August 4, 2011
Many women are familiar with the idea that our changing hormones can affect our sleep. Many of us actually encounter our first sleep problems during times of hormonal fluctuation — such as the insomnia some women suffer during pregnancy, or frequent waking during menopause.
But many women aren’t aware that another hormonal problem — a thyroid imbalance – can cause sleep problems throughout our lives.
The Thyroid and Sleep
The thyroid is our master gland of metabolism and energy, and so this tiny, butterfly-shaped bland packs a punch when it comes to our sleep patterns.
On one end is the most common thyroid problem, hypothyroidism, in which the thyroid is underactive and hormone levels are too low. In hypothyroidism, everything slows down. One common symptom of hypothyroidism is extreme fatigue. Typically, women who usually need seven hours, for example, to wake up feeling well in the morning find that eight, nine or even ten hours doesn’t even make a dent in their fatigue. And their sleep is often “unrefreshing,” meaning they wake up exhausted, still sleep-deprived.
Some women have described needing naps when they get home from work simply to muster the energy to make dinner, or napping in the car at lunchtime just to make it through the day. Some women catch up on weekends, sleeping 12 to 15 hours a night to store up energy for the rest of the week. This sort of abnormal fatigue and excessive sleep can be due to the slowed metabolism and general lack of energy associated with hypothyroidism.
Sleep researchers have found that people who are hypothyroid without proper treatment are also more likely to suffer from sleep apnea. Sleep apnea is a condition where breathing stops while sleeping — either due to airway obstruction, a failure of brain signals, or both. Every time breathing stops, the brain triggers a brief period of waking so as to restart breathing. Sleep is severely interrupted and fragmented, and normal sleep cycles are disrupted. Some people with sleep apnea may snore loudly, but some are otherwise quiet sleepers.
Hypothyroidism is also associated with a lack of sufficient Stage 4 sleep in some patients. Stage 4 is the restorative, deep sleep that helps repair daily stress on the body and restore energy. About 10 to 15% of all sleep should be Stage 4, and usually takes place earlier in the night. A deficiency in Stage 4 sleep can result in sleep deprivation (no matter how much time you’re actually “sleeping”), as well as excessive fatigue, weight gain, brain fog and other symptoms.
On the other side of the spectrum is hyperthyroidism, an overactive thyroid, with excessive levels of circulating thyroid hormone. In hyperthyroidism, the excessive thyroid hormone being produced by the body is acting like a stimulant — for some people, they feel for example like they’ve been drinking 30 cups of coffee every day. Sleep-related symptoms of hyperthyroidism can include insomnia, frequent waking, restlessness, anxiety, heart palpitations, restless leg syndrome, and tremors, all which can disrupt sleep. While some hyperthyroid patients report feeling energetic, many do not, and complain of fatigue and exhaustion, while at the same time feeling “keyed up” or anxious. They go to bed feeling exhausted, but have a difficult time getting to sleep, remaining asleep, and may wake unrefreshed.
Another common thyroid problem that can affect sleep is a transient thyroiditis — an inflammation of the thyroid gland. Thyroiditis is most common during post-partum, perimenopausal and menopausal periods. Symptoms of thyroiditis typically include pain and tenderness in the thyroid area, neck and throat. Hypothyroid or hyperthyroid symptoms such as weight changes, fatigue, or hair loss may also be present. Much like some people find that the inflammatory aches and pains of arthritis tend to worsen at night, some patients have a similar experience with thyroiditis, and find that their palpitations, achiness, and neck pain make it hard to sleep.
Help for Sleep
With almost 60 million Americans with thyroid conditions in the U.S., and the majority undiagnosed, there is a chance that your sleep problems may be caused by an undiagnosed thyroid problem. So the first step is a thorough thyroid evaluation.
Your doctor should take your personal and family medical history, and conduct a complete physical examination. This exam should evaluate your Achilles reflexes, measure your heart rate and your blood pressure, palpate your neck to feel for enlargement, among other observations. Blood tests for Thyroid Stimulating Hormone (TSH) test, free levels of key thyroid hormones T4 and T3, and antibodies tests to evaluate autoimmunity are also part of a thorough examination.
If a thyroid problem is identified, proper treatment will help balance the thyroid, and may resolve sleep problems without any further treatment necessary.
If sleep problems continue despite thyroid treatment, however, there are some additional options to consider.
Sleep hygiene refers to the environment and practices surrounding your sleep. You should always take a look at these issues to help resolve sleep problems. Some suggestions include:
· Avoiding naps, especially in the late afternoon, and if you do nap, limit it to 30 minutes.
· Staying away from stimulants, caffeine and alcohol, especially in the afternoon and evening.
· Keep a consistent sleep schedule.
· Don’t exercise before bed.
· Try mindfulness, meditative techniques to help fall asleep, including breathing, prayer, or guided imagery.
From the standpoint of natural supplements, there are several that can help. You should talk to your practitioner about what’s best for you, but some to consider include:
Magnesium and calcium — when taken at night, they may help calm down thyroiditis-related anxiety, palpitations, and may make it easier to fall asleep.
5 HTP (5 Hydroxytryptophan) — at levels of 100 to 400 mg, may help with sleep in some people.
Melatonin — can be helpful to some people, especially if they have a hard time falling asleep. A typical dose is 1 to 3 mg if you are under the age of 50, up to 6 mg over 50, taken at bedtime, but if you wake up groggy, it may be too much, cut the dose back.
(May 2006)
Mary Shomon is an internationally-known thyroid patient advocate, and is author of a number of best-selling health books, including Living Well With Hypothyroidism and The Thyroid Diet. Since 1997, she has run the Internet’s most popular thyroid patient sites: About.com Thyroid Site and Thyroid-Info.com
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Hi, Mary. I have struggled with insomnia my entire life, even as a baby! I’m going to discuss the possibility of an overactive thyroid with my doctor. Thank you for the advice.