Why Do I Keep Waking Up In The Middle Of The Night?

I have many patients who have “trouble sleeping”.  For some this means a problem falling asleep, but, for many, they say that they keep waking up in the middle of the night.  We know that we, as humans, usually have four to five REM (Rapid Eye Movement) and NREM (Non-Rapid Eye Movement)sleep cycles every night.  At the end of each cycle it is typical to briefly awaken before going into the next cycle.  Four to six of these “nocturnal awakenings” are considered normal.  This means that nobody actually sleeps through the night.   You should be able to go back to sleep.

The question should actually be….why can’t I go back to sleep after a sleep cycle?  There are many of these “sleep stealers” that can prevent us from falling back to sleep.  I will now talk about nine of these stealers of a good night’s sleep.

Sleep Stealer No. 1:  Having a Thyroid Problem.

The thyroid gland regulates metabolism.  An overactive thyroid gland can cause adrenaline surges leading to feelings of anxiety – which, in turn, can lead to insomnia.  Over the age of 50 – especially in women – hypothyroidism, or a lower-functioning thyroid, is more common.  Women are up to 8 times more prone to thyroid problems than men and 60% of insomnia is thyroid-related.

Sleep Stealer No. 2:  Mild Depression.

Interestingly, hypothyroid individuals also manifest depression tendencies.  Depression of any type (major or minor) and insomnia tend to go together.  17% of women who have insomnia also have mild depression.  Their depression symptoms (negative thoughts, excessive worry, lack of energy and body aches) are less severe than with major depression so these women are less likely to be diagnosed with sleep issues.

It is difficult to figure out which came first.  Did the depression cause the sleep issues, or did the sleep issues cause the depression symptoms?

Sleep Stealer No. 3:  Sleep Apnea

Most people think that sleep apnea is mainly an overweight male thing with snoring as the cardinal sign.  Research actually shows that 17 % of women are likely to have sleep apnea – but 85% of the cases go undiagnosed.  As women age, especially going through menopause, they are just as likely as men to have sleep apnea – even if they are at a healthy weight (Dr. Rafael Pelayo, MD of the Stanford Sleep Medicine Centre).  This may bring up the question of whether sleep apnea and sleep problems are related to changes in estrogen or progesterone levels.  Low progesterone is, in my opinion, can be just as much a factor in women as the possibility of low estrogen.

Women are also more likely to develop symptoms related to being sleep deprived – such as difficulty find the right word, clumsiness, fatigue, depression or anxiety.

Sleep Stealer No. 4:  Acid Reflux/Hiatus Hernia

Acid from the stomach can back up from the stomach into the esophagus – leading to heartburn or a muscular reflex reaction to attempt to get rid of it e.g., coughing.  Either way, it can cause you to wake up and have problems going back to sleep.  Individuals with Chronic reflux are twice-as-likely to have problems with sleeping.

Sleep Stealer No. 5:  Alcohol before bed

Alcohol before bed is a double-edged sword.  On the one hand, having more alcohol than your liver can process leads to a temporary increase in the Blood Alcohol Level.  This increase can actually help you to fall asleep – due to its sedative effect on the brain.  The drawback is that the sleep produced as you metabolize that alcohol over the next few hours disrupts the REM sleep – which is the most restful sleep.  This lack of REM sleep will make the second half of the night’s sleep restless and fragmented.

Sleep Stealer No. 6:  Vitamin D Deficiency

The Harvard School of Public Health found that 12 percent of individuals with low vitamin D slept for less than 5 hours per night, and 57% of were awake for 90 minutes or more in the middle of the night.

Vitamin D acts like a hormone as well as a vitamin and appears to have an effect on the parts of the brain that have a role in sleep production.

Sleep Stealer No. 7:  Exposure to Light After Sundown (Melatonin deficiency)

“Exposing eyes to light during the evening stops the body from making melatonin, the sleep hormone” says Dr. Richard Hansler, PhD at John Carroll University.  The blue light from smart phones is the most problematic.  Electronic devices are potent sleep disrupters.

Sleep Stealer No. 8:  Stress

The stress response or the “fight-or flight” response activates the parts of the brain associated with attention and arousal i.e, it is designed to keep you awake.  Chronic stress can cause stress-related insomnia.  From a naturopathic perspective, chronic stress can also lead to adrenal fatigue or hypocortisolism (adrenal underfunctioning). In the early stages of stress, the hormones adrenaline and cortisol are released which are energizing –but both of these hormones increase urine flow.   If the secretion of these hormones continues at night, the sleep architecture is often compromised and you get up more at night to urinate.

Sleep Stealer No. 9:  Nocturia due to Adrenal Fatigue/Low Aldosterone

Getting up at night to urinate – even if you have limited your fluid intake before bed and if it is unrelated to medical conditions like benign prostatic hypertrophy or  infection – may mean that your balance of water and electrolytes if off.  With adrenal fatigue, the hormone aldosterone is undersecreted which causes the body to increase urine production by eliminating sodium – including during the night.  In someone with later stage adrenal fatigue, nocturia due to the lack of salt is common (lack of aldosterone).  In other words, if you are in adrenal fatigue and if you consume water without enough salt, your body may try to maintain osmotic balance by getting rid of some of the water – which wakes you up to urinate.

So what do you do to determine the cause of why you can’t easily fall back to sleep:

  1.  Have a thyroid panel done by your N.D. or M.D.;
  2.  Talk to your healthcare provider about feelings of depression and anxiety;
  3. Have a sleep apnea screen if warranted;
  4. Have your hormonal levels or hormonal metabolites checked in saliva or urine (not blood alone after menopause) e.g. estrogen, progesterone and a  4 – point cortisol;
  5. Don’t eat past 7 p.m., stop drinking alcohol several hours before bed;
  6. Have your Vitamin D level checked;
  7. Put your electronic devices away at least one hour before bed;
  8. Potentially have your melatonin level checked and supplement, if necessary;
  9. Reduce your stress level;  practice mindfulness and meditation;
  10. Correct Adrenal Fatigue/Hypocortisolism if warranted

Until next time…Remember…Your Body is the Matter of Your Mind – so be Mindful of what matters In Your Body.

Dr. G

Are You Suffering From Sludge?

In a previous blog, I mentioned the book “Ultraprevention” by Dr. Mark Hyman, M.D.   According to Dr. Hyman, there are Five Forces of Illness.  The First of these Forces is what he calls the “sludge” factor.  Sludge (from a process I like to call “sludging”) is a term that means the result of abnormal or incomplete digestion and absorption of food.  Many of us are deluded into thinking that eating “right” i.e., eating lean meats, fruits, vegetables and cereals while avoiding fatty foods,  means that we don’t have to consider the possibility that we are malnourished.  This is unfortunately untrue.   Diet is important, of course, but how your body processes food is as important as the food itself.

Digestion, the breakdown of food into its components is complicated and involves severalHuman internal organs key players – the most important being hydrochloric acid from the stomach, pancreatic enzymes and bile from the liver/gallbladder.  If all of these digestive factors are working well, then there should be no fats, carbohydrates or proteins in the fecal material.  If there is, then either the digestion or absorption process has gone wrong.  Many individuals, for example, say that they eat well – but have digestive problems like chronic diarrhea, constipation or abdominal pain that is unrelated to an overt pathology.

It is now known that there is a process, called endothelial dysfunction, which occurs in the lining of the stomach and digestive tract, the lining of the arteries, the lining of the bones, the skin and the blood-brain barrier .  The same factors that cause inflammation in the gut can also cause inflammation in these other areas.   When a patient presents with symptoms on the skin (like psoriasis or eczema), autoimmune reactions or demonstrated arterial disease, the first thing that an ND suspects is a problem with digestion or absorption leading to a state of malnutrition.  Malnutrition in this sense is the chronic lack of certain essential nutrients that are either not being supplied in the diet or less-then-optimally absorbed that are necessary for the optimum functioning of the system in question.

70% of our immune system is located in the gut because swallowing “germs” is one of their major entrance routes into the body.   Any protein that is not recognized as yours is considered a potential invader and attacked.  The last thing that you want is your body to react against a food component.

Incomplete digestion is the major contributor for the digestion of food sensitivities.  Food How Do You Feel Question 3d Wordssensitivities occur when a food (especially protein) is not digested fully.   These incomplete breakdown particles can enter the circulation and create an antibody response because they are seen by the body as a foreign protein.

One of the reasons food sensitivities develop is a lack of hydrochloric acid (or HCL) production by the stomach or enzymes by the pancreas.    HCL is necessary for the breakdown of proteins into single amino acids.  Single amino acids don’t trigger an immune response where tripeptides (three amino acids bound together) can.   HCL is also necessary for mineral absorption.  This is why individuals that are taking a drug like Tecta for overacid conditions on a daily basis will eventually suffer from osteopenia or soft bones – due to the reduction in mineral absorption.   It has also been related, I believe, to creating low thyroid conditions – probably for the same reason.

In summary, chronic health conditions are usually related to problems with “sludging” or abnormal digestion and absorption of foods.  This “sludge” interferes with the cell’s ability to optimally function and is one of the first signs of the beginning of illness.

In the next blog, we will talk about Force 2:  Impaired Metabolism or Burnout.

Until then……

Dr. Gatis

Optimizing Progesterone and Estrogen – Especially After Menopause

pretty senior woman relaxing on a couchIn the last blog, I mentioned the importance of progesterone to a woman’s health – especially after menopause.  The biggest question for a woman to ask is…How do I know which of my hormones are low and by how much?  Venous blood values after menopause are virtually useless when talking about monitoring estrogen and progesterone levels because they do not accurately represent the amount of hormone active in the target tissues.  The current way to measure the “functional” hormone level is by saliva or urine test.  Both are non-invasive and simple to do.  In general, saliva testing measures the “free” or “active” forms of the tested hormones at the tissue level directly, while urine testing measures the excretory metabolites of the hormones (from which the hormone levels are extrapolated).  I usually use the urine testing at least once during hormonal therapy – as it is important for the physician to monitor the ratio of certain estrogen metabolites for the patient’s protection.  I believe that it is important for every woman over 30 to have urine metabolite testing done at least once every five years to assess her tendency to certain cancers – whether or not she is considering natural hormonal therapy options or hormone replacement outright.


Taking hormones or substances that affect hormones must always be taken in the context of general health and the functioning of other glands in the body that affect the reproductive hormones.  Adrenal function and thyroid function should always be evaluated before any therapy is prescribed.  I usually suggest that a four-point cortisol saliva evaluation be completed at the same time as the saliva female hormones – as this determines the adrenal/stress response of the person.  As we have stated before, over-or-under functioning adrenal glands influence the production and/or the action of the female hormones.  In other words, chronic stress can affect a woman’s hormonal balance.  The saliva hormone evaluation is usually used before any therapy is prescribed.  I also recommend a thorough naturopathic workup to evaluate the current state of the body and the organ functioning– especially if the woman is considering Bio-identical Hormone Replacement Therapy (BHRT) –


When the saliva results are known the first line of defense is to attempt to stimulate the natural production of hormones if at all possible.  There are many herbal and homeopathic combinations, for example, that claim to “balance” female hormones, and many of them do reduce or alleviate troublesome symptoms like hot flashes and so on.  It is important, in my mind, to do a follow-up saliva test or urine test to make sure that the tissue levels of the estrogen, progesterone and testosterone are now within normal levels.  If not, the woman may be still be at higher risk for heart disease, and will not get the full benefits and protection that the right amounts of estrogen, progesterone and testosterone can give for the brain, heart and nervous system.  Many of the symptoms and signs of aging are related to, or made worse, by hormonal decline.  Therefore, optimizing your hormonal function as you age just makes sense – as long as you do it safely and under the supervision of your health care professional.

Until next time….

Dr. Gatis

How to Maintain the Benefits of Having a Period When You No Longer Have One ~ Part One

It is now time to talk about a woman’s hormones and the effect on her body as she gets older. Having a period is nature’s way of keeping you young. The optimum amount of estrogen and progesterone during the various phases of the monthly cycle have definite effects on a woman’s health and longevity.
The first half of a woman’s cycle is dominated by estrogen and the second half by Portrait of mature woman sitting in countrysideprogesterone. In this blog we will concentrate on progesterone.

A woman really begins to show her age when her periods become irregular and eventually stop. Why is this? In the middle of her cycle when the egg is released, the part that is left, the corpus luteum, becomes a progesterone factory. Progesterone gets the uterus ready for a possible implantation if fertilization occurs. When a woman ceases to have her period the most immediate change is progesterone deficiency. Even though some progesterone continues to be produced by the adrenal glands after menopause, in many ways you could think of it as “no period, no progesterone”.

What about estrogen? It has been shown that a woman’s estrogen does decrease at menopause to about 50% of that she would have produced at age 30. Estrogen is also of major importance, of course, but the big change to my mind is the initial progesterone drop – which immediately changes the optimal progesterone to estrogen ratio and often produces symptoms like hot flashes and other deficiency symptoms. In fact, it is known that a woman has a higher risk for breast cancer if she has a low progesterone to estrogen ratio. In addition, a low P/E ratio can create abnormal bleeding during peri- and post-menopause and an increased risk of uterine cancer.

So let’s talk about natural progesterone (progesterone with the same biochemical structure that your body produces) versus “progestins” which are synthetic progesterones (and do NOT have the same biochemical structure that your body produces). Natural Progesterone works on many tissues other than the uterus. There are receptors for progesterone in the bone, brain and blood vessel walls, for example. Natural Progesterone balances estrogen, has a natural calming effect, helps sleep, increases metabolic rate, increases scalp hair, lowers cholesterol, lowers high blood pressure, is a natural diuretic, normalizes and improves libido, is a natural anti-depressant and anti-inflammatory.
Therefore, symptoms of progesterone deficiency include: anxiety, decreased HDL levels, decreased libido, depression, insomnia, pain and inflammation, insomnia and osteoporosis.

To be fair, synthetic progesterone or “progestins” do have some positive effects that they share with Natural progesterone. Both build bone, help thyroid function, protects against endometrial cancer and normalize zinc and copper levels. This is where the similarity ends, however. Here is partial list of the side-effects of progestins that natural progesterone does NOT have: increased appetite, increased LDL (bad cholesterol), decreased HDL (good cholesterol), insomnia, irritability, weight gain, breast tenderness, decreased energy, decreased sexual interest, fluid retention and hair loss. In addition, progestins stop the protective effects estrogen has on the heart. Dr. Stephen Sinatra, a cardiologist, states in his book “Heart Sense for Women” states “I have found that synthetic progestins can lead to serious side effects in my patients, including shortness of breath, fatigue, chest pain and high blood pressure.

Progesterone is extremely important to a peri and post-menopausal woman. Her life may depend on maintaining optimal levels of progesterone as well as estrogen. In the next blog we will talk about how we may accomplish this. Until next time…..

Dr. Gatis

How to Naturally Increase A Man’s Testosterone Level

In the last blog, I talked about what testosterone does to maintain a man’s health (in addition to maintaining erections). Most men would probably choose to die doing the horizontal mambo – but would in their 80’s and not in their 50’s. Testosterone levels are extremely important to males. How then can we optimize these levels? To my mind, it is always better to attempt to raise levels naturally rather than initiate hormone replacement as the first therapy option – and testosterone levels fluctuate according to diet and lifestyle


Seven to Eight hours of sleep per night is extremely important to optimize testosterone
levels. A lack of sleep affects many important hormones and chemicals in your body including melatonin. Melatonin, in addition to helping you fall asleep is an extremely strong antioxidant and some researchers claim that melatonin production is somehow linked to testosterone production.


Men who are overweight convert testosterone into estrogen in their fat cells due to an enzyme called aromatase. In other words, having abdominal fat lowers a man’s testosterone and increases estrogen. Losing the extra weight can bring the testosterone back up because the fat-cell conversion of testosterone to estrogen is reduced and the normal ratio of testosterone to estrogen is restored.


Testosterone reacts to your body’s needs. When a man is physically active, the brain sends out the signal to increase testosterone in order to build muscles and bones. Take time to move your body. Walk, run, skate. Do Tai Chi. Remember the old adage “Use it, or lose it”. This is true whether you are using a regular muscle or the “love muscle”. Interestingly, only short intense exercise has been shown to boost testosterone while aerobics and prolonged moderate exercise do not raise testosterone levels.


When a man is “stressed” the hormone cortisol is produced. Chronic elevations of cortisol affect a man’s ability to create adequate levels of testosterone. Learn to relax from the brain on down. Spend an hour-a-day on an activity that isn’t work or exercise related. Learn meditation or self-hypnosis techniques.


Many medications affect testosterone level. Discuss the drugs you are taking with your doctor or pharmacist to rule out drugs as the cause of your symptoms or low testosterone.

I value your feedback and would like to know the topics that are pertinent to you.

In Health,
Dr. Gatis