You fall to bed and are tired. Your body is tired. Your eyes are sad. But sleep will not come. Or it arrives, and drags away at 2 a.m., and you are sitting and looking at the ceiling and your mind is racing and your body aches.
Poor sleep is not an independent issue, especially when you are living with a chronic illness, this may be Lyme disease, mold toxicity, leaky gut, Candida overgrowth or another underlying condition. It is a symptom. And not even the sleep supplements or prescription will permanently cure it unless you solve the root cause that is causing your sleep disturbance.
This is what is really going on in your body, and what you can do about it.
Why Chronic Illness Disrupts Sleep at a Biological Level
Sleep is not a case of being too tired. It is a complicated biological process which is controlled by hormones, the nervous system, the immune system and the gut. Sleep disintegrates when any one of these systems is strained – which they are in chronic disease.
- Cortisol Dysregulation
Cortisol has a definite cycle in a healthy body: in the mornings, it is the highest level that wakes you up and decreases slowly during the day, allowing melatonin to increase in the afternoons. This rhythm is often reversed or flattened in individuals with chronic illness. Night time cortisol surges are a signal to the brain that it is time not to sleep but to stay awake. This is the reason why so many patients with chronic illnesses experience a second wind late at night and could not relax.
- Neuroinflammation
Examples of chronic infections that cross the blood-brain barrier and induce brain inflammation include Lyme disease, mold biotoxins, and gut-derived toxins. This neuroinflammation directly interferes with the parts of the brain that control the sleep cycles such as the hypothalamus and the pineal gland which produces melatonin. Your brain is too swollen to react to the melatonin that you are making.
- The Gut-Sleep Connection
About 90% of the serotonin – the forerunner of melatonin – is synthesized in the gut. The dysfunction of your gut microbiome, be it dysbiosis, Candida overgrowth, or intestinal permeability, reduces your serotonin production. A reduced amount of serotonin translates into reduced melatonin, and reduced melatonin translates into broken sleep. It is among the least considered reasons why improving gut health may lead to a tremendous increase in the quality of sleep.
- Nervous System Dysregulation
Chronic disease maintains the nervous system in a sympathetic state- otherwise referred to as fight-or-flight state. In this state, the body feels that it is in danger. The heart rate remains high, the digestion slows down and the brain is hypervigilant. To fall asleep and sleep, the parasympathetic nervous system must be in charge. This transition merely does not occur among many patients with chronic illnesses.
- Blood Sugar Instability
The impaired regulation of the blood sugar is common in many individuals with chronic illness. The drop in blood sugar levels during the night triggers a compensatory reaction by adrenaline and cortisol. This is a hormonal burst that rouses you up, usually between 2 am to 4 am – one of the most frequent patterns of sleep disruption in chronic illness.
The Sleep-Illness Vicious Cycle
The following is the issue that makes this so frustrating: chronic illness interferes with sleep, and sleep deprivation aggravates chronic illness.
When one is deep-sleeping, the body does repairing of tissue, balancing of immune functioning, removal of inflammatory waste in the brain via the glymphatic system and hormone balancing. All this restorative work does not occur when sleep is systematically disturbed. Inflammation increases. There is a weakening of the immune system. Gut permeability worsens. There is a buildup of toxins in the brain. And your chronic illness symptoms get worse – which makes sleep more difficult to get. The cycle continues.
This is the reason why attempting to sleep alone is seldom effective. Using melatonin without managing the underlying cortisol imbalances, gut inflammation or nervous system imbalances is the same as switching off the smoke alarm without turning off the fire.
What to Do About It: A Root Cause Approach
Address the Underlying Infection or Toxin Load
Unless your sleep is being caused by Lyme disease, mold biotoxins, or gut infections such as Candida or SIBO, then they must be identified and managed using appropriate functional testing. Sleep will be weak until you get rid of the cause of your neuroinflammation.
Stabilize Blood Sugar Before Bed
Before going to bed, a small protein and fat based snack, a handful of nuts or a small portion of chicken, will help prevent the blood sugar crash that leads to a 2 a.m. cortisol and adrenaline spurt. It is also important to avoid sugar and refined carbohydrates in the pre-sleep hours.
Support the Cortisol Rhythm
Experiencing natural light within 30 minutes of rising is even on a cloudy day, which resets the cortisol and melatonin rhythm. It is recommended to avoid light screens and artificial light after sunset, which helps to maintain the natural decrease in cortisol levels. Adaptogenic herbs like ashwagandha or phosphatidylserine can also prove useful in promoting a healthier cortisol curve when used in proper amounts.
Heal the Gut to Restore Serotonin
Serotonin can be enhanced in the long term with the help of supporting gut health with a clean anti-inflammatory diet, specific probiotics, and gut-healing nutrients such as L-glutamine and zinc carnosine. This is more of a gradual process, yet the sleep benefits that accompany real gut healing are likely to be profound and enduring.
Activate the Parasympathetic Nervous System
Slow, diaphragmatic pre-sleep breathing e.g. four-count inhalation and eight-count exhalation techniques turn on the vagus nerve and change the nervous system to out of fight-or-flight mode. Ten minutes of such practice prior to sleep can produce a statistically significant difference in sleep onset time.
The Bottom Line
Sleep deprivation and chronic illness are not two issues that are to be dealt with independently. They are closely interrelated and unless the underlying inflammation, gut malfunction, cortisol problems, or state of the nervous system that drives sleep is addressed, treatment of sleep alone will never be a long-term solution.
And when you have been experiencing months and years of insomnia with other chronic symptoms, this is a message of your body that something deeper is required. At HealthfullyU we strive to find and correct the underlying causes of your sleep disturbance and your chronic condition – because only the entire system heals, not the symptom that is making you stay up at night.
Frequently Asked Questions
Q: Is it normal to wake up at exactly 2 or 3 a.m. every night with chronic illness?
Yes, and it is also one of the most popular patterns. Waking 2-4 a.m. is usually an indication of a blood sugar crash leading to an adrenaline response, or a cortisol burst at a time when cortisol should be the lowest. It may also be related to the liver cycles of detoxification, that are especially active in the early morning. With the assistance of a functional wellness practitioner, it is possible to determine which pattern is fueling yours.
Q: Why doesn't melatonin work for me even at high doses?
The melatonin supplement does not deal with the causes of why your body is not producing or responding to melatonin in the proper way. When the melatonin receptors are blocked by neuroinflammation, or when cortisol is high at night, blocking melatonin production, there will be little effect of adding more melatonin externally. It is not the level of hormones but the root cause that should be dealt with.
Q: Can healing my gut actually improve my sleep?
Absolutely. Since a large percentage of serotonin is created in the gut, gut healing is among the strongest upstream triggers to enhance sleep naturally. HealthilyU has numerous clients who testify to the positive changes in their sleep as an incidental outcome of the gut healing program, despite the fact that sleep was not their main concern at the clinic.
Q: Should I avoid all sleep medications?
This is greatly reliant on the driver behind it. Others report the benefit of sleep in weeks of initiating gut healing or a stress support plan. In other individuals with active Lyme disease or severe mold toxicity, it can take months of specific treatment before sleep returns to normal. Improvement is often slow and non-linear – but it is accompanied by steady root cause improvements.
Q: How long does it take to restore healthy sleep when addressing root causes?
This is greatly reliant on the driver behind it. Others report the benefit of sleep in weeks of initiating gut healing or a stress support plan. In other individuals with active Lyme disease or severe mold toxicity, it can take months of specific treatment before sleep returns to normal. Improvement is often slow and non-linear – but it is accompanied by steady root cause improvements.