Sleeping is fundamental! Without sleep, you quickly end up exhausted, stressed out, walking around in a fog, and feeling like life is always an uphill climb. Sleep is especially important if you have a thyroid condition to help maintain your energy, focus, metabolism, and a robust immune system. Unfortunately, an underactive or overactive thyroid is associated with a variety of sleep-related symptoms. Let’s look at some of the ways that hypothyroidism and hyperthyroidism can affect your sleep, and some solutions to help ensure a good night’s rest, every night.
Sleep-related problems triggered by thyroid conditions
Need for excessive sleep: While it’s more common with hypothyroidism, both an underactive and overactive thyroid can significantly increase your need for sleep. According to the National Sleep Foundation, a healthy adult typically needs from seven to nine hours of sleep per night. But people with thyroid conditions — even with treatment — often report a need for far more sleep in order to function. Hypothyroidism can make you more tired overall. And the racing heart rate and sleep disruptions of hyperthyroidism can make you more exhausted than usual.
Unrefreshing sleep: Poor quality and does not relieve your fatigue. Unrefreshing or non-restorative sleep and is more common in people with thyroid conditions.
Snoring and sleep apnea: Research shows a strong correlation between thyroid function and both heavy snoring and sleep apnea. With sleep apnea, you can have heavy or shallow breathing, or periods when you stop breathing, and then start again with gasps or choking. These periods can last from seconds to minutes and can occur as often as 30 times per minute. Apnea is often accompanied by loud snoring. Sleep apnea often causes excessive daytime fatigue and sleepiness. Hypothyroidism is associated with a high risk of sleep apnea.
Upper airway resistance syndrome: Research has shown a link between hypothyroidism and a condition known as upper airway resistance syndrome, or UARS. With UARS, airway resistance is significant enough to disrupt your sleep by causing insomnia, snoring, apnea, and unrefreshing sleep.
Some key signs and symptoms of UARS include:
Sleep-onset insomnia, or difficulty falling asleep in less than 30 minutes
Headaches: Migraine disease diagnosis, or morning headaches at least once a week
Rhinitis: chronic nasal stuffiness, postnasal drip, or nasal allergies
Gastroesophageal reflux: weekly or more frequent heartburn
Asthma: a diagnosis of asthma, wheezing
Bruxism: grinding of the teeth
UARS increases your risk of sleep apnea, insomnia, unrefreshing sleep, overall fatigue, and daytime drowsiness.
Chronic insomnia: Insomnia is difficulty falling asleep and/or staying asleep. The National Sleep Foundation defines "chronic insomnia" as "disrupted sleep that occurs at least three nights per week and lasts at least three months.” Chronic insomnia is a common symptom in people with hyperthyroidism and Graves’ disease.
Solutions for better sleep
According to the American Sleep Association, about 40 percent of adults sleep less than seven hours per night, putting them in the category of chronic sleep deprivation. If you have a thyroid condition, you should aim to get at least the needed seven to nine hours per night, and even after treatment, you may find that you need more sleep than average.
But what can you do if you are experiencing any of the thyroid-related sleep problems?
Optimize your thyroid treatment: Research has shown that when your thyroid is the cause of sleep conditions like UARS and insomnia, getting optimal thyroid treatment can resolve your sleep problem. This means treatment that does not leave you borderline hyperthyroid or hypothyroid, but safely resolves your symptoms as best as possible. With hypothyroidism, in particular, optimal treatment often involves getting your thyroid stimulating hormone (TSH) level below 2.0, and your free thyroxine (Free T4) and free triiodothyronine (Free T3) into the upper half of the reference range.
Have a sleep study: If thyroid treatment does not resolve your sleep issues — especially snoring, UARS or apnea — it’s time for a sleep study. A sleep study can measure your oxygen intake and evaluate apnea episodes. Based on the results, your sleep specialist may recommend a variety of treatments, including a CPAP (continuous positive airway pressure) device, oral devices that help keep the airway open and prevent snoring, specialized upper airway stimulation (UAS) therapy, or surgery.
Practice sleep hygiene: There are some self-care approaches you can take to improve your sleep. Known as “sleep hygiene,” these tips can help you get better rest.
Some sleep hygiene tips include:
Having a sleep schedule, and aiming to go to bed and wake up around the same time daily
Avoiding caffeine, nicotine, heavy exercise, heavy or greasy foods, and stimulating screens (television, smartphone, computer) before bedtime
Keeping your sleep environment as dark as possible. Blackout shades/curtains and a sleep mask can help.
Keeping your bedroom cooler, ideally between 60 to 67 degrees — considered the temperature “sweet spot” for good sleep.
Wearing ear plugs, or using a sound machine if noise is interfering with sleep
One particularly helpful approach is to use guided audio meditation to help you fall asleep and experience more refreshing sleep. There are many CDs and audio download programs designed to help with sleep. Check out two favorites: Belleruth Naparstek’s Healthful Sleep CD/MP3 and Demo DiMartile’s Ultimate Deep Sleep Experience CD/MP3.
Get extra help: If you still have difficulty falling asleep or staying asleep, you may want to explore over-the-counter supplements or sleep aids, including:
Melatonin — A nightly dose of 5 mg or less can help you fall asleep more quickly.
Magnesium — A nighttime dose of magnesium relaxes muscles. For extra sleep-promoting benefits, soak in a warm tub and add some magnesium oil.
Valerian Root — this plant is found in a variety of sleep supplements and can help you relax, with some mild sedative properties.
GABA — If a racing mind is keeping you from falling asleep, think about gamma aminobutyric acid — GABA. This neurotransmitter fights anxiety and induces calm. Look for a patented formulation that crosses the blood-brain barrier, like Gabatrol or Kavinase.
Antihistamine-based sleep aids — over-the-counter antihistamines like diphenhydramine (Benadryl, Unisom SleepGels, others) and doxylamine succinate (Unisom SleepTabs) — can help you get a better night’s sleep. (But keep in mind that these medications can make you drowsy during the day, and cause thirst and a dry mouth.)
And, when nothing else works to help you fall asleep and stay asleep, talk to your healthcare provider about prescription drug options. Sleep is so essential that some practitioners feel like any risks or side effects of sleep medications are outweighed by the proven benefits of getting enough sleep. A medication like eszopiclone (Lunesta), zaleplon (Sonata), or zolpidem (Ambien) could be just what you need to get your ZZZZs.
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Mary Shomon is a thyroid disease, hormonal and autoimmune health writer, and patient advocate. For two decades, Mary has been a leading force advocating for more effective, patient-centered thyroid and hormonal health care. Mary is the New York Times bestselling author of “The Thyroid Diet Revolution,” “Your Healthy Pregnancy with Thyroid Disease,” “Living Well With Hypothyroidism,” and 10 other books on thyroid disease and integrative health. She co-stars in two PBS health specials, “Healthy Hormones,” and “Vibrant for Life.” Follow her on Twitter at @thyroidmary or at her Facebook communities: ThyroidSupport and ThyroidDiet.