Fatigue & insomnia

Insomnia — reset your inner clock and get back to sleep

by Marcelle Pick, OB/GYN NP

• Causes of insomnia in women
• Health effects of insomnia
• Problems with sleep aids
• Natural relief for insomnia

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 hormonal balance.

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, hot flashes, 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 insomnia.

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.

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 treatments.

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