case study: insomnia through a Functional lens, part 1
Posted by Andrea Nakayama
I’m back in your inbox today, talking about sleep.
That’s because sleep is part of our Non-Negotiable Trifecta.
My hope is that I’m both underscoring how important sleep is in any healing protocol and also identifying that when sleep issues present, we need to uncover what is happening (hello Sleep Assessment), why it’s happening, and how to remedy the particular concern being raised.
In other words, (don’t be fooled) sleep issues are not resolved with one singular remedy!
Let’s look at Shelly’s sleep challenges…
Shelly is a 47 year old retired nurse who’s just started her own health coaching practice. It was her own hormonal issues, which she’d managed with diet and lifestyle modification, that originally got her into health coaching.
Shelly eliminated her perimenopausal symptoms and felt like herself again. She’s now thrilled to help others do the same.
Yet Shelly’s been under a lot of stress lately: her son is having difficulty in school, and her husband got laid off at work (right when her own coaching business is just starting to thrive).
Shelly has gained a little more weight around her mid-section after losing over 25 lbs when she originally changed her diet to manage her fluctuating hormones. In an attempt to address the added weight (which also makes her feel a little self-conscious in her new health coaching role), she’s begun to implement some weight-loss tactics she’s recently learned about, including intermittent fasting.
Shelly came to us at the Functional Nutrition Alliance Clinic not because of the weight, but because she’s now having trouble sleeping.
What do we do?
Well, first we have to find out what’s going on in there!
Step 1: Assess
Since sleep is a Non-Negotiable, particularly for weight concerns, hormonal issues and detoxification, we give her our Sleep Assessment to glean more information about the specifics of her sleep issues.
Now that we know more about what she means by “sleep issues,” this is how we proceed:
First, we make sure she’s working with all the Sleep Non-Negotiables since these are foundational to restorative sleep for everyone. If I review Shelly’s story and her Sleep Assessment, there are a few things that can be dialed-in to better support a restful night.
When you review the Sleep Non-Negotiables, what do you see?
Next, we’ll aim to educate Shelly about her own specific biological function in relation to her challenges. It could be that some of the actions she’s taken to aid weight-loss are actually hindering her sleep! (Oooof. Catch-22!)
Heal vs. Ideal
Because Shelly’s under some added stress (kid problems, financial strain, the start of a new venture, even age), she likely has additional strain on the function of several key stress hormones that could impact her sleep. These hormones include cortisol, DHEA, and the fight or flight duo: epinephrine and norepinephrine.
The intermittent fasting, while OK in an ideal situation, may not presently be serving her.
You see, intermittent fasting in an environment already under stress can trigger an increase in cortisol levels. At certain times of day (like that mid-afternoon slump Shelly is having), increased cortisol levels can be highly beneficial. They keep us awake and full of drive!
However in the middle of the night (like that 2am waking time she’s experiencing), that spike in cortisol is both the culprit of waking her up like a screaming baby, and the stimulant that’s keeping her up!
There are a couple of key factors that increase cortisol levels:
- bright light (which is why we unplug and go for the no glow in our nighttime Non-Negotiables)
- danger (which puts us in a sympathetic vs parasympathetic state when we should be at rest)
Shelly has identified that both of these factors could be present in her current regime…
Shelly noted that her husband has not removed the alarm clock from their bedroom. There’s the glow that’s likely stimulating her eyes and brain and reducing her melatonin production, when she wakes in the night to use the bathroom, right when she needs it most to fall back to sleep and stay asleep!
Additionally, with her interest in intermittent fasting, she’s been shifting to a longer period of time between dinner and breakfast. She’s been aiming for 14 hours of fasting, with her last meal ending at 6:30pm, not eating again until the kids are out the door at 8:30am.
With further investigation on our part (we love our Functional Timelining), it’s discovered that her sleep challenges coincided with the onset of this fasting approach.
But why is it that I associated intermittent fasting with a state of danger?
Isn’t it supposed to help with increased weight and fat loss, reduced brain fog and risk of chronic disease?
You bet it does! Again, in an ideal “environment.” In theory.
An ideal environment for intermittent fasting is one where the individual doing it is not already in a heightened sympathetic (ie. stress) state. This is not the case for Shelly. She’s in what we need to consider a heal vs ideal situation right now.
Step 2: Recommend
Resolving Sleep Issues for Shelly:
- We suggested that Shelly’s husband put a washcloth or towel over the alarm clock. This way he could still hear the bell he likes to wake-up to while not disturbing his wife’s neurohormone production.
- While Shelly is currently waking in the night to use the bathroom (something we hope to shift as soon as possible), we asked that she move through the house (from bed to bathroom, back to bed) without turning on any lights.
- Slowly we will move Shelly’s bedtime back about an hour. We’ll do this incrementally so she can feel the benefits of “catching the circadian wave,” while not disrupting her beloved nighttime activities to the point of objection.
- We liked that Shelly found a bedtime magnesium that works well for her. While we won’t make any changes to that supplement right now, we will add some other herbs and nutrients. Our preference for her, given our Assessment, is 3 drops of passionflower vine extract and some lyposomal GABA to help with relaxation and gentle mood and hormone support. With further investigation and Assessment into her unique biological needs, as well as tracking, we may add some B6 at bedtime as well.
- Finally, we’ll ditch the intermittent fasting endeavor for now. Shelly will add a very small amount of food right before bed to support blood sugar regulation and adrenal balance through the night. We’re recommending a nighttime nugget that includes pumpkin seed butter, coconut oil, cacao butter, sea salt and stevia to carry her through until morning.
As you can see, these recommendations are specific to Shelly and her situation. They take into account her history, her particular biology, and what she’s able to realistically implement due to her current circumstances.
While next step labs will help our Assessment endeavors, there’s clearly lots we can do to shift things toward a more restful night while we wait.
Sleep issues, while they may present similarly on the outside, are always unique when we dig deep and find what’s going on in there.
And we’re not done!
Once Shelly begins to implement these changes, she’ll track both the steps she’s taking and the changes she sees in her sleep. This will give me as the clinician more information about the nature of her sleep issues, while also revealing the next steps for her to take towards resolution.
So stay tuned! We’ll conclude this case next week…
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