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Wellness Center

Happy at night

11/08/2007

Question:

When I wake up, I feel tired. I feel tired all day, but at night I feel great. I`m happy, full of energy. I wake at 3 AM and almost feel too happy and have too much energy. I can`t go back to sleep.  I sometimes take a sleeping pill, but it doesn`t help. I`ve been to a sleep clinic, psychiatrist, and my family doctor, and no one knows what`s wrong with me. I have been like this for three years. I don`t go out, I don`t have a life, and I can`t keep my house clean, unless it`s 3 o`clock in the morning.  I usually go back to sleep about 7 o`clock in the morning.  Can you please help me?  

Thank you. 

Answer:

This is clearly a very frustrating problem. I will start by stating that you would still benefit from seeing a sleep specialist in person with the records of your previous evaluations available.

Early morning awakening may be caused by several sleep disorders. Obstructive sleep apnea has a pattern of distribution during the night with an increased frequency during a rapid eye movement sleep. This stage of sleep is most pronounced during the early morning hours. Periodic limb movements of sleep may also have certain distribution that favors the beginning of the night or the early morning. REM behavior disorder may cause a similar pattern, but the patient usually has some dream recall.

With your complaints of isolated early morning awakening, several mood disorders should be considered. Importantly, depression is often thought to cause early morning awakening along with fatigue and very low energy during the day. Insomnia may be associated with an anxiety disorder and present with a pattern called sleep maintenance insomnia. The pattern of excessive activity and energy you are describing may be consistent with other mood disorders such as bipolar disorder.

Regardless of the cause of insomnia, after a period of time of awakening at a certain time of the night, a process called psychophysiological insomnia occurs and results in a self-reinforcing pattern of regular awakening, independent of the initial cause. Treatment in this case may include medications, but there is a strong role for behavioral changes. I recommend that you consult a sleep physician in your area.

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Response by:

Rami N Khayat, MD Rami N Khayat, MD
Clinical Assistant Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University