Age, indigestion and sleep apnea are all suspects. But if you can set your watch by your middle-of-the-night risings, blame alcohol.

It all results in the same thing: you just can’t get to sleep. But the underlying causes of insomnia are multiple, and it may be a mix of biological, medical and psychological issues, explains Michael Perlis, director of the Behavioral Sleep Medicine Program at the University of Pennsylvania.

Insomnia falls into several broad categories based on those times of the night when you have problems sleeping, and these tend to align with predictable triggers. “A general rule of thumb is that if you’re struggling to fall asleep at the start of the night, that’s due to anxiety or stressful life events,” Perlis says. Environmental issues—like a too-bright room, or staring at device screens—can also mess with your ability to fall asleep.

On the other hand, Perlis says depression is linked with “late insomnia”—the kind that wrests you from sleep so late in the night that you’re forced to rise early for the day.

When it comes to “middle insomnia,” which forces your eyes open a few hours after you’ve fallen asleep, Perlis says two common medical conditions are often to blame: gastroesophageal reflux disease, or GERD, and sleep apnea. “In the case of sleep apnea, you wake up because you’ve stopped breathing,” he explains. “With GERD, you wake up because stomach acids are burning your esophagus.”

Even the healthiest sleepers wake a few times during the night, though for the most part you’re not awake long enough to remember them, Perlis says.

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