Insomnia and hypothyroidism: Is there a link?

Rather than an underactive thyroid, doctors usually connect difficulties sleeping with an overactive thyroid. However, there is little evidence that hypothyroidism may be linked to sleep issues.

There is little research on the link between hypothyroidism and insomnia, and what little research there is has inconsistent outcomes.

According to one study, hypothyroidism is linked to insomnia but does not cause it directly. There was no link between the two in an older, smaller study.

This article examines whether hypothyroidism is associated to insomnia, as well as the reasons for such a link. It also looks into how people can manage their symptoms.

Hypothyroidism and insomnia

insomnia

Hypothyroidism and insomnia may be linked. A 2019 study looked at hypothyroidism and sleep quality.

For a full-blown diagnosis of hypothyroidism, a condition must have subclinical hypothyroidism.

The scientists discovered several associations between sleep of 2,224 people with subclinical hypothyroidism and 12,622 people with normal thyroid hormone levels. Subclinical hypothyroidism was associated with:

  • lower satisfaction with sleep quality
  • longer sleep latency, which is the amount of time it takes to go to sleep
  • shorter sleep duration

The researchers also discovered that people with both subclinical hypothyroidism and poor sleep quality were more likely to be female, younger, and underweight.

A 2014 study looked into the possibility of a link between subclinical hypothyroidism and poor sleep quality, however the sample size was smaller and less diversified. There were 682 men in the study, 38 of whom had hypothyroidism.

There was no link between thyroid hormone levels and poor sleep quality, according to the findings. However, due to the study’s limitations, it may not be accurate.

Is there a link?

Thyroid-stimulating hormone levels are high in subclinical hypothyroidism (TSH). The hypothalamus, a component of the brain, causes the pituitary gland to release more TSH when thyroid levels in the body are low.

TSH stimulates the thyroid gland to produce more of the hormone known as free thyroxine when it reaches the gland (T4).

Subclinical hypothyroidism is defined by normal T4 levels in the blood and increased TSH levels, which can indicate that hypothyroidism symptoms are nonexistent or moderate.

Researchers don’t entirely understand how elevated TSH levels can lead to poor sleep, but they do have an idea.

The hypothalamic-pituitary-thyroid (HPT) axis connects the hypothalamus, pituitary gland, and thyroid gland. The HPT axis gets increasingly active as a person falls asleep.

This stimulates the thyroid gland by increasing the secretion of TSH. Thyroid stimulation may cause sleep disturbances under specific physiological situations.

Other ways hypothyroidism can affect sleep

While it is unknown if hypothyroidism can cause insomnia directly, it is plausible that it can affect sleep indirectly. Hypothyroidism can cause the following symptoms:

Discomfort

Hypothyroidism’s physical effects can sometimes make it difficult to sleep. For example, if a person has joint or muscular pain, is sensitive to the cold, or is anxious, sleeping may be difficult.

According to an older 2011 study, insomnia is more common in people who have a higher number of medical issues. With this in mind, the vast range of symptoms caused by hypothyroidism might have a severe impact on sleep quality.

Side effects of medications

Hypothyroidism is treated with thyroxine, a hormone that increases low thyroid hormone levels and relieves hypothyroidism symptoms. It is an effective medication for many people when given at the proper dose.

If someone takes more than they require, they may encounter side effects such as:

  • feeling hot
  • shakiness
  • racing heartbeat
  • inability to sleep
  • anxiety or nervousness
  • increased appetite

Other health conditions

Hypothyroidism is linked to other sleep-disrupting conditions, such as obstructive sleep apnea (OSA), a condition in which breathing stops and causes periodically during the night.

Daytime tiredness, frequent waking, and difficulty sleeping can all be symptoms of OSA. If someone has OSA, others sleeping in the same room may hear excessive snoring, choking, or gasping noises.

Restless legs syndrome, which causes unpleasant crawling or tingling feelings in the legs while someone is sleeping, is linked to hypothyroidism.

What helps?

What relieves insomnia depends on the source of the problem. If you have hypothyroidism, your doctor may recommend:

  • lowering the dose of someone’s thyroxine to a more comfortable level if they are having side effects
  • beginning thyroxine treatment to relieve physical discomfort
  • testing for other conditions that may be causing insomnia

It is important not to change the dose of thyroxine without first consulting with a doctor.

If taking or altering thyroid medication does not help, a doctor may investigate other possible causes. They may inquire as to when their insomnia began, how frequently it occurs, and any changes that occurred in their life around that time.

If a doctor detects a sleep issue, such as OSA, he or she may refer the patient for a sleep study to confirm the diagnosis. Alternatively, if the insomnia is caused by another medical or mental health condition, the individual may begin treatment for it as well.

Is there anything else that can increase thyroid hormone levels?

Although there is no cure for hypothyroidism, it may nearly always be managed with medicine, which restores thyroid hormone levels to normal.

There is evidence that there are additional strategies for people to support their thyroid hormone levels, such as:

Exercise

An older study from 2015 looked at the effect of a regular physical activity program on 20 people who were being treated for hypothyroidism. Thyroid hormone levels were measured in blood before and after three months of daily one-hour exercise sessions, according to the authors.

They determined that exercise can improve thyroid function after comparing the results to people who did not engage in any physical activity at all.

Diet

Iodine is a nutrient used by the thyroid gland to produce thyroid hormones. The majority of people in the United States obtain enough iodine.

Iodine deficiency, on the other hand, can cause hypothyroidism in rare situations. People who are deficient in iodine can supplement their diet with foods like seaweed or take pills.

Taking iodine pills will not help if iodine insufficiency is not the cause.

Furthermore, people with autoimmune thyroid disease, such as Hashimoto’s disease, may discover that iodine in food or supplements aggravates their condition. A doctor or dietician can advise on the best course of action for each individual.

A diet that reduces inflammation is something that practically everyone can benefit from. Inflammation has been associated to a number of chronic illnesses, including autoimmune thyroiditis, according to the United States Department of Veterans Affairs. Thyroiditis can result in hypothyroidism.

An anti-inflammatory diet may help people with autoimmune hypothyroidism. This entails eating:

  • foods that contain omega-3 fatty acids, such as wild salmon
  • plenty of fresh fruits, vegetables, and whole grains
  • monounsaturated or “healthy” fats, such as olive oil, rather than saturated fat
  • at least 30 grams of fiber per day

Can people with hypothyroidism take melatonin?

Melatonin is a hormone that the body makes naturally as part of the sleep-wake cycle. Its production increases in the evening darkness, promoting healthy sleep, and decreases when a person is exposed to light, assisting them in waking up.

As a result, the sleep-wake cycle is synchronized with the rhythms of night and day.

Some people use extra melatonin to help them sleep. Short-term use of melatonin supplements appears to be safe, according to the National Institutes of Health, but there is limited evidence on long-term consequences.

A small study published in 2001 examined the effect of melatonin on females with hypothyroidism, 36 of whom were perimenopausal and 18 of whom were postmenopausal. The individuals were divided into two groups at random by the researchers. At bedtime, one group received a placebo, while the other received melatonin.

After 3–6 months, the scientists discovered that the melatonin group had significantly greater levels of thyroid hormones than the placebo group.

They hypothesized that low levels of melatonin due to aging were linked to low levels of thyroid hormones, which explains why taking a melatonin pill increased TSH levels as well.

To confirm that melatonin is safe and effective for people with hypothyroidism, large-scale investigations are required. People who want to use a melatonin supplement should see a doctor about appropriate amounts and keep in mind that the quality of supplements might vary greatly.

Other causes of insomnia

Insomnia can be caused by a variety of conditions, including:

  • stress
  • shift work
  • hormone changes, such as during pregnancy or menopause
  • lifestyle factors, such as:
    • using electronic devices close to bedtime
    • exercising too little
    • using caffeine, nicotine, illegal drugs, or alcohol
    • taking long naps in the day
    • having an irregular sleep schedule
  • environmental factors, such as:
    • noise or light
    • frequent travel to different time zones
    • a temperature that is too hot or cool in the bedroom

People who are having trouble sleeping may benefit from minimizing any of the probable risk factors for insomnia that they have control over. It can, for example, aid in:

  • quit smoking
  • get regular exercise, while avoiding exercise in the evening before sleep
  • manage stress or practice relaxation techniques
  • create a cool, dark, and comfortable sleep environment
  • wake up and go to bed at the same time every day
  • reduce or stop caffeine and alcohol consumption

Conclusion

In conclusion, hypothyroidism may be connected to insomnia, however evidence to date has been inconsistent.

People with hypothyroidism, on the other hand, frequently have difficulty tolerating low temperatures at night, as well as joint and muscular pain that can interfere with sleep. If the dose is too high, the side effects of thyroxine might also cause trouble sleeping.

Even if thyroid hormone shortage isn’t directly causing insomnia, the vast variety of symptoms associated with thyroid dysfunction can easily exacerbate sleeping problems and limit a person’s capacity to attain quality, deep sleep.

Consult a doctor if insomnia becomes a persistent issue. Treating the underlying issue and implementing sleep-promoting lifestyle modifications may be beneficial.

Sources:

  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363141/
  • https://pubmed.ncbi.nlm.nih.gov/11226744/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6770945/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3119827/
  • https://www.thyroid.org/thyroid-disease-cam/
  • https://www.medicalnewstoday.com/articles/hypothyroidism-and-insomnia
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8423342/
  • https://www.va.gov/WHOLEHEALTHLIBRARY/tools/hypothyroidism.asp
  • https://www.thyroid.org/hypothyroidism/
  • https://www.niddk.nih.gov/health-information/endocrine-diseases/hypothyroidism
  • https://www.nhlbi.nih.gov/health-topics/insomnia
  • https://www.nccih.nih.gov/health/melatonin-what-you-need-to-know
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6927586/

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