Why Women Wake Up at 3AM (And How to Break the Cycle)
Insights from Dr. Michelle Jacobson and Dominique Williams RSW, as heard on the Hysterical Women Podcast.
Many women search for answers about waking up at 3AM, insomnia, or disrupted sleep. While occasional sleep disturbance is common, persistent sleep problems often have identifiable causes that can be addressed with the right support.
Sleep problems are one of the most common concerns women raise in our clinic.
Sometimes it starts with occasional restlessness. Other times it becomes a frustrating cycle: you can’t fall asleep, or you wake in the middle of the night and can’t get back to sleep. Eventually the anxiety about sleep itself becomes part of the problem.
At Coven, we approach sleep as both a medical and behavioral issue. Hormones, stress, nervous system regulation, and daily habits can all influence sleep quality.
In a recent episode of the Hysterical Women podcast, Dominique Williams, MSW, RSW (Registered Social Worker at Coven Women’s Health) and Dr. Michelle Jacobson, OBGYN and Co-Founder of Coven discussed why sleep disruption is so common for women — and what actually helps.
Below are some of the key insights from that conversation.
Why Sleep Problems Can Become a Vicious Cycle
One of the most challenging aspects of sleep disruption is that it often becomes self-reinforcing.
When women start sleeping poorly, it’s common for anxious thoughts to appear at bedtime.
“I'm not going to sleep tonight. I'm going to feel terrible tomorrow.”
This type of thinking is what therapists call catastrophizing — predicting the worst outcome before it even happens.
According to Dominique Williams:
“When we start worrying about whether we’re going to sleep, the brain shifts into a more alert state. That makes it even harder to fall asleep. Over time, people can develop anxiety around sleep itself.”
This is one of the reasons behavioral sleep approaches are considered best practice for insomnia.
Step One: Understand What’s Disrupting Sleep
Before jumping to solutions, it’s important to understand what kind of sleep issue is actually happening.
Dr. Michelle Jacobson explains that sleep disruption isn’t one single problem.
Women may experience:
• Difficulty falling asleep
• Difficulty staying asleep
• Waking in the middle of the night and not being able to return to sleep
• Early morning waking
• Sleep disrupted by night sweats, bladder symptoms, anxiety, or stress
“The way we improve sleep has to be individualized,” says Dr. Jacobson. “We always start by understanding what’s actually causing the sleep disruption.”
Evidence-Based Therapy for Insomnia (CBT-I)
One of the most effective approaches for chronic sleep issues is Cognitive Behavioral Therapy for Insomnia (CBT-I).
CBT-I focuses on changing behaviors and thought patterns that interfere with sleep.
Dominique often starts with a simple but powerful tool: a sleep diary.
Tracking sleep patterns can reveal helpful insights, including:
• When someone is actually falling asleep
• How often they wake during the night
• What’s happening before bedtime
• Daytime habits that may affect sleep
This information helps identify patterns that can then be addressed through targeted strategies.
Re-Training the Brain for Sleep
One of the core principles of CBT-I is something called stimulus control.
The goal is to retrain the brain to associate the bed with sleep and intimacy only.
If someone lies awake in bed for long periods of time, the brain can begin associating the bed with wakefulness and frustration.
Dominique recommends a simple rule:
If you’re awake for about 15 minutes and can’t fall back asleep, get out of bed.
Do something quiet and relaxing until you feel sleepy again.
Examples include:
• Reading a book
• Listening to calming music
• Listening to a podcast
• Gentle breathing or relaxation exercises
Avoid stimulating activities like scrolling on your phone or checking the time repeatedly.
“The goal is to retrain your brain to recognize the bed as the place where sleep happens,” Dominique explains.
The Power of a Wind-Down Routine
One of the most underestimated sleep tools is a consistent evening routine.
Many of us create calming bedtime rituals for children — bath, brushing teeth, reading a story — but forget that adults benefit from the same cues.
A structured wind-down routine helps signal to the brain and nervous system that it’s time to transition into sleep.
Helpful wind-down activities may include:
• Gentle stretching
• Reading
• Journaling
• Breathwork
• Meditation or grounding exercises
Dominique often encourages women to write down worries or to-do lists before bed, so they’re no longer circling in the mind overnight.
Nervous System Regulation Matters
Stress and nervous system activation play a major role in sleep.
If the body remains in a high-alert state, falling asleep becomes much more difficult.
Techniques that support nervous system regulation can be surprisingly effective.
Examples include:
• Slow breathing exercises
• Progressive muscle relaxation
• Somatic unwinding (gradually relaxing each part of the body)
• Grounding techniques to quiet racing thoughts
These tools help shift the body from fight-or-flight mode into rest-and-digest mode, which supports sleep.
Daily Habits That Affect Sleep
Sleep doesn’t start at bedtime — it starts during the day.
Certain habits can significantly affect sleep quality, including:
• Caffeine intake
• Alcohol consumption
• Physical activity levels
• Late-night eating
• Screen exposure before bed
Dr. Jacobson notes that alcohol is a particularly common sleep disruptor.
“Wine can make people feel sleepy initially, but it often reduces sleep quality and can increase night sweats or nighttime waking.”
That doesn’t necessarily mean eliminating it completely — but understanding how it affects your sleep can help you make more informed choices.
When Sleep Disruption Is Medical
Sometimes sleep disruption is driven by underlying medical or hormonal factors.
These may include:
• Hormonal changes (such as perimenopause or menopause)
• Anxiety or mood disorders
• Bladder symptoms or nighttime urination
• Night sweats or hot flashes
• Sleep apnea or other sleep disorders
“We always start with a thorough history,” says Dr. Jacobson. “Sleep disruption can have multiple causes, and treatment needs to be targeted to what’s actually happening.”
What About Sleep Medications?
Many people are familiar with traditional sleeping pills.
These medications can help someone fall asleep through sedation, but they don’t always improve sleep architecture — the deeper, restorative stages of sleep.
Dr. Jacobson explains that newer medications are beginning to target the biological sleep-wake cycle more directly, rather than simply sedating the brain.
But medication is rarely the only solution.
“The most effective approach usually combines behavioral strategies, medical evaluation, and addressing the underlying triggers of poor sleep.”
When to Seek Support
Occasional sleep disruption is common. But persistent sleep problems shouldn’t be ignored.
You may want to speak with a healthcare provider if you experience:
• Chronic difficulty falling asleep
• Frequent nighttime waking
• Loud snoring or pauses in breathing during sleep
• Daytime exhaustion despite adequate time in bed
• Sleep disruption that affects mood, concentration, or quality of life
At Coven Women’s Health, our team takes an integrated approach to sleep, looking at hormonal health, mental wellbeing, lifestyle factors, and underlying medical conditions.
The Bottom Line
Sleep is one of the most powerful foundations of health — yet it’s often the first thing we sacrifice when life gets busy.
The good news is that small, targeted changes can make a meaningful difference.
As Dominique puts it:
“Sleep can feel complicated, but when we look at the patterns and address the behaviors and stressors around sleep, we can often make significant improvements.”
You can listen to the full conversation about sleep, stress, and women’s health on the Hysterical Women podcast featuring Dominique Williams and Dr. Michelle Jacobson.
