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 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 serious concern for many of our clinic patients. That’s
because sleeplessness can have far-ranging effects on our health, disturbing metabolism,
cognitive and neurotransmitter function, immunity and adrenal function, and overall
Even with many identifiable organic causes that might be treatable, conventional
practitioners often turn first to sleep medications, like Ambien, to treat insomnia.
At Women to Women, we start instead at the beginning, looking for clues that might
uncover the root source of insomnia. We see sleep as integral to our basic biological
rhythm — 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
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 activities such as cell
regeneration, detoxification, patterns of brain activity, and production of hormones
that regulate the sleep-wake cycle.
When it gets dark, your SCN begins to lower body temperature and also signals the
release of melatonin, the hormone that makes you sleepy. But exposure to
light at night — both natural and artificial — triggers an increase
in body temperature, along with the release of “wake-up” hormones like
cortisol. Light exposure also inhibits melatonin production. Because these
internal pathways are so sensitive to light and darkness, it is easy for them to
be thrown off — that’s why just switching on the lights for a few seconds
can shift your circadian cycle by more than 40 minutes!
Fortunately, your circadian rhythm can reset itself — up to a point. For instance,
when you have a newborn baby, or work the night shift, or travel across time zones,
your inner clock will adjust to the change. While this may not be a long-term solution
(think jet lag), it does enable you to function in the short term.
For most sleepless women, though, subtle and ongoing physiological imbalances are
responsible for upsetting 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, problems that become harder to shake
over time if not addressed quickly.
What is chronic insomnia, and what causes it?
Waking up and becoming alert in the middle of the night is a lonely and discouraging
experience. But when it happens night after night, it can generate anxiety and even
a sense of desperation — genuinely unpleasant feelings that can carry over
into your daylight hours. If you have trouble sleeping every night for more than
a few weeks, it is considered chronic insomnia, which can be broken down
into two types: primary and secondary.
Primary insomnia describes sleeping difficulties that do not have significant
physical or psychological causes at their root. This relatively short-term problem
is more likely to be brought on by conditions that interfere with sleep —
or poor “sleep hygiene.” Low-level worry and stress, an uncomfortable
sleep environment, alcohol consumption, smoking, or drinking coffee — especially
if you indulge close to bedtime — can all cause primary insomnia.
Secondary insomnia may be harder to trace because it occurs alongside,
or as a result of, a medical or psychological concern that upsets sleeping patterns,
and can be caused by medications, environmental factors, or physical issues. The
list of conditions contributing to secondary insomnia is a long one that includes
perimenopause, hormonal imbalance,
restless legs syndrome, fibromyalgia,
chronic pain, arthritis, breathing
problems (sleep apnea, nasal polyps, nasal changes),
insulin resistance, gastrointestinal
disorders, mineral deficiencies, and
urinary incontinence. For many, insomnia can quickly become as troubling
as the condition that’s causing it. Relief of secondary insomnia is most successful
when we target both the primary health concern and the accompanying
Hormonal imbalance and insomnia
Discovering the source of your insomnia can be challenging, but in our experience,
it may come down to hormonal imbalance. Secondary insomnia can be one of the first
signs of perimenopause, a time when
many women find themselves waking up throughout the night — or unable to fall
asleep 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. That makes us more sensitive to disturbances
when even a minor increase in body temperature can wake us up. Such temperature
changes, hot flashes, and night sweats can become annoyingly frequent during perimenopause
and menopause due to shifting hormones.
Another theory is that changing estrogen may be influencing both how much melatonin
we produce, and how we respond to it. Impaired regulation of the body’s two
major hormones, cortisol and/or insulin, is another cause of nocturnal waking in
some women. High levels of cortisol generated as a result of stress — actual
or perceived — can interfere with sleep patterns. So it may be hormonal imbalance
of one kind or another that is causing you, too, to lie awake at night — even
after an exhausting day.
What you’re missing while you’re sleepless
Feeling exhausted is an obvious consequence of insomnia, but adequate sleep is crucial
to your health for other reasons as well. Writers and philosophers have long wondered
about the underlying purpose of sleep but recent research has revealed an incredible
range of vital functions that occur while you’re sleeping. 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. During sleep,
your body builds muscle after activity, your brain recharges, and your immune system
is finally freed up to deal with any unfinished business of the day.
Do sleep aids really work? It depends on the method
The use of sleeping pills in America has more than doubled since 2000, and the side
effects are still being uncovered. It’s been reported that people using the
popular pill Ambien, for example, have been sleep-walking, bingeing on food, and
even driving during the night with no memory of it 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 worsen chronic insomnia by further
disturbing the body’s natural sleep mechanisms. Then you’ll have two
problems: insomnia and a drug dependency.
In extreme circumstances, short-term medication use can help a chronic insomniac
function, but sleeping pills will not resolve the problem. That’s like turning
up the radio to drown out 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
It’s clear that lack of sleep upsets metabolism, with studies linking it to
both obesity and type 2 diabetes. Scientists are finding that long-term sleep loss
can trigger or worsen insulin resistance
and disrupt the neuroendocrine (brain-hormone) regulation of appetite. Sleeplessness
leads to a rise in the hunger hormone (ghrelin) and a restriction of the
satiety, or “I’m-full,” hormone (leptin). In one study,
obese participants got almost two hours less sleep than people with average
body mass — so even a moderate increase in the amount of sleep you get may
help heal your metabolism.
The consequences 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. High
cortisol levels effectively keep us awake and alert, and thwart our production
of DHEA, an important
building block of our sex hormones. Insufficient levels of DHEA contribute to fatigue,
but are also associated with reduced muscle mass, bone loss, aching joints, decreased
sex drive, impaired immune function, and depression.
Sleep is a natural, essential process — like eating. Without it we can’t
meet life’s demands, keep our moods even, or balance our hormones. Your body
wants to sleep, and it will, once you know how to provide what it needs.
Investigating your insomnia
In case you haven’t made the connection, what you do during the day affects
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 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 behaviors, writing them 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 your body and your
emotional well-being. We believe the secrets to resolving your insomnia lie within
you. Here’s what we recommend to our patients with insomnia:
Create a nighttime ritual. Establishing a bedtime routine can help
send an internal message to your body — and your mind — that it’s
time to let go of the day and prepare for sleep. Experiment to find out what patterns
are relevant to your own physiology. Time-tested options include relaxing baths,
meditation, and aromatherapy (lavender is especially popular for calming the mind).
Take inventory of your sleep hygiene. Set a firm bedtime, and for
an hour or two beforehand, dim the lights, turn off the TV and computer, and help
yourself calm down from the day. It’s a good idea to make your bedroom as
comfortable as possible. Choose calming colors when decorating and keep the room
neat and organized. Your room should be dark when it’s time to sleep. You
might even want to consider black-out shades or wearing a sleep mask. Eat your last
meal of the day at least four hours before bed and avoid sugar, especially at night.
Cut down on 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. If sleepless nights have
left you drained of energy, it’s even more important to replenish nutrients
by eating right. Certain sleep disorders, like restless legs syndrome and leg cramps,
can be resolved with certain nutrients: magnesium, calcium, folate, and iron. In
general, you should 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 hormone levels, especially estrogen and
progesterone. This also can calm your nerves, and help you get more restful sleep.
If your symptoms are so intense they’re affecting 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 consider behavioral
modification techniques for insomnia. These include cognitive behavioral therapy,
directed imagery, and meditation. For additional guidance, see our outline of alternative insomnia
Press the “pause” button — 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 two things: the
conversation between your body and your mind and hormonal fluctuations that can
alter your sleep patterns. Both of these are signals from your body that something
is amiss. When you tune in to hear the message that your body is sending, your insomnia
may quickly become a thing of the past.
Related to this article:
References & further reading on insomnia in women
Last Modified Date: 04/20/2011
Principal Author: Marcelle Pick, OB/GYN NP