Do you fall asleep easily only to lie in bed wide awake at 3 a.m.? Do you sleep but don’t feel rested when you wake up? Do you dread bedtime because you have such a hard time falling asleep? My own personal hell: being awake in the middle of the night for hours with my mind making craziness out of nothing.
Sleep: delicious, life giving, deep sleep. Do you find it elusive? Is it the solution? The fountain of youth? All I know is everyone wants more of it and can’t get enough. Your cells and nervous system detox and regenerate. Your glymphatic system drains neurotoxins and neuroinflammation from your central nervous system while you sleep. The world seems brighter and has more sparkle after a good night’s sleep. There’s nothing you can’t do or take on after a deep, full night’s sleep. Its super fuel, liquid gold, your motivation, excitement and ease with life all at the same time.
This is a topic that is close and dear to my heart. I lost my ability to fall asleep and stay asleep in my third year of medical school. I don’t think I slept more than a few hours per night for over 10 years, nor did I sleep easefully for over 20 years. Although I mostly sleep wonderfully now, it remains my weak spot. If anything is out of balance in my life, if my heart is heavy or my stress level high, this is where I’m affected. My sleep patterns give me insight as to what may be off with my health and heart. It’s my integrity meter, my stress odometer, my most vulnerable truth about where my heart really stands. I can see it now as information from my unconscious, teaching me what needs more attention, more love or perhaps what needs letting go.
I must admit, knowing when I don’t sleep well is useful information doesn’t always help the middle of the night madness. I’m sure many of you can relate. Your mind may choose this time to fret over the unfinished minutiae of your life or create lists. Or it can create massive upheaval, devastation or destruction out of absolutely nothing grounded in reality. And your conscious awareness often can’t help you in this weird, middle of the night madness. The twilight mind’s is not to be talked out of it’s madness. As the moment you relax the conscious mind enough to fall back asleep, the madness takes over again.
“Earthquakes don’t happen in Colorado and if they did, your roof isn’t actually made of glass, so stop it with the craziness!“ says your sensible rational mind. Every fragile thing you can think of is sitting on top of your glass roof and there’s a massive earthquake coming and good god, your child’s bed is right under that big weird glass unicorn statue (where did that thing come from anyway?)
What’s important to remember is there’s a middle of the night madness that is not uncommon and is unlike any other irrationality we experience in other parts of our lives. Many of us have been there, it’s not pretty and the evolved psyche is not immune. It has its own unique flavor of madness.
Know that you are not alone. Know that you can’t talk yourself out of this place with your rational mind. Take a deep breath and try these four tips:
- Focus on things that make you happy, things you are grateful for, things that make your heart overflow with love, joy and gratitude. Kittens snuggling, your sweet children, football, winning at ping pong, whatever puts you into your heart and takes you out of your head.
- Put on an audible book, podcast, something you can listen to with your eyes closed and the lights off. Something light hearted ideally, interesting enough to take you away from the madness but boring enough for you to drift back off to sleep.
- Do any kind of breath work, meditation, visualization that works for you.
- And at the same time or if the above tips aren’t working, try some natural calming micronutrients that feed your brain, your adrenals, your parasympathetic nervous system, your limbic system the food it needs to fall back asleep deeply and naturally.
Some of my favorite middle of the night nutrients that won’t leave you drowsy in the morning:
Xymogen “Relax Max”
Glycine, “optimag Neuro” by Xymogen
Botanical tincture with Valerian root, California Poppy, Kava Kava, Oatstraw or chamomile.
Now let’s dive into the actual root causes of sleep dysfunction. I am a functional medicine doc after all, and I intend to find the actual underlying dysfunction. There are multiple organic causes of difficulty sleeping. I encourage you to find the actual cause and treat it. Then may you enjoy deep, restful, effortless sleep and wake up rested, vibrant and full of energy.
- Low thyroid: Waking up in the middle of the night can be a symptom of a low functioning thyroid. Alternatively, I find clinically that if your thyroid level is a bit high, you may have a hard time falling asleep. This is more common than people realize and it’s the first thing I check, personally, when my sleep is out of balance. I recommend getting a full thyroid panel (TSH, FT3, FT4, RT3) to help figure out if this is contributing to your sleep dysfunction.
- Adrenal Dysfunction: A common cause of the 3:00 am wake up or an inability to fall asleep is an elevation in your cortisol levels. Cortisol is a hormone secreted by your adrenal glands, which is responsible for your “flight or fight” response, your survival instinct. Optimally, your cortisol levels are at their highest in the morning and decrease to close to zero by the time you drift off into a delicious, easeful sleep at night.
However, your adrenals can get “stuck” in a pattern where they may spike at bedtime or in the middle of the night. It’s easy to imagine that one cannot easily sleep when your cells are screaming at you to “get up and run, as FAST as you can, from the tiger!” Unfortunately, your cells can’t distinguish between perceived stress and a true survival emergency.
New parents, shift workers, medical students are especially prone to this particular form of sleep dysfunction. As is anyone who has been burning the candle on both ends, which turns out to be many of us!
For example, if you have kids, remember waking up multiple times throughout the night to feed or check on your little one? These repetitive wake ups throughout the night to keep your baby alive and healthy can set a pattern in your adrenals to wake up in the middle of the night. This may contribute to increased nighttime cortisol levels. In some people, that middle of the night cortisol spike can remain in that pattern, even after your baby sleeps through the night (and thank goodness when that happens). There are great natural things out there that can help blunt overnight cortisol secretion. However, just so we know what’s actually going on, I do recommend doing the salivary adrenal test first.
https://www.diagnostechs.com/our-tests/adrenal-stress-index-asi/
- Low progesterone: This one is for the ladies. Another contributing factor to sleep dysfunction is progesterone deficiency. Other symptoms of low progesterone are anxiety, irritability, impatience, anger, menstrual headaches and migraines and heavy, painful or irregular periods. I think of progesterone as our “zen, calm” hormone. When it decreases, we lose our patience, are more irritable and have a hard time sleeping.
In a normal menstrual cycle, progesterone takes a big dive for 1-2 nights right before you get your period, it’s part of bringing on your bleed. These 1-2 nights of poor sleep and increased anxiety before your period is the more common, expected low progesterone state. Some people call this the “bitchy” part of their cycle. 😉 If these “bitchy” symptoms persist for more than a couple days before your period, you may want to get your progesterone levels checked. Husbands, boyfriends- you are welcome to chime in here – you may have a more objective opinion.;-)
Adrenal dysfunction may even be contributing to your low progesterone levels as progesterone converts directly to cortisol. Cortisol gets precedence in our hormonal system, as it’s our survival instinct. Even if it’s perceived stress from our daily busy lives, our cells are wired to react with: “screw your zen, calm, the wooly mammoth is about to STOMP on you, get up and run!” I recommend getting your progesterone levels tested day 17-21 of your cycle. And if your levels are low, bioidentical compounded progesterone may be something to consider with your functional medicine doctor.
- Low gaba: If your brain doesn’t have enough gaba, for a variety of reasons, it can make you more prone to anxiety and insomnia. Gaba is one of your main inhibitory neurotransmitters. It’s calming and balances out your stimulatory neurotransmitters. Be careful, however, when purchasing it, as much of the “gaba” out there won’t cross the blood brain barrier and simply gets urinated out.
- MTHFR: People with this gene mutation can have trouble with methylation, which is critical to the body’s processes for things like detoxification, hormone clearance and neurotransmitter clearance. With certain MTHFR snp’s(single nucleotide polymorphism), one can be more at risk for insomnia, anxiety, fatigue and depression. Treating this with supplements without knowing detailed information about your genetic makeup can result in elevated anxiety or insomnia. It’s a tricky one to treat, though, and I recommend that you find a physician with some training in this area. Or make an appointment today with myself or Dr. Amy Reidhead.
- CIRS or Mold Toxicity: One of the most common symptoms of mold toxicity is insomnia.
- Lyme Disease and its co-Infections: A common co-infection in Lyme disease is Bartonella. This bacteria can cause retractable insomnia in some people. Borrelia, the bacteria that causes Lyme disease can also cause insomnia.
Sleep deprivation is a form of torture. The studies in medical literature are immense when it comes to the far-reaching effects of poor sleep on your health and ability to detox especially in your brain. Some are cited below and quite depressing if you are someone who struggles with sleep. I don’t recommend you look at these studies if it will only serve to increase your stress level (skip the next paragraph if this is you.)
Cognitive decline, neurologic degeneration, depression, increased incidence of cardiovascular events and worse health outcomes of almost all kinds are illustrated in studies of sleep deprivation. In one study done as old as 1894 by a Russian scientist, the complete absence of sleep was fatal in puppies after only a few days. Aaaak!
I encourage you to find the root cause of your sleep dysfunction, whether it’s mild or severe. There may be nothing more important for vibrant health and vitality, brain function and absolute happiness than a good night’s sleep!
May you sleep effortlessly, restfully, all the way through the night. And live a beautiful, happy, long, healthy and active life.:-)
Stress Reduction techniques and sleep – the studies are astounding!
- Meditation (a favorite meditation app, Calm)
- Mindfulness stress reduction
- Breathwork
- Exercise
- Yoga
- Therapy that helps you work on the underlying stressors in life or old trauma and patterns that keep you awake at night. My favorite is EMDR (Eye Movement Desensitization and Reprocessing)
- Laughing out loud
- Creative Visualization
- The body scan
- A gratitude practice
- Love and dropping into your heart
References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656292/
https://www.ncbi.nlm.nih.gov/pubmed/9322273
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5489575/
https://academic.oup.com/sleep/article/26/2/117/2709164
https://journals.lww.com/psychosomaticmedicine/Abstract/2000/03000/Symptoms_of_Stress_and_Depression_as_Correlates_of.14.aspx
https://bmjopen.bmj.com/content/7/7/e014920?utm_source=trendmd&utm_medium=cpc&utm_campaign=jnis&trendmd-shared=1&utm_term=TrendMDPhase4&utm_content=Journalcontent
https://www.ncbi.nlm.nih.gov/pubmed/24136970
https://en.wikipedia.org/wiki/Glymphatic_system
