Persistent nighttime awakenings can be caused by various factors, including stress, poor sleep environment, diet, sleep disorders, inconsistent sleep schedules, hormonal changes, medications, underlying health conditions, overstimulation before bed, and aging. Stress and anxiety can cause overproduction of cortisol, which can disrupt sleep. To improve sleep quality, develop a calming bedtime routine, ensure a quiet, dark, and cool bedroom, avoid caffeine and alcohol, and consult a healthcare professional if you suspect a sleep disorder. Stick to a consistent sleep schedule, avoid hormonal changes, and review medications with a healthcare provider. Manage underlying health conditions through appropriate medical treatment and avoid stimulating activities before bed. As we age, maintaining good sleep hygiene and regular physical activity can contribute to better sleep.