Waking at 3am: Sleep-Maintenance Insomnia and How to Route It

Summary

Waking at 3–4am and struggling to get back to sleep is a *different problem* from not being able to fall asleep — it is **sleep-maintenance insomnia**, and the single most useful move is to stop treating it as one thing: triage it to its actual cause (alcohol rebound, a full bladder, the body's natural pre-dawn cortisol rise amplified by anxiety, untreated sleep apnea, depression's early-morning waking, pain, or a too-warm room), fix that cause, and use stimulus control (get out of bed rather than lie there clock-watching) plus CBT-I for the conditioned, "why am I awake *again*" loop that the