Fatigue & insomnia
Insomnia: reset your inner clock and get back to sleep
by Marcelle Pick, OB/GYN NP
In books and movies, unplanned nighttime wakefulness is often a time when fascinating
events occur and “eureka” moments strike. But for many sufferers of
insomnia, the reality of being awake when the rest of the world seems blissfully
asleep is pure misery and frustration, often accompanied by a variety of unpleasant
physical symptoms. Insomnia is a common concern for many of our patients, and among
the most serious. That’s because sleeplessness can have far-reaching effects
on our health, disturbing our metabolism, cognitive and neurotransmitter function,
immunity and adrenal function, and overall hormonal balance.
Despite various identifiable organic causes which might be treatable, many conventional
practitioners turn first to sleep medications, like Ambien, to relieve their patients’
insomnia. At Women to Women, we start at the beginning, looking for clues that might
lead to the root source of insomnia. We see sleep as integral to our fundamental
biological rhythms — a process that will naturally reset itself once any underlying
physical and psychological issues are addressed. So let’s take a look at the
causes of insomnia in women to see how you can to restore healthy sleeping patterns
— naturally and permanently.
Your natural sleep — wake cycle — the circadian rhythm
Our circadian (Latin for “approximately one day”) rhythm is a cycle
of about 24 hours that is linked to the rising and setting of the sun. Deep in our
brains, a tiny, powerful cluster of nerve cells called the suprachiasmatic nucleus
(SCN) works 24/7 as our internal clock, programming key biological activities such
as cell regeneration, detoxification, patterns of brain activity, and production
of hormones that regulate the sleep–wake cycle.
When it gets dark, the SCN begins to lower body temperature and signals the release
of melatonin, the hormone that makes us sleepy. Exposure to light — natural
or artificial — prompts an increase in our body temperature and the release
of “stay-alert” hormones like cortisol. Light exposure also
inhibits melatonin production. Because these pathways are so sensitive to light
and darkness, it is easy to throw them off — just switching on the lights
can shift the circadian cycle by more than 40 minutes!
Fortunately, Nature has made allowances for our ever-changing lives, and the circadian
rhythm can reset itself — to a point. For instance, when you have a newborn,
work the night shift, or travel across time zones, your inner clock will recalibrate
itself. This may not be the healthiest thing for you (as anyone with jet lag knows),
but it does enable you to function in the short term.
For most sleepless women, though, it’s most common that subtle and ongoing
physiological imbalances have thrown off their inner clocks. These include hormonal
imbalance, diet changes, stress, and certain daily habits. This circadian disturbance
can result in daytime fatigue and nighttime insomnia, a problem that tends to become
harder to shake over time, if not addressed.
What is chronic insomnia, and what causes it?
Waking up and becoming alert deep in the night is a lonely and discouraging experience.
But when it happens night after night, it can generate rising anxiety and even a
sense of desperation — feelings that can carry over into your daylight hours.
If you have trouble sleeping every night for more than a few weeks, it is characterized
as chronic insomnia, which can be broken down into two types: primary and
secondary.
Primary insomnia is characterized as sleeping difficulties that do not
have significant physical or psychological conditions at their root. Primary insomnia
is a relatively short-term problem that is more likely to be brought on by poor
“sleep hygiene.” Low-level worry and stress, an uncomfortable sleep
environment, alcohol consumption, and smoking or drinking coffee — especially
if you do indulge close to bedtime — can all cause primary insomnia.
Secondary insomnia may be harder to trace because it occurs alongside a
medical or psychological concern that upsets sleeping patterns, and can be caused
by medication, environmental factors, or physical issues. The list of conditions
contributing to secondary insomnia is a long one, including perimenopause,
hormonal imbalance, hot flashes, restless legs syndrome,
fibromyalgia, chronic pain, arthritis, breathing problems
such as sleep apnea, insulin resistance,
gastrointestinal disorders, mineral
deficiencies, and urinary incontinence.
For many, insomnia can quickly become as concerning as the condition causing it.
Relief of secondary insomnia is most successful when we target both the
primary health concern and the accompanying insomnia.
Hormonal imbalance and insomnia
Discovering what lies beneath your insomnia can be confusing, but in our experience,
it often comes down to hormonal imbalance. Secondary insomnia can be one of the
first signs of perimenopause, a time
when many women find themselves waking throughout the night — or unable to
drop off to sleep at all. Much of this has to do with temperature regulation and
the fact that as we age, we spend less time in deep sleep anyway, which makes us
more sensitive to disturbances. Even a minor increase in body temperature can wake
us up. As many of us know, temperature changes and night sweats can become annoyingly
frequent during perimenopause and menopause due to shifting hormones.
Another theory is that the changing tides of estrogen influence how much melatonin
we produce and how we respond to it. Impaired regulation of the body’s two
major hormones, cortisol and insulin, is another common cause of nocturnal waking
in women we see at the Clinic. So it could be hormonal imbalance of one kind or
another that is causing you to lie awake at night — even after an exhausting
day.
What you’re missing while you’re sleepless
Sleep aids: only masking the problem
The use of sleeping pills in America has more than doubled since 2000, and the side
effects are still being uncovered. People using the popular pill Ambien, for example,
have been reportedly sleep-walking, bingeing on food, and even driving during the
night with no recollection the next morning!
Artificial sleep aids are meant to treat temporary — not chronic — conditions.
But most pharmacologic sleep aids, called hypnotics, are habit-forming.
What’s worse, use of sleeping pills may exacerbate chronic insomnia by further
undermining the body’s natural sleep mechanisms. This can leave you with two
problems: insomnia and a drug dependency.
Short-term medication use may be necessary in extreme circumstances in order to
function, but sleeping pills will not resolve your insomnia. It’s like turning
up the radio so you won’t hear the fire alarm. In fact, recent evidence shows
that natural and behavioral
approaches to insomnia, like cognitive behavioral therapy and relaxation
techniques, are more effective than medication at treating long-term insomnia.
References
Poets, authors, and philosophers have long pondered the underlying purpose of sleep.
More recent, progressive research has revealed a host of vital functions for sleep
— some very intriguing and mysterious. But at its most basic level, sleep
is a restorative process of the brain and body, when your body does the important
work of detoxifying, repairing, and rebuilding tissues. Just for starters: muscle
is built during a period of rest after activity, your brain recharges its batteries,
and your immune system is finally freed up to deal with any unfinished business
of the day.
It’s clear that lack of sleep disrupts metabolism, with studies linking it
to obesity and type 2 diabetes. Scientists are finding that long-term sleep loss
can trigger or worsen insulin resistance
and disrupts the neuroendocrine regulation of appetite. Sleeplessness leads to a
rise in ghrelin (the hunger hormone) and a restriction in leptin
(the satiety hormone). In one study, obese participants slept almost two hours less
than those with average body mass index — so even a moderate increase in the
amount of sleep you get may help heal metabolism. (I talk about other ways to heal
metabolic imbalances in my article about regaining
core balance.)
The effects of our crazy, modern life — chronic stress, poor diet, excess
caffeine intake, and insulin resistance — all cause the adrenal glands to
pump out extra cortisol. This is so troublesome because
high cortisol levels keep us awake and thwart our
DHEA production. DHEA is an important precursor to our sex hormones,
and insufficient levels contribute to reduced muscle mass, bone loss, aching joints,
decreased sex drive, impaired immune function, depression — and last but not
least, fatigue.
Sleep is a natural, essential process — like eating. Without it we cannot
meet the demands of our waking lives, keep our moods on an even keel, or balance
our hormones. Your body wants to sleep, and it will, once you learn how to provide
it what it needs.
Investigating your insomnia
In case you haven’t made the connection, your daytime activities affect your
ability to sleep at night. So I encourage you to keep a
sleep log for a week or two to assess your “sleep hygiene” and
other factors that may be contributing to your insomnia.
Here are some factors you may want to track:
- Foods you eat and when you eat them
- Caffeine, nicotine, and alcohol consumption
- Medications, vitamins, minerals, and supplements, and when you take them
- Levels of stress and anxiety
- Exercise routines
- Menstrual cycle patterns
- Bedtime schedule
- Room environment (temperature, light, noise, bedding)
Many women can pinpoint the specific causes of their insomnia simply by observing
their own behavior, writing it down, and tuning into the patterns that emerge.
Getting back to sleep — the Women to Women approach
At Women to Women, we know how upsetting insomnia is to both physiological and emotional
well-being. We believe the clues to resolving your insomnia dilemma lie within you.
Here’s what we recommend to our patients with insomnia:
- Take inventory of your sleep hygiene. Set a firm bedtime,
and for an hour or two beforehand, dim the lights, turn off electronics, and cultivate
tranquility. Make sure your bedroom is comfortable and dark when it’s time
to sleep. Eat your last meal of the day at least four hours before bed and avoid
sugar, especially in the evening. Reduce your consumption of coffee, cigarettes,
and alcohol. Exercise each day, but never too vigorously in the evenings.
- Try nature’s sleep aids. Before bed, drink warm
milk or calming herbal teas, such as passionfruit, chamomile, or valerian root.
At our practice we sometimes use a natural supplement called phosphatidyl serine,
as well as a melatonin precursor called 5-HTP, with great success. (For
best results, see a qualified naturopath or practitioner of functional medicine.)
- Meet your body’s nutritional needs. Your body is
fueled by food, so if sleepless nights have drained you of your energy, it’s
even more important to replenish nutrients. Certain sleep disorders, like restless
legs syndrome and leg cramps, can be resolved by repleting certain nutrients:
magnesium, calcium, folate, and iron. Focus on eating a balanced diet of whole foods,
and make sure you take a high-quality multivitamin–mineral supplement daily to fill
any gaps.
- Balance your hormones. We recommend
phytotherapy to gently rebalance estrogen and progesterone levels, calm nerves,
and facilitate more restful sleep. If your symptoms are so intense they’re
impacting your quality of life, you may want to discuss
bioidentical HRT with your healthcare practitioner.
If none of these steps helps you sleep better, you may want to contemplate behavioral
modification techniques for insomnia like cognitive behavioral therapy, directed
imagery, or meditation. For additional guidance, see our outline of
alternative insomnia treatments.
Press pause — it’s time for a rest
It’s good to know that insomnia is a highly treatable condition that doesn’t
usually require sleeping pills. Sleeplessness really comes down to the cross-talk
between your body and your mind — and hormonal fluctuations that alter your
sleep patterns are a signal from your body that something is amiss. Tune in to hear
what your body wants you to know, and your insomnia may quickly become a thing of
the past.
Our Personal Program is a great place to start
The Personal Program promotes natural hormonal balance with nutritional supplements, our exclusive endocrine support formula, dietary and lifestyle guidance, and optional phone consultations with our Nurse–Educators. It is a convenient, at-home version of what we recommend to all our patients at the clinic.
If you have questions, don't hesitate to call us toll-free at . We're here to listen and help.
We’re always happy to welcome new patients to our medical clinic in Yarmouth, Maine, for those who can make the trip. Click here for information about making an appointment.
Related to this article:
References & further reading on insomnia in women
Original Publication Date: 12/28/2006
Last Modified:
10/26/2009
Principal Author: Marcelle Pick, OB/GYN NP