3am panic

Okay, for some of us it's a predictable result of that giant chocolate with a filter-coffee chaser that we consumed at 11pm. Or it's a case of low blood sugar from over-indulging can result in that disoriented, nervous feeling, explains Dr Colinda Linde, a clinical psychologist who specialises in cognitive behaviour therapy.

So it comes as so surprise that one should avoid stimulants such as caffeine late at night, and if you're lucky, that will be the end of the early-morning wake-up calls.

But there may be more worrying physical and mental reasons why your brain wakes up in full-acceleration mode when your body still has the handbrake up.

For some, says psychiatrist Frans Hugo, the cause may be a serious medical condition such as cardiac problems. 'Diabetics can experience hypoglycaemia in the middle of the night. Stomach ulcers may wake you up during the night with anxiety. Epilepsy can also occur at night and may be accompanied by anxiety. Sleep disorders such as obstructive sleep apnoea may lead to awakening feeling anxious.'

Mental disorders may also be at the root of your early-morning episodes. Panic disorder is a common cause of such attacks, and may include physical symptoms such as a racing heart, shortness of breath, sweating and even stomach discomfort. Generalised anxiety disorder can also be a cause, when feelings and fears that can't be consciously suppressed rise to the surface, explains Dr Linde. Changes in sleep pattern are a classic symptom of clinical depression, too.

'The same area of the brain is involved with both the experience of anxiety and with our REM (rapid eye movement) sleep,' says Julie-Anne Roberts of the Depression and Anxiety Support Group. 'This shared biological connection suggests that anxiety and sleep are interrelated.'

A drop in the temperature in the room often occurs around this time, which can wake you up, allowing worries to rush into your mind, even if you're not suffering from one of these specific physical problems. This is most likely to happen when you're under stress at work or in your personal life. 'If all the dangerous conditions have been excluded, one may think of just ordinary excessive life stress, like burning the candle at both ends at work and at home,' says Dr Hugo.

What to do
If the 3am waking is part of a pattern of anxiety, or continues for more than a night or two, you should ask your general practitioner to rule out medical conditions. Don't allow lying in bed worrying to become a pattern.

When you wake up feeling anxious or panicky, breathe slowly, and repeat a calming word or phrase to yourself. But if you don't drop off again within a few minutes, get up and go to another room. Have a notepad and pen handy, and write down all your worries. Now put them into two categories – things you can control, and things beyond your control.

'This is one of the techniques we often recommend to patients,' says Dr Linde. 'But it should not turn into a party with tea and biscuits and watching a gripping movie on television. Read something really boring if you have to, and don't go back to bed until you feel calm and sleepy. The brain should not be rewarded for bad behaviour.'

Where to get help