The Four Types of Sleep Problems

Sleep problems can be divided into four main categories based on the pattern of sleep disturbance that you experience. These patterns can help you narrow down some of the contributing factors in your sleep trouble. Working on sleep can get complicated, because so much of the advice is generic, when sleep problems are actually quite specific. 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.

Difficulty Falling Asleep

Falling asleep is supposed to be easy as laying down at night. You’re exhausted from the day, you know you need sleep, but then you just lay there staring into the darkness. Something isn’t right. There are a number of 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, properly. The answer here is not necessarily taking melatonin at bedtime, although that helps for some people. The answer is actually 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, it’s important to give your body 2 screen-free low light hours before bed. It’s not easy, but so worth it.
• Magnesium deficiency – Magnesium is your body’s natural and most important muscle relaxer and if you are low on magnesium, then 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, craving for ice, and that their skin becomes more pale. Your iron levels are easily measured by your doctor and make sure they look at 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 while we get literally 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 laying in certain positions, can be a big detrement 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, racing mind, and allergy symtpoms. To help manage nighttime histamine, avoid high histamine foods at bedtime like 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.

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 sleep 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 hypothalamus, pituitary, adrenal axis, and the part that takes the biggest beating is your adrenal glands. Your adrenals help your body respond to stress, but if you’re in a constantly stressed-out state then those poor little babies are pumping out hormones for all they’re worth, and they get tired. We’ll talk much more about this very problem later in the season, but night time cortisol spikes are a common reason for night time waking and they usually follow a pattern (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). Doing everything you can to re-boost your circadian rhythm, like the sunlight when you first wake up and 2 hours of low light that we talked about in the melatonin section can help, 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 or just becasue of your diet or genetics, low blood sugar is considered to be a life threatening event by your body, and your body will wake you up for that. Especially suspect low blood sugar if you crave sweet or carb-type foods (bread, pasta, pastries, cakes, etc…), if you wake up in the night hungry, or if you don’t feel hungry in the night but eating makes falling back to sleep easier. If you notice any of these in yourself, really focus on high protein breakfast and dinner especially and only letting 1/4 of your dinner plate 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.
• 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 healthy 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. For more about breaking mental bad habits, go back and listen to Season One, Episode 34 on Breaking Mental Bad Habits.
• 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 culprits is drinking alcohol in the evening. This can happen with any alcoholic drink because all alcohol raises histamine, but is most likely with high-histamine alcohols like red wine, white wine, and beer. As mentioned earlier, having 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 there is still a histamine spike.
• 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 it should be evaluated by your doctor or a urologist. Barring any structural problem, sometimes this comes down to timing and circulation. If you’re drinking water too close to bedtime, that could obviously contribute to this. Also, if your circulation isn’t great and so your kidneys are doing most of their work while you’re horizontal, that is something you should work on. In that case, doing more cardiovascular exercise and taking care of your heart health could help with the night time waking.

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 cannot be explained by another health problem. Most sleep disorders can be fully explained by other health problems, although 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 was relying 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 disorder 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.

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 alltogether. It is more likely to reflect a larger, more global problem that relates 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 also 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 forgets momentarily to send the signals for your body to breathe. Either way, the best treatments are either devices to open your airway by changing your jaw position, or a CPAP machine, that 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 then advise you on the right path forward.
• Mouth breathing – Mouth breathing is actually 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 really 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 actually 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.