The Four Types of Sleep Problems

There are four types of sleep problems, based on the pattern of sleep disturbance that you experience. These patterns can help you narrow down some of the contributing factors and lead you to solutions that will help you get a better night of sleep. Working on sleep can get complicated because sleep problems are quite specific, but sleep strategies tend to be generic. Today's goal is to help you zero in on what could be causing your issue so that you can find the solution more quickly.

Four Types of Sleep Problems: Difficulty Falling Asleep

Falling asleep is supposed to be as easy as lying down at night. You're exhausted from the day, you know you need sleep, but then you just lie there staring into the darkness.

Something clearly isn't right, but how do you know what? There are many factors that can contribute to this type of sleep disorder, so let's dive into the most common.

• Low melatonin—This problem mostly comes down to modern life. If you stare into a screen all day (like I do), it's pretty rich to expect your body to be able to make the sleep hormone melatonin, which uses nighttime darkness as a trigger. The answer here is not necessarily taking melatonin at bedtime, although that helps for some people. The answer is having a fixed wake-up time every day and getting 15 - 30 minutes of bright light, preferably natural, first thing. If you, like me, live in a climate that won't provide bright outdoor light first thing when you wake up, I suggest you try a light that mimics daytime for the first 15-30 minutes of your day. Also, giving your body two screen-free, low-light hours before bed is important. It's not easy, but so worth it.

• Magnesium deficiency—Magnesium is your body's natural and most important muscle relaxer. If you are low on magnesium, your body and mind stay tense and wound up, making sleep genuinely difficult. Other symptoms of magnesium deficiency can include constipation, leg cramps, muscle twitches, restless legs, and estrogen dominance.

• Iron deficiency—Iron deficiency makes you feel tired, weak, sometimes short of breath, and ironically makes it more difficult to fall asleep. Some people with iron deficiency also notice restless legs, a craving for ice, and that their skin becomes paler. Your iron levels are easily measured by your doctor. Make sure he or she tests your red blood cells and also your long-term iron storage level, called ferretin. For some people, improving iron levels improves sleep.

• Sedentary lifestyle—The modern world is great at wearing us out mentally. At the same time, we get zero physical activity, and if this is the case for you, it can seriously hurt your sleep. Even 20 minutes of exercise or activity during the day, especially earlier in the day, can help to get this issue back on track.

• Pain—Pain, especially pain that is better with motion or pain that prohibits lying in certain positions, can be a big detriment to sleep. In this situation, it is best to work with a doctor or care team who can help you manage the pain effectively. This might include massage therapy, physical therapy, pain medications, natural antiinflammatories like fish oil, bacopa, or turmeric, or therapeutic devices like the Bemer mat, red light therapy, or others.

• High nighttime histamine—Histamine is one of the neurotransmitters that helps you to wake up in the morning, but it can be triggered by foods and your environment as well. Other signs that histamine might be the problem include itching, waking up hot, a racing mind, and allergy symptoms. To help manage nighttime histamine, avoid high-histamine foods at bedtime. This includes aged cheese, fermented foods, leftovers, and alcohol. Also, taking a binder like activated charcoal after dinner can help to buffer the effects of histamine. Activated charcoal isn't a good long-term solution, but if it helps your sleep, then at least you know histamine is part of the problem. Also, if you've never taken activated charcoal before, don't be surprised if your stool is black the following day.

Four Types of Sleep Problems: Difficulty Staying Asleep

The perfect sleep looks like falling into bed, drifting off easily, and waking up in the morning feeling rested. But if that sounds like a fairy tale because you fall asleep and then wake up fifteen times, this is the section for you. There are a lot of things that can wake you up in the night; here are some of the most common.

• High cortisol—if you've been under a lot of pressure for a long time, then the system that takes the biggest hit is called your HPA axis. That translates to the hypothalamus, pituitary, and adrenal axis, and the glands that take the biggest beating are your adrenal glands. Your adrenals help your body respond to stress, but if you're constantly stressed out, then those poor babies are pumping out hormones for all they're worth. They get tired. We'll talk much more about this problem later in the season (or in a future blog post), but nighttime cortisol spikes are a common reason for nighttime waking. Often, they usually follow a pattern. I hear things like, "I wake up every morning at 4:00 am, and that's it. I'm awake for 2 hours, only to fall back asleep a half hour before my alarm." Resetting your circadian rhythm, with sunlight or a full spectrum light when you first wake up and two hours of low light before bed can help. Also, maintaining a regular sleep and wake schedule, as well as balancing blood sugars, because failing adrenals also cause blood sugar imbalance.

• Blood sugar imbalance—Whether your blood sugar is unstable because of your adrenals, your diet, or your genes, low blood sugar is a life threatening event for your body, and your body will wake you up for that. Suspect low blood sugar if you crave sweet or carb-type foods (bread, pasta, pastries, cakes, etc) or if you eat these foods in the evening. Also, if you wake up in the night hungry, or if you don't feel hungry, but eating makes you fall back to sleep easier. If you notice any of these in yourself, really focus on high protein breakfast and dinner. Maximum one quarter of your dinner plate can be a starchy food like pasta, rice, corn, or potatoes. The rest of the plate should be protein and vegetables and if the protein is a more carb-rich source like beans or quinoa, then don't add an additional starchy food. Also, if you're eating dessert, make sure it comes out of that quarter of a plate.

• Anxiety—Anxiety at night ties into your adrenals as well, because it is a good sign that your stress hormones are high. If you wake up at night thinking about something you forgot to do, or worrying about an event coming up, or just worrying, then it's definitely time to work on your adrenal health and also start to find tools to help with your anxiety. Keeping a pencil, paper, and book light by your bed can help if you're thinking about work or creative ideas - jot them down in low light and go back to sleep knowing that you won't forget them. If you're worrying about a loved one or something that is going on in your life, then learning some basic anxiety tools like meditation or how to break mental bad habits might help.

• Pain—Pain is a factor in waking up from sleep as well, but again this is best addressed by a pain management specialist or team, because pain is a many-headed monster.

• Restless legs or cramping—Restless legs or leg cramps can wake you up in the night, and it's typically a sign of one of three things. Magnesium deficiency, iron deficiency, or dehydration. Your doctor can test your iron, but the other two are best explored by you at home. There are blood tests for magnesium, but they won't show most magnesium deficiencies because your body will deplete your tissue magnesium to keep blood levels stable.

• Histamine—Histamine spikes in the night can certainly wake you up, and one of the most frequent causes is drinking alcohol in the evening. This can happen with any alcoholic drink because all alcohol raises histamine, but it is most likely with high-histamine alcohols like red wine, white wine, and beer. As mentioned earlier, taking some activated charcoal before bed can help, but it isn't a long-term solution. Some distilled alcohol is lower in histamine, but it's still alcoholic, so it still raises histamine to a lesser degree.

• Going to the Bathroom—Waking up once a night can be normal, but waking multiple times to go to the bathroom is potentially not normal. There are lots of causes for this - enlarged prostate, uterine or bladder prolapse, and others so your doctor or a urologist should evaluate it. Barring any structural problem, sometimes this comes down to timing and circulation. If you're drinking water too close to bedtime, that could contribute. Also, if your circulation isn't great then your kidneys get better blood flow when you're horizontal. In that case, doing more cardiovascular exercise and taking care of your heart health could help with the nighttime waking.

Four Types of Sleep Problems: Difficulty Falling and Staying Asleep

If you're having a hard time falling asleep and a hard time staying asleep then things get a bit more complicated. There are a few things to look into and we've touched on many of them, with the exception of true insomnia.

• True insomnia - True insomnia, or severe insomnia, is more rare than you would imagine, and this is characterized by difficulty falling and/or staying asleep that happens more than three nights a week for more than three months that another health problem cannot explain. Most sleep disorders can be explained by other health problems. However, often doctors don't look into magnesium deficiency, don't link sleep and blood sugars, or don't ensure patients are practicing good sleep hygiene. The best intervention for true insomnia, in my opinion, is sleep restriction and CBT-I, which stands for Cognitive Behavioral Therapy - Insomnia.

• Medication withdrawal or dosage changes - Medication withdrawals can disrupt sleep in a multitude of ways, and can cause difficulty falling asleep, difficulty staying asleep, or both. This is especially common with antihistamines, antipsychotics, antidepressants, and antiseizure medications, but can be caused by any medication. Changing doses up or down can create a panic situation for your body because it is impossible to help your body understand why something it relied on was there one minute and not the next (or not there one minute and flooding the system the next.) This is one of the most difficult types of sleep disorders to work with and should be handled by your medical team, along with a naturopathic doctor who can help your doctor balance the side effects of the medications.

• Anxiety, Pain, and Histamine - We've talked about all of these already today, but anxiety, pain, and histamine are all much bigger problems that can affect sleep in a myriad of ways, and getting to the bottom of the root cause can help you sleep soundly.

Four Types of Sleep Problems: Sleeping But Waking Unrested

If it feels like you sleep well, but you wake up unrested, then this is a different type of sleep problem altogether. It is more likely to reflect a larger, more global problem related to airflow and blood oxygenation. A few things to look into are:

• Iron deficiency anemia—If you don't have enough iron, then your blood doesn't carry oxygen effectively, which means you are constantly having to breathe harder and faster than normal to keep your brain alive. That sounds overly dramatic, but it's the truth. We've discussed some of the signs that you may need iron already, but it's also good to ask your doctor to test your red blood cells and your ferritin. If you don't want to go to your doctor, then go donate blood - they will do a quick check of your iron levels before you donate, so if you get denied for low iron, then you'll know to follow up with your doctor and get on a good supplement routine.

• Sleep apnea—Sleep apnea is a sleep disorder in which your body wakes up frequently at night because you stop breathing. This can be because something blocks your airways, like soft tissue in your throat, mucus, or even the weight of your body on the muscles that help you breathe. It can also be caused by a more central issue in which your brain momentarily forgets to send the signals for your body to breathe. Either way, the best treatments are devices to open your airway by changing your jaw position, or a CPAP machine, which adds oxygen to your sleeping environment via a mask or nasal cannula. The best course of action here is a sleep study from your doctor, who can advise you on the right path forward.

• Mouth breathing—Mouth breathing is a really poor way to oxygenate your blood, and if you're a chronic mouth breather at night, then your sleep quality can suffer for it. There is a technique called mouth taping (that is exactly what it sounds like - it's taping your mouth shut at night so that you're forced to breathe through your nose), that can improve your sleep quality. Just be sure to use an appropriate tape that won't bother you during sleep, and that will break away if you have to open your mouth for some reason.

Knowing which of these patterns your sleep falls into can help you begin to untangle the reasons for your sleeplessness.