I can't sleep: is it my hormones?

About 30% of adults report insomnia at any one time, with 10% suffering from chronic insomnia[i]. Women as well as people over 60 tend to be more affected. There can also be grave consequences, including a range of other chronic health conditions (such as diabetes, high blood pressure and weight gain), unproductive work lives, car accidents and fatalities. For these reasons, insomnia is considered a serious public health problem. 

Do I have a sleep problem?

Most of us suffer from time to time from difficulty sleeping, perhaps due to temporary stresses, irregular eating or other minor causes. These periods can be disruptive, but if they do not become a regular pattern, they rarely require serious intervention.

The Cleveland Clinic defines chronic insomnia as difficulty sleeping at least 3 times a week for 3 months or longer[ii]. Since it is a more serious condition, we will focus here on chronic (rather than temporary) insomnia.

There is much debate on how much sleep is enough. Since there are significant individual differences in sleep needs, we won’t launch into that but will focus instead on indicators of healthy sleep and sleep deprivation.

There is some agreement on what constitutes healthy sleep: falling asleep within 30 minutes, sleeping through the night (or falling asleep quickly again after awakening), you wake up feeling refreshed and can awaken at an appropriate time without an alarm.

Conversely, signs of sleep deprivation include: falling asleep easily during the day, increased irritability, inability to focus or concentrate, increased response time, increased fatigue, reduced short-term memory and reduced performance of certain tasks.

If you suspect you have chronic insomnia, it can be helpful to get a formal diagnosis, though there is no single test that can determine this.

Your doctor may require bloodwork, you might be asked to describe the history and pattern of your sleep problems, or to keep a sleep diary. A sleep study may be recommended if your doctor suspects you have sleep apnea or another sleep disorder.

What is causing my insomnia?

There are many factors that contribute to insomnia, more than one of these might apply to you:

·      Chronic stress

·      Chronic pain

·      Cancer

·      Anxiety disorder, depression or other mental health condition

·      Gastrointestinal disorders like heartburn

·      Neurological disorders such as Altzheimer’s, Parkinson’s

·      Certain prescription or recreational drugs

·      Other sleep disorders such as obstructive sleep apnea or restless legs syndrome

·      Lifestyle factors including shiftwork, poor or irregular sleep habits, sharing your bed with a snoring partner or a nocturnal pet

Addressing some of these can be an important part of prevention, we will get to that later.

Insomnia and hormones

A final common cause of insomnia is hormones.

One example is problems with the thyroid gland, which is part of the endocrine system. Hyperthyroidism, or an overactive thyroid, can cause sleep problems as a result of increased nervousness and restlessness, as well as nightsweats and frequent urination. Underactive thyroid, or hypothyroidism, can also contribute to sleep problems since falling asleep is a complex process controlled by the endocrine system.

Thyroid function issues can be identified through bloodwork, and in most cases there are also other symptoms in addition to insomnia typically present that point to it.

40-50% of women experience sleep problems either in perimenopause or after menopausal transition in the form of difficulty falling asleep or staying asleep, possibly influenced by reduced levels of melatonin and growth hormone, both of which affect sleep. Women who get nightsweats (hot flashes at night) are especially affected since these can further disrupt sleep.

Pregnancy and the post-partum period are other times when sleep for women can be disrupted as a result of hormones. In the case of pregnancy, physical factors (such as feeling like a beached whale!) can make sleep even more difficult. And after delivery, baby is likely to cause awakening at night regardless of what’s going on with hormones.

Other types of endocrine system disruption can contribute to sleep problems in women, such as any kind of hormonal therapy, including birth control (oral contraceptives and hormone-releasing IUDs) and even cortisone shots. A surprising and often overlooked cause of sleep problems is head injury, since two main components of the endocrine system involved with controlling sleep are the hypothalamus and the pituitary gland, both of which are located in the brain. 

What can I do on my own about my insomnia?

Over-the-counter drugs for insomnia are a common first response to sleep problems. These are usually versions of antihistamines (do you remember they make you drowsy?). However, tolerance builds up easily (you have to take more and more to get the same effect) and for many people these drugs come with side effects.

Another popular intervention is the supplement Melatonin, which is also the sleep-inducing hormone produced naturally by the body. However, tolerance seems to develop and there is a lack of consensus about timing and dosing. Nonetheless, research shows it to be effective in providing modest relief for getting to sleep, staying asleep, as well as jet lag without the side effects of drugs.[iii]

Acupuncture, a reliable non-pharmacological approach for many health conditions, can also be  helpful.

One vital initial intervention (though it may not be the last) is improving what’s called “sleep hygiene”, or habits related directly to sleeping or falling asleep. No matter the cause of insomnia, these measures almost always result in improvement, here are some[iv]:

·      Avoid food and drinks containing caffeine (this one’s obvious), as well as alcohol and recreational drugs (alcohol is commonly thought of as a central nervous depressant, but it’s also a stimulant)

·      Try adding a deep-breathing or meditation routine to your day, ideally at the beginning and towards the end of the day

·      Try to avoid falling asleep right after dinner (you may wake up soon and not be able to fall asleep again)

·      Get thick, black curtains for your bedroom that keep out all light (most bedrooms have some exposure to light from streetlights or other outside light sources)

·      Get the TV, tablets and cell phones out of the bedroom (alarms and notifications can distract and wake you up, and the blue light disrupts sleep as well)

·      Exercise regularly, but not too close to bedtime

·      Establish a regular bedtime routine that incorporates a relaxing hour or so before actually getting into bed (such as reading with a cup of warm tea, taking a warm bath); try stick to it on weekends as well since weekends can be the insomniac’s undoing

·      Don’t eat a large meal or drink a lot in the evening

Conventional medical treatment for insomnia

Doctors will often share many of the sleep hygiene suggestions just mentioned.

For hormone-related sleep problems caused by deficient thyroid function, doctors will treat the thyroid condition (see separate articles on hypothyroidism as well as Hashimoto’s thyroiditis).

For other menopause-related causes of insomnia, hormone replacement therapy (HRT) in the form of a pill, patch, ring, gel, cream or spray is currently recommended. It was once thought that HRT also contributed positively to reducing the risk of heart attack. However, more recent studies have shown that hormonal therapy actually increases the risk of heart attacks, breast cancer and stroke, as well as blood clots in the legs and lungs. Because of the risks, HRT is recommended only for short-term relief of symptoms[v].

“Sleeping pills” used to be the main medical treatment for insomnia, but increasingly the first line of therapy is cognitive behavioral therapy (CBT), which has a track record of being as or more effective and safer than prescription drugs. Provided by a psychologist in-person or online, CBT is often short-term (as little as 4 weeks) and can involve several tools including guided imagery and biofeedback.

Prescription medications are still part of the conventional medical approach to insomnia, often alongside CBT. Most are “sedative-hypnotics” (the well-known drug Ambien is one of these). It’s strongly advised that sedative-hypnotics be used for 2 to 4 weeks, only when needed and relying on low doses where possible. There is also a risk they will become habit-forming[vi].

A homeopathic approach to hormone-related insomnia

Because of the shortcomings of many conventional medical approaches to insomnia, homeopathy, which is a federally-recognized form of medicine in the US, is a viable option.

One advantage is that it can directly address the hormonal root cause of the insomnia, whether it’s menopause (see separate article on this), thyroid function, post-partum (homeopathic medicines can be safely taken while pregnant and after), or other hormonal “insults” such as oral contraceptives, or head injury.

Another advantage is that the remedies work with the body’s own ability to heal itself. This means that, unlike prescription drugs or supplements, they are taken until resolution is reached, not for an indefinite period.

We will first have a long conversation that includes a detailed analysis of all your insomnia symptoms: emotional, cognitive and physical; some may be common, others may not.

While I typically introduce medicines one at a time, which makes it possible to track and understand progress, I often use a range of remedy types helpful for insomnia, including low-potency (that target the hormonal system), high-potency, gemmotherapy tinctures and Bachflower essences.

To learn more about how I could help you with hormone-related insomnia call me for a free 15-minute consultation or schedule one on the online scheduler.

[i] https://www.sleepassociation.org/about-sleep/sleep-statistics/

[ii] https://my.clevelandclinic.org/health/diseases/12119-insomnia#symptoms-and-causes

[iii] Ferracioli-Oda, E, A Qawasmi M Bloch (2013) “Meta-analysis: Melatonin for the treatment of sleep disorders” PlosOne 8(5): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3656905/

[iv] https://www.sleepassociation.org/about-sleep/sleep-hygiene-tips/

[v] “Estrogen and hormones” Cleveland Clinic: https://my.clevelandclinic.org/health/articles/16979-estrogen--hormones

[vi] Pagel, J, R S Pandi-Perumal J Monti (2018) “Treating insomnia with medications” Sleep Science and Practice 2:5: https://sleep.biomedcentral.com/track/pdf/10.1186/s41606-018-0025-z.pdf