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