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It’s 3:17 a.m. Your eyes pop open. Again.

You didn’t hear a noise. You don’t necessarily need the bathroom. Yet your brain has apparently decided it’s noon. If this happens regularly, don’t automatically assume you have insomnia. Don’t rush in for sleep aids.

Sometimes the problem isn’t sleeping. Something could be waking you up. Here are some possibilities.

1. Hormonal changes: Women in perimenopause and menopause frequently experience fragmented sleep, sometimes even before a hot flash becomes obvious.

Men aren’t exempt, either. Declining or fluctuating testosterone, estrogen and progesterone can affect serotonin, GABA and the brain’s temperature-control center. Correcting the hormone deficiencies will fix the sleep problems better than a Z drug or benzo.

2. Blood sugar fluctuations: Your body continues regulating glucose while you sleep. If you awaken sweaty, shaky, hungry or with a pounding heart, blood sugar is one possibility. A meal heavy in carbohydrates, especially followed by dessert, can create blood-sugar swings that may make it harder to sleep.

3. Cortisol and stress: Cortisol levels follow a circadian rhythm, declining later in the day and rising toward morning. Stress disrupts circadian rhythms and alters that healthy bell-shaped curve. Addressing your adrenal health and maintaining calm is a long-term fix compared to prescribed sleepers.

4. Sleep apnea: Sleep apnea can cause repeated brief awakenings that you may not even remember. Clues include snoring, gasping, morning headaches, dry mouth, nighttime urination and daytime exhaustion. Remember, it can be dangerous to use sleeping pills when you have apnea.

5. Reflux: Reflux doesn’t always produce classic heartburn. Lying down soon after eating can allow stomach contents to travel upward, causing coughing, throat clearing, burning, hoarseness or unexplained early awakenings. No sleeping pill fixes this, but diet can.

6. Alcohol: Wine may help you fall asleep, but sedation isn’t the same thing as restorative sleep. As alcohol is metabolized, sleep can become more fragmented. It can also worsen snoring and obstructive sleep apnea.

If you regularly enjoy an evening drink and then wake up early, try skipping the nightcap (or drinking it much earlier in the day), and see if things improve. Do not combine sleep aids with alcohol.

Investigate your habits

You’ll have to become your own sleep detective. For one week, keep a notepad beside your bed. When you awaken, write down the time and what you notice: hot, sweaty, hungry, heart pounding, coughing, reflux, pain, anxious, gasping or needing to go to the bathroom.

Also record anything unusual from the evening: alcohol, dessert, late dinner, a new medication or an especially stressful day.

You may discover a pattern. Occasional nighttime awakenings are normal. But if you’re awake at roughly the same time night after night, don’t focus only on sleep. This type of “insomnia” may not be a diagnosis; it may be a clue.

Read the longer version of this article, which includes testing options, practical tips and important warnings, at suzycohen.com.

This information is opinion only. It is not intended to treat, cure or diagnose your condition. Consult with your doctor before using any new drug or supplement.