Insomnia: A Paradoxically Low Energy State

It Takes Energy to be Able to Relax and Sleep Soundly

Insomnia is a huge problem in society today, and it is unfortunately often “treated” with benzodiazepines which are highly addictive. There is a better way. Find out more about addictions and withdrawals in my article on the topic.

Sleep is very important for a plethora of reasons, and I understand the desire for a quick fix when someone cannot get restful restorative sleep. However, there are many physiological reasons why someone may be having trouble with sleep, and these can and should be rectified. Especially before attempting any type of sleep medication.

Insomnia as a result of suboptimal energy production.

I mentioned insomnia in my article on ADHD, illustrating the point that low energy production paradoxically leads to someone being unable to be in a relaxed state. As is the case with ADHD, when you are not producing enough energy it is very hard for you to be able to have restful sleep. Going to sleep is actually a very energy-intensive process. This is why hyperactivity and insomnia can be symptoms of an overall hypometabolic, hypothyroid, low-energy state.

As mentioned in many of my previous articles, when someone is producing an adequate amount of energy and has an optimal metabolic rate they should be at the right temperature. This means they will be around 98.6 degrees Fahrenheit or 37 degrees Celsius. Thus, a classic “test” of whether someone’s thyroid function/metabolism is functioning optimally is testing their temperature. If the temperature is far below what it should be (such as being lower than 36.5 degrees Celsius) this can be a good sign that they do not have an optimal metabolic rate.

“Increasing the body’s energy level and temperature improves the quality of sleep.”

-Ray Peat Ph.D.

So, the overall basic approach to treating insomnia or trouble sleeping would be to make sure the overall metabolic rate, and thus energy production, is adequate. For severely hypothyroid people, a thyroid supplement may be warranted, which can include NDT (natural desiccated thyroid). NDT should contain natural proportions of T3 and T4, active and inactive thyroid hormones. Classic signs of hypothyroidism would be high cholesterol, high TSH (thyroid stimulating hormone), high rT3 (reverse T3), low body temperature, low pulse rate and even low ferritin. Also, hypothyroidism can result in cold hands and feet, constipation, orange palms and soles of feet, frequent headaches and infections (such as colds, sinus infections etc), fatigue, hair thinning and a plethora of other symptoms.

“Insomnia is a low energy state and is usually cured by the right dose of thyroid hormone, with adequate glucose and other nutrients. Insomnia is extremely common in aging people and is the main problem at menopause.” - Ray Peat, Ph.D.

Not all of these need to be present to constitute hypothyroidism. For example, you can certainly have a “low TSH” and be hypothyroid. TSH is a pituitary hormone and is essentially an “alarm” hormone made by the brain in order to let your thyroid gland know that there is a perceived need for more thyroid hormone production. However, over time a chronically elevated TSH may slowly start to decrease because the body, in a way, “gives up” trying to make you increase thyroid hormone production. Further, TSH can be suppressed because there is enough T4 (inactive thyroid hormone) around, but there may not be enough T3 active thyroid hormone. You see, T3 is the hormone that actually matters when it comes to increasing the metabolic rate and energy production. If the body is having a hard time converting T4 into T3, then this will result in a low metabolic rate. This can be the case, with a “low” or “normal” TSH. This is why TSH should never be interpreted alone, but rather it should be interpreted with the other markers. By the way, I would consider a TSH of 2 or above to be high, even though many blood tests would say a high TSH is 4 or above.

Total cholesterol and LDL are very important because we take LDL cholesterol and convert it into the steroid hormones such as pregnenolone, testosterone, progesterone and so on. This conversion requires adequate levels of T3, vitamin A and other nutrients such as pantothenic acid (vitamin B5). Thus, if you are struggling with high cholesterol numbers, this can be a clear sign that you may have trouble converting the cholesterol into hormones. So, does it make sense to lower cholesterol with a statin medication, or rather by increasing its turnover into the hormones by increasing the levels of active thyroid hormone? To me, the answer is clearly the latter.

Reverse T3 “rT3” is an important marker because if you are not converting T4 into T3 well you may be converting the T4 into “reverse T3” which blocks the effects of T3. In other words, you may be turning inactive T4 into a hormone that is essentially the opposite of active thyroid hormone. It is important to check this blood marker especially if you are taking T4 medication. I think T4 monotherapy (Synthroid, Thyroxin, Levothyroxin) is a bad idea, you should always take T4 and T3 together if you are taking thyroid hormones. A big reason for this is of course because if you take T4 but most of it is becoming rT3, then you are simply making the situation worse.

“Insomnia, worry and "restless legs" at bedtime are problems for many old people, and I think they are variations of the basic energy-depletion problem.”

-Ray Peat Ph.D.

The liver plays a large role in converting T4 into the active T3. If the liver is sluggish then this thyroid conversion is decreased. Estrogen and high levels of free fatty acids also lower this conversion. This is part of why “estrogen dominance” can lead to hypothyroidism, and why women are far more likely to be hypothyroid than men. Free fatty acids are increased in the bloodstream when there are high-stress hormones in the body, such as adrenaline. Important minerals that are needed for the conversion of T4 to T3 include selenium, copper, zinc and magnesium. B vitamins, vitamin A and consuming enough carbohydrates are also very important for the conversion. It is very important to “use glucose well” and I wrote an article on how to do just that “How to Utilize Glucose Well”. That is a very important topic, especially for those with insomnia.

If energy production is efficient, relaxation is faster than the passive return motion of the foot, so the foot swings freely back to its original position, and over-shoots slightly, causing a slight swinging action. In hypothyroidism, the foot returns as if controlled by a pneumatic door-closer, and settles slowly and precisely into its relaxed position, sometimes with a hesitating, intermittent motion. This slow replenishment of energy, and slow relaxation, can cause muscles to cramp easily. The aching leg muscles of children at the end of an active day are often a sign of hypothyroidism, and sometimes the gastrocnemius muscle becomes very swollen and hypertrophied in hypothyroid children. The same process, of slow energy regeneration, can cause rhythm disturbance in the heart, and often causes insomnia and restless sleep.

-Ray Peat, Ph.D.

Also, as I wrote about extensively in my article on PCOS, when your thyroid/liver/gonads are not operating optimally, your body compensates for this by increasing the activity of the hypothalamus, pituitary and adrenals. To put this in simple terms, if your energy production isn’t optimal via the active thyroid hormone T3, then your body will increase the production of pituitary and adrenal hormones such as cortisol, adrenaline, and prolactin. High-stress hormones are clearly involved in insomnia, and if you are compensating for low energy production by increasing the production of stress hormones, sleep will suffer.

When a normal body temperature is maintained by thyroid-supported respiration, rather than by the stress hormones, sleep is efficient. - Ray Peat Ph.D.

Having said all that, there is more to the story of insomnia than producing enough energy, but it is likely the most important thing to address in an insomniac.

Insomnia as a result of poor blood sugar regulation.

As mentioned many times in my previous articles, when someone's blood sugar/blood glucose is too low then every stressor is amplified. Similarly, when your blood glucose is too low it will be very hard to sleep. Having low blood sugar is a stress in and of itself, and a response to this stress the body “rectifies” the situation via increased stress hormones. Cortisol, adrenaline and similar stress hormones are increased in order to raise the blood glucose level. If this is happening in the middle of the night (say around 3 am in the morning) then this can cause someone to wake up, usually in an agitated, restless and even sweaty state. The direct “fix” for this situation would be to increase the blood glucose level by consuming something, like a piece of fruit. This will enable the body to “turn off” the stress response as you are increasing the blood glucose level with food, instead of by “shredding your own tissue”.

You see if we need more glucose but cannot get it from food or from stored glycogen (stored glucose) then your body must get glucose by breaking down your own tissue, you break down your muscles and glands (such as the thymus gland) into amino acids, you deaminate the amino acids and then make glucose and the toxic byproduct ammonia. If you want to avoid this, then blood glucose cannot get too low for too long. The best way to avoid this in the night is by making sure your stored glycogen is adequate to last you through the night. If you make it through the night, then you can eat food in the morning when you wake up and avoid the need to eat during the night. Of course, this should help you sleep through the night.

“For many cells, the threshold for excitation (and response) is governed by the energy charge of the cell. This is clearest in the case of brain cells: seizures can be produced by either hypoxia or hypoglycemia, and in the low energy state of hypothyroidism, deep normal sleep is seldom possible.”

“Hypothyroidism is the most common basic cause of low blood sugar, and very commonly causes insomnia. I have noticed that "bedtime worries" are associated with hypothyroidism, and disappear when it is corrected. “

“In the last 20 years, I have seen almost everyone's insomnia disappear when they correct their hypothyroidism, sometimes just with dietary changes, but more often with a thyroid supplement. Many times, people have told me that they get to sleep within a few minutes when they take a minimal dose of thyroid at bedtime. By increasing the rate of energy production, relaxation and sleep are made possible.”

“Taking thyroid will sometimes help thin people gain weight, by improving protein metabolism, and it often helps people to sleep more soundly.”

“The basal metabolic rate, which is mainly governed by thyroid, roughly corresponds to the average body temperature. However, in hypothyroidism, there is an adaptive increase in the activity of the sympathetic nervous system, producing more adrenalin, which helps to maintain body temperature by causing vasoconstriction in the skin. In aging, menopause, and various stressful conditions, the increased adrenalin (and the increased cortisol production which is produced by excess adrenalin) causes a tendency to wake more easily, and to have less restful sleep.”

“Increased body temperature improves sleep, especially the deep slow wave sleep. A hot bath, or even warming the feet, has the same effect as thyroid in improving sleep. Salty and sugary foods taken at bedtime, or during the night, help to improve the quality and duration of sleep. Both salt and sugar lower the adrenalin level, and both tend to raise the body temperature.

Hypothyroidism tends to cause the blood and other body fluids to be deficient in both sodium and glucose. Consuming salty carbohydrate foods momentarily makes up to some extent for the thyroid deficiency.”

-Ray Peat, Ph.D.

Liver glycogen in part depends on the diet and in part depends on liver health. Many things can increase the liver’s ability to hold on to adequate stored glycogen, such as the amino acid taurine, biotin and manganese. Also, adequate thyroid function/metabolism is essential for the liver to be able to hold onto enough stored glycogen. It always goes back to energy production in the end. Oxaloacetate (product benaGene) can also help with blood sugar regulation, we make this naturally via an enzyme that requires biotin and manganese. I talk about this more in my article on PMS. Low blood glucose is also a major contributor to hyperactivity in ADHD.

Increasing GABA to help with sleep.

GABA is a very important neurotransmitter for relaxation and sleep quality. I have written about GABA in many of my previous articles, in fact, my first article was on the balance between glutamate and GABA, “The Dance of Glutamate and GABA”.

There are many things one can do to increase GABA so that one can be more relaxed, less anxious, and be able to sleep soundly.

Vitamin B6, especially in the form of P5P, can really help to increase GABA. This is because B6 is needed to convert glutamate, which is for all intents and purposes the opposite of GABA, into GABA. Supplementing vitamin B6 with magnesium is a great idea, and in many studies, they are taken together. Magnesium is also very beneficial for sleep by itself for many reasons. One such reason is that magnesium is crucial for optimal energy/ATP production. I have to mention that having optimal thyroid function/metabolism is necessary for the cells to “hold on” to magnesium. In a low-energy state, magnesium is rapidly lost. So, there is a vicious cycle when someone isn’t producing energy well.

Many other things can be taken to increase GABA. Taurine, theanine, glycine and agmatine are all amino acids that can be supplemented to improve sleep quality and increase GABA. Glycine can be exceptionally beneficial for insomnia, 5-15mg at night is generally a good dosage. You can purchase glycine powder and dissolve it in water or in teas. Alternatively, you can consume high-glycine foods such as gelatin (can make your own jello), and collagen and different cuts of meat such as lamb shank.

One of the strongest GABA-promoting hormones we produce is the neurosteroid allopregnanolone. This hormone comes downstream from pregnenolone and progesterone. As mentioned earlier, we need adequate thyroid hormones to convert cholesterol into steroid hormones. If we don’t produce enough pregnenolone we won’t produce enough allopregnanolone. Luckily, people can supplement both pregnenolone and progesterone, and this should help increase allopregnanolone.

Progesterone itself is very good at helping with sleep, and when taken as progesterone dissolved in vitamin E (as a topical oil or cream, or taken orally as an oil) can be very helpful for helping someone calm down and go to sleep. Progesterone and allopregenolone are quite sedating, but pregnenolone is not. Pregnenolone is very good for brain function and focus, but it should probably not be taken at night to help with sleep. Rather, pregnenolone can be taken in the morning which should help people function well and will lead to an increase in productivity, while also being converted to allopregnanolone so when it is time for bed people can get to sleep.

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There are many herbal products that can be consumed as teas, tinctures and capsules. Valerian root and tulsi/holy basil are very powerful herbs for increasing GABA and thus improving sleep. Lemon balm is very effective at preventing the breakdown of GABA. So, if your issue is that you “waste” GABA too quickly, lemon balm may be very helpful as it will prevent this wastage by helping you retain the GABA you have. Chamomile tea with some honey is also a great option.

Other considerations for insomnia.

Gut irritation could be a major contributor to insomnia, or at the very least can hinder one’s ability to sleep through the night. Many things can irritate the gut, the worst offenders are food additives which are also present in many medications, foods and supplements. Silica/silicon dioxide, titanium dioxide, talc and so on are some examples of these very harmful additives. Even citric acid (mostly synthesized from mold) can be toxic and extremely irritating. Gut irritation does not even need to be felt, you may not even experience any direct “pain” from these gut irritants but your body certainly feels the effects of the intestinal irritation and inflammation. This can cause bruxism, or teeth clenching and grinding at night, and can cause you to wake up in the middle of the night. Food colourings/food dyes are also examples of additives that can cause many problems and are associated with ADHD and other issues as well.

A common cause of intestinal irritation is actually bacterial overgrowth. Having too much bacteria in the intestines, especially the small intestine, can lead to constant low-grade irritation and inflammation. Endotoxin from gram-negative bacteria can activate the “toll-like receptors” such as TLR4 in the intestines and this leads to a massive stress and inflammatory response in the body. Leaky gut or intestinal permeability makes this situation worse, as endotoxin, bacteria or irritants can get into the bloodstream and wreak havoc everywhere, not just in the intestines. This is a common cause of not just insomnia, but also many other issues such as autoimmune problems like arthritis.

Zinc carnosine, creatine and collagen/glycine/gelatin can be very helpful for intestinal permeability/leaky gut.

Avoiding gut irritants is important, but it is also important to “clean up” the intestine and eradicate any potential bacterial overgrowth, especially SIBO “small intestinal bacterial overgrowth”. There are many ways to do this. There are antibiotics such as ones in the penicillin class (amoxicillin), tetracycline class (minocycline, doxycycline) or the macrolide class (azithromycin, erythromycin). Many would not want to try these. There are many natural antimicrobials such as oregano oil, Ceylon cinnamon, berberine, and monolaurin, to name a few. You can also try “spore-based probiotics” which can have antibacterial effects when taken for 2-3 months. CoreBioitic is one such product.

Ray Peat’s daily raw carrot salad is a great idea. This is not only antimicrobial but should also help “sweep” the intestine of the bacteria, bringing them to the bowel to help excrete them. The recipe is shredded raw carrots, olive or coconut oil, vinegar and salt. Eat this salad daily for best results, it doesn’t work overnight. Activated charcoal can act similarly, it is an adsorbent (not absorbent) which means things will stick to the activated charcoal, so the charcoal can move the substances it grabs out to the bowel. Over time, this should be very helpful for insomnia.

Other common intestinal irritants are A1 proteins from cow dairy and gluten. Also, nuts, seeds and other foods that are hard to digest.

Consuming enough calcium can also be very helpful for sleep. A1 cow dairy can be very harmful to some, but A2 cow dairy should work for most people. A2 dairy products include dairy from A2 cows, and also from other non-cow milk-producing animals such as goats. Goat milk is always a better option in my opinion, but nothing wrong with some A2 cow milk and cheese to get in the calcium.

Certain foods are said to be sleep including, kiwis are known to have this effect.

Elevated histamine can also cause issues with sleep. This is a large topic and one I have written about a lot in free and premium articles. For example, in my anxiety article (free article) I talked about histamine. My allergies/histamine article is premium (partially paid article). I will recap very briefly here. Some things that can help lower histamine would be stinge nettle leaf tea, vitamin B6 (P5P), theanine, vitamin C and consuming enough vitamin A, copper and zinc in foods.

Vitamin D also improves sleep quality. It’s best to try and get enough sunlight exposure when you can, especially early in the day and in the evening to get some natural red light. Checking your vitamin D level in a blood test is also a good idea so you can determine if you have low levels.

Consuming enough salt is also important to improve your ability to sleep well. It’s not a good idea to go out of your way to avoid eating salt. I speak about this in more detail in my article on high blood pressure.

To the extent that nocturnal stress resembles shock, taking some extra salt at bedtime is logical. It lowers adrenalin and tends to increase blood volume. In hypoxic stress, tissue retains water, and increasing the sodium content of the blood opposes that tendency. It is often a remedy for insomnia.

-Ray Peat, Ph.D.

This may seem counterintuitive, but I do not think lots of exercise is a good way to “cure” insomnia. Running/jogging a lot can massively increase the body’s stress response and paradoxically can lead to worse sleep, even if you are “tiering yourself out”. I think daily activity and good exercise habits are very important, but I would suggest more walking in nature for the insomniac as opposed to running and cycling.

I also am a big proponent of trying to wake up at the same time every morning and to wake up early. Sleeping in can be tempting but waking up past noon can have long-lasting ill effects on one’s sleep schedule. Logically, waking up past noon would make it very difficult to fall asleep at a reasonable time that day. This can lead to an unfavourable cycle that is not desirable for people with sleep issues. This means, that waking up late, even if it’s just on the weekend, can have long-lasting negative effects on sleep.

If someone desperately needs help sleeping and they feel they have insomnia and as a result are convinced they need to be medicated, then I would caution against going on a sleeping pill or a benzo like Xanax. Instead, I would suggest talking to your doctor about a safer, less addictive/habit-forming medication that can help with sleep. One example would be the blood pressure/hypertension medication clonidine. This medication is not habit-forming and does not have terrible side effects, relative to other medications. Clonidine works by lowering stress hormones and can be useful for sleep. It’s even used for bruxism, teeth clenching and grinding at night, in more severe cases. It shouldn’t be surprising, that clonidine is also used for ADHD, a condition that seems to share many causes with insomnia.

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*None of this is medical advice. I am not a medical professional, always talk to your doctor*

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