia, this category of insomnia is different from initial or sleep-onset insomnia, which is a difficulty falling asleep at the beginning of sleep.

Due to the disrupted sleep patterns caused by middle-of-the-night insomnia, many sufferers of the condition complain of fatigue the following day. Excessive daytime sleepiness

Excessive daytime sleepiness

Excessive daytime sleepiness is characterized by persistent sleepiness, and often a general lack of energy, even after apparently adequate night time sleep...

 has been noted as being nearly two times higher in individuals with nocturnal awakenings compared to those who sleep through the night.

Prevalence

Waking up in the middle of the night, or nocturnal awakening, is the most frequently reported insomnia symptom, with approximately 35% of Americans over 18 reporting waking up three or more times per week. Of those who experience nocturnal awakenings, 43% report difficulty in resuming sleep after waking, while over 90% report the condition persisting for more than six months. Greater than 50% contend with MOTN conditions for more than five years.

A 2008 "Sleep in America" poll conducted by the National Sleep Foundation

National Sleep Foundation

The National Sleep Foundation is an independent nonprofit organization in the USA whose objectives are to improve public health and safety by achieving understanding of sleep and sleep disorders, and to support sleep-related education, research, and advocacy.Established in 1990, the NSF relies on...

 found that 42% of respondents awakened during the night at least a few nights a week, and 29% said they woke up too early and couldn’t get back to sleep. Other clinical studies have reported between 25% and 35% of people experience nocturnal awakenings at least three nights a week.

Common causes

• Pain
• Pregnancy
• Anxiety
• Difficulty breathing / sleep apnea
• Need to use the bathroom
• Hunger or thirst
• Illness

Nocturnal awakenings are more common in older patients and have been associated with depressive disorders, chronic pain

Chronic pain

Chronic pain has several different meanings in medicine. Traditionally, the distinction between acute and chronic pain has relied upon an arbitrary interval of time from onset; the two most commonly used markers being 3 months and 6 months since the initiation of pain, though some theorists and...

, obstructive sleep apnea

Obstructive sleep apnea

Obstructive sleep apnea or obstructive sleep apnea syndrome is the most common type of sleep apnea and is caused by obstruction of the upper airway. It is characterized by repetitive pauses in breathing during sleep, despite the effort to breathe, and is usually associated with a reduction in...

, obesity

Obesity

Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...

, alcohol

Alcoholic beverage

An alcoholic beverage is a drink containing ethanol, commonly known as alcohol. Alcoholic beverages are divided into three general classes: beers, wines, and spirits. They are legally consumed in most countries, and over 100 countries have laws regulating their production, sale, and consumption...

 consumption, hypertension

Hypertension

Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...

, gastroesophageal reflux disease

Gastroesophageal reflux disease

Gastroesophageal reflux disease , gastro-oesophageal reflux disease , gastric reflux disease, or acid reflux disease is chronic symptoms or mucosal damage caused by stomach acid coming up from the stomach into the esophagus...

, heart disease

Heart disease

Heart disease, cardiac disease or cardiopathy is an umbrella term for a variety of diseases affecting the heart. , it is the leading cause of death in the United States, England, Canada and Wales, accounting for 25.4% of the total deaths in the United States.-Types:-Coronary heart disease:Coronary...

, menopause

Menopause

Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries: the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subsequent shedding of the uterine lining...

, prostate

Prostate

The prostate is a compound tubuloalveolar exocrine gland of the male reproductive system in most mammals....

 problems, and bipolar disorders.

Treatment

Middle-of-the-night insomnia is often treated with medication, although there are no current U.S. Food and Drug Administration-approved medications specifically for treating MOTN awakening. Because most medications usually require 6–8 hours of sleep to avoid lingering effects the next day, these are often used every night at bedtime to prevent awakenings. Medication may not be prescribed in some cases, especially if the cause turns out to be the patient ingesting too much fluid during the day or just before he goes to sleep.
Sleep restriction therapy and stimulus control therapy as described in insomnia

Insomnia

Insomnia is most often defined by an individual's report of sleeping difficulties. While the term is sometimes used in sleep literature to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, insomnia is often defined as a positive response to either of two questions:...

 have shown significance in treating middle of night insomnia.
Some studies have shown that zaleplon

Zaleplon

Zaleplon is a sedative/hypnotic, mainly used for insomnia. It is a nonbenzodiazepine hypnotic from the pyrazolopyrimidine class. In terms of adverse effects zaleplon appears to offer little improvement compared to both benzodiazepines and other non-benzodiazepine Z-drugs.Sonata is manufactured by...

, which has a short elimination half-life

Half-life

Half-life, abbreviated t½, is the period of time it takes for the amount of a substance undergoing decay to decrease by half. The name was originally used to describe a characteristic of unstable atoms , but it may apply to any quantity which follows a set-rate decay.The original term, dating to...

, may be suitable for middle-of-the-night administration because it does not impair next day performance.