Dr. Doni, author of The Stress Remedy, explains how inflammation and pain are common reasons for waking during the night and offers solutions to break the cycle.
Research indicates that lack of sleep can take years off your life and lead to major health concerns. Understanding and addressing what is preventing you from getting good sleep is one of the best things you can do for your health. The 12 possible causes of insomnia I am covering in this series, as described in the introductory article are:
- Waking to use the bathroom
- Blood sugar imbalance
- Elevated cortisol
- Weight gain
- Inflammation and pain
- Food sensitivities
- Imbalanced neurotransmitters
- Hormonal changes
- Low melatonin
If you would like to go back and read this blog series from the beginning, click here.
As we start off the New Year, recovering from holiday treats and travel, it is the perfect time to discuss inflammation and pain, and how they can throw off your sleep—as perhaps you have noticed this week!
What do I mean by inflammation?
Let’s start by understanding inflammation—what it is, where it is located, and why it is an issue for sleep.
We usually think of inflammation as redness, swelling, and throbbing—such as when you stub your toe—but it can affect your internal organs as well. Inflammation is an important part of the immune response that is involved in attracting the immune system to an area that needs to heal; it also protects an area that is damaged. It is your body’s response to an injury, infection (even a common cold virus) or allergen.
Inflammation is, therefore, a good thing because it helps us recover and heal. However, it also has the potential to be detrimental to your health. Chronic inflammation (inflammation that sticks around for a long time and just won’t go away) can lead to, and is involved in, many health issues and diseases, including heart disease, arthritis, asthma and diabetes. Chronic inflammation can be caused by recurring physical or emotional stress, an imbalanced stress response and oxidative stress (stress at a cellular level).
The problem with inflammation
The problem is cytokines—‘inflammatory messengers’ which send signals anywhere in the body. These messengers can send signals to your heart, your cells and your nervous system. In fact, research is now showing that cytokines—and inflammation—are involved in anxiety and depression, as well as in obesity and cancer. So when you hear “inflammation,” don’t just think of a painful, swollen joint. Think of a process involving multiple factors that can either work for, or against, your health, and can go anywhere in your body—wherever you are most susceptible.
What has this got to do with my sleep problems?
Cytokines are also involved in insomnia. In this study comparing normal sleepers to people with insomnia, it was found that normal cytokine levels were increased in those who were not sleeping well thus increasing inflammatory messages in the body.
It has also been found that chronic inflammation and elevated cytokines, from any cause, can lead to insomnia. This means that if you have inflammation as a result of arthritis, sinusitis, anxiety, or any other source of cytokines, then you are more likely to have a hard time staying asleep—and of feeling tired the next day.
Two other major, and often unrecognized, triggers of cytokines and inflammation that have the potential to influence sleep are food sensitivities and intestinal permeability (leaky gut). You can read all about leaky gut here. Food sensitivities are different than food allergies—although both cause inflammation. Food sensitivities cause inflammation in a more delayed and subtle way than allergies do, and are associated with over 200 different symptoms that can show up throughout the body for weeks after eating the food in question.
I’ll be discussing food sensitivities in more depth next time when I will look at how gluten sensitivity affects sleep. In the meantime, I mainly want to emphasize that, when the intestinal lining is not as healthy as it could be, it allows food in your gut to trigger an immune response. When this happens, a cloud of inflammatory messengers can spread a signal of inflammation all the way to your nervous system, which can cause you to have a difficult time falling asleep, or can wake you up during the night. So your sleep issue may be related to something you ate, or to the health of your digestion.
Then, of course, there is the pain associated with inflammation—whether from a sore back, stomach upset, or even head pain or nerve pain. This too, can wake you, with every move you make. So, pain can make sleep difficult, and difficult sleep can make pain more likely – it is another vicious cycle which can be tough to break. It is only when we calm the inflammation enough, while also helping your body to heal, that you’ll be back to sleeping well.
How can I tell if I have inflammation?
Often we know simply based on the way you feel – your symptoms. However, there are blood tests for inflammation, including what is known as the SED rate, as well as C-reactive protein (CRP). Because there are so many potential causes and influences on inflammation, these tests can be vague–but they can give us a general sense of the degree of inflammation present. When inflammation is very high, then these tests will clearly show it. Elevated levels of CRP are associated with heart disease so this test is also used to assess heart disease risk.
Labs are developing more fine-tuned tests for cytokine levels, including a newly-released test for cytokines associated with Lyme disease, called iSpot Lyme. In the future, as more is learned about cytokine patterns through research, perhaps tests will be developed that allow us to relate cytokine levels to specific health issues, such as insomnia.
How can we resolve the issue?
Identify sources of inflammation and address them
If you have not yet been tested for food sensitivities, now is the time. This will tell you whether there are foods you are eating that are simply re-triggering the vicious cycle of pain, inflammation and disrupted sleep. These tests will also give you a better sense of whether leaky gut is present so you can start healing it. Click here to find food sensitivity test kits you can order and do at home with a finger prick.
Choose foods that are anti-inflammatory and avoid those that are inflammatory
The main foods to avoid or minimize are sugar, alcohol, dairy products (milk, cheese, and yogurt), trans fats (partially hydrogenated oils), processed foods, refined carbs (white bread, rice, potatoes, and cereals), gluten (wheat, barley, rye, and spelt), and red meat as these are known to cause inflammation. Key anti-inflammatory foods are colorful fruits (berries, for example), vegetables (such as leafy greens), and healthy fats (like olive oil). The kinds of fats you eat is very important as the body uses them to either increase or decrease inflammation. For example, the fats in fish (like salmon) and nuts (except for peanuts) are used to make anti-inflammatory messengers and to protect your cells whereas the fats in red meat (and other foods high in saturated fats) are used to make inflammatory cytokines. The same foods that decrease inflammation are often also high in anti-oxidants, which means they help block oxidative stress and decrease inflammation as well.
Use anti-inflammatory herbs and enzymes*
There are many herbs that are known to decrease inflammation, including turmeric (curcumin), boswellia, ginger, and rosemary. These herbs can be taken individually or in combination, such as in this product called Zyflamend . Enzymes, such as bromelain and pancreatic enzymes, when taken on an empty stomach, can also decrease inflammation in the body.
In some cases, say with a severe autoimmune flare or after a major injury, pain medications and/or anti-inflammatory medications (NSAIDS such as Ibuprofen and Aleve), or steroids (like prednisone) may be necessary temporarily to help calm down the inflammatory response and get you on the path to healing. Diet and herbal approaches can be used in addition to medications to support healing, ease the transition off medications, and ultimately to improve sleep. My goal, as a naturopathic doctor, is to help patients make changes to their diet and lifestyle alongside using natural therapies in order to help speed their recovery. Whenever possible, I aim to decrease the need for medication because long term use of anti-inflammatory medications and/or steroids can damage the intestinal lining and lead to further inflammation.
If you are caught in this vicious cycle of inflammation, pain and poor sleep, please know that it is going to take time to resolve. Cytokines and an immune system that is on high alert require time to calm down, and they will only calm as you address what triggered them in the first place. As time goes on, and with diligence, however, it is possible for your immune response to shift – even from autoimmunity—to healthy immune function.
There you have it—inflammation and pain, and how they can affect your sleep. If the holidays got your inflammation up and your sleep thrown off, you may want to consider taking a few days, a week, or even 3 weeks to shift your diet away from inflammatory foods, and to support your body back to health. One way to do this is to follow the guidelines in the Hamptons Cleanse.
*Please keep in mind that any and all supplements—nutrients, herbs, enzymes, or other—should be used with caution. My recommendation is that you seek the care of a naturopathic doctor (with a doctorate degree from a federally-accredited program) and that you have a primary care physician or practitioner whom you can contact to help you with individual dosing and protocols. If you ever experience negative symptoms after taking a product, stop taking it immediately and contact your doctor right away.