Insomnia, a condition in which a person has trouble falling asleep, staying asleep, or experiencing frequent waking, is a worldwide issue affecting up to 59% of adults in the US.

Regular, restorative sleep has an incredible impact on your overall health. The body goes through many stages of sleep throughout the night while working on detoxifying, replenishing hormones, repairing damaged cells and tissues, and processing emotions from the day.

Our body works on its own internal clock, the circadian rhythm, and is influenced by the amount of light throughout the day. It signals to the brain when we should be awake and when it's time for sleep. When it's dark, the pineal gland in your brain secretes the hormone melatonin. As melatonin rises, it works to suppress glutamate, a neurotransmitter, and cortisol, a stress hormone. This helps facilitate calmness and promotes the onset of sleep. The proper balance of these hormones and neurotransmitters plays a critical role in the quality and duration of sleep.

When there is a disruption in the circadian rhythm, a person can begin to experience impaired sleep. This article will review the risk factors for insomnia and recommendations for personalized lab work and sleep hygiene to help those suffering from insomnia.  

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What is Insomnia?

Insomnia is considered chronic when it occurs at least three nights a week for a minimum of three months. This can increase one's risk of developing adverse health outcomes and chronic diseases like dementia, depression, stroke, hypertension, obesity, and diabetes.

Each age group has set hours of sleep required for optimal health. If you aren't meeting these requirements, you may have insomnia.

• Infants* 4 months to 12 months should sleep 12 to 16 hours per 24 hours (including naps)
• 1 to 2 years of age should sleep 11 to 14 hours per 24 hours (including naps)
• 3 to 5 years of age should sleep 10 to 13 hours per 24 hours (including naps)
• 6 to 12 years of age should sleep 9 to 12 hours per 24 hours
• Teenagers 13 to 18 years of age should sleep 8 to 10 hours per 24 hours
• Over 18 it is recommended that adults achieve 7 hours of sleep or more per 24 hours

Insomnia Signs & Symptoms

There are several signs and symptoms that people will experience when they have insomnia. (1,2):

• Difficulty falling asleep
• Difficulty staying asleep, possibly waking several times throughout the night
• Waking too early in the morning, despite still feeling tired
• Not feeling well rested upon waking
• Fatigue or sluggishness during the day
• Mood issues like irritability, anxiety, depression
• Poor focus or memory
• Increased clumsiness or errors
• Snoring

Insomnia Possible Causes

Insomnia has a long list of possible causes: (1,2)  

Stress

Stress can come in many forms, and the body is built to tolerate a certain amount. When stress becomes chronic, a person remains in a sympathetic nervous system state (aka fight or flight), and the body releases cortisol in response. Excessive cortisol production will cause impairments in melatonin production and contribute to systemic inflammation and blood glucose dysregulation. This pattern in and of itself creates a cycle of stress. Stress can also be experienced through other illnesses or external experiences like a busy lifestyle, processed foods, and stressful jobs.  

Poor Sleep Hygiene

Not uncommon in the modern world, as many individuals do not prioritize sleep. The constant exposure to blue light directly contributes to insomnia by impairing the body's natural circadian rhythm and melatonin production. Other factors include:

• Irregular bedtime hours.
• An uncomfortable sleeping environment.
• Eating a heavy meal within 3 hours of bedtime.
• Engaging in intense exercise within 1 hour of bedtime.
• Having a stressful conversation in the hours before bedtime.

Mood Disorders/Trauma

In addition to being a sign or symptom of insomnia, they can also be a cause. Anxiety, depression, and PTSD are all associated with disrupted sleep patterns.  

Medications

Many commonly prescribed medications are associated with insomnia.

• Antidepressants, beta-blockers, and NSAIDs that can deplete melatonin.
• Oral contraceptives deplete vitamin B6, which is needed to convert neurotransmitters glutamate to Gamma-aminobutyric acid (GABA), a calming neurotransmitter.
• Diuretics use contributes to magnesium depletion, a critical mineral needed to produce neurotransmitters.

Medical Issues

Insomnia is often a result of another disease process affecting the quality of sleep. This can include sleep apnea, diabetes mellitus, urinary issues related to an overactive bladder or benign prostatic hypertrophy, dementia, restless leg syndrome, congestive heart failure, pulmonary disease, hormonal shifts during pregnancy, peri-menopause, or menopause.

Stimulants

• ‍Caffeine is one of the most widely used stimulants and may contribute to insomnia when taken close to bedtime.
• Some over-the-counter medications, like Excedrin, contain caffeine or other stimulants that affect sleep quality.
• Nicotine has been shown to impair all stages of sleep.   ‍
• Alcohol consumption causes insomnia by blocking glutamate. As the alcohol wears off and GABA levels decline, a glutamate surge contributes to wakefulness, anxiety, and restlessness.

Age

Many older adults will experience insomnia due to physiologic changes in their bodies. As we age, the production of melatonin declines and is shifted to later hours while the production of cortisol increases and its peak occurs earlier in the night. In addition to these changes, factors influencing poor sleep include chronic diseases, medication side effects, decreased mobility, decreased social interaction, possible caregiver burden, and other lifestyle choices (3,4).

Sedentary Lifestyle

Studies have shown the benefit of exercise and improving sleep quality. Exercise helps those with insomnia by tiring out the body through physical movement. Establishing a circadian rhythm by choosing activities outdoors during daylight hours can help alleviate stress and anxiety that may prevent a person from falling or staying asleep.

6 Speciality Labs That Get To The Root Cause Of Insomnia

Depending on the individual's health circumstances and the type of insomnia they are experiencing, lab work can play a valuable role in identifying the root cause of the sleep disorder.  

Neurotransmitters

Neurotransmitters play a critical role in the quality of sleep and can be tested with the Neurotransmitters test by ZRT Laboratory. Many who have insomnia have an imbalance that is contributing to their symptoms. These tests show glutamate to GABA ratio along with the levels of epinephrine that can contribute to a chronic sympathetic state.  

Salivary Hormones

In addition to learning neurotransmitter status, obtaining salivary levels of stress and sex hormones is recommended and can be obtained with the Cortisol salivary test by ZRT Laboratory and the Saliva Profile I by ZRT Laboratory. Unbalanced cortisol patterns throughout the day can contribute to lower melatonin, hot flashes or hypoglycemia, resulting in poor sleep quality.

Insulin Resistance  

Obtaining fasting glucose, hemoglobin A1c and fasting insulin will help identify if a patient has insulin resistance or blood sugar dysregulation that may be adding to poor sleep quality.

Nutrient Assessment

Many who have insomnia also have a chronic disease as a risk factor for sleep disorder. Certain medications used to treat common chronic diseases are associated with nutrient depletion. The Micronutrient test by SpectraCell Laboratories will provide a comprehensive report of vitamins, minerals, antioxidants, fatty acids, and amino acids which are essential for optimal health.

Gut Health

The health of the gut microbiome directly influences a person's overall health, and we are becoming increasingly more aware of their role in producing neurotransmitters as part of the gut-brain axis. The GI-MAP + Zonulin by Diagnostic Solutions and GI Effects® Comprehensive by Genova Diagnostics tests can offer inside into gut health. In supporting a healthy microbiome, proper levels of neurotransmitters can be restored, improving a person's insomnia.

Sleep Apnea Work-Up

For individuals who snore, it is recommended they obtain a sleep study to rule out the presence of sleep apnea as a cause of insomnia. In the case of sleep apnea, your cells are chronically exposed to low oxygen states that result in downstream disease, contributing to insomnia and affecting overall health and longevity.

Functional Medicine Treatment for Insomnia

Sleep Hygiene

These are established behaviors in the hours before bedtime to help facilitate deep, restorative sleep. The following tips are recommended:

• Aim for the same bedtime and wake-up routine each day of the week.
• Early AM light exposure can help set a circadian rhythm and improve sleep.
• Commit to regular exercise, preferably in the morning or earlier in the day. Remember to avoid high-intensity workouts of any kind one hour before bedtime.
• Avoid other intense activities like schedule planning, budgeting, or stressful conversations an hour before bedtime.
• Create calm evening rituals that facilitate mental and physical relaxation. For example, take an Epsom salt bath, read a book, journal, meditate, stretch or listen to music.
• Consider dimming your lights throughout the house 1-2 hours before bedtime.
• Avoid blue light in the evening hours leading up to bed. This includes TV and all electronic devices. Blue light has been shown to disrupt normal circadian rhythms and contribute to insomnia. You can also consider using blue-blocking glasses.
• Create a clean and quiet bedroom. Consider investing in earplugs or a white noise machine if you are in an environment where you can't control the surrounding noise. If you are sensitive to allergens, investing in an air purifier can be beneficial. Temperature is also critical, as cooler temperatures have been recommended for more optimal sleep.
• Be mindful of when you eat. It is recommended to avoid eating 3 hours before bedtime. This is so that your body does not have to spend its energy digesting your food and can tend to the other very important processes that happen while you sleep.  

Reduce Stimulants

• Given that caffeine's stimulatory effects are experienced differently between individuals, it is not necessary to completely avoid it to prevent insomnia. However, limiting its intake after 2 pm is recommended to ensure your body has had enough time to metabolize it properly.    
• The use of nicotine provides a lasting stimulant effect. By quitting smoking, you cannot only improve your insomnia but also have a reduced risk of developing respiratory-related conditions that can cause insomnia.
• Consider swapping alcohol for a calming bedtime drink like chamomile, lavender, or lemon balm tea. There are even non-alcoholic "wine" and "mocktails" on the market that are made with adaptogenic and calming herbs.
• If you have difficulty avoiding alcohol, try limiting your alcohol consumption to earlier in the evening, several hours before bedtime. This can help offset the middle of the night waking from the surge in glutamate.  

Balance Blood Sugar

If you are struggling with episodes of hypoglycemia, causing nighttime waking, consider partaking in a healthy bedtime snack. This should include a healthy carbohydrate and fat (for example, apple with almond butter) to facilitate stable blood sugars while sleeping. A small snack like this does not contribute much to digestive energy; therefore, it should not affect your sleep.

Supplements

Supplemental melatonin has been shown to be an effective supplement to assist with insomnia. It is best to take this 30 minutes before bedtime. *Melatonin is generally safe for short-term use. When it comes to melatonin, less is more—1 to 3 milligrams; two hours before bedtime is enough for therapeutic benefits. If melatonin is shown to be beneficial in your sleep pattern, it is recommended to take it at night for one month and then stop to see if your body has adjusted.

Alternatively, if sleep is difficult to sustain, supplementing with 5-hydroxytryptophan (5-HTP), a precursor to serotonin, before bed will help to facilitate a more steady flow of melatonin throughout the night.

*Important to note that you should not take 5-HTP if you are on an SSRI or SNRI, as this can increase your risk of developing serotonin syndrome.

If cortisol patterns contribute to insomnia related to hot flashes, supporting your adrenals with calming, adaptogenic herbs can be helpful. Examples include American ginseng, Rhodiola, ashwagandha, and magnolia berry.

Neurotransmitter levels can be supported through proper supplementation. Vitamin B6 and Magnesium are nutrients that are essential for helping to convert glutamate to GABA. In addition, supplementing with GABA and L-Theanine was shown to improve sleep latency by improving overall GABA activity.

Summary

Most individuals will experience some degree of insomnia throughout their life. The reasons for this can vary tremendously. However, the root of a person's insomnia is primarily driven by lifestyle choices. In examining your daily routines, stressors, diet, activity, screen time, and bedroom environment, several positive, modifiable changes can likely be made to stop struggling from insomnia. Moreover, personalized lab work is beneficial for narrowing down the root cause of your insomnia.