Thyroid Strong

Sleep problems and Hashimoto’s go hand in hand. It’s frustrating enough that Hashimoto’s and disrupted sleep worsen each other. Yet, you could feel like you can never get enough sleep no matter what you do. It’s a cycle that can go downhill quickly. Fixing sleep can take a bit of self-discipline, but I assure you that consistent restorative sleep is possible.

How does sleep disruption affect metabolism and autoimmunity?


Your circadian rhythm is your body clock that recognizes the day-night cycle based on outside cues from light, temperature, food, movement, and more. Along with sleep, the rhythm regulates the natural cycles of your hormones, immune function, neurotransmitters, and your cells’ energy production. 

If your sleep or circadian rhythm is off, it can throw off your metabolism, resulting in or worsening [1][2]: 

Autoimmune diseases and sleep problems also contribute to each other because you need sleep to balance your immune system. Chronic insomnia is associated with an increased risk of autoimmune diseases [3].Conversely, autoimmune diseases commonly cause disrupted sleep as well, possibly due to brain inflammation and symptoms such as anxiety, pain, and cold intolerance [4].

If hypothyroid symptoms are affecting your sleep, you’re not alone. A 2019 study found that 2224 hypothyroid patients reported significantly poorer sleep quality compared to individuals with normal thyroid function [4].

Aside from classic symptoms, hypothyroid may contribute to [5]:

  • Feeling tired but can’t fall asleep
  • Shorter sleep duration
  • Feeling groggy when waking up
  • Reduced overall sleep quality
  • Hypersomnolence or the feeling that you can never sleep enough

Obstructive sleep apnea (OSA) is a common cause of sleep disturbance among hypothyroid patients, especially if they’re overweight. OSA is also stressful to your body and very dangerous for long-term health. OSA increases whole-body inflammation, the risk of heart disease, and all-cause mortality (risk of death in general) [6]. Therefore, it’s crucial to check for and treat OSA as you address Hashimoto’s as better sleep will improve thyroid hormone function [7–9] 

As with other autoimmune conditions, Hashimoto’s increases brain inflammation that can disrupt sleep [10,11]. Yet, disturbed sleep may also increase neuroinflammation, making the brain fog worse [12]. Therefore, you need to address both factors that interfere with sleep and the neuroinflammation in order to sleep well.

Hypersomnolence

Hypersomnolence, a feeling of all-day sleepiness despite getting a lot of sleep, is also common among Hashimoto’s patients. The good news is that studies confirm that thyroid hormone replacement with T4 improves these symptoms [13,14]. If this symptom still persists despite the thyroid medications, consider the following tips:

How to optimize your sleep and overcome sleep problems with Hashimoto’s


Luckily, there are a TON of things you can do to improve sleep even with Hashimoto’s. Number one is making sure your thyroid hormones are in optimal range by working with a functional medicine doctor. You also want to take your thyroid medications correctly as prescribed–typically within 30-60 minutes of waking up, on an empty stomach, and apart from other medications or supplements. These will greatly help with insomnia, other symptoms that can keep you up, and hypersomnolence.

After that, start working on these steps that are within your control.

Eat a balanced diet 

Certain nutrients, their amounts, and your pattern of eating can all affect your sleep quality. These are the foundational considerations for diet as it relates to sleep.

Optimal protein intake with each meal

Low protein intake may make it hard to fall asleep and lowers your quality of sleep [15]. The amino acid tryptophan is the precursor for melatonin, so it’s supportive for sleep. However, excessive amino acid intake might compete with tryptophan getting into the brain. Some amino acids such as tyrosine may be stimulating as well.

Optimal protein is best. It is important to get protein with each meal though. I recommend eating a minimum of 30 grams of protein per primary meal. 

Quality carbohydrates

Carbs are important for helping tryptophan get into your brain. So, many people find that they need some carbs with dinner to sleep well.

However, refined carbs can be inflammatory so eating a lot of things like noodles, bread, and pastry may reduce your sleep quality [15,16].

Therefore, get your carbs from non-inflammatory whole food sources such as sweet potatoes, winter squashes, and root vegetables such as beets and rutabaga.

Eat vegetables with every meal

People who eat vegetables in sufficient amounts have better sleep. Be sure to eat vegetables with every meal. Aim for 7 servings of vegetables a day. 

Eat at consistent times

Timing of meals matters with regard to sleep. Unless you are intermittent fasting, regular meals will likely help your sleep more than erratic eating. Consistency in timing is associated with better sleep quality. Also, you want to finish your last meal at least 3 – 4 hours before bedtime.

Limit caffeine after noon

Do you drink caffeine after noon? It may sound like a no-brainer, but it can be easy to forget that it may keep you up at night. If possible, try giving up all stimulants for a week to see if they’ve been interfering with your sleep. Otherwise, keep the coffee and all stimulants to before 12 pm, especially if you’re caffeine sensitive.

Low histamine

If you struggle with histamine and inflammation as I do, high histamine foods can keep you up. See this article on how to cut down histamine from your diet.

Limit alcohol

Drinking alcohol can reduce sleep quality. It will also increase inflammation [17]. Drink alcohol only occasionally and in low to moderate amounts. Otherwise, it can wreck your sleep and potentially lead to a flare.

Practice sleep hygiene

Many sleep struggles nowadays come from unhealthy circadian rhythms and the inability to shut off your mind at night. 

Sleep hygiene can help retrain your nervous system and circadian rhythm to create optimal conditions for

  • Falling asleep easily
  • Staying asleep throughout the night
  • Waking feeling refreshed

Therefore, practicing these basic sleep hygiene techniques can improve your sleep quality and circadian rhythm.

1. Set up your bedroom environment for your best sleep. Use your bedroom for sleep (and sex) only, if possible. Don’t work or watch TV there. When you enter your bedroom, your brain and body should think “sleep”. Also, your bedroom should be:

  • Comfortably cool. If you struggle with heat or hot flashes, the Ooler Chili pad can help cool you down and maintain sleep quality.
  • Completely dark as any light exposure can affect melatonin production. I recommend also using a Manta Mask to completely block out any light that can reach your eyes.
  • Clean, calm, and free of clutter with soothing colors
  • Free of mold, environmental allergens, or chemicals that can ruin your sleep. You may want to get your home inspected for mold and buy a quality air purifier.

2. Avoid screens for at least 30 minutes leading up to bed, especially in your bedroom. Remove the TV, smartphone, or other screens. These are stimulating to your  nervous system and suppress melatonin. 

3. Keep a regular sleep-wake schedule. Ideally, you want to be in bed by 10 pm and up around 6 am. But if that’s not possible, rise at the same time every morning and with the sun. In the morning, get sun on your face and your eyes looking at the horizon for the first 30 minutes after waking to reset your circadian rhythm.            

New research shows that for many people, 6.5 hours of sleep may be enough. Also, that undisturbed sleep is more important than the overall duration [18,19]. 

4. Do the same, simple pre-bedtime routine every night 

  • Dim lights in bed and let yourself relax prior to turning out the lights to fall asleep (breathing, meditation, sleep sounds, etc. can be helpful)
  • Take a hot bath or shower before sleep to relax your muscles and cause your body to cool down for bedtime

Exercise

When it comes to exercise and sleep, the total weekly amount, time of day, and intensity matter.

Amount

How much movement are you getting a week? You know, us ladies dealing with Hashimoto’s have to work harder and more consistently than the rest to stay on our A-game! 

Work up to 10k steps a day. Resistance training should be 20 minutes, 3-5x per week. 

Time of day

Many people, myself included, get energized from working out. Jacked up and focused isn’t what you want if you’re trying to fall and stay asleep. 

Personally, I don’t work out after 5 pm. I don’t recommend you do either. Ideally, work out in the morning. At least walking, if not a full workout. For your harder sessions, like kettlebells, I recommend exercising in the early afternoon at the latest. No later than 3 pm.

Some people will find exercise to have a relaxing effect and actually improve sleep when done later [20]. If you aren’t having luck with other approaches, you can try working out around 8 pm and see what happens. If you’re not sleeping well anyways, there’s not much to lose.

Intensity

Any exercise is better than none. However, moderate to vigorous levels may give you the best benefit for improved sleep quality. Again, timing matters. Vigorous exercise is more likely to help sleep when done earlier in the day [21].

That’s why I prefer to do my Thyroid Strong workouts in the morning to reset your circadian rhythm and jump start your cortisol which should be highest when you first wake. If I don’t get it in first thing in the morning, then I try to get my kettlebell workout in before 2pm.

Screen for and treat sleep apnea and other sleep disorders

Does your partner tell you that you stop breathing in your sleep? Do you wake up choking or gasping? Do you ever wake up with a jolt, like you got an adrenaline rush? Do you feel like you can never get enough sleep? If you answered yes to any of these, or have risk factors for sleep apnea, you need to get a sleep study.

Apnea is immediately treatable with a continuous positive airway pressure (CPAP) device. Untreated apnea can keep you from fully healing or losing weight even if you’re doing everything else right. 

Exercise actually improves sleep apnea, regardless of weight loss [22]. While weight loss often helps with apnea, it doesn’t always completely cure it, so speak to your doctor before stopping any treatment [23].

Sleep supplements for Hashimoto’s

Many women with Hashimoto’s need a little supplement support to help with their sleep in addition to the diet, exercise, and sleep hygiene mentioned earlier. To ensure you get a Thyroid Strong exclusive practitioner-quality supplement, make your Thyroid Strong Fullscript account here to get my recommended supplement list and a 15% discount. 

The following supplements can be beneficial.

  • Magnesium promotes relaxation and improves many aspects of sleep quality [24]. It’s also a commonly deficient, though very important, mineral.
  • Vitamin D3 is involved in melatonin production and works with magnesium to support sleep [25]. It’s a good idea to take vitamin K2 as well since it works with vitamin D3 [26].
  • Theanine comes from green tea and promotes relaxation, which can help you wind down to sleep. 
  • Passionflower is also a beneficial herb to promote relaxation and help with sleep, especially with Hashimoto’s [27].
  • Cortisol Manager is a great blend if you struggle with sleep or sleep disruption due to stress or cortisol issues. It has many relaxing adaptogenic herbs that help with stress along with theanine. 
  • Insomnitol is probably the strongest and most effective sleep supplement with melatonin, its precursors, and a few sedating herbs. 

Most of these supplements can be taken 30-60 minutes before bed, but high doses of vitamin D should only be taken in the morning. As always, you should check with a naturopathic doctor to see if the supplements are right for you. If you’re taking medications, always check with your doctor or pharmacist for drug interactions.

Conclusion


Sleep problems and Hashimoto’s is a two-way street. If you improve one of them, the other is likely to benefit. My recommendation is to address them both at once. With some self-discipline and consistency, a great night of restorative sleep is possible.

If you need a community of supportive women who understand your struggles and are walking the walk to overcome their Hashimoto’s, you are in the right place. Thyroid Strong gives you the tools and support to become strong, motivated, and successful in your healing journey. Join us today and get Thyroid Strong!

References


1 Depner, C. M., Stothard, E. R. and Wright, K. P., Jr. (2014) Metabolic consequences of sleep and circadian disorders. Curr. Diab. Rep. 14, 507.

2 St-Onge, M.-P. (2017) Sleep-obesity relation: underlying mechanisms and consequences for treatment. Obes. Rev. 18 Suppl 1, 34–39.

3 Kok, V. C., Horng, J.-T., Hung, G.-D., Xu, J.-L., Hung, T.-W., Chen, Y.-C. and Chen, C.-L. (2016) Risk of Autoimmune Disease in Adults with Chronic Insomnia Requiring Sleep-Inducing Pills: A Population-Based Longitudinal Study. J. Gen. Intern. Med. 31, 1019–1026.

4 Zielinski, M. R., Systrom, D. M. and Rose, N. R. (2019) Fatigue, Sleep, and Autoimmune and Related Disorders. Front. Immunol. 10, 1827.

5 Song, L., Lei, J., Jiang, K., Lei, Y., Tang, Y., Zhu, J., Li, Z. and Tang, H. (2019) The Association Between Subclinical Hypothyroidism and Sleep Quality: A Population-Based Study. Risk Manag. Healthc. Policy 12, 369–374.

6 Marshall, N. S., Wong, K. K. H., Liu, P. Y., Cullen, S. R. J., Knuiman, M. W. and Grunstein, R. R. (2008) Sleep apnea as an independent risk factor for all-cause mortality: the Busselton Health Study. Sleep 31, 1079–1085.

7 Lin, C. C., Tsan, K. W. and Chen, P. J. (1992) The relationship between sleep apnea syndrome and hypothyroidism. Chest 102, 1663–1667.

8 Kittle, W. M. and Chaudhary, B. A. (1988) Sleep apnea and hypothyroidism. South. Med. J. 81, 1421–1425.

9 Petrone, A., Mormile, F., Bruni, G., Quartieri, M., Bonsignore, M. R. and Marrone, O. (2016) Abnormal thyroid hormones and non-thyroidal illness syndrome in obstructive sleep apnea, and effects of CPAP treatment. Sleep Med. 23, 21–25.

10 Cai, Y.-J., Wang, F., Chen, Z.-X., Li, L., Fan, H., Wu, Z.-B., Ge, J.-F., Hu, W., Wang, Q.-N. and Zhu, D.-F. (2018) Hashimoto’s thyroiditis induces neuroinflammation and emotional alterations in euthyroid mice. J. Neuroinflammation 15, 299.

11 Pak, V. M., Onen, S.-H., Bliwise, D. L., Kutner, N. G., Russell, K. L. and Onen, F. (2020) Sleep Disturbances in MCI and AD: Neuroinflammation as a Possible Mediating Pathway. Front. Aging Neurosci. 12, 69.

12 Zhu, B., Dong, Y., Xu, Z., Gompf, H. S., Ward, S. A. P., Xue, Z., Miao, C., Zhang, Y., Chamberlin, N. L. and Xie, Z. (2012) Sleep disturbance induces neuroinflammation and impairment of learning and memory. Neurobiol. Dis. 48, 348–355.

13 Shinno, H., Inami, Y., Inagaki, T., Kawamukai, T., Utani, E., Nakamura, Y. and Horiguchi, J. (2009) Successful treatment with levothyroxine for idiopathic hypersomnia patients with subclinical hypothyroidism. Gen. Hosp. Psychiatry 31, 190–193.

14 Kim, M., Chae, S. H., Oh, E. H., Kim, B.-K., Kim, D. J. and Cho, J. W. (2015) A Case of Hypersomnolence with Subclinical Hypothyroidism Treated with Levothyroxine. J Sleep Med, Korean Sleep Research Society 12, 23–25.

15 St-Onge, M.-P., Mikic, A. and Pietrolungo, C. E. (2016) Effects of Diet on Sleep Quality. Adv. Nutr. 7, 938–949.

16 Katagiri, R., Asakura, K., Kobayashi, S., Suga, H. and Sasaki, S. (2014) Low intake of vegetables, high intake of confectionary, and unhealthy eating habits are associated with poor sleep quality among middle-aged female Japanese workers. J. Occup. Health 56, 359–368.

17 Stein, M. D. and Friedmann, P. D. (2005) Disturbed sleep and its relationship to alcohol use. Subst. Abus. 26, 1–13.

18 Finan, P. H., Quartana, P. J. and Smith, M. T. (2015) The Effects of Sleep Continuity Disruption on Positive Mood and Sleep Architecture in Healthy Adults. Sleep 38, 1735–1742.

19 Medic, G., Wille, M. and Hemels, M. E. (2017) Short- and long-term health consequences of sleep disruption. Nat. Sci. Sleep 9, 151–161.

20 Youngstedt, S. D. and Kline, C. E. (2006) Epidemiology of exercise and sleep. Sleep Biol. Rhythms 4, 215–221.

21 Dolezal, B. A., Neufeld, E. V., Boland, D. M., Martin, J. L. and Cooper, C. B. (2017) Interrelationship between Sleep and Exercise: A Systematic Review. Adv. Prev. Med. 2017, 1364387.

22 Iftikhar, I. H., Kline, C. E. and Youngstedt, S. D. (2014) Effects of exercise training on sleep apnea: a meta-analysis. Lung 192, 175–184.

23 Pacheco, D. (2020, November 20) How weight affects sleep apnea. Sleep Foundation. Available at https://www.sleepfoundation.org/sleep-apnea/weight-loss-and-sleep-apnea

24 Arab, A., Rafie, N., Amani, R. and Shirani, F. (2022) The Role of Magnesium in Sleep Health: a Systematic Review of Available Literature. Biol. Trace Elem. Res.

25 Romano, F., Muscogiuri, G., Di Benedetto, E., Zhukouskaya, V. V., Barrea, L., Savastano, S., Colao, A. and Di Somma, C. (2020) Vitamin D and Sleep Regulation: Is there a Role for Vitamin D? Curr. Pharm. Des. 26, 2492–2496.

26 van Ballegooijen, A. J., Pilz, S., Tomaschitz, A., Grübler, M. R. and Verheyen, N. (2017) The Synergistic Interplay between Vitamins D and K for Bone and Cardiovascular Health: A Narrative Review. Int. J. Endocrinol. 2017, 7454376.

27 (2019, January 19) Medicinal plants for hypothyroidism. Botanical online. Available at https://www.botanical-online.com/en/medicinal-plants/hypothyroidism-remedies

Learn the 3 things NOT TO DO in your workout if you have Hashimoto's and WHAT TO DO instead!

Sign up to our newsletter and we'll email you this free guide.

You have Successfully Subscribed!

Pin It on Pinterest