Recently I interviewed Dr. Damiana Corca, as she discussed effective sleep strategies for those with thyroid and autoimmune thyroid conditions. If you would prefer to listen the interview you can access it by Clicking Here [1].
Dr. Eric Osansky:
With me, I have Dr. Damiana Corca. Today, we are going to be talking about effective sleep strategies. Dr. Damiana is a holistic sleep specialist with training in acupuncture, Chinese medicine, and functional medicine. She is committed to supporting people who struggle with sleep issues by helping them discover the root cause of their sleep issue so they can get good sleep and continue to do so for the rest of their lives. She also has a local private practice in good ol’ Boulder, Colorado. She serves her clients worldwide through private telemedicine consulting as well as group programs. She is also the founder of the Corca sleep Method. Thank you so much for joining us, Dr. Damiana.
Dr. Damiana Corca:
Thank you for having me.
Dr. Eric:
You’re welcome. Why don’t we start out with your backstory? How did you start helping people with sleep issues? Did you personally have a sleep issue?
Dr. Damiana:
I’ve had sleep issues on and off. About a decade ago, I noticed that a lot of my patients have sleep issues, even if they didn’t come in for that. Even if they had a different complaint, I noticed that if they don’t sleep well, they don’t recover well. If I can help them sleep better, everything gets better. That got me thinking. I started focusing more and more on sleep issues. I realized how many people don’t sleep well. Sometimes we settle for less. We don’t know what really good sleep is. That’s what I’ve been doing.
Dr. Eric:
Why is it important to get good quality sleep? Everyone knows it’s important, but in your words, why is it important?
Dr. Damiana:
First and foremost, it feels so good, doesn’t it? Just to go to sleep and sleep for seven, eight, nine hours. You wake up in the morning and feel so refreshed. It feels like a new day. When you don’t sleep well, you wake up more anxious, depressed, tired. You have a harder time focusing. You have to go for caffeine in order to have energy. It’s been correlated with bigger issues like increased risk of dementia and many other problems that I sometimes don’t even want to talk about because a lot of people I work with want to sleep. They just can’t. As opposed to people who push themselves and choose not to sleep.
Dr. Eric:
There are some people who would love to get sleep but can’t fall asleep, or they wake up in the middle of the night. Then there are those people who intentionally stay up late and neglect their sleep. Even with those people, it’s challenging. If someone stays up to midnight or 1am, it might be challenging for them to get into the habit of going to sleep at 9pm or 10pm.
Speaking of sleep times, what would you say is the ideal sleep time? Someone will say you want to go to sleep at 9pm. Some will say between 10pm and 11pm. In your opinion, is there a specific time or time range that most people should go to sleep?
Dr. Damiana:
Definitely somewhere between 9pm and 11pm is a good time. Everyone is a little different. We are made differently. We also have different schedules. Having a routine is important. Noticing if you do a little bit of a winding down process and prepare for bed, what is your natural time that you feel sleepy? If you prepare a little bit and allow your body to relax instead of pushing yourself too much or working too late. It can vary.
Many people say 10pm is a very good time to sleep because it helps with the detox process and helps the body during sleep to take care of all these different functions that cannot be done while we’re awake. A little bit of flexibility there. More important is to watch your body to see what it wants, noticing when you feel sleepy or groggy. Of course, if you tend to stay up late, you will say, “I only feel sleepy at 1am.” That’s not a true assessment because it’s already delayed for some reason. That’s a bigger story on how to shift that and work with that. If you only get sleepy at 2am, that doesn’t necessarily mean that’s not perfect. It can be for some, especially if that’s how your work schedule works. But typically, earlier in the night is best.
Dr. Eric:
I typically go to sleep between 10pm and 10:30pm. I have been trying to go to bed a little earlier than that. Maybe it’s not necessary because I am trying to go to bed before 11pm. As far as duration of sleep, I strive for seven or 7.5 hours of sleep. That’s another question. Do you believe people should be getting a certain number of hours of sleep? The magic number seems to be eight hours, but as you said, everyone is different. Would some people be okay with seven hours? Some people might need more than eight hours. What is your input there?
Dr. Damiana:
As you pointed out, everyone is a little different. When we sleep well, we tend to sleep in hour-and-a-half chunks. We have about five of those. The minimum is 7.5 then. It takes a little bit to fall asleep. Maybe you wake up a little bit during the night. That goes to the magic number of eight hours. I sleep most of the time 7.5 hours. In the winter, or if I go through a lot of mental work or emotional challenges or physical challenges, sometimes I can do nine hours. It feels really wonderful. I add one of those hour-and-a-half chunks in a sense.
If we sleep well and go through the sleep cycle correctly, it’s in those chunks. When you wake up in the morning and realize you have half an hour before your alarm goes off, and you try to go back to sleep, if you feel you’re already awake, it’s not worth pushing it because you go into a deeper sleep. Then you will wake up really groggy in half an hour. Half an hour ago, you felt so good.
Also, people feel anxious if they can’t fall asleep. Their body says, “No, it’s time to wake up.” It doesn’t allow you. Having this concept in mind about these hour-and-a-half chunks can serve you well on how to organize your sleep but also not to push certain things because it’s not helpful.
If you want to sleep longer, I always tell people to go to sleep earlier but keep the wake-up time consistent. That is more important. Not sleeping in, but finishing work earlier, eating earlier, winding down earlier, and noticing when your body feels sleepy. It should feel sleepier if you feel you need more sleep. Then you can wake up at the same time.
Dr. Eric:
Most people listening to this have a thyroid or autoimmune condition like Hashimoto’s or Graves’. Do people with certain health conditions need more sleep? Or does it depend on the person? Even if someone has an autoimmune condition, they might still be okay with seven hours.
Dr. Damiana:
With Hashimoto’s being hypothyroid, I have seen it both ways. Theoretically, you should be tired and should be wanting to sleep a lot, but it doesn’t work like that. It’s an autoimmune problem, so there are more consequences. Of course, the people who come and see me have insomnia, so I see those people. But I do see a lot of people who have Hashimoto’s and insomnia. It’s a problem because they feel so tired, yet they can’t sleep. They need to rest in order to recover their adrenal glands to support the stress system, so the thyroid can recover, yet they can’t sleep. With Graves’, there is insomnia there. In both cases, it would be wonderful to get more sleep, but it often doesn’t happen, which makes matters worse.
Dr. Eric:
Ideally, it would be nice to get more sleep, but if you’re struggling to fall asleep or stay asleep throughout the night- With Hashimoto’s or Graves’, it sounds like they might benefit from longer than eight hours of sleep. The problem is a lot of those people have insomnia, so they might be lucky to get three or four hours of sleep let alone nine or ten hours of sleep.
Dr. Damiana:
Exactly. As you know, we can only do so many changes in outside habits. It’s more figuring out working with the autoimmune issues, looking at the root cause and why this is happening so then the sleep gets better. That is the deeper work. Sometimes people get frustrated when they do all the right things. They have the perfect bedtime routine and already avoid caffeine, yet they still can’t sleep. Sleep is connected with so much, including autoimmune issues and the thyroid. It takes longer. These good habits that you perhaps already have are helpful, but additional layers are needed, and it can take longer. You will get to that place where you can sleep, which will help the healing process.
Dr. Eric:
Like all my guests, I do research, and I listen to other interviews. I heard you talking about different types of insomnia. Can you discuss those different types?
Dr. Damiana:
Yeah. The way I look at them is inspired by Chinese medicine. I am going to give you a couple of examples. Let’s say you have trouble falling asleep. Typically, we think trouble falling asleep is just trouble falling asleep, and that is all. There is typically not much variation to it. But in my mind, there is.
The two main types I see are the anxious type and the overthinking type. Those can overlap sometimes. The way I ask people questions, you can see how they are different. The way it shows up in anxious insomnia, they are wide awake and can’t fall asleep. The overthinking type manifests more in they almost doze off, they toss and turn, they think they weren’t sleeping but then realize they had a dream. It’s different. Even now, it might sound very different, but the root causes aren’t different.
The easiest way to explain this is the overthinking type is related to digestion. We digest food, but we also digest thoughts. When we have trouble digesting thoughts—it comes hand in hand—it causes insomnia where you can’t fall asleep. You are too tired to read a book. You’re frustrated. For some people, it’s not worrying. They just get stuck on certain thoughts or a song. After a while, if you keep having that, anxiety will kick in, but the root cause is different.
The other folks with the anxious type, they never doze off. They are wide awake. They typically try to read something. They get sleepy and put the book down. As soon as they turn off the light, they are wide awake again. That can happen for a few hours sometimes. Even just an hour. There is this subtle difference.
The overthinking type leads more to digestion issues. The anxious type is more related to a very stressed, dysregulated nervous system that more than anything points to cortisol issues and adrenal gland issues. It can go into hormones and the thyroid. Does that make sense to you? Do you have any more questions to help clarify this?
Dr. Eric:
It makes sense. The overthinking type definitely makes sense. As far as the anxiety, for example, a lot of my patients with hyperthyroidism have anxiety. Of course, that’s due to the elevation in thyroid hormone. A lot of people have the anxiety type who don’t have hyperthyroidism. The one thing I didn’t understand: Is it the anxiety type that over time leads to adrenal issues? Or are the adrenal issues causing the anxiety?
Dr. Damiana:
Very initially, I believe it is the stress in a person’s life that causes the adrenal issues. Thenif the cortisol production gets dysregulated, then it can be too high at night. You are telling yourself it is time to sleep. Your body says, “No, we’re not going to sleep.” You get that sensation of being aroused or wired and tired.
The thing is, when I came up with this concept, it was from the Chinese medicine perspective. In a way, the treatment wasn’t all that different if it was high thyroid hormone or high cortisol. The body is too activated at the incorrect time; hence, you can’t fall asleep. It is a survival mechanism. When you get too activated at night, the body says you have to stay awake and deal with this problem. Many times, you can’t deal with it. It’s not something you can do right then and there. That’s the underlying message. It’s not fully safe to surrender.
It’s very vulnerable to fall asleep. Yes, we live in houses with locked doors. We’re pretty safe. But if you think about it, we are lying in bed and lose awareness and consciousness of our environment. A certain level of relaxation has to happen in order to fully fall asleep. The stressor could be something outside emotional. It could be too much thyroid hormone or other reasons.
Dr. Eric:
How important are lifestyle factors, like diet and stress management, when it comes to overcoming these types of insomnia?
Dr. Damiana:
They are very important. Let’s say you don’t have real insomnia, just some sleep issues here and there. They’re not really bad. You notice making certain changes helps. Those lifestyle changes are amazing and very important. Likely, that’s all you need to do to sleep well.
For the people who have tried those things and it still doesn’t make a difference, it doesn’t mean that those lifestyle changes are not important or valid. It just means there is more work to be done. You have to look deeper. How are all the organs functioning together? You mentioned the thyroid or digestive issues or hormone imbalance. I always tell people: You are doing the right things. Don’t get frustrated and give up on them. Just look for help. There are probably things you’re not aware of. That’s why we’re trained in this, to help you figure out and understand what is happening. If we understand it is the thyroid or the hormones, then we can further help you make further changes that will really make an impact on your sleep. Then you feel the efforts you do are very targeted rather than working so hard and not really seeing the results.
Dr. Eric:
They probably don’t know they have this until they get tested, but let’s say they have elevated cortisol levels, which would be revealed by an adrenal saliva test or dried urine test. If someone makes dietary changes- Either way, whether it helps or not, it’s important to eat well. It’s important for most people to practice some type of mind/body medicine since most people are stressed. As you’ve said, if that’s not helping, that’s where they would need to seek the advice of someone, or maybe get testing for adrenals. Based on that, they can come up with a plan to address the adrenals. Would that be correct?
Dr. Damiana:
That is correct. Just to make acorrelation between- Stress often affects the cortisol levels. In time, too much cortisol will occur in the evenings. Then you can’t sleep. That is just one scenario. But the correlation with food, let’s say you eat more carbs, too much sugar. There is a very close relationship between cortisol and sugar. By eating healthier and balanced meals that have plenty of protein and healthy fat and less carbs, it keeps the blood sugar in balance, which is very closely related to cortisol. That helps you heal in time.
If you do the opposite, it makes it worse. If you’re sleep-deprived, and your blood sugar falls, the brain says, “Give me food quickly. Give it to me in the form that gets absorbed the fastest.” That’s usually sugar, like a cookie. Once you get into that pattern, it makes things harder. If you get into that stable place, where you eat three times a day- I am a big proponent of when you go through a lot of stress when we don’t sleep, eat three times a day rather than not because it can support your body so you don’t get into this stress mechanism that makes things worse generally.
Dr. Eric:
If someone eats too late, that could also cause sleep issues. Do you recommend for most people to stop eating at a certain time?
Dr. Damiana:
6pm or 7pm would be great. At least three hours before going to sleep. There are a couple different reasons for that. First, you want to digest your food so then your body can shift its resources to falling asleep. We think about this concept of falling asleep as a passive concept. It’s not. Falling asleep takes a fair amount of energy, as does staying asleep. It takes the same amount of energy in the brain as we’re awake. It’s just different. It doesn’t feel like that to us. You want to eat and digest food with plenty of time before you go to bed.
The other thing is if you eat too late, and there are some blood sugar imbalances, it can either prevent you from falling asleep, or it can wake you up depending on how close you ate that meal to when you went to bed. It can create a bunch of problems there. It’s a bit of a complex mechanism as to why that happens, but it’s very much so correlated and very closely related. That’s why it’s so important.
Dr. Eric:
Thanks for sharing that. I’d like to talk about supplements now. I don’t know if you recommend supplements at all for sleep, but if so, what are they? I’d also love to get your thoughts on melatonin and CBD.
Dr. Damiana:
Sure. I do use supplements in my practice. This is always a tricky question because it has to be tailored to the individual based on the person and their problem and tests.
You mentioned melatonin. I get that question a lot because a lot of people try it and ask me if they should take it or not. I would say in my experience it’s generally safe. People tend to take too much of it for sleep purposes. Our bodies only make about .5mg of melatonin. We make the most melatonin as teenagers. At its highest point, it can be at .9mg. When people take 5mg and 10mg, I don’t know if it’s necessarily doing much more than taking 1mg or 3mg. Of course, melatonin has other benefits, such as anti-inflammatory. Some people take even higher dosages for different reasons. But to support sleep, smaller dosages is plenty, up to 3mg if it’s to be helpful.
I especially recommend it when people travel across many time zones, and they try to get into this new time zone. It can be helpful to support the body to give it the message that we’re on a different part of the planet. It does feel to the body very jarring and disturbing to travel many time zones so fast.
As far as CBD, I also typically don’t recommend it to my patients just because we’re trying to figure out why exactly they’re not sleeping and solving the issues at their root. If they need something along the way because it takes a while to heal those sleep issues, and it helps with anxiety, then it can be super helpful. A lot of my patients already know about it and take it. There is a different extract called CBN. A combination of CBD and CBN is supposed to be more helpful for sleep issues.
Dr. Eric:
How about herbs such as Valerian or kava?
Dr. Damiana:
They can be helpful. You could try them. I rarely use them. Sometimes they are in some of the combinations I use. You can pick those up at the health store and see what happens. They can be very helpful for some people. Usually, I use them in combination with something else rather than just trying to give someone an herb to see if it helps.
Dr. Eric:
Rarely would you give Valerian root or kava by itself, but you might give a combination formula that has a smaller amount of that herb as well as other herbs.
Dr. Damiana:
Correct. In Chinese medicine, I do give herbs. That’s different. We look at the patient and give a certain diagnosis based on patterns. That’s when we give herbs. Even then, it’s not a single herb; it’s always a combination of herbs that keep each other in check and make each other more potent. It’s usually five or ten herbs in a capsule or tablet or strong tea. Sometimes I use herbs like that, but rarely individual herbs, unless it’s something like lemon balm. Maybe I did a test, and I can see they need to support GABA and glutamate. It has to be a specific thing I know is going to help them because of a test or something they told me.
Dr. Eric:
Speaking of GABA, do you ever give that directly, or do you usually give the precursors?
Dr. Damiana:
GABA is one I sometimes do use directly. I do it if I do a urinary neurotransmitter test. If I see it’s super low, I do a precursor + GABA and then eventually drop the GABA if they are feeling better, just doing the precursor. But if it’s really low, and their symptoms really fit with someone who would benefit from 5-Htp, then I will use some 5-Htp.
Dr. Eric:
Do you do urinary neurotransmitter testing on most of your patients?
Dr. Damiana:
Not most, but a fair amount of people. It depends what exactly is going on with them. Let’s say it’s really obvious that it’s perimenopause. There is a lot of hormonal issues. I will do a test to look at their hormones. The urinary neurotransmitter test is fairly common; it’s one of the most common ones I use in my practice. It’s not a perfect test. I wrote an article about it recently. The levels of our neurochemicals in the brain don’t always reflect what is in the urine, but it gives us a general idea. Over and over again in my practice, following supplementation recommendations based on that test shows me there is value in them, even if they are not as exact as far as reflecting what our brain is using as far as GABA or serotonin goes.
Dr. Eric:
When it comes to high cortisol, what are your thoughts on phosphatidylserine? And ashwagandha? I know you might not give them individually, but those are also two common ones. Ashwagandha is common. Phosphatidylserine, a lot of people will recommend it for high cortisol.
Dr. Damiana:
Ashwagandha, I use quite commonly but rarely by itself. I usually combine it with rhodiola or holy basil or a combination formula. As far as phosphatidylserine, I really love it for the right person. I rarely give it to people without seeing a test. It’s very good if you have high cortisol in the evening. I also want to see how much cortisol your adrenal glands are producing overall so I don’t give too much. It can backfire and cause more insomnia. It can be very useful if we know exactly how much and when exactly the person needs it and for how long. If you’re working holistically, you don’t have to take phosphatidylserinefor a long time, not longer than a couple of months generally. They’re wonderful products.
Dr. Eric:
I agree about the testing, especially with the phosphatidylserine. I wouldn’t recommend it unless someone has high cortisol levels.
When it comes to melatonin, do you have any strategies for increasing it naturally without having to take a supplement of it?
Dr. Damiana:
Trying to think here if I do. I was thinking more physiologically. Avoiding screens in the evening. Allowing plenty of time to be in that quiet place. No bright lights. No blue lights like cell phones or computers. Some people use these apps where you can make the screen darker, but I still tell people it would be better if you read a book on paper and put a candle on and took a hot bath. That simulates for the body relaxation. It tells it, “It’s all good” instead of using an app on your phone that makes the screen yellower. You’re still exposed to the energy from the news or an email. That also stunts the melatonin production.
When you have too much cortisol, melatonin has to go down. When you have cortisol, it’s not a bad thing; it gives you energy and tells your body there is something you need to address here. If you are reading a work email in the evening, and your body is getting upset, your body doesn’t know it’s an email. All your body knows is there is something upsetting, so you need to stay up. The cortisol goes up, and the melatonin goes down.
Sometimes it doesn’t help right away. It may not work the first or second night. You have to do it for a few weeks. There is a learned stress response that you have to undo, which takes time. You can tell your body it’s safe to relax in the evening; there is no big bear or upsetting email or upsetting conversation with your partner coming for you. Your body can’t tell the difference. It’s still upsetting.
Dr. Eric:
Those are excellent points. I also agree on limiting screen time. I can’t say I always follow that.
Dr. Damiana:
That’s okay.
Dr. Eric:
But I have been trying more lately. You bring up a good point about not just being exposed to the blue light, but also if you come across something disturbing, like an email or an article, that raises cortisol, that is a good reason to turn off all electronics and read a physical book a couple hours before bed, like we did many years ago when we didn’t have all these other devices.
Dr. Damiana:
Kindles are not that bad these days. They’re more okay. It’s more like an iPad. It’s so tempting to flip over and go online. You can’t do that with Kindles, right? I haven’t owned a Kindle in a long time. I don’t know if you can go online and scroll the internet. Sometimes I read on my iPad. I can watch my mind wanting to check email and having to tell myself not to do it. Why? It can wait until the morning. There is an addiction. That novelty, it gives us dopamine, and we feel satisfied. It’s not helpful in the evening.
Dr. Eric:
I wanted to quickly get your thoughts on using things like sleep apps and devices like an Oura ring to measure sleep and sleep quality.
Dr. Damiana:
They can be helpful. I don’t think they’re 100% accurate. If you use them over a certain period of time, and then you make certain changes, then you can see the difference. That is where the amazing value in these apps is.
I always try to tell people not to obsess over these apps. The first thing people do in the morning is they don’t even feel how they feel; they just look at the app and decide how they feel based on what the app said, how many hours they slept. I always ask people how they feel, how their energy is. Give it some time, and then look at it, instead of letting the app decide how we feel based on their rating or how many hours it says we slept. It can go both ways. Sometimes, it says we got less sleep than we think, or it may say we got more than we think.
Dr. Eric:
When should someone consider working with a sleep specialist such as yourself?
Dr. Damiana:
If you have done a number of things you know can be helpful, such as winding down in the evening, and you notice you don’t get consistent sleep for 7.5 hours at least, or you wake up too early, or you can’t fall asleep within 10 minutes, or you wake up in the middle of the night and it takes a while to go back to sleep, or you wake up exhausted and don’t know why, those are all good reasons. Some people just want to optimize their health and sleep, even if it’s not a big problem. It can still be beneficial because sleep is so important for so many reasons.
The most common one I hear over and over is the fear of developing dementia. I know that firsthand. My dad had Alzheimer’s from 61-65, and he passed away. It was difficult to watch, and it was difficult for him. I can see why we would want to avoid that at all costs. Trying to get good quality sleep every night is quite helpful.
Dr. Eric:
Thank you. Are there any questions that I didn’t ask that I should have asked related to sleep? I’m sure there is more we can cover, but anything you would have wanted me to ask you?
Dr. Damiana:
Nothing comes to mind. When I do these interviews, I always think I could talk for hours and hours. That’s why I have written a book. It will hopefully come out by the end of this year. I wanted to have everything organized and educate people on why we don’t get good sleep and how we can get better sleep.
I do have a free gift for your listeners though. I cover the five main misconceptions around sleep, and I added another five not commonly known things about sleep. If you go to my website DamianaCorca.com/SleepMyths, you can download that guide for free. It will give more information about various things, like caffeine. It may sound silly, but some people are still wondering about milk. And eight other things. That is a good place to start working with sleep. It points out the main things we can do around sleep to make a change. If those are not enough, working with someone like me is truly advised.
Dr. Eric:
Thank you so much. We will be on the lookout for your book. Thanks for all the information you shared with us, Dr. Damiana.
Dr. Damiana:
You’re welcome. Thank you for having me.