You sleep a lot. Why do you still feel tired when you wake up?

Hypothyroidism causes your metabolism and everything else slow down. This means that you are not making enough of the energy currency of the body or ATP. You need proper thyroid hormone balance for ATP to increase and then your energy will increase.

On the other side of that, you need quality sleep for your body to function properly. The amount and quality you get can make or break your health. Sleep quality plays a role in weight gain, weight loss, cancer risk or cancer prevention and everything in between. We need quality sleep for things like good bone density, lower inflammation, improve your mood and ability to manage your emotions and thinking, healthy skin, and most importantly, balancing hormones. Thyroid hormones are hormones just like your sex hormones.

You need quality sleep to balance your hormones.

It also improves your immune system and your ability to resist infection, decrease your risk for dementia, heart disease and improves your overall quality of life.

We all need about 7 or 8 hours per night for the best possible benefits.

You may remember the stages of sleep from science class - I personally don’t remember so let’s dig into this.

Stage one- the lightest phase. You are not completely unconscious but you are also not totally aware of your surroundings and you can be woken up easily by any noise. Your brain waves are shifting from alpha to theta waves.

Stage two- this is where we spend about half our sleep. Our heart rate slows, body temp drops just a bit to get us ready for REM sleep. Our brain waves fluctuate here from decreased activity to more burst of active waves which is how we retain our memories. This is the rest and recovery stage.

Stage 3- our deep sleep stage. We have trouble waking up from this one and our brain is having delta waves so we are basically unconscious and this is also a restorative stage for our brain. This stage is what helps us physically recover from the days activities. Our brain actually shrinks at this stage so it can detoxify itself. We also have increased blood flow and muscle and tissues repair themselves and/or grow.

We don’t usually wake out of a stage 3 sleep on our own but if someone or something wakes us from this stage, we may find ourselves tired and even feeling groggy which is because this period of rest carries over into our morning because we were interrupted. This is what can cause us to have brain fog as well. Ideally we should be sleeping in stage 3 for around 2 hours per night. As we age, this time is shortened.

The fourth stage is the REM or rapid eye movement that happens for a short time after stage 3 and this is where we find ourself dreaming and this is also where our memories become implanted in our memory? In this stage we are unable to move except for our eyes and breath. Our heart rate and brain activity can increase here and is why our dreams sometimes feel so real. I’m curious if this heart rate increase happens around 2-3am when many of you are also dealing with low blood sugar and that increased heart rate can wake you up.

After we go through all four stages, we come back to stage one and do it all over again. During the transition from REM to stage one, you can easily wake. It is said that this sleep cycle of stage one through 4 between 4 and 6 times.You spend ¾ of your time in stages 1-3 but as the night progresses you spend more time in REM and less time in stage 3.

So you may do stage one for 5-10 minutes, stage 2 for up to 25 minutes, stage 3 up to 4o minutes and REM about 10 for that first cycle, then as the night goes on you spend up to an hour in REM.

We need all these stages to be fully rested and to have that repair process happen. When we are sleeping well and going through all the stages, we have better production of cortisol and melatonin to keep our circadian rhythms working properly. Not only do cortisol and melatonin operate on a circadian rhythm but your thyroid hormones do as well so it would seem that good quality sleep patterns will improve thyroid function as well.

Keeping your circadian rhythm working well means not having exposure to unnatural light sources like devices give off when the sun goes down.

A portion of gene expression and biochemical processes are affected by how well your circadian rhythm works. Tissue repair and restoration happens better when this is functioning properly.  You may have heard of the HPA axis or hypothalamic pituitary adrenal axis. This is how cortisol is managed, most hormones are managed by the hypothalamus in the brain.

Again, cortisol and melatonin are controlled by the circadian rhythm with melatonin being secreted from the pineal gland and your gut. This is what makes you tired at night and is turned off by blue lights. Melatonin also acts as an antioxidant and was suggested for use in higher amounts of around 3-7milligrams for help in covid cases. It isn’t a trigger for a sleep state but gets your body ready for sleep. It is kind of a powerhouse of a hormone with aid in cancer prevention, helping keep your blood pressure under control and keep estrogen from getting too high. It can also help you with jet lag.

The best way to improve your circadian rhythm and melatonin and cortisol regulation it to get good exposure to sunlight during the day. Get outside and get some sun - it is how we are meant to be.  Melatonin should be high at night and cortisol should be high in the morning. If you drag in the morning and you felt like you slept enough, and your thyroid hormones are regulated well, then it could be your cortisol is not high in the morning. You can test for this with a salvia test but it isn’t super accurate unless you test it for a whole month and most people are not going to do that.

Cortisol is the waking hormone and is said to be high in stress responses. It is helpful in giving our strength a boost and improve our ability to focus. Avoiding chronic stress is going to be something you may need to work on if these hormones are out of whack.

How does our gut health play a role in all of this? Our gut is said to be the second brain and has a lot of neurotransmitters in it that contribute to our cognitive abilities, our mood and how well we sleep and is linked up with the vagus nerve. Much of our rest and digest or parasympathetic state occur with the help of the vagus nerve. Being in parasympathetic helps promote a resting state which we need for good sleep.

The neurotransmitters I’m about to discuss don’t work well if our gut is a mess which means that we need good gut health for good health and as the saying goes, all disease begins in the gut.

The neurotransmitter GABA is a calming nerve signal that helps us sleep but doesn’t work well if we are not getting good sleep.

Acetylcholine is a neurotransmitter that helps us in REM sleep and when we are dreaming to be wakeful but not awake.

Serotonin is a feel good hormone with most of it being found in the gut. We need a healthy gut and a functioning immune system to produce serotonin. When we get that exposure to the sunlight in the morning, the hypothalamus gets a signal that it is time to wake up and a signal is sent to the gut to start making serotonin. We need adequate production of serotonin to make melatonin for use when it is time for bed. it also helps produce vitamin D.

Most of you have heard of ATP- it is cellular energy and thyroid hormone helps produce it. Adenosine is the A in ATP and is a neurotransmitter (produced in the gut). It builds in the brain as the day goes on because most of us are alert and active. Have you ever really used your brain all day and just felt exhausted at the end of the day? This is because you used a ton of ATP and there is a build up of adenosine in the brain that gets cleared out while you sleep.

A note for the caffeine users- caffeine prevents us from being drowsy by blocking receptors for adenosine on our cells. That crash you feel when caffeine wears off is all those receptors becoming available for adenosine again which can cause you to just feel massively tired. Consuming a lot of caffeine can also cause cortisol and adrenaline to increase which keeps you awake longer and prevents the restoration our body needs when we sleep. If caffeine is increasing cortisol and adrenaline, those hormones come down eventually and often decrease too much causing further fatigue feelings. This can also mess with blood sugar, causing it to dip too low causing fatigue as well. That afternoon dip where you go for a coffee is not the answer long term.

Other things affected by sleep or lack of sleep- your metabolism. Not only does thyroid hormone affect your metabolism but how well you sleep does too. Our metabolism is slower at night and higher in the morning. What you eat for breakfast will determine whether you ride the blood sugar roller coaster all day long with dips in energy or whether your energy is steady the rest of the day.

The satiety hormone, leptin, tells you that you are full when the stomach is full and a signal is sent to the brain. Leptin is secreted and takes away our hunger. We feel content and full and satisfied. Leptin is not signaled well when we don’t get good sleep. We often look to refined carbs and sugar to fill us up when we are tired and it is probably because leptin is not being signaled. So lack of sleep can lead to weight gain or an increase in fat stores.

Ghrelin is the hormone that signals hunger and is raised when we get poor sleep. So it makes it kind of a challenge to make good food choices when leptin isn’t being received and we have too much ghrelin. Poor food choices can make it hard to fall asleep and get good sleep. it is another vicious cycle. We are craving sugar and fat and all the processed foods that keep us unhealthy. It is a survival mechanism that we have not evolved from yet. It is an evolutionary idea that we need to eat more to survive. In our hunter gatherer age this would not have been a problem because there was no ice cream or cookies or crackers to snack on back then. Unfortunately now we have access to so much crap and it is really just harming us and contributing to chronic illness.

Another problem that occurs when we are not sleeping well is we become less sensitive to insulin because our body is in fight or flight mode or sympathetic mode. Lack of sleep or poor quality sleep causes our body to shuttle glucose away from our cells and to places like the brain and muscle to be sure we can have a quick fuel source should we need to run from a predator. Darn evolution has not caught up with the industrial and agricultural revolutions.

The best and first thing we need to do is to give our eyes and our body exposure to sunlight in the morning when we wake up. Great to do in warm weather, not so fun in places that have a winter. It is more important to get natural light so it doesn’t have to be the sun. Sometimes in Minnesota where I live, we don’t see the actual sun shine for days- so natural light is okay. This will tell the hypothalamus that is daylight and sets the circadian rhythm on the right foot.

Getting your hypothalamus that signal will help all your hormones released by the hypothalamus to work properly. That includes the thyroid hormone production that starts in the brain. Natural light exposure will improve cortisol and melatonin production to help you get good sleep.

I’ve talked about blue light exposure before and that is the light that comes from tv, indoor lighting, devices and so on. Blue light is stimulatory and keeps us from making melatonin at night. Red light, much like the rays from a sunset. can promote rest and relaxation though I’m sure you are not going to put red lights in all your lamps at home. Not really that practical. Using night shift on apple devices can help but it is not enough to improve melatonin and sleep.

Sun exposure between 6 and 8am for 10 to 15 minutes is ideal. I’m up around that time but I’m not outside yet. it is important though because our skin has receptors for light exposure that are similar to those in the eyes. There is more natural blue light in the sky in the morning which helps to wake us up.

How to get more red light? Bonfires, candle light, dim your lights, avoid LED lights at home. How to improve your exposure? Get outside as much as possible, cover LED type indicator lights that might be on in your bedroom, keep your phone out of your room or at the very least on airplane mode. I used to use a white noise podcast on spotify on my phone to help me sleep but then I found myself scrolling before bed and then when I woke up. Such a waste of time so I bought a white noise machine. Keep your bedroom cool and dark too.

What does this sleep wake cycle look like?

Say you wake up at 6 am. Before 7 your blood pressure will increase from you resting state pressure which will help wake up your body and start the energy production process to be more than when you were sleeping. Cortisol has been gradually rising. Within an hour and a half of waking, melatonin production stops until evening.

If you have eaten within an hour or so of waking, your digestive tract has started working and you may have a bowel movement soon.

At around 10am is when you have the most energy and focus for the day due to your morning coffee and cortisol has risen.

There should be no afternoon slump between 2 and 5pm but your body should be feeling great and in peak physical performance.

Around 6-7, your body will have its highest body temperature and blood pressure and by around 8pm cortisol should be dipping and melatonin increasing so that you can go to sleep when the sun goes down.

By 10pm all the way through to 2am your digestion slows down and your body has done its repairing for the night and being asleep at this time frame is important because growth hormone is at its highest around 11pm. After 2 am melatonin slowly decreases while cortisol begins to rise to help you wake up in a few hours.

Next episode will talk about all the things that screw with this circadian rhythm like stress, poor blood sugar regulation, your diet, how hydrated you are, and more.

Thanks for listening. I hope you found this interesting. Please reach out if you have any questions or you want to work with me to figure out your health.