Episode 80: Unlocking Insomnia

This week we welcome back Dr. Kaycie Rosen Grigel, ND to discussing the relationship between hormones and sleep along with tips and tricks you can utilize in your day-to-day.

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The content of this podcast has not been evaluated by Health Canada or the FDA. It is educational in nature and should not be taken as medical advice. Always consult a qualified medical professional to see if a diet, lifestyle change or supplement is right for you. Any supplements mentioned are not intended to diagnose, treat, cure or prevent any disease. Please note that the opinions of the guests or hosts are their own and may not reflect those of Advanced Orthomolecular Research, Inc.

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Welcome to Supplementing Health, a podcast presented by Advanced Orthomolecular Research. We are all about applying evidence based and effective dietary lifestyle and natural health product strategies for your optimal health. In each episode, we will feature very engaging clinicians and experts from the world of functional and naturopathic medicine to help achieve our mission to empower people to lead their best lives naturally.

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[01:09] Cassy Price: Thanks for tuning into Supplementing Health. Today I am happy to be welcoming back Dr. Kaycie Rosen Grigel, Naturopathic Doctor. Last time Dr. Grigel joined us we discussed how hormones can influence anxiety and mood disorders so if you would like to check out that episode, it is episode 39 and I highly recommend you give it a listen. Today we will be discussing the relationship between hormones and sleep patterns. Welcome back Kaycie. Thanks for joining me.

[01:30] Dr. Kaycie Rosen Grigel: Thanks so much for having me.

[01:32] Cassy Price: So, melatonin is known as the sleep hormone. Would you share what melatonin’s mechanism of action is that regulates sleep?

[01:43] Dr. Kaycie Rosen Grigel: Absolutely. Melatonin is produced in our pineal gland, which is right in the centre of our brain. It is produced in response to darkness. It is inhibited by light. It is one of our primary hormones that regulate the circadian rhythm of the sleep wake cycle of the body. It sends a signal to our hypothalamus which sometimes we call our master gland. That then, initiates the night-state physiological functions. Things like lower blood pressure, lower metabolism and also sleep.

[02:18] Cassy Price: Are there other hormones outside of melatonin that directly affect your sleep patterns?

[02:24] Dr. Kaycie Rosen Grigel: Absolutely. Cortisol is the most obvious of these because it also has a circadian rhythm. It sort of does the opposite. Cortisol is something that makes us feel more awake. Also, when I look at folks who are having insomnia, we look at progesterone, estrogen, I look at thyroid and I also look at neurotransmitters such as GABA, histamine or serotonin, glutamate and those kinds of things.

[02:52] Cassy Price: Melatonin influences the pituitary gland which is a big part of thyroid hormones. How does that relationship actually play into your sleep and overall hormone balance?

[03:05] Dr. Kaycie Rosen Grigel: Sure. Melatonin sort of has a balancing effect on the hormones that are governed by the pituitary. Generally, when melatonin is high, cortisol, thyroid and the reproductive hormone secretion is much lower. One interesting example of that is women in Northern climates for instance, will have greater fertility during the summer months, when there is a lot more light and therefore less melatonin production. Generally, they have to be there to balance each other out.

[03:40] Cassy Price: What is the relationship that vitamin D has with all of this then? Technically, vitamin D is also a hormone but one that we can create from those rays of sun. Does it have some sort of role in this relationship as well?

[03:53] Dr. Kaycie Rosen Grigel: That is an interesting question. Vitamin D certainly, as we all know, is something that is produced in the skin in response to sunshine and it also impacts mood, and it can impact our sleep because of its impact on mood. I don’t know. I would have to look up if there is a direct correlation between vitamin D and melatonin activity, but it certainly can play a role in how we think and feel during the different months of year based on how much light there is.

[04:29] Cassy Price: Interesting. You had previously mentioned that cortisol has its own circadian rhythm and often that is referred to as the cortisol curve. Where it spikes early in the earlier hours of the day as part of your waking process, and then will drop off later in the evening to help you calm down and go to sleep. However, if you’ve got HPA access dysfunction obviously that curve can be completely out of whack. Can you explain the interplay of hormones that can cause this imbalance and how that can shift your sleep and what happens there?

[05:02] Dr. Kaycie Rosen Grigel: Absolutely. Cortisol basically has one job. It mobilizes start energy and it turns it into glucose to feed your body. Cortisol does this at two different times. The first is when we are under stress. It is one of our primary stress hormones. Historically stress for humans meant escape from danger, run from a bear, so in order to do this we have to think and move fast. Adrenaline or what we call epinephrin is made during stress. This helps our heart beat faster, it helps our brain and it helps power our muscles to make a quick escape. We make cortisol at the same time as adrenaline. What it does is, is again, it makes that glucose and feeds the brain, the muscles and the heart and helps us to escape from danger. The other time we make cortisol is when we haven’t eaten in a while. Say seven or eight hours later after a meal if we haven’t eaten, then cortisol will be produced to mobilize sugar so that you can keep going on with your day. How that relates to sleep is if we have a ton of stress and we are making cortisol late at night, it keeps us up. What I see even more is that for a lot of my patients if blood sugar isn’t stable, say you eat dinner at 6pm, by 3am it has been nine hours since you ate last. Often what will happen is that the blood sugar will get low, and cortisol will spike and you will feel wide awake.

[06:38] Cassy Price: Interesting. That is part of why some people get that 3am waking spike when you have had a busy day or things like that?

[06:45] Dr. Kaycie Rosen Grigel: That’s right.

[06:46] Cassy Price: Awesome. How much does what you eat for your different meals or after a fasting period impact your overall cortisol production?

[06:57] Dr. Kaycie Rosen Grigel: Diet and cortisol – there is kind of two different things that we are looking at. One is just keeping in mind that all of our steroid hormones which include things like estrogen and progesterone and testosterone, as well as cortisol, they are all made from cholesterol. If there is a lot of cholesterol restriction in the diet, which in vegetarian but vegan diets in particular don’t have any cholesterol in them; or if we are not giving our body the building blocks to make cholesterol which mostly has to do with eating an adequate amount of carbohydrate; or if we take statins that reduce our total cholesterol to a very low number, it can be challenging to make enough of these hormones. That is one piece. I think what you are getting at has to do with blood sugar control. If we overproduce cortisol that can actually cause some extra blood sugar fragility because what happens is when we are stressed all of the time, we are mobilizing sugar all of the time and then you end up having this tendency toward what we call metabolic syndrome or that blood sugar fragility anyway. Also, if we eat a lot of refined carbohydrates the blood sugar spikes and then it falls more dramatically and then later we make more cortisol and then it becomes sort of a cycle.

[08:26] Cassy Price: Then we know that obviously the things that our ancestors perceived as stress has very much shifted in modern day. We get consistent triggers of stress, even if we don’t consciously consider them stress, there are things stressing our bodies out like the screens that we are constantly sitting in front of and traffic and whatnot. Knowing that and that that has now shifted how much cortisol our bodies produce, do things like short term and long-term traumas, big ‘t’ and little ‘t’ traumas, also play a role in what our body perceives as threats in that cortisol production pattern?

[09:05] Dr. Kaycie Rosen Grigel: Absolutely. Because our life is so dramatically different than it was from our ancestors just in terms of what stress means and how stress plays out physiologically, our stress response is somewhat inappropriate now based on the type of stress we are having. We do get this blood sugar spike, more than we need. Then it plays this different role in what our metabolism does. It causes us to gain weight and it also can cause that blood sugar fragility. If we have short term stressors, we may be making a lot of those stress hormones all the time and that may disrupt sleep. This can be manageable in the short term. It is usually explainable in the short term, but if it becomes a long-term trauma that is even just a trauma that our mind keeps reliving, if this stress is persisting for years, it can really reprogram that circadian rhythm and that can become really challenging to manage in the long term.

[10:19] Cassy Price: Speaking of the metabolic piece of it, a 3pm slump or cravings later in the day especially if you have had a busy or stressful day at work and things like that, I am guessing all ties into this whole hormone picture that we are talking about with cortisol spikes at inappropriate times and whatnot. If you are experiencing those slumps, is that an indicator that you are going to have a rough night later in the day as well or can that be managed so that you can correct it on the fly?

[10:53] Dr. Kaycie Rosen Grigel: Sure. Diet is a really powerful tool for managing blood sugar, obviously. If we know that we are going to have stress we generally need to be little more careful with our diet. There is basically a couple of ways that I have people think about that. One is think about the things that help your blood sugar to be more stable over time. That is basically protein, fats and fibre. Protein and fats because it takes our liver longer to process them so you get more of the slow release into the blood stream, as opposed to refined carbohydrates which go into the blood stream right away and spike, and then it crashes. That is one piece; it is proteins, fats and fibre. Then fibre, basically binds stuff in our digestive tract long enough that it gets absorbed in the blood stream more slowly. That is one piece, the protein fats and fibre. It also has to do with timing. Timing, if we skip breakfast for instance, it is really hard to make up for that core blood sugar later in the day. You have to start first thing in the morning by feeding something that is going to balance your blood sugar throughout the day. Then something that has a little bit with that blood stabilisation piece at lunchtime is helpful. That helps to moderate that mid-afternoon slump. Conversely with sleep if you are having that waking at 3 in the morning piece, a little protein snack before bed can really go a long way because you are doing the same thing. You are helping that blood sugar to stay more stable for longer and then you don’t get that cortisol spike at 3am.

[12:46] Cassy Price: Interesting. With things like beans or vegetarian/vegan proteins, you are getting the carbs and the protein in the same grouping. Would something like that be better than say a glass of milk that has natural sugars in it? Does that matter?

[13:10] Dr. Kaycie Rosen Grigel: That is an interesting question. I think it is pretty personal and it has to do with what your body tolerates. My mentor always said that a bowl of yellow pea soup before bed is the best thing for sleep. I, in 18 years of practice, have had very few patients take me up on wanting to eat yellow pea soup before bed. To answer that question, perhaps, it might be more effective. I’ll have folks eat an apple with some peanut butter and then you are getting a little bit of carbohydrate, a little bit of fibre and a bunch of protein. You can do things that are simpler too. Something like a handful of nuts or a spoonful of peanut butter or a hardboiled egg or a little bit of Greek yogurt and berries, whatever feels right.

[13:56] Cassy Price: Okay. Insomnia is often a symptom that actually accompanies menopause and becomes more common as we age. Is there a reason behind that? Is it due to the hormonal shifts or is there something else at play there?

[14:13] Dr. Kaycie Rosen Grigel: Well, you have a few things butting up against each other when you are getting into that menopausal or premenopausal time. When we talk about that midlife hormonal shift, I like to talk to my patients about how hormones really work like a symphony. They have to all be balanced and they have to all work together. The balance between estrogen and progesterone does shift as we head towards menopause. This in itself can cause some insomnia. Also, just symptoms such as hot flashes and night sweats can also cause some insomnia because a lot of women are going to wake up in the middle of the night and they are hot and they are sweaty. That is disruptive in itself. Also, it is important for us to recognise that as our ovaries stop producing estrogen and progesterone, the production of these hormones actually moves up to your adrenals. If your adrenals are already taxed from a stressful life, that can exacerbate any pre-existing imbalance in adrenal hormone production. Something that was mildly problematic before with cortisol can be more problematic. Then at the same time, with that symphony, sometimes we will also see concurrent shifts in thyroid hormone and that can also disrupt your sleep.

[15:35] Cassy Price: Is it poor sleep that affects hormone functions? Is it like that chicken and the egg situation, almost like a cyclical pattern? If you’re having sleep issues, that can affect your hormone production, which then can affect your sleep issues again. How do you start to break that cycle?

[15:53] Dr. Kaycie Rosen Grigel: That is a great question. They do really feed each other. Once you start getting out of balance it does tend to spiral. Lack of sleep or shortened sleep has been shown to increase net 10 cortisol levels and blood sugar dysregulation. That makes that whole pattern a little bit worse. A lot of that in terms of correction, we might talk about that a little bit later, is getting in those habits of sleep hygiene and working at that sleep piece, and then using different things to supplement and correct these imbalances.

[16:39] Cassy Price: Okay. Things like melatonin supplements and that sort of stuff?

[16:44] Dr. Kaycie Rosen Grigel: Yes, there are quite a few things that I use. One of the things that I do like to talk to my patients about, we always talk about three pillars of sleep. Three things that have to be working in order for sleep to happen. One is we have to get our adrenals to go to sleep. One is that we have to get our brain to go to sleep. One is that we have to get our body, our muscles and skeletal system, to sleep. We can use different types of natural substances to supplement that function in each of those arenas.

[17:24] Cassy Price: Now you mentioned earlier symptoms like night sweats or hot flashes interfering with sleep especially when you are in that perimenopausal or menopausal stage. Are there issues with hormonal changes during menstruation and pregnancy that can create similar disturbances for sleep?

[17:45] Dr. Kaycie Rosen Grigel: Absolutely. Any time we are going to see a shift in the balance between estrogen and progesterone, we definitely will see some changes. Especially as women get into their late 30s it is very common to have a few tough nights of sleep before a cycle. That again has to do with that shift between progesterone and estrogen balance. Then in pregnancy there are so many reasons that you might be having trouble with sleep ranging from achy backs and hips, you might get heart burn, you might get overheated. Other physical discomforts can disrupt sleep as much as any other hormone shift, which still could disrupt your sleep. Some women just depending on what their hormones do outside of pregnancy actually sleep better during this time.

[18:34] Cassy Price: Interesting. Are postpartum sleep disorders a common thing that we see beyond just having a new baby that wakes you up frequently?

[18:43] Dr. Kaycie Rosen Grigel: Yes. Absolutely. Babies tend to not be great sleepers, at least for a little while. It is going to take any baby some amount of time to get on a schedule. There are certainly some profound hormonal shifts that take place during this time. Beyond that, when you are up every couple of hours for somewhere between a couple of months to a few years in a row, this can take a serious toll on the quality of your sleep. Often, I see women who need to regulate their whole circadian rhythm after childbirth, particularly after that first year to two years after the baby is born.

[19:24] Cassy Price: That is quite a while. Are there supplements that you recommend for balancing those hormones to help with sleep? I know you mentioned different natural therapies that we can use to calm the adrenals, the body and the mind. That is more for that sleep aspect. Are there different supplements? Are they the same supplements that you use for balancing those hormones?

[19:46] Dr. Kaycie Rosen Grigel: Yes. Depending on what is out of balance. If things like thyroid or reproductive hormones are out of balance then we can do some specific stuff for that. In terms of those three pillars that I talked about, sometimes if we address just one of those pillars it will be plenty to get a person sleeping again. Sometimes we need to put a few things together. For adrenal, if there is that strong adrenal component especially if you are waking in the middle of the night, I like blends that contain things like ashwagandha and phosphatidylserine because what they do is, they are tonics for the adrenals. They make the adrenals get stronger over time. It is because they say, “okay, now you can relax. You don’t have to make those hormones right now.” In terms of brain health, melatonin is certainly helpful for getting the brain to go to sleep because of that pineal piece. I also really like GABA because it is a primary inhibitory neurotransmitter. It helps the brain to shut off like we are helping the adrenals to shut off. In terms of muscle relaxation and pain control, that is going to really depend on what your particular situation is, but using some minerals such as magnesium can really be helpful for getting the muscles to relax and get you to sleep.

[21:13] Cassy Price: Okay, cool. For creating good sleep hygiene, what are your main tips for helping people fall asleep and stay asleep?

[21:24] Dr. Kaycie Rosen Grigel: I almost would prefer to talk about sleep hygiene first before supplementation because it absolutely is the foundation and It always should come first. Number one as we all know is screen time. Light inhibits melatonin production especially that blue light you are getting from phones and computer screens. That can make it super hard to fall asleep. I know the nights I try to work a little bit later; I always pay for it when I am trying to go to sleep. Generally, I have no screens in the bedroom. I try to stop screen time an hour before bed. Obviously, doing relaxing things like have a bath or a cup of herbal tea or some yoga or stretching or meditation, something for 15-20 minutes. Even reading a book before trying to sleep is invaluable for getting the body and mind ready. Finally, if you are waking at two or three in the morning, a light protein snack just like we talked about to keep that blood sugar stable so that you can stay sleeping for the rest of the night. Keeping in mind that alcohol, particularly red wine and sugar, are very disruptive to sleep and they also cause hot flashes. Just keeping in mind that what is going into your body in those last couple of hours before bed really impacts how well you sleep through the night.

[22:49] Cassy Price: Awesome. Thank you so much for joining me. There has been lots of great information in here. Our listeners, if they want to work with you, they can get a hold of you through your website for your Colorado clinic, is that correct?

[23:01] Dr. Kaycie Rosen Grigel: That’s right. It is goldmanholisticmedicine.com

[23:05] Cassy Price: Perfect. Thank you so much again for taking the time to chat with me today.

[23:08] Dr. Kaycie Rosen Grigel: Thank you so much.

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Thank you for listening to Supplementing Health. For more information about our guests, past shows, and future topics, please visit AOR.ca/podcasts or AOR.us/podcasts. Do you have a topic you want us to cover? We invite you to engage with us on social media to request a future topic or email us at [email protected] We hope you tune in again next week to learn more about supplementing your health.

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