Waking Up in the Middle of the Night

Published: August 10, 2012

Series Parts: [ 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 ]

What's New in S.H.I.N.E. — Part 4: More on Sleep

Welcome to part 4 of my series reviewing and updating the core elements of the SHINE protocol for CFS and fibromyalgia.

Just as I did in the first 3 parts of this series, in part 4 I again focus on sleep. This time I look at a pattern that bedevils the nights of most patients with CFS and fibromyalgia — waking up between 2 and 4 a.m. in the morning and being unable to go back to sleep.

Why does this happen and how can you prevent it? Is it nighttime adrenal and low blood sugar problems? Acid reflux? Other causes? This week you'll find out!

Why Does This Happen?

Don't you hate it when you wake up, glance at the alarm clock, and realize that it's 2:00, 3:00 or 4:00 a.m., you're wide awake — and unlikely to go back to sleep anytime soon? Well, if misery loves company, you have a lot of company. This type of insomnia is very common among my patients with CFS/FM.

For many years we didn't understand why this happened. What was waking so many people up? Why were they being so abruptly exiled from Dreamland? The good news is that we've discovered the cause. The even better news is that because we know the cause, we also now know the remedies.

Hormones Shifting into Reverse

First, an explanation of the cause: Your body functions in natural cycles. You inhale and then exhale. Your heart beats and then rests. The same cyclic pattern is true of your hormones — levels naturally rise and fall, often in synch with the day/night cycle of the planet. In fact, there's even a master clock in the brain that responds to light and regulates hormones. And that clock reports to an area of the brain called the hypothalamus — the very area that has "blown a fuse" in CFS/FM!

As a result, natural levels of the hormone cortisol can be reversed in patients with CFS/FM. Generated by the adrenal gland, cortisol is called a "stress hormone" because it helps your body respond to any physical, mental or emotional challenge. That includes helping control levels of blood sugar (glucose), your body's main fuel.

Needless to say, the tide of cortisol should be high during the day (when you're active and need to be on your toes) and low at bedtime (when your body is ready for eight or more hours of refreshing R&R). But it was recently discovered that in many folks with CFS/FM that pattern is reversed.

Cortisol is too low during the day, causing daytime fatigue. It's too high in the evening, when you should be feeling sleepy. And it's once again too low in the middle of the night, causing blood sugar levels to drop — which wakes you up.

What to Do?

Here are a few very effective recommendations:

1. Get natural and prescription sleep support.

To begin, you should review my recent articles on natural sleep support and prescription sleep support and sleep hygiene. After that, consider trying these two excellent natural sleep formulas:

  1. An herbal sleep-support supplement that helps maintain healthy cortisol levels. Exhausted all day and wide awake at bedtime? This suggests that your adrenal (stress handler glands) day/night cycles are mixed up, with cortisol too low during the day and too high at bedtime. What to do? Research shows that the anti-insomnia formula in some herbal sleep-supplements can cut elevated cortisol levels by up to 60%. If cortisol ups and downs are your problem, you'll probably notice results the first night. In other words, you'll sleep better right away. Being what is called an adaptogen (balance restorer), this type of supplement helps raise cortisol when it is too low, and lower it when it is too high.
  2. An herbal supplement that promotes healthy sleep. I find these types of sleep-supporting herbal mixes to be the best natural sleep support available — and it is excellent for day to day insomnia as well as the severe insomnia of CFS/FMS. Look for one that contains the sleep-supporting herbals Wild lettuce, Jamaican Dogwood, hops, theanine, valerian, and passion flower.

Both of these types of herbal mixes can be taken together as well as with prescription sleep aids.

2. Eat a high-protein snack at bedtime.

Wake up wide awake or in a sweat during the night? In those with adrenal exhaustion (very common in CFS), low blood sugar is common during the night. Just eating 1 ounce of cheese, turkey or other high-protein food at bedtime stabilizes blood sugar levels throughout the night, so you're less likely to wake up from low blood sugar while sleeping. Try it for a night or 2 to see if it helps.

3. If you wake up with night sweats, check other hormone levels.

If you're a man, you may have a testosterone deficiency (see Can Testosterone Be Good for You?). If you're a woman, you may have low levels of estrogen.

4. Address acid reflux.

Acid reflux — also called heartburn or GERD (gastrointestinal reflux disease) — is an incredibly common problem in patients with CFS/FM — and in everybody else, with an estimated 30 million Americans having regular bouts. What's happening? The food-dissolving hydrochloric acid of the stomach "refluxes" up through the esophageal sphincter into the esophagus and throat, where it doesn't belong. That means you're even more at risk for acid reflux when you're sleeping and when gravity can't keep the acid in the stomach where it belongs. During sleep, you inhale the acid, break into a sweat, and wake up wide awake — not even realizing you've had reflux! A simple test? For 1-2 nights take an acid blocker at bedtime (e.g., Zantac or Prilosec) to see if it helps. Don’t use these long term though, as they get toxic and worsen the problem. You’re just using them 1-2 nights to see if you sleep better. If they do, stop them and then follow these few simple actions to help keep nighttime heartburn under control:

  • Make gravity your friend again. Many experts suggest you do that by elevating the head of the bed by 6 inches using strips of lumber, bricks or other clunky devices. I think that's difficult, unnecessary, and looks funky. Instead, buy yourself a sleep wedge pillow, which raises your body from the waist up and works well to keep acid in your stomach.
  • Take bicarbonate of soda at bedtime. I think acid-blocking drugs are usually unnecessary (because your body needs stomach acid) and dangerous (because they can increase the risk of infections, fractures, infections and even heart attacks). But neutralizing acid at nighttime, when you don't need it to digest food, is a good idea. And you can do it simply and inexpensively. Just dissolve 1/2 teaspoon of alkalinizing bicarbonate of soda (like Arm and Hammer) in 4 ounces of water and drink it at bedtime. (Note: This remedy should not be given to children under 16 years old.)
  • Take 5 to 6 mg of melatonin at bedtime. Studies show that regular use of this sleep-regulating hormone at this higher dosage can help reduce nighttime acid reflux.
  • Don't eat two hours before bedtime. You want to give food a chance to digest and move out of your stomach before you start to sleep, thereby cutting down on nighttime acid reflux.

Learn More

To find more solutions to the problem of chronic acid indigestion, see Eliminating Chronic Acid Reflux & Indigestion. I will devote an upcoming newsletter to this important topic as well — and introduce you to 3 new therapies that will make things much easier!

Jacob Teitelbaum, MD

is one of the world's leading integrative medical authorities on fibromyalgia and chronic fatigue. He is the lead author of eight research studies on their effective treatments, and has published numerous health & wellness books, including the bestseller on fibromyalgia From Fatigued to Fantastic! and The Fatigue and Fibromyalgia Solution. His newest book (June 10, 2024) is You Can Heal From Long COVID. Dr. Teitelbaum is one of the most frequently quoted fibromyalgia experts in the world and appears often as a guest on news and talk shows nationwide including Good Morning America, The Dr. Oz Show, Oprah & Friends, CNN, and Fox News Health.

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