Waking up in the middle of the night is a common experience for many people, but for frontline health workers and first responders, it can be especially frustrating due to the unique demands of your job. The irregular hours, exposure to high-stress situations, and the nature of night shifts can all contribute to disruptions in your sleep patterns. This is primarily because of circadian misalignment, where your internal body clock is out of sync with the traditional day-night cycle. This can make it difficult to fall back asleep when you wake up in the middle of the night, leaving you feeling tired and unrefreshed the next day.

Understanding Why You Wake Up at Night

It’s important to understand that waking up at night is often a normal part of the sleep cycle. Your body naturally cycles through different stages of sleep, and brief awakenings can occur during these transitions. However, there are several factors that can cause these awakenings to become more prolonged and disruptive:

Disrupted Circadian Rhythm:

As a shift worker, your circadian rhythm is often out of sync with your work schedule. This misalignment can cause difficulties in maintaining continuous sleep, leading to frequent awakenings.

Lack of Sleep Pressure:

After coming off a night shift, your body may not experience the same "sleep pressure"—the biological drive to sleep—that it would under normal circumstances. This can make it harder to fall asleep and stay asleep.

Stress and Anxiety:

The high-stress nature of your work can lead to increased anxiety, which can keep your mind active even when your body is exhausted.

Environmental Factors:

Noise, light, and temperature fluctuations in your sleep environment can also play a significant role in waking you up during the night.

Strategies to Help You Go Back to Sleep

If you find yourself awake in the middle of the night and unable to return to sleep, here are some evidence-based strategies that can help:

Check Your Sleep Environment
Your sleep environment plays a crucial role in your ability to stay asleep. If you wake up during the night, take a moment to assess your surroundings

Temperature
Aim to keep your bedroom between 18 and 20 degrees celsius (65 and 68 degrees Fahrenheit.) If you’re too hot or cold, adjust your blankets or the thermostat to find a more comfortable temperature.

I found that just throwing the blankets off and getting cold puts me straight back to sleep.  In my sleep I just cover myself up again.

Light
Even small amounts of light can disrupt your sleep. Consider using blackout curtains, an eye mask, or removing any sources of light from your room.

Noise
Unwanted noise can easily wake you up. Consider using earplugs or a white noise machine to create a more peaceful sleep environment.

Relaxation Techniques

Waking up in the middle of the night can sometimes trigger anxiety, especially if you’re worried about losing valuable sleep before your next shift. To help calm your mind and body, try incorporating relaxation techniques:

Diaphragmatic Breathing
Place one hand on your chest and the other on your abdomen. Slowly breathe in, focusing on expanding your diaphragm rather than your chest. This type of breathing can help reduce stress and promote relaxation.

Progressive Muscle Relaxation
Start from your toes and work your way up to your head, tensing and then slowly releasing each muscle group. This technique helps release physical tension, which can aid in falling back asleep.

Mindfulness Meditation
Focus your attention on your breath, and gently redirect your mind whenever it starts to wander. This practice can help you stay present and avoid getting caught up in anxious thoughts about sleep.

Don’t Lie Awake in Bed
If you find yourself still awake after 20 to 30 minutes, it’s best to get out of bed. Lying awake can create a negative association between your bed and sleeplessness, making it harder to fall asleep in the future. Instead, try a quiet, relaxing activity like reading a book or listening to calming music. Avoid bright screens or engaging activities that might wake you up further.

Addressing Nightmares
Nightmares can be particularly distressing, jolting you awake with a racing heart and anxious thoughts. To help calm your mind and body after a nightmare:

Guided Imagery
Visualise a peaceful scene, such as a quiet beach or a serene forest. This can help shift your focus away from the distressing dream and promote relaxation.

Journaling
Writing down your nightmare can help process the emotions associated with it, making it easier to let go and return to sleep.

What to Avoid When You Wake Up at Night

It’s important to be mindful of certain activities that can make it harder to fall back asleep:

Avoid Screen Time
The blue light emitted from screens will interfere with your body’s natural sleep signals. If you need to get up, use zero blue emitting lights and avoid using your phone or other devices.

Don’t Watch the Clock
Constantly checking the time can increase anxiety about losing sleep. Turn your clock away from you or place it out of reach to reduce the temptation.

Limit Stimulants
Avoid consuming caffeine, nicotine, or alcohol before bed, as these substances can disrupt your sleep.

When to Seek Medical Advice

If you regularly find yourself waking up at night and struggling to fall back asleep, it may be time to seek medical advice. Signs that it’s time to consult a doctor include:

- Persistent daytime fatigue

- Difficulty concentrating at work

- Mood swings or irritability

- Increased anxiety about sleep

These symptoms could indicate a chronic sleep disorder or another underlying health condition that needs to be addressed.

Please don’t just put poor sleep down to shift work.

It’s imperative you seek help from a professional as evidence shows there are many underlying disorders that shift workers just write off to shift work. 

Conclusion

Waking up in the middle of the night is a common challenge, especially for those working in high-stress, shift work-based roles like frontline health workers and first responders. However, by understanding the reasons behind these awakenings and implementing strategies to manage them, you can improve your sleep quality and overall well-being. Remember, your ability to care for others starts with taking care of yourself. Prioritising your sleep is not a luxury—it’s a necessity for maintaining the physical and mental resilience needed for your vital role in the community.

About Roger Sutherland

As a coach and advocate for shift workers, my goal is to provide practical, evidence-based strategies that empower individuals to thrive in their roles. By understanding and addressing the challenges of shift work sleep disorder, shift workers can achieve better health outcomes and lead more fulfilling lives both on and off the job.

Note:

• I also run Nutrition, Health & Wellbeing Seminars for shift working environments.