Transcript 

Surprising Sleep Conditions that Create Insomnia with Michelle Shapiro

Michelle Shapiro [00:00:00]:

There are very few symptoms that people can experience quite as frustrating as sleep issues. And this is something that insomnia is something that I've experienced through many different parts of my life. In college, I really experienced it as an experience with panic attack and anxiety. Panic attacks and anxiety. In recent years, I had the experience of having a pots diagnosis for what I believe was potentially something called hyper adrenergic pots, which we're going to talk about in this episode. But there's a lot of different reasons why sleep might be an issue for us. And I think oftentimes when we are telling people we have sleep issues, they are often written off as having poor sleep hygiene or you just have anxiety. Of course, medications are prescribed frequently for this or something along the lines of just take a magnesium, when in reality, the experience of having sleep issues can be so debilitating, frightening.

Michelle Shapiro [00:01:04]:
There's terror potentially, that's associated with it. So I wanted to talk about not only how do we strike really strong sleep hygiene, of course, but also what are some of those hidden reasons why we might be having sleep problems that we're not aware of. And again, I have had the joy of experiencing so many different types of sleep issues that I can speak, of course, from client experience, and I'm willing and happy to speak from my own as well. Of course, one of the most common recent reasons I've been seeing people have sleep issues is actually histamine related, which I don't think many people who listen to this podcast will be surprised to hear Histamines. And we talk about Histamines in the context of histamine intolerance or mast cell activation syndrome as being these kind of, they're like chemical messengers that kind of act almost like neurotransmitters. And they're very excitatory, so they want to keep us awake and alert in case there is any sort of emergency. I want to tell you about a client of mine, and an experience that really changed the way I viewed insomnia and viewed sleep issues. So I have this incredible client who for years was experiencing not only insomnia in ways of waking up in the middle of the night, but also with a lot of trouble falling asleep.

How can histamines affect your sleep?

Michelle Shapiro [00:02:27]:
And with that insomnia came some paranoia and just a tremendous amount of anxiety. This client, who's probably one of my favorite people on earth, had tried really every sleep medication you can imagine, trazodone, ambien, muscle relaxers, other anxiety, SSRI medications, anxiety and depression medications, and really found no resolve with her sleep issues. She had tried herbal supplements. We had trial supplements before. It became, after a bit of working together, very clear to me that the nights where she had had more histamine y food, she was having worse sleep issues, or if she was in a stressful time, she was having more sleep issues. But even the medications she was using for anxiety, which was helping with the anxiety, were not helping with sleep. And so we ended up doing some over the counter medication for histamines, as well as supplements to help with histamines, either blocking them or helping to get them out of the body. And she slept through the night.

Michelle Shapiro [00:03:40]:
And it's been, I think, close to a year and a half since we implemented that, and her sleep has been basically perfect since. Now, this is not going to be the same for every person because we all have different root causes for why we're not sleeping. But this was one of my favorite things to ever happen in my practice, because we both understood how debilitating these sleep issues were and how frightening they were. And to not feel like there's any resolution or any end to them, or feel like there was any direction to go in was so scary for this client. So it was really exciting when we found her root cause for sleep. So that's kind of my first discrete sleep issues that might be happening is people might be having excess histamines that can be causing that. Now, once histamines are released from our body, it can take up to three months to clear them, even them being released from the mast cells one time, it can take three months to clear. So symptomatically, using antihistamines may not help with sleep issues in the short term.

How to use long-term and short-term tools to tackle root causes of insomnia

Michelle Shapiro [00:04:46]:
And this is something that I want people to understand also overall, about anything we do in functional nutrition. So let's take anxiety as an example. If we're working with anxiety, there's things that will help with anxiety in the short term, and there's things that will help with anxiety in the long term. Oftentimes, when people are looking at for anxiety supplements, they land in the realm of ashwagandha, adaptogens, rhodiola. And while those may help people with anxiety, they're not really intended to help people with anxiety in the short term. It's not the same thing as taking a xanax or klonopin. It's not the same thing as even taking something like gaba or passion flower, which may actually help more in the short term. That's for the long term.

Michelle Shapiro [00:05:31]:
Now, the root causes of sleep issues or anxiety are going to be different than what helps with symptom reduction. So if someone has a histamine intolerance that is causing insomnia, it doesn't necessarily mean that if you lower histamines in the short term that it's going to help with symptoms in the short term. You may have to do other things in the short term to help so that the histamine issues can resolve in the long term. It's the same thing with anxiety. If you have a vitamin deficiency that is causing anxiety, which it certainly can, let's say, a vitamin B twelve deficiency. Taking vitamin B twelve doesn't calm your nervous system. It doesn't tell your body that it's safe in the short term. In the long term, that will help with the root cause of anxiety.

Michelle Shapiro [00:06:18]:
But I think where we get really confused is are we taking these things for the short term to help us with anxiety or sleep issues? Are we taking these things to help target the root cause? Where I see a lot of people getting frustrated and nervous around going to functional practitioners is that a lot of functional practitioners are only targeting the root cause. So again, if there was, let's take a gut issue. If there was a digestion issue and we went to a functional practitioner, they may say, I think the root cause of your gut issues are parasites, though when we take a parasite protocol, we might feel more sick and we might feel more symptomatic. So what's really important when we're approaching sleep and we're approaching anxiety is we need to make sure that we're also helping you, the listener, our clients, with how you're feeling in the short term as well. So sometimes antihistamines will help in both the short term and the long term. And sometimes they only help in the long term. And that could be, again, one type of root cause for sleep. What I want you to take away from this episode is that there are so many different root causes for every single set of symptoms we have.

The importance of managing histamines for sleep

Michelle Shapiro [00:07:36]:
So just because one thing doesn't work for you doesn't mean that there aren't ten other possible explanations or root causes or that the support you're using is only working in the long term, but not the short term. So we need a bunch of long term and short term tools for every root cause. Basically, it's. It might look a little bit like throwing a lot at the wall and seeing what sticks, and it might literally be that sometimes. But the approach and strategy is very clear, which is we want to get symptom reduction in the short term, and we want to help with the root cause in the long term. So if histamines are driving sleep issues, then anything that helps with histamines should help with the sleep issues. If anxiety is what's driving insomnia, then we need to help with anxiety again, not only in the short term, but the long term. Magnesium is something that does help a lot of people in both the long term and the short term.

Michelle Shapiro [00:08:33]:
But I caution if you're in a highly sensitive body to be very careful and slow with your magnesium supplementation. Some people might get a little bit disoriented or dizzy, even lower blood pressure from magnesium. So it's just something to be aware of if you're in a highly sensitive body. But magnesium is one of those good examples of it can help with initiation of sleep, and it can help with keeping you asleep, and it might be able to help with anxiety and stress as well. And I definitely have a lot of clients reporting that in addition to the studies definitely supporting that as well. So another kind of sneaky condition that could be contributing to sleep issues is a specific form of pots called hyper adrenergic pots. So this is where you are releasing too much norepinephrine, epinephrine, and adrenaline. And a lot of times this can lead us to feelings of, again, alertness, hyper vigilance, feeling awake.

How can Hyperadrenergic POTS impact sleep?

Michelle Shapiro [00:09:33]:
There's a specific sensation with hyper adrenergic pots that some people experience that creates a set of symptoms called adrenaline dumping. It's a phenomenon that happens with hyper adrenergic pots, which are these episodes of what I experienced as pure terror. You feel like you kind of want to jump out of your skin, but there's nowhere to go. If you jump out, I guess would be the best way of explaining it. It is extremely uncomfortable and unpleasant, and if anyone listening has experienced this, I I just empathize with you and feel for you so much, and I'm thinking of you and sending you a lot of love. And really, in that experience of hyper adrenergic pots, what is happening again is you've essentially dumped, there's been a huge dump or pour outpour of adrenaline, and your body is experiencing what it's like to have a lot of adrenaline floating through your bloodstream and in your brain, receiving those chemicals and messages. And adrenaline is intended to help us run. Adrenaline is intended to help us fight.

Michelle Shapiro [00:10:35]:
Adrenaline is intended to help energize us when we need it, raise our blood pressure. And so what that looks like is possibly high blood pressure that would happen in these episodes, as well as dizziness, extreme anxiety, and certainly awakeness and alertness. So when it comes to hyper adrenergic pots, if that is potentially something that you have had diagnosed or are looking to have diagnosed and or are interested in what's going on here, in this conversation, what's really important is the same pot strategies, compression, electrolytes, except with a little bit of alteration, because there is a high blood pressure feature to this. In order for us to sleep well, our heart rate needs to drop before we go to sleep, and our blood pressure generally drops a little bit before sleep as well. So any approach to help with hypovolemic pots, which is usually the one that people are most aware of, which is low blood volume, is, is going to help with hyper adrenergic pots, with the exception of not maybe going as high on the salt or as high on the compression as it can exacerbate those high blood pressure episodes that happen from the adrenaline and the epinephrine. So in this case, again, what you would want to do is make sure that your nervous system is being taken care of in every way you can. From a supplement perspective, from a safety perspective, from a breath work perspective, and focusing on if you are doing any limbic system retraining programs, that's where you're really going to put your focus is on the nervous system. And then I would not be doing anything else to stress out the body during that time.

Michelle Shapiro [00:12:15]:
So I would keep also, even if you're in these, again, consistent night episodes of hyper adrenergic pots, I would be thinking about how to calm the body before sleep. Maybe chamomile tea. If you are using any tinctures, herbal tinctures like peach juice by organic olivia, if you are using gaba, passion flour, glycine, any of these supportive supplements for sleep and anxiety, this is where it will help you. Anything that calms the nervous system is going to be a goal. And then also, some people do benefit from added minerals as well. But this is something that, again, if you're having these, really, if you're, if you are suspicious of the fact that you're diagnosed, that you are not diagnosed with pots, but you're suspicious that you might have it or you might have hyper adrenergic pots, this is where you are going to want to go to your interventional cardiologist, perhaps even a rheumatologist in some cases might be able to pick up on mcas and send you the right place for pots. But this is where you might want to explore that and also explore again, just as an underlying root of insomnia. If you're having these glaring and extremely intense adrenaline like episodes, that if you've had them and you hear me talk about it, you'll know I think it's that kind of experience unique to us.

Michelle Shapiro [00:13:32]:
This would be a little bit different than another kind of hidden reason for sleep issues, which is cortisol issue. And I think that a lot of us are now starting to hear and know that these cortisol issues happen usually between the hours of, like, 230 and 05:00 a.m. is when we're starting to see people draw that pattern recognition around it. And what often can be happening is that a. An episode of low blood sugar during the night can trigger the body to want to get sugar from within, because our body has this amazing capacity to create glucose from non glucose products. Um, it's this process called gluconeogenesis. And cortisol, our main stress hormone that we've heard so much about, is not only our main stress hormone, it is also our rising hormone. It's the hormone that wakes us up in the morning.

The relationship between cortisol spikes and sleep disruptions, and how blood sugar regulation can prevent cortisol-induced wakefulness

Michelle Shapiro [00:14:26]:
So if cortisol detects that there is a stressor, it will wake us up, like, you know, the rooster cockadoodle do earlier than what it believes our wake time to be. And that's why we wake up in that, like, two to five window when we want to be sleeping until, you know, seven or something like that. What can help to prevent this particular form of dysregulation, sleep dysregulation, is making sure that your blood sugar doesn't drop so that your cortisol isn't signaled to wake you up. The reason the cortisol is signaled, again is because cortisol needs to do its job to get you blood sugar from inside, because cortisol can induce gluconeogenesis, and we just don't want to trigger that huge cortisol surge by making sure our blood sugar is stable. It's very controversial when it comes to sleep, whether we should be eating a few hours before bed or we should be eating right before bed. Oftentimes, people will tell you that eating right before bed is sleep disruptive, and there's certainly research to emphasize that. However, if you are having unstable blood sugar and you need to have a snack before bed and it helps you sleep, I don't want you to be so concerned about the insulin resistant component of it, or needing to do intermittent fasting, which can be very disruptive for blood sugar and sleep. I want you to be more concerned about sleeping because sleeping itself is going to help you with insulin resistance anyway, so we have to make sure we can sleep.

Michelle Shapiro [00:15:59]:
It's really important. So I have found for clients that just having some berries and some seeds is really supportive for producing tryptophan. It's really supportive for helping to prevent that low blood sugar drop, like an hour or two before bed. If you're making any of those, like you've seen online, those sleepy time mocktails, that would be really nice to have. Also just paired with, again, a little bit of protein and a little bit of fat. Eating a huge meal before sleep is disruptive to sleep, but having a small amount, an hour or so before sleep can actually help prevent that low blood sugar drop, which may be instigating that cortisol spike. So, so far, we've gone over three potential hidden patterns of the body or conditions that might be causing sleep issues. The first being mcas and histamine issues, the second being hyper adrenergic pots, and the third being cortisol issues.

Michelle Shapiro [00:16:57]:
Again, anything that helps with the nervous system is also going to help with the cortisol issues as well. Something that I think we do know about as a diagnosis, but we may not know is affecting us, is sleep apnea. So the clients who I've had, who've experienced sleep apnea do not experience it, as always, as waking up constantly throughout the night. What I have seen certain clients experience it as, and this has happened with several of my clients, is of feeling like they are clawing at their throat, like almost like they're drowning, which can feel really, really scary. And that is what prompted them to get a sleep study to make sure and to rule out sleep apnea, which I would absolutely recommend. If there's any question, if you're waking up like you have not gotten any sleep, if you do feel like you're having any breathing issues in the night, it's definitely worth investigating. A very interesting way that clients have also caught sleep apnea before is with their aura rings. So generally, we want our heart rate variability, our hrv, to be high on the our ring, and we want our resting heart rate to be low or low enough, but not too low.

Michelle Shapiro [00:18:11]:
Those with sleep apnea may actually experience a phenomenon where their heart rate variability in the middle of the night jumps up to like 100 or 200. If at baseline it's like a 30 or something like that, there's a huge jump. And clients have expressed before that, oh, this is a good thing. This means my heart rate variability during the night is very high. It also can be a sign that you're stopping and starting breathing throughout the night. So if you also notice that your sleep is very low quality and you notice that your heart rate variability is jumping up really high in the night, it might be worth investigating sleep apnea with your doctor and doing a sleep study. So that's just something else that might be a condition that's getting in the way of proper sleep that we don't know might be getting in the way of it. Additionally, hormonal changes and disruptions, like changes in estrogen and progesterone, can certainly also influence our sleep.

How hormonal fluctuations, particularly around ovulation and menstruation, can be potential contributors to poor sleep quality

Michelle Shapiro [00:19:09]:
I have clients who notice that they sleep the worst during ovulation, and I have clients who notice that they sleep the worst a couple of days before their cycle starts. So whether it's the drop in hormones or the spike in hormones, if you notice your patterns, I think this is where sleep tracking becomes really important. And I don't only mean using a ring or using your apple Watch or something like that, or a whoop, but also just writing down your sleep patterns as well. I think that can be really helpful. Like I noticed I fell asleep at this time and I woke up on this time, on this day of the cycle that will let you know more about the root cause. So if you are, again, this is all for self investigation through using your practitioners as well and this reflection. But if you're a person who during ovulation notices really poor sleep, that might be, again, lead you in the direction of exploring something related to estrogen. If you notice your sleep gets really poor right before your cycle, it might be something related to that drop in hormones and what that feels and looks like for you.

How can nutrient deficiencies cause sleep problems?

Michelle Shapiro [00:20:13]:
So that's where I would probably be exploring something around minerals potentially as well. I would for both, but I would be really thinking about that in that drop before your cycle. Also, other conditions that might influence sleep issues are nutrient deficiencies. Namely I'm thinking of vitamin D, vitamin B, twelve. I'm thinking of magnesium, I'm thinking of iron. Iron deficiency can cause restless leg syndrome and those small twitches may cause sleeplessness both mentally and physically. So that is something that I would definitely explore again. If chronic insomnia is a concern for you and you are not responding to different medications, something I want to mention around that also is that if you are not responding to Ambien or trazodone or those things are not helping you sleep, it is really important to explore these different conditions or syndromes or patterns.

Michelle Shapiro [00:21:17]:
Because let's say if you do have a histamine issue. Like my client taking sleep medication may not, because it's not targeting the root cause, it may not alleviate sleep issues. So I have had clients who have literally taken Ambien and not been able to sleep, and an antihistamine did help instead. And this has been several of my clients, actually, not just the one amazing client that we were talking about before, but I think that it's so important to acknowledge the root cause in this. And if you are a person who is suffering with insomnia, to understand that you are never trapped, because there are always different root causes to explore. And I never want you to feel like you're backed into a corner where, oh, my gosh, the sleep medication didn't work for me. I'm never going to get sleep. There's always a different direction to go.

Michelle Shapiro [00:22:12]:
There's always something else to explore, there's always something to try, and there's always, there's always some sort of relief for you. Even if it's not perfect sleep, there's ways to get that relief. When it comes to the experience of sleep, I think it's really important that we reframe when we're having those bouts of insomnia, how scary they are, we have to reframe that. So if I ever wake up from sleep at 02:00 a.m. i immediately move to a different room, I will make sure I don't sit and perseverate on how I'm not sleeping. I immediately move to another room, I open a book, start reading, do things that relax me. Sometimes I'll even start my day because I think a lot of the recommendations we get around sleep are, of course, avoid blue light. Of course avoid waking yourself up.

My personal strategy for reframing insomnia and coping with sleepless nights

Michelle Shapiro [00:23:10]:
But that leaves people who experience insomnia in a really uncomfortable position where they feel like they can't use the tools that soothe them. So what I want to say is just do what works for you to literally distract yourself and just say, even if it's ten nights in a row, it's okay. It's just another crap night of sleep. I'm not going to die from a bad night of sleep. I hate it. But I'm going to make it through this and really just immediately accept. Tonight might not be my night. I might not be sleeping well tonight.

Michelle Shapiro [00:23:42]:
I might have some anxiety, and I'm going to ride this wave. That's really my biggest recommendation when it comes to sleep, is to just immediately embrace the fact I'm not sleeping well. I don't like it. I have had years of my life with insomnia, where I used to force myself to listen to meditations. If you've experienced insomnia, you know this, those like sleepy meditations on YouTube. And I always found myself getting more frustrated by them that they weren't making me sleep. And what has helped me so much is just accepting it and trying to move on and really, again, just riding that wave. So that's my recommendation in the moment.

Michelle Shapiro [00:24:23]:
And if you are literally listening to this when you can't sleep, I just want you to know with 100% certainty you are making it through tonight. You might note again like this, but you are going to make it through it. And if you can't sleep, it's okay. You'll sleep another day. Other sneaky conditions that might be affecting sleep without us realizing are really any chronic pain conditions. So I notice with a lot of clients that neck pain specifically, especially in my hyper mobile clients and my clients who have Potsdenn, is tremendously challenging. The pain can make sleep tremendously challenging. So what I would say has worked for a lot of clients and myself is if you are experiencing that pain, finding a way to potentially elevate the neck in a way that works.

How can chronic pain, particularly neck pain, and other conditions like hyperthyroidism, affect sleep quality?

Michelle Shapiro [00:25:13]:
And this is where I want you to work with your practitioners, whether it's your chiropractor, whether it's your physical therapist who might know more about your body and ask what sleep positions might be most of helpful, what kind of pillows might be most helpful. I can't give broad spectrum recommendations because everyone's body is different. So this is where you're going to rely on your practitioners to help with that as well. I think having too low of blood pressure or heart rate is also something that comes up as being incredibly challenging and frustrating for people around sleep. So making sure that you're getting adequate minerals and electrolytes throughout the day is of paramount importance. And enough hydration, too low of blood pressure or too low of heart rate can wake us up in the night as well. So just making sure you're getting enough of those fluids and then any conditions which are make our metabolism quicker can also in influence sleep. One that's coming to mind is hyperthyroidism.

Michelle Shapiro [00:26:17]:
That can certainly influence sleep and keep us alert and awake as well. Timing medications and supplements is essential. Something that I want to mention too is that if you are taking b supplements, B vitamins and vitamin C both have energizing effects. So that's something that I would tell people to switch to before 12:00 p.m. just making sure you're getting those finished in the morning is, I find, really, really important. And then having again, the supplements that you're taking later in the day be more relaxing and sleep supportive, like magnesium, like any of those anxiety supportive supplements or herbs that you might be taking as well. So that those might be helpful, too, to just think about the timing. Of course, if you are on medications, you're working with your doctor on that, but noticing the timing of medications, especially if you're taking stimulants, to make sure, of course, that you're timing them well to help with sleep.

How seasonal changes may affect sleep patterns

Michelle Shapiro [00:27:09]:
The same thing goes for caffeine. I find most clients do best with caffeine, of course, beverages, or if you're taking caffeine pills or something like that, of course, taking those in the earlier part of the day, as that can influence sleep as well. And what I also want to talk about is that seasonality, the different seasons, the change in the seasons can really influence our sleep patterns. So creating, of course, that optimal sleep environment that's is really important. But also, if you are a person who sleeps a little bit later in summer, just knowing that as the seasons change, your sleep patterns might change as well. And again, if you notice for a couple weeks, you're waking up at the same time that 02:00 a.m. mark, you're noticing that your sleep is a little bit altered. It's an opportunity to look inward and see what are my root causes for why this is, you know, happening.

Michelle Shapiro [00:28:08]:
And what I wanted to do in this episode was really give you a lot of different avenues for conditions, environment changes, stress, all these things can influence sleep. And the best we can do when our sleep is influenced is to be as non reactive as possible and explore those root causes. There are, again, these are just some of the root causes of different sleep issues that we can encounter, but it doesn't mean there aren't others. And I just, again, want you, if you are listening to this, this, to know that there is always something that can be done to either change your sleep or to change your perception and experience of sleeplessness. So there's always something. And I know that insomnia of any kind is so uncomfortable and so frightening in the moment. And I, again, just want to give you so much hope here. I have seen so many clients over the years and myself get amazing sleep after years of really poor sleep.

Michelle Shapiro [00:29:05]:
Especially for us creative type people, especially for us highly sensitive people, it is entirely possible. And I just want to keep feeding you that hope and giving you that hope that it is. And know that there are so many explanations for why you aren't sleeping well.