Early morning awakening: why you wake too early and what can help

Most people wake early now and then. Early morning awakening is different: you wake well before you need to, perhaps in the small hours, and cannot drift back to sleep, so you lie awake until it is time to get up or you give up and start the day tired.

It is not usually described as a disease in its own right. Instead, UK health services treat it as one of the patterns that make up insomnia. The NHS describes insomnia as regularly having problems sleeping, and lists waking up early and not being able to go back to sleep next to difficulty falling asleep and waking several times in the night.

How much sleep a person needs varies. The NHS says that on average adults need 7 to 9 hours, and NHS inform stresses that what matters is whether you feel you get enough sleep and whether the sleep is good quality. Waking at 5am matters much less if you went to bed at 9pm and feel rested than if you are exhausted all day.

The pattern is usually the same: you fall asleep reasonably well, then wake before your alarm and cannot settle again. Some people notice racing thoughts or worry as soon as they wake. Others simply feel alert.

The daytime effects are those the NHS lists for insomnia in general. They can limit what you are able to do during the day and affect mood.

• Feeling tired and irritable during the day.

• Finding it difficult to concentrate because you are tired.

• Still feeling tired after waking up.

• Finding it hard to nap even though you are tired.

• A knock-on effect on mood, relationships and work if it goes on for months or years, as NHS inform notes for persistent insomnia.

There is rarely a single cause. NHS inform says insomnia can be triggered by many factors and that it is not always possible to identify a clear cause. The NHS lists the most common ones as stress, anxiety or depression, noise, a room that is too hot or too cold, an uncomfortable bed, alcohol, caffeine or nicotine, illegal drugs such as cocaine or ecstasy, jet lag and shift work.

It also lists conditions and medicines that can cause insomnia, including mental health conditions such as schizophrenia or bipolar disorder, Alzheimer's disease or Parkinson's disease, restless legs syndrome, an overactive thyroid and the menopause. Many medicines can also cause it. Long-term pain, snoring or interrupted breathing during sleep (sleep apnoea), and narcolepsy are listed among the things that keep people from a good night's sleep.

Because depression and anxiety appear in that list, persistent early waking together with low mood, loss of interest or constant worry is a good reason to tell a GP about both, rather than treating the sleep problem alone.

The NHS says insomnia usually gets better by changing your sleeping habits. Its advice and the advice of NHS inform and the NHS Every Mind Matters service overlap, and the main points are below.

• Get up at the same time every day, and keep to this even after a bad night. The NHS advises against sleeping in after a poor night.

• Go to bed only when you are sleepy. NHS inform adds that it is better to stay up until you are ready to sleep than to go to bed early and worry about not sleeping.

• Keep the bedroom dark, quiet and comfortable, using curtains, blinds, an eye mask or ear plugs if needed. Every Mind Matters suggests keeping clocks out of view.

• If you are lying awake, try not to force sleep. Every Mind Matters and NHS inform both suggest getting up after around 20 minutes, doing something relaxing and going back to bed when sleepy.

• Relax for at least an hour before bed, and avoid phones and other screens, because the blue light can make you more awake.

• Avoid caffeine and alcohol and big late meals, and do not exercise too close to bedtime. The NHS gives 6 hours before bed for caffeine, alcohol and smoking and 4 hours for exercise.

• Write down worries and a to-do list before bed, as NHS inform and Every Mind Matters both suggest.

• Do not nap during the day and do not drive when you feel sleepy.

The NHS says you can buy sleeping aids from a pharmacy, some with natural ingredients such as valerian or lavender and others containing an antihistamine. It says they cannot cure insomnia, may help you sleep better for 1 to 2 weeks and should not be taken for longer. Some can cause drowsiness, so it is worth checking with a doctor before taking anything for sleep problems.

The NHS advises seeing a GP if changing your sleeping habits has not helped, if you have had trouble sleeping for months, or if insomnia is affecting your daily life so that it is hard to cope. A GP will try to find out what is causing it, because treating an underlying health condition may be enough to return sleep to normal, as NHS inform notes.

If sleep habits are not enough, the NHS says you may be offered CBT, either face to face with a therapist or through an online self-help programme. It helps you change the thoughts and behaviours that keep you from sleeping. NHS inform describes CBT-I as an effective treatment for many people that can have long-lasting results, and also points to its own self-help guide and to an online CBT course.

A GP may refer you to a sleep clinic if you have symptoms of another sleep disorder such as sleep apnoea.

On medication, the NHS says sleeping pills are only prescribed for a few days or weeks at the most, and only when insomnia is very bad and other treatments have not worked. NHS inform adds that medication can be effective in the short term but can also make insomnia worse, cause addiction or have other side effects.

Waiting times and the availability of talking therapies vary by area. Some people choose to pay privately for a therapist trained in CBT for insomnia. In general terms the content of the therapy is the same; what differs is how quickly it can be arranged.

Early waking on its own is not an emergency. Contact your GP practice if your sleep is affecting daily life, if you are not looking after yourself or struggling with responsibilities, as NHS inform advises, or if you have had trouble sleeping for months.

If low mood or anxiety comes with the sleep problem and you feel you cannot cope, tell a GP or use NHS 111 for mental health advice. If you ever feel in immediate danger or that you might harm yourself, call 999 or go to A&E.