When to Seek Help

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Sybil Cooper, WellTheory Health Coach

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How Do I Know When It’s Time to See a Health Care Professional?

You’ve worked on your morning and evening routine, you’ve tried sleep aids, your environment is conducive to sleep — you feel as if you’ve done all the things — and yet you are still:

• waking up feeling tired
• finding yourself falling asleep during the day at inopportune times
• unable to stay awake watching TV or while driving
• finding it difficult to complete regular daytime activities
• snoring or gasping for air while you are sleeping, according to your sleep partner
• having trouble falling asleep or staying asleep

Sleep disorders (or sleep-wake disorders) involve problems with the quality, timing, and amount of sleep, which result in daytime distress and impairment in functioning. Sleep-wake disorders often occur along with medical or mental health conditions, such as depression, anxiety, or cognitive disorders. There are several different types of sleep-wake disorders, of which insomnia is the most common. Other sleep-wake disorders include obstructive sleep apnea, parasomnias such as nightmares and sleepwalking, narcolepsy, and restless leg syndrome. It’s important to be evaluated by a health care provider if you suspect you have a sleep disorder.

Insomnia is different from sleep deprivation. You can be sleep deprived (not getting enough hours of sleep) but not have insomnia. Insomnia involves an inability to fall asleep and/or stay. We all suffer from acute insomnia at times, especially during times of stress. The term insomnia, as defined by Thomas Ruth, PhD in his article in the Journal of Clinical Sleep Medicine, is “... a disorder with the following diagnostic criteria: (1) difficulty falling asleep, staying asleep or nonrestorative sleep; (2) this difficulty is present despite adequate opportunity and circumstance to sleep; (3) this impairment in sleep is associated with daytime impairment or distress; and (4) this sleep difficulty occurs at least 3 times per week and has been a problem for at least 1 month.”

If you may be dealing with chronic insomnia, be prepared to discuss with your health care practitioner all that you’ve tried, and bring any sleep logs that you kept. Your practitioner can then refer you to a sleep professional who may assess you for a sleep disorder. This might involve an at-home sleep assessment or an in-clinic assessment for disorders such as sleep apnea and narcolepsy.

What Causes Sleep Disorders?

There are some common health concerns you can discuss with your health care provider that can also be root causes of sleep disorders, including:

• Hormone disruption. Progesterone, which falls approximately 10 years prior to estrogen declining toward menopause, facilitates sleep. As this important sex hormone declines disproportionately to estrogen, our sleep is impacted. Hypothyroidism, as is seen in Hashimoto’s autoimmune thyroiditis, can lead to a softening of the tissue at the back of the throat, and when combined with mouth breathing and sleeping on your back, may lead to sleep apnea.
• Gut dysfunction. As you will learn in the nutrition section of this program, autoimmunity often has some level of gut dysfunction, which can lead to nutrient depletion that can impact sleep through several mechanisms. For example, nutrients such as magnesium play a key role in sleep. Magnesium promotes proper function of GABA , a neurotransmitter in the brain that promotes relaxation and helps you fall asleep. Chronic inflammation due to gut dysfunction can lead to increased levels of stress hormones that interfere with sleep. Liver congestion can lead to impaired liver function such as in the breakdown of melatonin and cortisol, which can disrupt circadian patterns of wakefulness and sleepiness.
• Mental health concerns (anxiety/depression). Anxiety and depression can have neurotransmitter disruptions as a root cause, which in turn can be initiated by nutrient deficiencies. Excessive worry and anxiousness over an inability to fall asleep can further drive sleep disorders. Speak with your health care provider regarding calming herbs and supplements that aid in promoting relaxation and more efficient sleep.
• Medications. Some medications can cause sleep disruption, especially corticosteroids used to calm inflammation during autoimmune flares. See this list of common medications that may negatively affect your sleep.

Those of us dealing with autoimmunity often feel fatigued. It can be difficult to determine if you’re feeling sleepy, tired, or fatigued. We often use tired and sleepy, as well as tired and fatigued, interchangeably, and can feel any combination of them at once. Ask yourself if you’re struggling to stay awake, or do you feel drowsy? Diane Macedo, in The Sleep Fix, describes fatigue as when “you’re physically and mentally drained. Some signs of fatigue are heavy limbs, low energy, and an inability to concentrate.” It is important to describe to your health care practitioners how you are feeling, giving examples, rather than labeling it as insomnia or anxiety, as these terms can have very specific meanings to medical professionals.

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Extra Resources

If you’d like to read more about sleep to be knowledgeable about what might be at play, we recommend the following books:

• Sleep Smarter by Shawn Stevenson
• The Sleep Fix by Diane Macedo — a great book if you are also a shift worker
• The Circadian Code by Satchin Panda
• Breath by James Nestor

In particular, Diane Macedo discusses several cognitive behavior therapy for insomnia (CBT-i) tools in The Sleep Fix that you might find useful.

Take Action

If you suspect that you might have a sleep disorder, discuss your concerns with your health care provider.