Overcoming Insomnia In Graves’ Disease and Hashimoto’s Thyroiditis
Published July 29 2013
Updated October 28 2014
Many people with thyroid and autoimmune thyroid conditions have difficulty sleeping. Some people have difficulty falling asleep, while others have problems staying asleep. And of course some people have both problems. Obviously getting sufficient sleep is important in order to achieve optimal health, and so what I’m going to do is discuss some of the most common factors which cause sleep problems, and I’ll give some suggestions to help improve one’s sleep.
High Nighttime Cortisol Levels. Having high cortisol levels can cause insomnia (1). And the best way to determine if someone has high cortisol levels is through testing. This is one of the downfalls of serum testing for cortisol, as this involves a one sample test, and usually occurs during the day. With a saliva test you can measure the cortisol levels in the morning, afternoon, evening, and right before going to bed to get a complete picture of what’s going on with the adrenals. High morning cortisol levels can also interfere with sleep, and is something to consider testing for if you are able to fall asleep without a problem, but constantly wake up in the middle of the night and can’t fall back asleep.
Cortisol responds to stress and inflammation, and so whenever someone has high cortisol levels it is important to address the root cause of these problems. Stress is one of the biggest factors, and numerous studies show a correlation between stress and insomnia (2) (3).
However, since getting sufficient sleep is extremely important, when someone has high cortisol levels at night I will usually recommend for them to take something to help decrease the cortisol levels. One supplement which can usually help with this is phosphatidylserine (4). So I frequently will have someone with high nighttime cortisol levels take this before going to bed, and then again if they wake up in the middle of the night. The herbs ashwagandha and rehmannia can also help to lower high cortisol levels in some people, and so there are times when I will recommend these herbs to my patients. However, imbalances in cortisol are usually caused by chronic stress, and so while taking supplements on a temporary basis is fine, it is also important to improve one’s stress handling skills, and in order to help accomplish this I’d recommend incorporating one or more stress management techniques on a daily basis.
Reactive Hypoglycemia. Having problems with the blood sugar levels can potentially lead to insomnia. This seems to be more common with reactive hypoglycemia. When this is the case, many times just changing one’s diet can help with this, and therefore will help a person to sleep better. If the blood sugar imbalance is due to a deficiency of chromium, then in addition to eating well, supplementing with chromium usually is necessary. The herb gymnema can also help with the blood sugar levels, and therefore might be beneficial when blood sugar imbalances are the cause of insomnia. But if someone has reactive hypoglycemia they should start by eating a diet consisting of whole foods, cut out the refined foods and sugars, and try not to go long periods of time without eating in order to help keep the blood sugar levels stable.
Decreased Melatonin. Melatonin is a hormone which is made by the pineal gland, and plays a very important role in helping people to sleep. Whereas cortisol rises in the morning and decreases as the day goes by, melatonin levels usually begin to rise later in the day, and should be at the highest levels throughout the night, before decreasing early in the morning. If someone has decreased amounts of melatonin at night, taking a melatonin supplement can frequently help the person to sleep better. For example, studies show that melatonin can help with age-related insomnia (5), as melatonin production normally decreases as we age.
However, although age can be a factor, it usually isn’t the primary factor, and ultimately the cause of the decreased production of melatonin should be addressed. Melatonin production is greatest in the dark, and so it is important to sleep in a room that is completely dark, and not have the television on while trying to fall asleep. There also is some evidence that frequent EMF exposure can affect the production of melatonin, although this is still controversial. A recent study showed that the production of melatonin in newborns might be influenced by magnetic fields produced by incubators (6). However, more research needs to be conducted regarding the possible negative effects of EMFs on melatonin levels. For more information on melatonin I’d check out my article entitled “Melatonin and Thyroid Health“.
Progesterone deficiency. Having low progesterone levels can also interfere with sleep quality. Progesterone exerts a sleep induction or hypnotic effect and is a potent respiratory stimulant that has been associated with a decrease in the number of central and obstructive sleep apnea episodes (7). Other studies show that balancing the hormones estradiol and progesterone can help with sleep (8). Many healthcare professionals will recommend bioidentical progesterone for those who have a deficiency. However, this doesn’t address the cause of the low progesterone levels, and a big factor which can lead to a decrease in progesterone is weakened adrenals, which is usually a result of dysregulation of the hypothalamic-pituitary-adrenal axis.
Mineral Deficiencies. Certain mineral deficiencies can also cause insomnia. While many people are aware that a magnesium deficiency can cause problems with sleep, I came across a study which showed that taking zinc might also help with insomnia (9). However, all of the participants took a supplement which consisted of zinc, magnesium, and melatonin, and so it’s possible that the magnesium and/or melatonin played a greater role in helping with the insomnia. With that being said, in most cases it won’t hurt to try taking some magnesium right before going to bed, and some people might benefit from taking a small amount of zinc.
Caffeine. To no surprise, the consumption of caffeine can also cause insomnia. And those who consume caffeine later in the day are even more likely to have problems with sleep. One study showed that several genes have been identified as potentially influencing caffeine-induced insomnia (10). This could explain why one person who drinks a single cup of coffee per day has problems sleeping due to the caffeine, while someone else who drinks multiple cups of coffee per day sleeps fine. Just like anything else, caffeine has a different effect on different people. But those people with insomnia who consume caffeine regularly, whether it’s in the form of coffee, soda, chocolate, or something else, might want to try avoiding these sources for at least a few weeks and see if they notice an improvement in their sleep.
Aspartame. There is evidence that consuming aspartame can result in insomnia (11). This should make you wonder how many other artificial ingredients and other chemicals might have a similar effect on one’s body, and thus result in sleeping difficulties. As a result, one should not only avoid aspartame, but other artificial ingredients as well.
Alcohol Consumption. Drinking too much alcohol can also potentially interfere with sleep. At all dosages, alcohol causes a reduction in sleep onset latency, a more consolidated first half sleep and an increase in sleep disruption in the second half of sleep (12). On the other hand, there are some people who seem to sleep better when drinking alcohol, although numerous experts suggest that chronic consumption is likely to lead to greater late night sleep disturbances (13).
Neurotransmitter Imbalance. Imbalances in the neurotransmitters can potentially lead to insomnia. For example, low serotonin levels are found in people with depression, and can also lead to insomnia (14). When this is the case, taking tryptophan, which is a precursor to serotonin, can help some people in this area (15). 5-HTP is the immediate precursor of serotonin (16), and therefore also might benefit some people with insomnia. The reason why increasing serotonin levels by taking 5-HTP can frequently help with sleep is because serotonin is a precursor of melatonin. As a result, low serotonin levels will usually lead to low melatonin levels. And while someone can take a melatonin supplement, this of course isn’t doing anything for the serotonin deficiency.
Can Valerian Root Help With Insomnia?
I’ve mentioned a few different supplements which can help with insomnia, including phosphatidylserine, ashwagandha, and rehmannia (for high cortisol levels), melatonin, magnesium, and 5-HTP. Valerian root is an herb which can also help some people with insomnia (17) (18). While valerian root doesn’t help everyone who has insomnia, in my experience, for those people it can help, this herb needs to be taken for at least a few weeks before noticing a difference. Many people will take this herb for a few days, and when they don’t notice a change they will discontinue taking it, even though it might have helped had they given it a little more time. There is also evidence that chamomile and passion flower can help with insomnia (19). However, one study I came across found no benefit of a chamomile extract on sleep efficiency and total sleep time in people with chronic primary insomnia (20).
In summary, it is common for people with thyroid and autoimmune thyroid conditions to have trouble falling and/or staying asleep. Numerous factors can be responsible for insomnia in people with these conditions. One needs to consider high cortisol levels, an imbalance in the blood sugar levels, decreased melatonin production at night, a progesterone deficiency, mineral deficiencies, caffeine, consumption of aspartame and other chemicals, and a neurotransmitter imbalance. Correcting insomnia can be a challenge, but doing so is essential for anyone who is trying to obtain optimal health.