EP.270/ Why you may be waking up at 2am each night
Many clients come to me for their endometriosis symptoms, often pain, bloating or menstrual irregularities, but when we work together, we look at the bigger picture and explore all of their symptoms, not just the classic endo ones, as it can give us more info about what’s going on.
And when we do this, much of the time, sleep problems come up – especially waking up in the early hours of the morning.
So, if you’re someone who suffers with insomnia or night waking, today’s episode may be helpful.
If a client is struggling with this issue – my initial thoughts are: what are they eating for dinner? Is the plate balanced for blood sugar and are they eating enough carbs?
Let’s first start with blood sugar. If you eat a high starch meal, say a bowl of pasta before bed or a bowl of cereal, and say you’re not really eating a lot of fibre with it, or fat or protein, normally, your blood sugar levels are going to spike pretty high, although everybody has individual responses. This is because starchy foods break down easily in the gut, they are then converted to glucose and the glucose is absorbed into the blood stream, creating this quickly elevated glucose level, or blood sugar level.
What then happens is the body panics and sends out lots of a hormone called insulin, which picks up all of this glucose and shoves any excess glucose away into storage, because high levels are damaging for the body. As a result, blood sugar levels plummet and this triggers the stress response to kick in and releases cortisol and adrenaline, which free up that stored away glucose back into the blood stream.
Now normally, these systems would work to our benefit. Insulin is the hormone that delivers glucose to our cells for energy every time we eat and providing we’re eating in a way that supports blood sugar, we should get a nice steady delivery of glucose to our cells over time. And that means, we can sleep soundly.
Additionally, the stress response uses cortisol to release stored glucose when we need it for energy, in stressful situations. So, for example, if we had to run for our train, the body would release glucose to give us the energy to do that. Which is great, we want extra energy when we’re in stressful situations or situations of physical exertion.
What we don’t want, is the stress response kicking off in the middle of the night, releasing cortisol and adrenaline and making us feel wide awake. In fact, cortisol should be low at night, which allows melatonin, one of sleep hormones (GABA is the other one, by the way) to rise. Cortisol then slowly begins to rise in the early hours of the morning and melatonin falls, and the increase in cortisol is what helps you to wake up.
So, if we’re having a meal before bed that causes our blood sugar levels to spike sharply and then drop, the chances are, cortisol and adrenaline may wake you up in the night. Now some of you may be thinking “but I feel lovely and sleepy after a starchy meal” – yes, that’s the feeling of a blood sugar crash, essentially, our body is starved of fuel and so we get lethargic and sleepy. Often, I see this as the first stage of a blood sugar dip, if we then don’t refuel, that’s when the stress response kicks in and we get shaky, wired, anxious, etc. So, some of you may find you eat this lovely big bowl of pasta and then fall asleep in front of the TV, head to bed, only to wake up a few hours later. This would be a sign that you need to tweak your meals a bit.
But don’t worry, I’m not going to tell you to take anything away. I am going to tell you to add. ADD fibre, in the form of veggies, protein in the form of beans, fish, meat, eggs and finally healthy fats like avocado, olive oil or nuts. So, if you are having a bowl of spaghetti for dinner, add some prawns, lots of love oil and a hearty, fibre rich salad.
And remember – we’ve talked about this so many times, but I’ll say it again for those who are new to the show: the rough ratios for blood sugar are half a plate of low starchy veggies like asparagus, broccoli, peppers, tomatoes, etc., a quarter of the plate is protein like beans, tofu, eggs, fish, etc., and the final quarter is a complex, starchier carb like quinoa, sweet potato, rice, etc., topped with two heaped tablespoons of a healthy fat.
Now, for some of us, we do better splitting that final quarter between the starchy carbs and fat, so essentially, half of that final quarter is dedicated to carbs, which is what like an 1/8th of the plate? This is usually better for those of us who are experiencing blood sugar struggles or don’t have a high energy output and are sitting at a desk all day. For these people, that much starchy carbohydrate may spike blood sugar levels too much initially – but over time, as they work on blood sugar stabilisation, we tend to see responses improve and they can increase their serving sizes, if they want to.
Now, despite this, I actually think many of us would do better at night, with that quarter plate of carbs. Some of you listening are probably like “but didn’t she say starchy meals will cause us to spike and crash?”.
Well, yes, when those carbs aren’t properly balanced with fat, fibre, and protein and when they’re refined and not wholefoods. Typically, you’re going to get a much bigger spike from processed, refined carbs like pizza, crisps, sugar, bread, white rice, and pasta over whole foods like beans, vegetables, fruit, whole grains and root veggies, though I will say that some of us do spike from foods like potatoes, but you can work around that by adding those extra food groups and cooking and cooling your starches, as I shared in episode 255.
So, yes, if we have too many carbs without the other lovely food groups we’re going to crash and burn, but what happens if we have too little carbs? We have a similar problem. Our blood sugar levels are too low, and they dip in the night and up goes the stress response.
I had this with a client who was eating a very restrictive SIBO diet, and I suspected she wasn’t eating enough carbs – eventually, she got a continuous glucose monitor and her levels were actually going quite dangerously low in the early hours. She upped her carb intake in the evening and started sleeping through the night again and had consistent and even blood sugar levels.
But that’s not the only reason carbs help at night. Carbs actually help us to produce melatonin, they support an amino acid called tryptophan to reach the brain, which is the precursor to serotonin (meaning, in short, it makes serotonin) and then that serotonin is converted into melatonin by certain enzymes which are only activated by darkness (which is why getting off screens and turning down the lights is so important for sleep!).
If we don’t have enough carbs in our system, we may be struggling to make adequate melatonin.
Now, the other thing to consider here is the role of protein. Protein is helpful to have with dinner because it supports healthy blood sugar levels and it actually helps to keep us full and satisfied, so no waking up hungry or going to bed starving. It also contains the amino acid tryptophan, which we already know is very important for sleep, and foods rich in tryptophan include turkey, eggs, chicken, fish, tofu, peanuts and to an extent, bananas.
However, it’s not as simple as just eating a load of tryptophan-based protein foods for dinner and this is for two reasons:
Protein is actually energising. Many protein foods are rich in an amino acid called tyrosine and this amino acid helps to make stimulating neurotransmitters and hormones like adrenaline and dopamine. Some research shows that high protein meals at night can actually be stimulating, especially in the absence of adequate carbs, as without carbohydrates, we can’t get tryptophan to the brain to make serotonin.
The second reason is that amino acids compete to get across the blood brain barrier and into the brain, and if you’re eating a protein rich meal, especially in the absence of carbohydrates, tryptophan often takes the back seat.
So, whilst everyone is different, my general recommendation is not to go low protein at dinner, but you don’t need to go over the top with it either. In fact, research shows that one of the best times to have a high protein meal is at breakfast, which shows benefits such as better blood sugar levels and as we know, it boosts energising hormones and neurotransmitters, so a great way to start the day.
We’re all individual and our bodies will respond differently, but a good middle of the road approach would be to try the blood sugar balancing plate which focuses on a quarter plate of protein and a quarter plate of starchier carbs and see how you do. If you feel you need to make adjustments, start experimenting with your protein and carb ratios to find the right balance for you.
If you find yourself getting hungry just before bed, a possible option would be to try a small banana and at least a tablespoon of peanut butter. Both contain tryptophan but not too many amino acids that tryptophan gets pushed to the side-lines, and the banana provides glucose to help with the tryptophan conversion. Eat the peanut butter first, and go for crunchy, because the fat, fibre and protein can help prevent that spike from the banana, and go for a small banana, if possible, as this fruit can be quite notorious for blood sugar spikes and we of course want to avoid that.
Now remember, every person is different, and research is showing more and more how we all respond individually to foods, so it’s really about taking this information and finding what works for you.
Another thing to note is that research on this topic really varies, likely down to how individual responses are when it comes to what we eat, so whilst this info is hopefully helpful, in time, we may understand more about how food affects how we sleep, and this general advice may change. I’ve linked to some further reading if you want to learn more.
Finally, there are other reasons for night waking – such as low progesterone and HPA axis regulation, so if you don’t find these methods helpful, you may want to start exploring those.
Okay, that’s it for this week! I hope this episode brings you some much deserved better-quality sleep.
Show Notes:
https://link.springer.com/article/10.1007/s40675-018-0103-x
https://pubmed.ncbi.nlm.nih.gov/23419282/
https://jcsm.aasm.org/doi/10.5664/jcsm.5384
https://www.health.harvard.edu/mind-and-mood/serotonin-the-natural-mood-booster#:~:text=One%20way%20to%20sneak%20more,chance%20at%20reaching%20your%20brain.
https://pubmed.ncbi.nlm.nih.gov/18681982/
https://pubmed.ncbi.nlm.nih.gov/12499331/
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