Ask Well: Awake at 2 A.M.

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Many people occasionally wake up in the middle of the night and find themselves unable to get back to sleep. But if it happens often, and you are consistently tired and not functioning well during the day, that indicates a problem, said Dr. Meir H. Kryger, a professor at Yale School of Medicine and the author of “The iGuide to Sleep.”

Stressful events, a loud pet or a snoring bedmate may be to blame, or the problem could be a medical issue such as a cough, sleep apnea or getting up to urinate, which could be a sign of diabetes. Dr. Kryger said he has had patients who are wakened by the sensation of their heart beating rapidly because of a cardiac rhythm problem.

Worrying about being awake only makes the problem worse. “We see that in patients who’ve had insomnia for a while,” Dr. Kryger said. “They wake up and become so angry, frustrated and aroused that they can’t fall asleep.”

In some cases better habits can help. Nicotine or alcohol levels fall during sleep and can cause people to awaken, so quitting smoking or avoiding alcoholic beverages, especially before bedtime, can help. Steer clear of heavy or spicy meals before trying to sleep if heartburn or acid reflux is keeping you up.

You may be tempted to nap during the day to compensate for lost sleep time, but this can just prolong the problem, Dr. Kryger said. Avoid taking naps that are longer than 20 minutes, particularly in the evening.

If you wake up at night and find that you still cannot get back to sleep after 20 minutes, do not lie there in anguish staring at your clock. Get out of bed and do something that distracts and relaxes you, like reading a book. Then return to bed when you feel sleepy.

If none of this helps and the problem persists for more than a few weeks, it might be time to see a sleep specialist who can investigate. Some problems may need to be addressed with cognitive behavioral therapy or medications, Dr. Kryger said.