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clear search termsCommon Roots of Poor Sleep
We all know it: high-quality sleep is vital to every client’s healing. While the body appears from the outside to be still and inactive, sleep is a time when the body is quite busy. During the night, we restock our supply of hormones, process significant toxins, repair damaged tissue, generate vital white blood cells for immunity, eliminate the effects of stress, and process heavy emotions. Unfortunately we have an epidemic of poor sleep – from trouble falling asleep to often-interrupted sleep to actual insomnia. There are, however, several straightforward remedies you can offer your patients in this area. Whenever a new client is struggling with sleep, it is always a critical first priority to address in their healing journey. Sleeping soundly will increase your patients’ motivation to make further lifestyle changes (e.g. when well rested, it is always easier to eat more healthily). And your help in making it happen will increase your credibility with them substantially.
We fall asleep largely due to the gifts of the pineal gland, a small ant-sized lobe near the middle of our skull in the interbrain. Following our circadian rhythm, the pineal gland secretes a neurotransmitter and hormone called melatonin. Melatonin suppresses the activity of other neurotransmitters and helps to calm the brain (in part by countering the stress hormone cortisol). And as we become more drowsy, the brain slowly begins to turn off our voluntary skeletal muscle functions, so we don’t move around too much and try to act out our dreams or disrupt the body’s internal revitalization work (also why it’s so hard to move your limbs or shout out in response to a nightmare).
For ideal sleep, melatonin should be rising steadily and cortisol should be rock-bottom low at bedtime. But there’s a catch: the pineal gland secretes melatonin largely in response to darkness. And our evening cortisol levels are lowest in environments with low noise. With our addictions to TV, video games, and email and social media in the evening, however, our choices can get in the way of these natural pro-sleep chemical shifts. These devices mostly display full-spectrum light which can confuse the brain about whether it’s night-time or not. We also, unfortunately, tend to watch shows or view email that can be stressful (e.g. the evening news, a crime show, work email, or ever-longer to-do lists). Digesting a heavy meal eaten later in the evening may also impair sleep.
So the first thing we can offer our sleepless patients is support with their “sleep hygiene”. You may be amazed at how often this is all they need in order to get better sleep. Help them to identify more calming, quieter evening activities (e.g. reading a book, taking a warm bath, going for a light stroll outdoors, playing with a pet, folding laundry). I recommend no email, TV, next-day-planning, or stressful conversations in the full hour (minimum!) prior to bedtime. If noise is an issue, recommend soft foam ear plugs or the white noise of a fan. It is also important for the bedroom not to be too hot, as this can disrupt sleep during the night. Herbal tea (e.g. lavender, chamomile, passionflower) can also help one to relax and set the tone for sleep. Consider also recommending no food a full two to three hours before bed and no caffeinated food or drink after 2pm in the afternoon (e.g. tea, coffee, soda, chocolate, mate). Many patients are stunned to realize how much that mid-afternoon coffee or a later-evening, heavy meal prevents sound sleep. Here is a helpful patient handout on the power of Sleep Hygiene.
There are definitely many cases, however, where pro-sleep behavior is simply not enough. For some clients, their brains simply aren’t able to make enough melatonin to ensure solid sleep all night long. Or there is a chemical imbalance preventing sufficient relaxation.
- If they have trouble falling asleep, consider 300mcg or 1mg of melatonin taken 30 min. prior to bedtime (start with the lowest dose for several days before increasing, as this is often enough; taking too much will result in grogginess the next morning). This is safe and effective for short-term use.. Note that melatonin actually helps also to reduce blood pressure during the night too, a key respite for patients with hypertension. Use of beta blocker medications or frequent use of NSAIDs may deplete melatonin and cause these sleep difficulties. If it doesn’t help, however, then there may be a different imbalance at play. Please read on…
- If your client falls asleep fine but awakens in the middle of the night and cannot easily go back to sleep, their problem is likely an insufficient, steady supply of melatonin throughout the night. Giving them regular melatonin before bed probably will not help much. Instead, consider sustained release melatonin or 100-200mg of 5-HTP (5-hydroxytryptophan) before bed. The body makes melatonin from a neurotransmitter called serotonin. And serotonin synthesis requires the amino acid tryptophan (which may be depleted in those with inadequate protein intake or those with ongoing infectious challenges). 5-HTP is a precursor to serotonin that, in a healthy body, can be converted to melatonin a few hours later. A steady flow of melatonin will help patients to sleep more deeply, soundly, and without interruption. Note: do not recommend 5-HTP to any client taking an SSRI or SNRI (or other serotonin-enhancing) antidepressant or sleep medications without their physician’s oversight (e.g. Zoloft, Trazadone, Wellbutrin, Ambien) as there is a risk of them developing serotonin sickness.
- If a client has trouble with overnight “hot flashes” (especially if they are not perimenopausal/menopausal women), then the cause is usually abnormal cortisol rhythms. If the flashes occur in the later hours of night (e.g. 2-4am), that is usually associated with high cortisol that is rising to meet the day early and aggressively (showing that the body has been primed to expect very stressful circumstances). Significant, sustainable stress relief is key. Night-time intake of calming adaptogenic herbs can often be helpful (e.g. holy basil, ashwagandha, magnolia, l-theanine e.g. Xymogen’s “CortiSolv”). On the other hand if the hot flashes are earlier in the night, especially if they are associated with hunger, these might be due to low cortisol and thus low blood sugar overnight during the natural fasting window that occurs then (the same dynamic might also be the result of hyperinsulinemia). The flash is due to a surge of epinephrine to force blood sugar back up to an acceptable level. A bedtime snack that includes some carbohydrate and healthy fat might be helpful in the short-term (e.g apple with almond butter).
- If a patient has full-fledged insomnia, a combination of melatonin and 5-HTP (yes, you can take both at the same time) is often quite helpful in combination with the sleep hygiene methods mentioned above – at least temporarily while you are helping them to reduce chronic stress and increase primary food satisfaction.
- If a client has trouble getting stressful thoughts out of their minds at bedtime or cannot sleep due to pain, it is often because of an imbalance of excitatory and inhibitory neurotransmitters in the brain (specifically glutamate and GABA, respectively). They will likely benefit greatly from taking calming herbs one to two hours prior to bedtime. There are many blends available, and we recommend in particular an ashwaghanda and/or holy basil anchored formula. Our lives overall in modern times tend to create glutamate-dominant dynamics which can challenge the brain to calm down and allow sleep. The conversion of glutamate to GABA especially requires as cofactors both magnesium (a common insufficiency, with stress increasing urinary loss) and Vitamin B6 (depleted by several types of drugs, especially oral, estrogen-containing medications/contraceptives). L-theanine can also help to increase GABA activity.
- If a client has trouble sleeping when they have had an alcoholic beverage(s) in the evening, this is usually because alcohol interferes with GABA/Glutamate balance in the middle of the night. Initially alcohol increases GABA (inhibitory) and blocks Glutamate (stimulatory). Once the alcohol is metabolized and its effects wear off, however, there is a rebound effect that increases glutamate which wakes you up and makes sleep light and/or interrupted the rest of the night. Taurine is an amino acid that acts in the brain as a calming neurotransmitter and may be taken at bedtime to ease and reduce the rebound effect. Taurine increases GABA receptor binding and thus promotes an inhibitory state. ~ 1000mg of taurine prior to bedtime may help to help reduce this interference.
Of course, sleep medications may be useful for acute situations when one is going through short-term trauma. Unfortunately, all of them work essentially as mild sedatives and are not addressing the root cause of any long-term sleep disturbance. They also come with a wide range of side effects that render them not ideal for long-term use – from dry mouth to stomach ache to a hangover-like fatigue the following day. But it’s also important to make sure your patients understand that many of these medications can increase the risk of both cancer and death – even with just occasional usage. If your clients wish to stop taking these medications, encourage them to do so slowly (weaning) to avoid any chemical backlash from neurotransmitter imbalance.
Without restful sleep, sustainable healing in the body is nearly impossible. Plus it can be challenging for any of us to consider lifestyle change when we are exhausted, especially chronically, due to poor sleep. Consistent, deep, sustained sleep is a seemingly simple, not-so-sexy but scientifically anchored imperative for getting well and staying well. Help your clients to be wildly satisfied by addressing poor sleep as an initial priority in your work together.
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61 Questions for “Common Roots of Poor Sleep”
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SAFM Team says:
Yes indeed! You may consider selecting someone from our Practitioner Directory to support your needs: https://practitioners.schoolafm.com/ .
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I have a client (35 y/o female) who wakes up exhausted – it takes her 30 min to get out of bed. In going through the Adrenals and Thyroid Myths and Truths Deep Dive course, it was highlighted that too low of cortisol is most likely causing this, indicating a hypothyroid state of parasympathetic dominance, giving her the feeling she can’t get out of bed. Further, in the course you mention GI issues, and/or poor liver detoxification could be triggering such a feeling. Wondering what else should I consider with a client like this to help her wake up a bit easier?
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19.1
Great question, Shay. Yes, there are multiple reasons why someone can have issues with waking up rested in the morning and taking a long time to get out of bed:
– Insufficient hours of sleep before midnight.
– Waking up in the middle of the sleep cycle can make someone feel particularly groggy; you could recommend using a sleep cycle calculator such as this one: https://sleepcalculator.com/
– Uncomfortable sleeping conditions: a bedroom that’s too hot or too cold, a snoring partner, TV that’s on all night, sources of light, etc.
– Allergies – many people sleep with their pets despite being allergic, this can cause either cortisol or adrenaline spikes
– inflammation – check for any sources of mold (improperly maintained humidifiers can be a source of that) or toxins in the environment
– sleep apnea, undiagnosed or untreated will lead to poor sleep quality and morning grogginess
– general toxicity – night time ‘liver hour’ in TCM is said to occur between 1 and 3 AM
– cortisol that’s too low in the morning, as you point out, could lead to the parasympathetic dominance, vs healthy sympathetic, morning state, which can result in low thyroid function
– excessive melatonin especially if the cortisol is on the low side – inquire about the use of any sleep-aids or test for cortisol-melatonin balance using DUTCH Complete or Plus
Hope this helps.
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I see you suggested tryptophan with vitamin B6 for a question above, just before bedtime. Wouldn’t taking B6 before bedtime be too stimulating? I was under the impression that B vitamins should be taken with food, earlier in the day as they can be stimulating
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18.1
Yes, vitamin B6 and tryptophan are two main building blocks for making serotonin and melatonin which helps with staying asleep. Indeed, B vitamins, in general, can be stimulating and we generally advise clients to take those with food during the day, but when you are trying to support your client with having sound sleep during the night and their issue is low levels of melatonin, taking this combination of nutrients works very well.
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Tammy Ruggiero says:
Do you have any experience with sleep paralysis and can you offer any solutions? Thanks!
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17.1
Sleep paralysis is a form of interruption of REM sleep. If you wake up before an REM sleep cycle is finished, your body may not regain regular function in sync with your mind. In normal sleeping, muscle control resumes before a person become consciously awake. There is a likely genetic connection, and stress/trauma are known triggers and exacerbating factors. Since GABA and Glycine are the two calming neurotransmitters at play in allowing atonia during sleep, perhaps there are issues with imbalance in calming vs. stimulatory neurotransmitters or issues with GABA/Glycine receptors or reuptake (perhaps where genetic might play a role?). This will be interesting: http://www.jneurosci.org/content/32/29/9785.long
From an interconnectedness perspective, I would think about the importance of oxidative stress and the likely role of neuropathy of some type. Look upstream as to what might be contributing to related factors (e.g. toxicity, B12 deficiency, B6 deficiency, EFA imbalance, poor methylation, poor glutathione synthesis, and – of course – sleep hygiene and stress levels, as well as prior trauma). If this only happens in the middle of the night (vs. morning), I would also think about checking melatonin and overnight cortisol levels (e.g. as part of DUTCH testing). Alas, I do not have any direct experience with supporting clients with this dynamic. However, I am happy to offer some resources which might be helpful. First of all, I find this to be an interesting story: https://www.thecut.com/2016/07/a-neuroscientist-tried-to-help-me-overcome-my-sleep-paralysis.html (which points to some interesting foundational truths as well as the enigma of the dynamic). This is foundational and quite detailed: https://www.sciencedirect.com/science/article/pii/S1087079217301120 .
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Lance Templet says:
I fall asleep very quickly, no issue going to sleep. But I awaken several times throughout the night and find it a challenge trying to go back to sleep. Then I am finally up at 3:30 am and
That is it, I am up. What supplements would you recommend I try?
Help, want to sleep throughout the night.Thank you.
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Alas, we are unable to give any type of personal insight in this venue. Given what you describe the root cause of your insomnia may be either low serotonin/melatonin production, high night-time cortisol, issues with blood sugar stability, toxicity or food sensitivities. I would start exploring those that resonate with you with appropriate testing or food elimination diet.
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A question about a 17 year old female, currently treated for anxiety by low dose betablockers due to reporting some palpitations during anxious periods, with some improvement in overall anxiety (no other drugs taken). She reports waking up nightly and has a great deal of trouble getting back to sleep, consequently exhausted most of the time. She has had frequent nightmares for as long as she can recall. Although she states she has no trouble falling asleep initially, due to typical teenage evening activity of constant screen time, her usual sleep time is around 1am. Would it be wise to start her on just 100mg 5-HTP or do you think melatonin should also be tried – in other words would the melatonin likely help with earlier sleep time, or is her screen time use likely going to override its benefit and therefore be useless in bringing on some earlier sleepiness? In terms of the 5-HTP how long is it recommended to use it for if it is beneficial? Also what are some upstream causes to look for other than than the anxiety, which incidentally, she has been seeing a psychologist weekly for several months. Menses started at almost 17 years of age, vegan for 3 years, on the low side of normal weight with BMI 17, mostly organic lifelong diet, nil vaccines. Nil lab work, has a severe needle phobia
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I would not jump to 5-HTP because there is too much low-hanging explanation elsewhere. And the presence of nightmares makes it highly unlikely that there is a shortage of serotonin (to promote melatonin synthesis). Too much screen time and late bedtime are undoubtedly a major part of the problem. Anxiety is likely driven by estrogen dominance and exacerbated by a diet that is very high in copper (vs zinc). I would supplement with ~20g zinc picolinate and 200mg magnesium glycinate twice daily (AM and PM) and a good B-complex once daily – all with meals. I would use something like l-theanine (300-400mg) in the mid-evening as a way of calming the brain and encouraging earlier sleep, but to your point, the sleep hygiene is key. And of course, at her age, she has to WANT the benefits of lifestyle change. I am also glad she is getting some counseling, as the ongoing nightmares might be a sign of suppressed and/or unprocessed trauma/phobia. Make sure her make-up and personal hygiene products are high-quality, clean brands.
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Veronika Bar says:
I see the contraindication of taking 5-htp while on SSRI. What would be other options to address sleep for a client with a 20y history of various SSRIs, going to sleep fine, but waking too early (4am) and not feeling rested? Thank you
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Given the long history of SSRI use, it is indeed quite likely that there is some depletion of serotonin production which might inhibit optimal melatonin synthesis over night. I would start by exploring a combination of tryptophan and activated Vitamin B6 (P5P) right before bedtime. If you are a Semester student, there are numerous posts on this topic in the Q&A treasure chest; just search individually for “SSRI” and/or “tryptophan” as keywords. And of course, working on consistently optimal “sleep hygiene” is key for keeping a balanced HPATG axis to prevent cortisol fluctuations from wreaking havoc on his body’s usage of melatonin.
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Eileen Ramos says:
When taking 5-HTP an hour before bed, is that with food or w/o food. The bottle I have purchased recommends with food. And if we are also recommending 300mg 2x/ day with food then can the person take both Magnesium and 5-HTP one hour before bed with a tablespoon of almond butter/ healthy snack?? TIA
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I would recommend taking the magnesium with dinner. Then taking the 5-HTP on an empty stomach before bed. I would avoid the night-time snack entirely (unless this person has dramatic blood sugar issues and is vulnerable to low overnight blood sugar troughs, but I am suspicious you are mentioning it just in the sense of putting something in her stomach for the 5-HTP, which again, I wouldn’t do). Be sure you are using a 5-HTP with B6 ideally in the P5P form to make sure you are getting a good conversion to actual serotonin e.g. Designs for Health’s 5-HTP products (comes in both 50mg and 100mg dose increments).
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Hi Tracy! I have a client whom I have been working with for 9 months. When she started with me she was sleeping 3-4 hours a night and consistently waking up for the day by 3am (could not fall back asleep ever). She responded well to 5-HTP 200 mg along with a lot of work on removing food sensitivities, changing up diet, exercise, sleep hygiene, etc. She has worked on regulating blood sugar, has Hashi’s and thyroid is more balanced and adrenals functioning better but oddly as it neared fall she found herself waking earlier and earlier again. When we started together she was needing a two hour nap daily just to make it until dinner and then was back in bed by 8pm. That all improved and she said she was back into the land of the living! She is a teacher and did start back up at work and is not stressed, loves her job, loves her life. But again, this waking up earlier and earlier. Now after a month of it and then throw in daylight savings (which her body cannot adjust to at all so she is now up at 3:30am for the day) she is finding herself exhausted and needing naps again. She is discouraged and feels like she is backtracking. I am not even sure what to suggest she try since she has worked on so many things already and made improvements. She had Type 2 Diabetes and brought her insulin levels back down and blood sugar is decent. She eats very low glycemic and has never reintroduced any foods she was found sensitive too. She does not consume alcohol or caffeine.
Any thoughts or suggestions? Thank you!
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Fascinating! Whenever a patient experiences a “reversal” of symptoms after a dramatic improvement, while maintaining the healthier choices, we have to think about unintended consequences of our supportive recommendations. The three things that come to mind to me in this case (and I encourage you to think of others) include: (1) Is her diet TOO low glycemic, so it’s too stressful on her body and causing higher overnight cortisol that is getting her up early again? (2) Did she eliminate her food sensitivities, prioritize new foods w/o sufficiently healing her gut, and just develop a NEW set of food sensitivities which are causing high cortisol? (3) Did she lose weight and put more toxins in circulation that she is not well able to clear (imbalanced Phase 1 & 2 detox) that is promoting oxidative stress and thus higher stress hormones as well? If she’s using an adrenal blend at night, make sure it doesn’t have rhodiola in it; some people find that quite stimulating. Probably best for her to not take any nutrient supplements (other than maybe magnesium) with dinner. Hope that helps!
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Jk Turnage says:
What is your opinion on the use of kava for sleep? Particularly as a treatment for severe restless legs.
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Alas, I don’t have much experience at all using kava as a supplement. This is a reputable resource which might be helpful to you: https://examine.com/supplements/kava/ . I do believe it’s important to use a source that is third-party validated for purity and to confirm lack of toxic contaminants. I also recommend checking liver enzymes after 1-2 months of use to ensure no hepatotoxicity with a unique individual – sooner if there are any liver concerns at all. Of course, kava is only a triage, “rapid relief” treatment; it’s not getting to the root cause of something likes Restless Leg Syndrome, which is usually in the gut. The incidence of RLS is very highly correlated with SIBO in clinical studies. In the functional medicine model, an agent like kava might provide some temporary support, but the goal would be to identify, address, and get rid of the true root causes.
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KE says:
Hi! Thanks for the great article. You referenced something about low cortisol causing people to wake in the middle of the night; I wake between 2 and 5 times most nights. I am almost 40 and I’ve had problems sleeping for 15 years. I have trouble falling asleep and staying asleep. I have great sleep hygiene (no TV in room, dark, white noise, earplugs, and try to stay away from screens prior to bed time). I’ve been on zolpidem tartrate for 8 years, have weaned down to 3 mg to just help me fall asleep, and have been able to get off of it for a few weeks (but was sad to have to go back on). I was on 10 mg Prozac (lowest dose) for 7 years but stopped that in the Fall. I have tried 5-HTP and L-Tryptophan. I have tried phosphorylated serine (it helped me sleep the first night, but after that seemed to make things worse.) I have tried Rooibos tea, melatonin (slow release up to 3 mg) and Benesom from Metagenics. I think the latter two help a bit but I can count on one hand the number of nights I’ve slept a solid 6 hours in the past 8 years. I have heterozygous MTHFR a1298c, and homozygous COMT and MAO-A. I sleep a little better the few nights after I get my period. I also read your article on NAC… I have tried L-Theanine but never tried these together. If you have any thoughts on what I should try next, I’d greatly appreciate it! (P.S. I’m on a paleo type diet and also have had problems with acne recently).
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Oh my heart goes out to you with such lack of sleep! It’s such a powerful and necessary part of wellness; I appreciate your continued focus and experimentation to get to the bottom of your unique case. What I most want to recommend is that you find a practitioner trained n functional medicine who can partner with you to do the appropriate testing to fully assess what is holding you back. Indeed, both high *or* low cortisol can impair sleep: the former due to cortisol’s interference in the *action* of melatonin (fight or flight, essentially) and the latter due to low blood sugar. And/or you might also struggle with an overload of stimulatory catecholamines (e.g. adrenaline) thanks to your COMT SNPs. And/or you might lack a sufficient steady supply of activated vitamin B6 to help your body make adequate melatonin throughout the night. Or given you feel you sleep better to some degree based on your menstrual cycle, you might struggle with estrogen dominance the rest of the month – which can also impair sleep. If I were you – or supporting you – I would want to pursue two types of tests: a DUTCH comprehensive hormone test (which would assess both sex and stress hormones) and a urinary Organic Acids test (e.g. Genova’s Organix or ONE profile) which would share neurotransmitter metabolites as well as cellular, functional nutrient sufficiency markers. With this data in hand and savvy interpretation, I think you would have clear answers. In the interim, given all your share, if I were you (and I’m not; but if I were and had the symptoms you describe – knowing nothing else) I personally would do four things: (1) Eliminate caffeine from my diet 100% (not just coffee but black tea and chocolate too). (2) Focus on the cortisol/adrenaline connection and use Xymogen’s “CortiSolv” about an hour before bed (and 2 caps at once vs. rec’d one). (3) Don’t drink any liquids at all (minus a few sips to take capsules) after 7:30pm. (4) Make sure my magnesium level is optimal (ideally “RBC Magnesium” (not serum) is in the upper third of the reference range and no lower); if no data, I would take 400-500mg magnesium taurate with dinner. I wish you the very best of wellness!
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Chris Kaldy says:
Is there harm in taking the valerian root and ashwaghanda for months on end, or any of these combinations?
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No, not that I know of, and certainly we should prioritize “whatever works” in helping a unique individual to get a sound, lengthy night of sleep. However, I do believe the focus as we move along should really be on identifying and addressing the root cause of issues with sleep, as they tend to manifest in other areas of life as well (e.g. poor sleep hygiene, intake of stimulants, food sensitivities, suboptimal sleeping environment, high evening cortisol, too high or low overnight cortisol).
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One of my clients has recently discovered that he snores, because he could hear himself doing it in the middle of the night. Could you explain what the connection is between snoring and sleep apnea and more broadly whether snoring is a sign of poor/interrupted sleep that we could do something about? Thanks!
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Yes, they are closely related in many cases where sleep apnea is accompanied by snoring during the breathing phases of the apnea. Of course, both can wreak havoc on the body via lack of both oxygen and restorative sleep. The most common causes include physical impingement of airways, often secondary to obesity, and inflammation of airways, often secondary to allergy or sensitivity (e.g. seasonal allergy, mold in home, food sensitivity). Since you are a current study, you will want to be sure to read this prior Q&A post (https://schoolafm.com/ws_qa/sleep-apnea/) as well as a prior one as part of a case study, capturing the coincident dynamics I often see at play (https://schoolafm.com/ws_qa/obesity-testosterone-and-andropause/). For a man in this case, I would think about testosterone level, insulin level, weight (and more important body fat), and allergy/sensitivity. It’s key to be aware of sleep apnea, as its a key contributor to downstream heart issues when left unaddressed. I would recommend a clinic sleep study (to confirm either way), and if necessary, I am indeed a fan of CPAP and related devices to support body functioning while the root causes are being assessed/addressed.
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Anthony Llabres says:
Personally I find many folks are suffering from insulin resistance and hypoglycemia at night. LOW blood sugar will cause a surge in cortisol/adrenaline and poof, you’re awake. Resolve blood sugar dysregulation and they sleep through the night assuming good pre bed hygeine. Good stuff!
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An excellent point! For my clients with insulin resistance, I often recommend a before-bed snack of some carbohydrate paired with healthy fat (e.g. a small apple with a tablespoon of almond butter), and this seems to help quite a bit while we are working on reversing the insulin resistance. I will add to your comment that the moderate stage of insulin resistance is often the worst – when fasting insulin is quite high – and thus fasting blood sugar can be driven too low. I agree 100% that this can be a significant cause of insomnia…especially if there is also low cortisol. Because of cortisol’s key role in keeping blood sugar stable during times when we fast (such as overnight), suboptimal cortisol can definitely lead to blood sugar lows. Then – as you well say – the body must remedy the blood sugar drop by sending out a surge of epinephrine (or adrenaline). And we wake up.
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This small snack before bed can also work for people with low cortisol during the night yes?
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Yes – definitely!
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Peter says:
What would you recommend for a client who has the opposite reactions? I know a person who tried both 5-HTP and melatonin individually for better sleep, and both drugs absolutely prevented all sleep for as long as they were taken… days and days. No other medications.
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Oh, great question! I would say that low serotonin/melatonin is clearly not an issue. And the reaction is a good example of the fact that more isn’t better, especially of neurotransmitters and hormones. It’s more likely that high epinephrine, high cortisol, or very low cortisol is at play. OR too much stimulant intake earlier in the day (e.g. 3pm coffee or 6pm dark chocolate). Just going off this data alone, I would do a salivary adrenal hormone test to see what targeted support is needed. Eliminate caffeine entirely – or at least nothing after ~11am). Do an experiment too of cutting out alcohol.
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Aren’t our bodies interesting? Yes, this person already consumes zero caffeine and zero alcohol; never has. No supplements currently either. Had insomnia with an SSRI but was able to sleep with GABA-ergics like Ativan. All hay fever and seasonal allergies completely vanished on onset of depression; had a terrible reaction to inositol. Doesn’t tolerate B-complex well either. Also has vitiligo. I wonder if it’s overmethylation?
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Ah – fascinating, indeed! The fact you share – that allergies disappears upon depression onset – is vital information. Low serum histamine (and the subsequent external signs, as you mention) can indeed be a sign of over-methylation. What can happen in these cases is the slow evolution of copper toxicity, which exacerbates anxiety and can definitely create insomnia, especially due to overproduction of catecholamines. And to your point, inhibitory agents such as benzos are usually quite effective. If possible, I recommend specific labwork: RBC Zinc, cerulosplasmin, and RBC copper. Pyroluria might also be involved (which would compound the need for more zinc, as well as more Vitamin B6, esp. in its P5P form). Night-time agents such as l-theanine, taurine, and NAC are likely to be helpful simply by calming epinephrine action and calming the GABA to Glutamate conversion (promoting inhibitory action in the brain). A multi-sample salivary cortisol test would confirm to what extent inappropriate cortisol is contributing, and this can often be very well managed with appropriate adaptogenic herbs. I hope this is helpful, and I appreciate your sharing. A great case study!
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Sherry says:
So I have been having sleeping issues for awhile. I have tried all of these things with no real success. I will be ok for awhile then hit a real bad patch of sleep. Where I wake up constantly and have trouble going back to sleep only to wake up again and again. After a couple nights of this I feel like something is surging through my veins and my heart races. At that point what would you recommend? I have had my neurotransmitters tested when I am in this state and they were all very high.
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5.1
Hi Sherry – Given what you share, my suspicion is you wrestle with one or both of two things. If your “bad patches” align in any way with monthly menstrual cycles, then your hormones might be directly affecting your neurotransmitters. In this case, you might find this to be helpful: http://www.webmd.com/women/pms/features/why-pms-gives-you-insomnia . Otherwise – and what I think is more likely – you may wrestle with surges of epinephrine/norepinephrine during the night (what we like to call “adrenaline”) due to having too low of a cortisol level overnight. Have you ever checked your free and metabolized cortisol levels? You can order your own test kit for this type of thing, and you want one that measures cortisol multiple times during your waking hours (e.g. urinary hormone metabolite test such as DUTCH Complete or DUTCH Adrenal https://dutchtest.com/product/dutch-complete-2/ ). Cortisol can dramatically impair sleep if it’s either too high or too low, and this kind of test will help you understand better your cortisol levels before sleep and overnight. I believe this would be a critical piece of information to learn about yourself. Of course, the more sleep-deprived you become, the worse the hormone imbalance becomes, with adrenaline surging even more often in reaction to the stress of being exhausted. It’s important to get to the true root cause of the imbalance and address it. A skilled health coach can help you to navigate this exploration a bit more.
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4
Another question. How would we identify whether waking up in the middle of the night is caused by a melatonin issue or a low cortisol issue in the absence of any salivary testing?
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4.1
Great question. Ask your client if they ever go to the fridge for food or drink (besides water) when they wake up; that can be a subconciously-motivated choice when cortisol (and thus perhaps blood sugar) is low. Otherwise, the easiest way is to support with 1mg melatonin or 50-100mg of 5-HTP and see if the issue is resolved.
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4.2
Great question! Ask your client if they ever go to the fridge for food or drink (besides water) when they wake up; that can be a subconciously-motivated choice when cortisol (and thus perhaps blood sugar) is low. Otherwise, the easiest way is to support with 1mg melatonin or 50-100mg of 5-HTP and see if the issue is resolved.
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3
Thanks for your prompt answer! Ok so using 5 htp before bed with a client with higher than normal a.m. cortisol should be ok? It’s just the higher cortisol at night where the l tryptophan is a better option?
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3.1
Typically, yes. But I recommend experimenting either way until your client gets relief. Occasionally I will find a client with mid-normal cortisol function who still gets stimulated at night with 5-HTP but gets great benefit from using l-tryptophan. A great reminder that we can plan our recommendations based on general tendencies but every client is unique! Thanks for your question.
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2
Question about the 5 htp and cortisol relationship. I notice you suggest 5 htp for clients that can’t stay asleep. If a client has high cortisol in the morning would 5 htp be contraindicated before bed?
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2.1
Great question, Heather! I believe you are a SAFM member, so you can access a targeted Q&A on this exact topic in the Membership Database: https://schoolafm.com/ws_qa/supporting-serotonin-tryptophan-vs-5-htp/ . Ultimately what you want to know is the full circadian cycle of cortisol. A high first-AM level may be followed by a precipitous drop and very low levels throughout the rest of the day (a clear sign of greater adrenal dysfunction). For a client who has elevated evening and/or night-time cortisol, I would use l-tryptophan instead of 5-HTP. Clinical research shows that 5-HTP can increase cortisol moderately. In cases of individuals who have very low cortisol, this can actually be of great benefit, especially of avoiding the middle-of-the-night blood sugar drops that can cause those with low cortisol to sleep quite poorly.
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1
Tracy-
Hi! Hope all is going well. Missed your call the other day as I was at work. Hope I can listen to a replay.
I have a client who has no trouble going to sleep but wakes up in the night. She has tried what you are suggesting here and says she is not stressed, has good pre-sleep hygiene and doesn’t drink alcohol.
What about food sensitivities as a possible cause? I have yet to go deeper with her re primary food (she did the circle of life and claims she is close to the outer edge on most things) and this may be at the heart of it all, but for now I am wondering about food sensitivities.
Let me know what you think.
Hope you are coming north this fall!
Jean-
1.1
If there is good sleep hygiene and no alcohol AND a client has already tried 5-HTP, then I encourage you to look at the potential role of cortisol. Low cortisol at night can cause someone to wake up due to low blood sugar (which causes an epinephrine surge). Food sensitivities can be involved in this cortisol vein because ongoing intake of foods to which our body responds with antibodies and inflammation can definitely cause dysregulation of the HPATG axis over time (in the same way that any other sustained stress would do). So yes, I would definitely explore food sensitivities; they can have dramatic, far-ranging negative impact. But I would try 5-HTP first in order to ensure that inconsistent/insufficient production of melatonin throughout the night is not a primary cause. If low cortisol is involved, then consistent, deep, healing sleep is critical for that healing.
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Hi – Ive been having issues with getting and staying asleep. I just got my Dutch results and would like feedback on what supplements to take. Is there someone I can contact?