Waking too early

Three causes, three different directions

1. Low mood

Waking early and being unable to get back to sleep, with the heaviest feeling in the morning, is a long-described pattern in the literature on depression. If you have that pattern together with loss of interest, sadness, or a sense of worthlessness lasting more than two weeks, take the PHQ-9 and be seen.

2. An advanced circadian rhythm

Becoming sleepy very early in the evening and waking very early in the morning, while total sleep remains adequate and you are alert during the day. This is a problem of TIMING, not of the ability to sleep. It becomes more common with age.

The approach is entirely different: not sleeping pills but light. Bright light exposure in the late afternoon and evening, and avoiding bright light in the very early morning, helps push the rhythm later.

3. Going to bed too early

If you get into bed at 9pm and your sleep need is seven hours, then being awake at 4am is correct. The problem is not the early waking but the expectation of sleeping until six. A sleep diary reveals this very quickly.

How to tell them apart yourself

How to use light correctly

For the advanced-rhythm group, light is the main tool and it has to be used at the right time or it works against you. The principle: light in the LATE AFTERNOON AND EVENING pushes the rhythm later; light in the EARLY MORNING pulls it earlier still.

• Get outdoors, or use bright indoor light, during the last couple of hours of the afternoon and the start of the evening.
• Avoid bright light immediately on waking too early. This is the opposite of the usual advice, and it is correct specifically for this group.
• If you have to be up early, keep the light dim for the first hour and then increase it gradually.
• Push the bedtime slightly later every few days rather than changing it abruptly.

When early waking is a symptom of depression

The characteristic pattern involves several features together, not only the early waking: waking around two hours before the intended time, being unable to return to sleep, and feeling heaviest in the morning with gradual improvement through the day. Many people describe the morning as the hardest part of the day.

If that pattern matches you, take the PHQ-9 on the tools page and be seen. It is worth saying that depression is treatable, and insomnia within depression usually improves as mood improves. But whatever sleep problem remains afterwards still needs treating in its own right, because it is a strong predictor of relapse.