How does thyroid function impact sleep quality. What are the connections between thyroid disorders and common sleep problems. Can treating thyroid issues improve sleep disorders. How do sleep disturbances affect thyroid health.

The Intricate Link Between Thyroid Function and Sleep Physiology

The thyroid gland plays a crucial role in regulating numerous bodily functions, including sleep patterns. Thyroid hormones, particularly thyroxine (T4) and triiodothyronine (T3), influence various physiological processes that can significantly impact sleep quality and duration. Understanding this complex relationship is essential for diagnosing and treating both thyroid disorders and sleep disturbances effectively.

How exactly do thyroid hormones affect sleep? Thyroid hormones regulate metabolism, body temperature, and heart rate – all of which play important roles in the sleep-wake cycle. When thyroid function is disrupted, it can lead to changes in these processes, potentially causing sleep problems.

Key Ways Thyroid Function Impacts Sleep:

• Regulation of circadian rhythms
• Influence on body temperature fluctuations
• Effects on neurotransmitter production and activity
• Modulation of energy levels and fatigue

Hyperthyroidism and Its Effects on Sleep Quality

Hyperthyroidism, characterized by an overactive thyroid gland producing excess thyroid hormones, can have significant impacts on sleep patterns and quality. Research has shown that individuals with hyperthyroidism often experience various sleep disturbances, which can further exacerbate their overall health condition.

What are the most common sleep issues associated with hyperthyroidism? Studies have identified several key sleep problems that frequently occur in patients with this thyroid disorder:

• Difficulty falling asleep (prolonged sleep latency)
• Trouble maintaining sleep throughout the night
• Increased nighttime awakenings
• Excessive daytime sleepiness
• Restlessness and hyperactivity

Research by Stern et al. found that 66.4% of patients with Graves’ disease, the most common cause of hyperthyroidism, reported difficulty falling asleep. This high prevalence highlights the significant impact that elevated thyroid hormone levels can have on sleep initiation.

Mechanisms Behind Sleep Disruption in Hyperthyroidism

Why does hyperthyroidism cause these sleep disturbances? Several factors contribute to sleep problems in individuals with an overactive thyroid:

1. Increased metabolic rate leading to heightened arousal
2. Anxiety and mood changes affecting sleep onset
3. Tremors and physical discomfort interfering with sleep maintenance
4. Alterations in appetite and digestion disrupting sleep patterns
5. Changes in body temperature regulation affecting sleep quality

Hypothyroidism and Its Impact on Sleep Disorders

While hyperthyroidism is known to cause sleep disturbances, hypothyroidism – an underactive thyroid gland – can also significantly affect sleep quality and duration. Hypothyroidism affects nearly 5% of the US population and can lead to various sleep-related issues that may be overlooked in clinical settings.

How does hypothyroidism influence sleep patterns? The reduced production of thyroid hormones in hypothyroidism can result in several sleep-related problems:

• Excessive daytime sleepiness
• Increased total sleep time
• Sleep apnea and breathing difficulties during sleep
• Restless legs syndrome
• Insomnia in some cases

Interestingly, the relationship between hypothyroidism and sleep disorders is bidirectional. Not only can hypothyroidism lead to sleep problems, but certain sleep disorders may also impact thyroid function. This complex interplay underscores the importance of considering thyroid health when evaluating and treating sleep disorders.

Obstructive Sleep Apnea and Hypothyroidism

One of the most significant connections between hypothyroidism and sleep disorders is the increased prevalence of obstructive sleep apnea (OSA) in individuals with an underactive thyroid. Why is this association important? OSA can exacerbate the symptoms of hypothyroidism and vice versa, creating a challenging cycle for patients and healthcare providers.

Several factors contribute to the higher risk of OSA in hypothyroid patients:

1. Increased soft tissue deposition in the upper airway
2. Reduced respiratory muscle function
3. Alterations in ventilatory drive
4. Changes in body mass index and weight gain

The Role of Thyroid Dysfunction in Insomnia

Insomnia, characterized by difficulty falling asleep, staying asleep, or both, is a common sleep disorder that can significantly impact quality of life. Both hyperthyroidism and hypothyroidism have been associated with insomnia, albeit through different mechanisms.

How does thyroid dysfunction contribute to insomnia? The impact of thyroid disorders on sleep initiation and maintenance can be explained by several factors:

Hyperthyroidism and Insomnia:

• Increased anxiety and restlessness
• Elevated heart rate and body temperature
• Heightened sensitivity to environmental stimuli

Hypothyroidism and Insomnia:

• Fatigue and daytime sleepiness leading to irregular sleep patterns
• Depression and mood changes affecting sleep quality
• Possible sleep-disordered breathing contributing to nighttime awakenings

It’s important to note that while hypothyroidism is more commonly associated with hypersomnia (excessive sleepiness), some patients may experience insomnia, especially in the early stages of the disorder or due to concurrent depression.

Restless Legs Syndrome and Thyroid Function

Restless Legs Syndrome (RLS) is a neurological disorder characterized by an irresistible urge to move the legs, often accompanied by uncomfortable sensations. Recent research has suggested a potential link between thyroid dysfunction and the development or exacerbation of RLS symptoms.

What is the connection between thyroid disorders and RLS? While the exact mechanism is not fully understood, several theories have been proposed:

• Alterations in dopamine metabolism
• Changes in iron metabolism and storage
• Peripheral neuropathy associated with thyroid dysfunction
• Autoimmune processes affecting both thyroid and neurological function

Studies have shown a higher prevalence of RLS in patients with hypothyroidism compared to the general population. Additionally, some patients with hyperthyroidism may experience RLS-like symptoms due to increased muscle tension and anxiety.

Treatment Considerations for RLS in Thyroid Disorders

How should RLS be approached in patients with thyroid dysfunction? A comprehensive treatment plan should consider both the thyroid disorder and RLS symptoms:

1. Optimize thyroid hormone levels through appropriate medication
2. Address any underlying iron deficiency
3. Consider dopaminergic agents for RLS symptom management
4. Implement sleep hygiene improvements and lifestyle modifications
5. Explore non-pharmacological interventions such as massage and stretching

Circadian Rhythm Disruptions in Thyroid Disorders

The circadian rhythm, our internal biological clock, plays a crucial role in regulating sleep-wake cycles, hormone production, and various physiological processes. Thyroid dysfunction can significantly impact circadian rhythms, leading to sleep disturbances and other health issues.

How do thyroid hormones influence circadian rhythms? Thyroid hormones interact with the circadian system in several ways:

• Regulation of core body temperature fluctuations
• Modulation of melatonin production and secretion
• Influence on cortisol rhythms and stress responses
• Effects on clock gene expression in various tissues

In hyperthyroidism, the increased metabolic rate and heightened sympathetic activity can lead to a phase advance in circadian rhythms, causing earlier sleep onset and wake times. Conversely, hypothyroidism may result in a phase delay, leading to later sleep onset and difficulty waking in the morning.

Chronotherapy in Thyroid Disorder Management

Can chronotherapy be beneficial for patients with thyroid-related sleep disturbances? Chronotherapy, which involves timing medical treatments to align with the body’s natural rhythms, may offer potential benefits:

1. Optimizing the timing of thyroid medication administration
2. Using light therapy to help regulate circadian rhythms
3. Implementing sleep schedule adjustments to support natural hormone fluctuations
4. Incorporating melatonin supplementation when appropriate

The Impact of Sleep Disorders on Thyroid Function

While much attention has been given to how thyroid dysfunction affects sleep, it’s equally important to consider the reverse relationship: how sleep disorders can impact thyroid health. Emerging research suggests that chronic sleep disturbances may have significant effects on thyroid function and hormone production.

How do sleep disorders influence thyroid health? Several mechanisms have been proposed:

• Alterations in hypothalamic-pituitary-thyroid (HPT) axis regulation
• Changes in thyroid hormone metabolism and clearance
• Increased inflammation and oxidative stress affecting thyroid tissue
• Disruptions in the circadian rhythm of thyroid hormone secretion

Obstructive Sleep Apnea and Thyroid Function

What is the relationship between OSA and thyroid disorders? OSA has been associated with several thyroid-related issues:

1. Increased risk of subclinical and overt hypothyroidism
2. Alterations in thyroid hormone levels, particularly TSH
3. Potential exacerbation of existing thyroid disorders
4. Complications in managing thyroid medication dosages

These findings underscore the importance of screening for thyroid dysfunction in patients with OSA and vice versa. Proper management of both conditions may lead to improved outcomes and quality of life for affected individuals.

Diagnostic Considerations for Sleep Disorders in Thyroid Patients

Given the complex relationship between thyroid function and sleep, it’s crucial to consider both aspects when evaluating patients with either thyroid disorders or sleep complaints. A comprehensive diagnostic approach can help identify underlying issues and guide appropriate treatment strategies.

What diagnostic tools should be considered for assessing sleep disorders in thyroid patients? Several methods can be employed:

• Thyroid function tests (TSH, free T4, free T3)
• Sleep questionnaires and symptom assessments
• Actigraphy for monitoring sleep-wake patterns
• Polysomnography for diagnosing specific sleep disorders
• Evaluation of circadian markers (e.g., melatonin, cortisol)

Challenges in Diagnosing Sleep Disorders in Thyroid Patients

Why can diagnosing sleep disorders in thyroid patients be challenging? Several factors contribute to the complexity of diagnosis:

1. Overlap of symptoms between thyroid dysfunction and sleep disorders
2. Variability in thyroid hormone levels and their effects on sleep
3. Potential masking of sleep symptoms by thyroid medication
4. Comorbid conditions that may influence both thyroid and sleep health
5. Individual variations in sensitivity to thyroid hormone fluctuations

To address these challenges, a multidisciplinary approach involving endocrinologists, sleep specialists, and primary care physicians may be necessary to provide comprehensive care for patients with coexisting thyroid and sleep disorders.

Treatment Strategies for Thyroid-Related Sleep Disturbances

Effectively managing sleep disturbances in patients with thyroid disorders requires a tailored approach that addresses both the underlying thyroid dysfunction and the specific sleep issues. A comprehensive treatment plan should consider the interplay between thyroid hormones, sleep physiology, and overall health.

What are the key components of treating thyroid-related sleep disturbances? Several strategies can be employed:

• Optimizing thyroid hormone levels through appropriate medication
• Addressing specific sleep disorders (e.g., CPAP for OSA)
• Implementing sleep hygiene improvements
• Considering chronotherapy approaches
• Managing comorbid conditions that may affect sleep

Pharmacological Considerations

How should medication management be approached in patients with thyroid-related sleep issues? Several factors should be considered:

1. Timing of thyroid hormone replacement to align with circadian rhythms
2. Careful use of sleep medications, considering potential interactions
3. Evaluation of other medications that may affect sleep or thyroid function
4. Monitoring of thyroid hormone levels and adjusting dosages as needed
5. Consideration of melatonin supplementation when appropriate

It’s important to note that treatment should be individualized based on the specific thyroid disorder, sleep complaints, and overall health status of each patient. Regular follow-ups and adjustments to the treatment plan may be necessary to achieve optimal outcomes.

Future Directions in Thyroid and Sleep Research

As our understanding of the relationship between thyroid function and sleep continues to evolve, several areas of research show promise for improving diagnosis, treatment, and overall patient care. Ongoing studies and emerging technologies offer exciting possibilities for advancing the field.

What are some promising areas of future research in thyroid and sleep medicine? Several directions are being explored:

• Genetic studies to identify susceptibility factors for thyroid-related sleep disorders
• Advanced neuroimaging techniques to elucidate brain-thyroid-sleep connections
• Development of more sensitive and specific biomarkers for thyroid dysfunction and sleep disturbances
• Investigation of novel therapeutic approaches, including targeted molecular therapies
• Long-term studies on the impact of treating thyroid disorders on sleep health outcomes

Emerging Technologies in Thyroid and Sleep Management

How might new technologies improve the care of patients with thyroid-related sleep issues? Several innovative approaches are being developed:

1. Wearable devices for continuous monitoring of thyroid hormone levels and sleep patterns
2. Artificial intelligence algorithms for early detection of thyroid dysfunction based on sleep data
3. Personalized medicine approaches using genetic and biomarker profiles
4. Telemedicine platforms for remote monitoring and management of thyroid and sleep disorders
5. Virtual reality applications for sleep therapy and relaxation techniques

These advancements hold the potential to revolutionize the diagnosis and treatment of thyroid-related sleep disturbances, ultimately improving patient outcomes and quality of life. As research progresses, it will be crucial for healthcare providers to stay informed about the latest developments in this rapidly evolving field.

Thyroid Dysfunction and Sleep Disorders

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Front Endocrinol (Lausanne). 2021; 12: 725829.

Published online 2021 Aug 24. doi: 10.3389/fendo.2021.725829

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Thyroid disorders and sleep disorders are common problems in the general population that can affect people of all ages, backgrounds, and sexes, but little is known about their clinical associations. We reviewed the literature assessing the associations between thyroid disease and sleep disorders and noted that hyperthyroidism and hypothyroidism have clinical overlap with sleep conditions such as insomnia, restless legs syndrome, and obstructive sleep apnea. These findings highlight the importance of identifying and managing thyroid dysfunction for patients with these common sleep disorders. Additional research is needed to further understand how thyroid dysfunction affects sleep physiology.

Keywords: hyperthyroidism, hypothyroidism, insomnia, restless legs syndrome, sleep, sleep apnea, obstructive, sleep initiation and maintenance disorders

Millions of Americans have sleep-related disturbances each year, and extensive research has shown that inadequate or dysfunctional sleep has a far-reaching health impact. Although the cause, severity, and consequences of sleep disturbances vary widely across the spectrum of individuals, a large portion of sleep medicine research focuses on the impact of sleep disorders (e. g., insomnia, obstructive sleep apnea [OSA]) on cardiovascular and neurologic health. Consequently, the effects of sleep disorders on many other organ systems have been explored in considerably less detail. The purpose of this paper is to discuss the effects of thyroid function on sleep and highlight the relationships between thyroid pathologies and sleep health. Additionally, we explore the impact of common sleep disorders on the health and function of the thyroid gland.

The thyroid produces 2 main hormones, thyroxine (T4) and triiodothyronine (T3), which affect numerous physiologic processes in the body, including body temperature maintenance, digestion, and vital functions such as heart rate and respiration (1). Symptoms that develop because of improper production of these hormones can have far-reaching effects on the body and may vary immensely in severity, depending on the cause of the dysfunction. Hypothyroidism, which generally is caused by an underactive thyroid, affects nearly 5% of the US population. Hyperthyroidism, which generally is caused by an overactive thyroid, affects approximately 1% of the US population (2). Both conditions usually are treated pharmacologically, either by replacing the thyroid hormone that is missing or by trying to block the production or effect (or both) of the excess thyroid hormone.

Although thyroid dysfunction is known to affect many bodily systems, the relationship between thyroid disorders and sleep function currently is not well understood. Because sleep disorders are rarely the sole presenting symptom of thyroid dysfunction, it is important to consider the relationship between thyroid function and sleep when providing a whole-body treatment approach for patients with these disorders.

Hyperthyroidism

Hyperthyroidism, defined as the presence of increased thyroid activity, and thyrotoxicosis, defined as the presence of too much thyroid hormone, are common and well-known causes of sleep dysfunction. Often, sleep disturbances associated with hyperthyroidism are caused by hyperkinetic features of the disorder. Stern et al. (3) assessed 137 patients with Graves disease, the most common cause of hyperthyroidism, and reported that 66.4% of study participants had difficulty falling asleep. Sridhar et al. (4) suggested that elevated levels of thyroid hormone were associated with several components of sleep dysfunction, including prolonged sleep latency, difficulty maintaining sleep, and excessive daytime sleepiness. Specifically, thyroid hormone−mediated changes in appetite, bowel movements, and mood (eg, increased anxiety) were associated with significantly prolonged sleep latency. Similarly, patients with tremor caused by elevated thyroid hormones had markedly increased difficulty in maintaining sleep. Xia et al. (5) showed a direct correlation between levels of thyroid-stimulating hormone (TSH), T3, and T4 and the severity of insomnia symptoms.

Additionally, hyperthyroidism can cause or worsen other conditions such as anxiety or depression, which in turn can further impair sleep and insomnia (6). Chattopadhyay et al. (7) assessed a group of 36 patients in India with newly diagnosed Graves disease and comorbid psychiatric concerns, including 41% with generalized anxiety disorder, 16% with obsessive-compulsive disorder, and 16% with undifferentiated mood disorders. The patients reported primary concerns about insomnia, irritability, and anxiety. The study divided patients into 2 treatment groups. One group was treated with antithyroid and antipsychotic medications, and the other group was treated with only antithyroid drugs. The study showed significant improvement in symptoms of insomnia, irritability, and anxiety for both groups. However, the extent of symptomatic improvement was not significantly different between groups. These findings support the idea that disordered sleep and psychiatric problems are closely tied to excessive thyroid activity, and treatment of the thyroid dysfunction can improve or resolve the associated psychiatric symptoms.

Hypothyroidism

Hypothyroidism, defined as the decreased production of thyroid hormones, may affect overall sleep quality. Although no direct biochemical connection has been established between hypothyroidism and insomnia, some studies have shown a relationship between untreated subclinical hypothyroidism and poor sleep quality. Song et al. (8) showed that people with lower thyroid hormone levels or even subclinical hypothyroidism generally have longer sleep latency, shorter sleep duration, and lower satisfaction with their sleep quality compared with euthyroid individuals. However, a study by Akatsu et al. (9) did not show a relationship between subclinical hypothyroidism and sleep quality. Both studies had relatively small sample sizes, and neither study effectively investigated or identified the actual mechanisms by which lower thyroid hormone levels might affect sleep quality.

One possible reason why hypothyroidism and insomnia may commonly co-occur is because the symptoms associated with thyroid hormone deficiency may contribute to insomnia. For example, underactive thyroid is associated with muscle and joint pain, cold intolerance, and increased anxiety, and these symptoms can contribute to sleep deficiencies. Budhiraja et al. (10) suggest that a higher number of medical comorbidities is associated with a higher risk of insomnia. Even if thyroid hormone deficiency is not directly causing insomnia, the wide range of symptoms associated with thyroid dysfunction can easily exacerbate sleeping difficulties and reduce a person’s ability to achieve quality, restful sleep.

OSA is another common sleep disorder with many causes, and it affects a large portion of the general population. One of the most rigorous population-based studies of OSA was conducted by Young et al. (11), who reported that among adults aged 30 to 60 years, the prevalence of OSA was 9% for women and 24% for men. Although thyroid dysfunction is generally not thought to be among the primary causes of OSA, studies have shown that they appear to be related. Thavaraputta et al. (12) used a multivariate logistic regression analysis to show a significant association between hypothyroidism and OSA after adjusting for demographic characteristics, health care access, body mass index, alcohol use, smoking, and other comorbidities that are common among patients with OSA and hypothyroidism. Resta et al. (13) evaluated obese patients with and without sleep disturbances and showed a higher prevalence of hypothyroidism among patients referred to a sleep clinic for sleep-disordered breathing.

The aforementioned studies support the hypothesis that hypothyroidism may contribute to OSA. However, the specific pathophysiologic mechanism remains relatively elusive. Mete et al. (14) described several mechanisms by which hypothyroidism may be associated with OSA symptoms. For example, some patients with hypothyroidism may have increased thyroid size that causes or worsens upper airway obstruction. Hypothyroidism also could alter ventilatory drive and respiratory muscle function.

The effects of hypothyroidism treatment on OSA have been mixed. Lin et al. (15) showed that T4 replacement therapy improved symptoms of OSA for some patients. This finding was corroborated by Kittle and Chaudhary (16), who showed that thyroid hormone therapy could diminish (or in some cases, completely eliminate) apneic episodes and arterial oxygen desaturations, thus improving sleep satisfaction and sleep efficiency. However, both studies reported that some patients did not have improvements in their sleep experience with thyroid hormone replacement therapy. Bielicki et al. (17) indicated that although hypothyroidism may be a contributing, if not causal, component of OSA for some patients, most patients with OSA have normal thyroid function or do not have improvement in sleep symptoms with thyroid treatment. In fact, many studies, including one by Bruyneel et al. (18), showed that TSH and T4 levels were not significantly different among patients with moderate or severe OSA, suggesting that thyroid hormone levels are not necessarily a marker of OSA severity. Similarly, Mete et al. (14) assessed 150 patients with polysomnographically diagnosed OSA (50 mild, 50 moderate, and 50 severe OSA cases) and showed no significant association between OSA severity and thyroid hormone levels.

Interestingly, Petrone et al. (19) evaluated 125 patients with moderate to severe OSA plus 60 control patients with normal nocturnal respirations and showed that 10. 4% of patients with OSA had nonthyroidal illness syndrome (NTIS), defined as normal TSH and low T3 levels. Another 8% in the OSA group had subclinical hypothyroidism, defined as elevated TSH and normal T4 levels. No patients in the control group had NTIS or subclinical hypothyroidism. Patients with NTIS had decreased mean nocturnal oxygen saturations and increased time with oxygen saturation below 90%. After treatment with continuous positive airway pressure, 100% of patients with NTIS had T3 levels increase to the normal range, and 75% of patients with subclinical hypothyroidism had a decrease in TSH levels. No hormonal changes were seen with any of the control patients, who had normal levels.

A study by Bahammam et al. (20) evaluated 271 patients referred for sleep studies and measured the patients’ TSH and T4 levels to determine the prevalence of thyroid disease. Among the patients with confirmed OSA, the prevalence of newly diagnosed clinical hypothyroidism was 0.4%, whereas it was 1. 4% in patients without OSA. However, the prevalence of newly diagnosed subclinical hypothyroidism was 11.1% for patients with OSA and 4% of patients without OSA.

These studies illuminate the relationship between hypothyroidism and OSA but also highlight the heterogeneity of causes and contributing factors that can influence a patient’s symptoms. Although many studies support the hypothesis that OSA is associated with thyroid dysfunction, the level of thyroid dysfunction does not appear to predict OSA severity and the severity of OSA may have subtle effects on thyroid hormone levels. Currently, the exact mechanism underlying the interplay between OSA and thyroid function remains unclear.

A well-known example of thyroid dysfunction contributing to sleep disturbances is abnormal thyroid function that increases the risk of restless legs syndrome (RLS). People with RLS have an uncomfortable or unpleasant sensation in their legs or body when they rest. Thus, RLS symptoms, which usually occur when a person is trying to sleep, can lead to insomnia and sleep dysfunction (21). Conditions with higher levels of thyroid hormones (eg, pregnancy, Graves disease) also are associated with a higher prevalence of RLS symptoms.

Although the exact pathophysiology of RLS is still being investigated, Pereira and Andersen (22) hypothesized that the dopaminergic system has an important role, given the effectiveness of dopamine agonists in alleviating RLS symptoms. Tan et al. (21) suggested that elevated levels of thyroid hormone can be an inciting stimulus for RLS-like symptoms, such as tremors, hyperkinetic states, and insomnia. Their study evaluated 146 patients with biochemically confirmed thyroid disorders and 434 control patients without thyroid disorders. Twelve patients (8.2%) with confirmed thyroid disorders had RLS-like symptoms, whereas only 4 control patients (0.9%) were similarly affected. Furthermore, of the 12 patients with thyroid disorders and RLS-like symptoms, 4 (33%) had complete resolution of RLS symptoms with adequate thyroid treatment. These findings underscore the idea that hyperthyroidism and hypothyroidism may exacerbate RLS symptoms, even if they are not the primary drivers of the disorder. Notably, they showed no significant difference in the prevalence of RLS between patients with and without thyroid dysfunction.

Ahmed et al. (23) reported that RLS symptoms were considerably more prevalent in patients with hypothyroidism than in patients with normal thyroid function. Additionally, patients who had hyperthyroidism before their hypothyroidism, which can commonly occur in autoimmune processes such as Hashimoto thyroiditis, were considerably more likely to have RLS symptoms compared with patients who did not have hyperthyroidism before hypothyroidism. Pradella-Hallinan et al. (24) showed that patients with RLS and subsequent Graves disease had worsening of their RLS symptoms during the hyperthyroid state. Several patients in that study had new-onset RLS after Graves disease developed.

Although thyroid dysfunction does not appear to directly cause RLS, it does affect RLS symptoms. With this in mind, thyroid hormone levels are a potentially modifiable risk factor for RLS, and clinicians should consider correcting thyroid abnormalities to minimize the symptoms of RLS and their effects on sleep.

Thyroid dysfunction can contribute to a myriad of symptoms that involve nearly every system in the body, including sleep function. Even though current evidence suggests that thyroid hormone levels are not markers of sleep dysfunction, untreated thyroid dysfunction clearly can affect a person’s ability to achieve healthy, restful sleep. Although sleep dysfunction is not among the most common symptoms that clinicians associate with thyroid disorders, thyroid and sleep dysfunction commonly co-occur. Clinicians should keep this association in mind when using a whole-body approach to treat patients with thyroid dysfunction and sleep disorders.

MG: Data collection, literature review, manuscript writing and revision. VB: Consultation and expert advice, manuscript revision, and content recommendation. JC: Primary research advisor, data collection, literature review, manuscript writing and revision. All authors contributed to the article and approved the submitted version.

JC is supported by the Mayo Clinic in Florida Research Accelerator for Clinicians Engaged in Research Program and the Department of Medicine Catalyst for Advancing in Academics award.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

NTIS, nonthyroidal illness syndrome; OSA, obstructive sleep apnea; RLS, restless legs syndrome; T3, triiodothyronine; T4, thyroxine; TSH, thyroid-stimulating hormone.

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Sleep Better With Hypothyroidism | Everyday Health

Tired during the day? If you have hypothyroidism, you’re more likely to experience fatigue, but getting better sleep can help boost energy.

By Elizabeth Shimer BowersMedically Reviewed by Rosalyn Carson-DeWitt, MD

Reviewed: November 21, 2019

Medically Reviewed

Keeping your bedroom dark and cool can help you fall asleep. Ken Tackett/Shutterstock

Sleep is important for everyone, but it’s especially important if you have hypothyroidism. That’s because fatigue is a hallmark of the condition.

Hypothyroidism is a deficiency in thyroid hormones that causes metabolism and many other bodily functions to slow down. “Thyroid hormones help regulate metabolism, determine heart rate, and are involved in the function of almost every organ system in the body,” says Kristine Arthur, MD, an internist with MemorialCare at Orange Coast Medical Center in Fountain Valley, California. “Because thyroid hormones are involved in so many bodily processes, when they are low, you can have both daytime and nighttime symptoms, including fatigue during the day and poor sleep at night.”

Besides causing daytime fatigue by slowing metabolism, hypothyroidism increases the risk for some sleep disorders. “About 30 percent of people with hypothyroidism have sleep apnea,” says Robert S. Rosenberg, DO, medical director of the Sleep Disorders Center of Prescott Valley, Arizona, and author of Sleep Soundly Every Night, Feel Fantastic Every Day. “In this group of people, it’s the drop in oxygen and the struggle to breathe against a closed airway that disrupts their sleep.”

Hypothyroidism may also prevent the deepest, most important sleep, Dr. Rosenberg says. This may be another contributor to daytime fatigue in people with hypothyroidism, he says.

How to Get Better Sleep

When it comes to fighting the fatigue of hypothyroidism, part of the answer is simply to sleep more, but knowing what to do and doing it are different beasts. Many people don’t get the sleep they need. Adults should sleep at least seven hours each night, according to the American Academy of Sleep Medicine, but the Centers for Disease Control and Prevention (CDC) says that as many as one-third of adults in the U.S. report not getting the recommended amount of shut-eye.

The first step toward getting better sleep and fighting fatigue if you have hypothyroidism is to get your thyroid hormones back within normal range by taking thyroid hormone replacement medication. “First, anyone with suspected or known hypothyroidism needs to have their hormone levels checked and managed carefully,” Dr. Arthur says. “This needs to be done by a doctor. You shouldn’t try to boost thyroid function on your own with over-the-counter medications or supplements.” It’s also important to keep in mind that if your medication dose is too high, you may feel wired and begin to experience insomnia.

Other conditions that can interfere with your sleep need to be addressed as well. If you suspect you have sleep apnea, talk to your doctor. He or she may recommend lifestyle changes, such as losing weight or quitting smoking, or prescribe a treatment, such as a continuous positive airway pressure (CPAP) machine.

Beyond treating the root cause of hypothyroidism, Rosenberg says the best advice for getting better sleep is the same as it is for anyone who occasionally or regularly lies awake at night. Here are some tips to try.

1. Keep your bedroom cool. “A comfortable bedroom temperature is important, especially while you’re in the process of getting your thyroid regulated,” Rosenberg says. He suggests setting your thermostat between 65 and 70 degrees Fahrenheit.

2. Embrace the dark. “Try turning down all lights at least an hour before you go to bed,” Arthur says. Keep your bedroom dark and cover all bright or flashing lights. “Darkness helps with natural melatonin production,” she says.

3. Calm down. “Having a relaxing presleep routine is one of the most important things you can do to help facilitate good sleep,” Arthur says. “Take a warm bath with relaxing scents like lavender, read a favorite book (not an e-book with a backlit screen), or listen to relaxing music,” she says.

4. Sleep in a comfy bed. “If your mattress is over seven years old, it can cause a problem,” Rosenberg says. Make sure your bed is comfortable and supportive for a good night’s sleep.

5. Avoid nighttime feasts. Indulging in a large meal close to bedtime can disrupt sleep, as can eating something unusual. If you’re struggling with sleep problems, avoid spicy dishes and caffeine — even chocolate.

6. Have a small snack instead. “Eating a little something with a combination of protein and carbohydrates, such as whole-grain crackers and peanut butter, before bed can help keep blood sugars balanced overnight,” Arthur says.

7. De-stress. One of the biggest contributors to sleep problems is stress, and people tend to think about stressful situations instead of closing their eyes when they climb into bed. To address these issues in a beneficial way, try writing in a journal or practicing relaxation techniques, such as meditation.

If you continue to struggle with sleep issues, talk to your doctor to determine the root cause and address it to help yourself get the quality rest you need.

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How does the thyroid gland affect sleep?

The thyroid gland is a small organ located at the base of the neck. When the thyroid gland is fully functional, most people do not know what functions it performs. But if the hormones are produced incorrectly, then the reaction on the body has a serious impact.

The thyroid gland is responsible for the production of the hormones T3 and T4. T3 is the active form and T4 is the inactive form. Thyroid dysfunction can occur in several ways. The most common form is hypothyroidism, or underproduction of one or more thyroid hormones. Hormonal imbalance often provokes sleep disturbance, general weakness, depression.

Symptoms of thyroid imbalance

Problems with the functioning of this body can lead to the following:

• fatigue;
• constipation;
• obesity;
• thinning hair;
• deterioration in heart rate;
• insomnia;
• memory problems;
• menstrual disorders in women.

What effect do thyroid hormones have on sleep quality?

The thyroid gland and insomnia are interconnected. A person who has problems with this organ often has sleep disturbances. This condition not only leads to a deterioration in the quality of life, but also exacerbates the symptoms of the underlying disease. That is why it is required to control both the state of the body and the quality of sleep.

With hypothyroidism, patients can sleep 7-9 hours , but at the same time feel tired and unwell, while with hyperthyroidism, people, on the contrary, complain of increased nervousness and insomnia. What is the reason for this? In the course of the study, scientists confirmed the fact that lack of sleep leads to an aggravation of dysfunction in the synthesis of the hormone T4. This trend has been seen among women. As statistics show, it is the representatives of the weaker sex who suffer from thyroid problems 7 times more often than men. Men, on the other hand, are less likely to experience insomnia. It can be concluded that problems with the thyroid gland in most cases are found in patients.

What is the relationship between the thyroid gland and the quality of sleep?

How are the thyroid gland and sleep related? Their connection lies in the ratio of the amount of sleep and the synthesis of thyroid hormones. One-time lack of sleep leads to the activation of hormone production, and chronic, on the contrary, causes them to slow down. To normalize sleep, you need to carefully monitor the state of the body. Special medications and proper nutrition help bring his work back to normal. Very useful for the thyroid gland are salmon and other fatty fish, greens, leafy vegetables, Brazil nuts. In addition, a person needs to pay attention to physical activity. A sedentary lifestyle can lead to thyroid problems and insomnia. To prevent this from happening, you need to play sports. You can give preference to calm types of training. Yoga is a very effective and beneficial activity.

How does sleep affect the functioning of the body?

When a person has a sleep disorder, he cannot lose weight. Insomnia is dangerous because it slows down the ability to lose fat. And thyroid imbalance can be directly related to blood sugar problems. They can cause insulin resistance or hypoglycemia. That is why the patient needs to be examined by a doctor. Timely treatment prevents the development of complications and improves the quality of life.

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19 Thyroid Warning Signs You Shouldn’t Ignore!

Thyroid problems are 10 times more common in women than in men. What can cause the thyroid gland to fail? These can be genetic causes, autoimmune attacks, pregnancy, stress, malnutrition, or environmental toxins. Consider all the possible signs of thyroid dysfunction.

1. Your strength is exhausted

There are many reasons for feeling tired and lacking energy, but all of them are related to hypothyroidism, a disease in which thyroid hormones are not produced enough. If you still feel tired in the mornings or throughout the day after a night’s sleep, this may indicate that your thyroid gland may not be working actively enough. Too little thyroid hormone circulating in your circulation and cells means your muscles aren’t getting the signals to start working.

2. You are depressed

An unusual feeling of depression or sadness can also be a symptom of hypothyroidism. Why? Because by producing too few hormones, the thyroid can affect levels of the “feel good” neurotransmitter, serotonin, in the brain. If the thyroid gland is not active enough, then other systems of the body also “roll down”, and therefore it is not surprising that our mood also drops.

3. Nervousness and anxiety

Anxiety is associated with hyperthyroidism, when the thyroid gland produces too much thyroid hormone. Overwhelmed with constant “all systems go!” signals, your metabolism and your entire body can get overexcited. If you feel like you can’t relax, then your thyroid may be overactive.

4. Appetite and taste preferences have changed

Increased appetite may indicate hyperthyroidism, when too many hormones produced can make you feel hungry all the time. The only difference and, one might say, the “plus” of this is that in this case, malfunctions in the thyroid gland due to its hyperactivity compensate for the use of excess calories due to increased appetite, so the person ultimately does not gain weight.

On the other hand, an underactive thyroid can create confusion in your sense of taste and smell.

5. Fuzzy thinking

Of course, fuzzy thinking can be the result of lack of sleep or aging, but cognitive abilities can also take a significant hit as a result of malfunctions of the thyroid gland. Too high levels of thyroid hormones (hyperthyroidism) can make it difficult to concentrate, and too low (hypothyroidism) can lead to forgetfulness and “foggy thinking.”

6. Loss of interest in sex

Poor or no interest in sex can be a side effect of thyroid disease. Low hormone levels can cause low libido, but the overall effect of other hypothyroid symptoms – lack of energy, body aches – can also play a role.

7. Everything is trembling before the eyes

This “trembling” may appear due to rapid heartbeat. You may feel like your heart is fluttering or skipping a beat or two, or beating too hard or too fast. You can also note such sensations on your wrist or on pulse points on your throat or neck. A “fluttering” heart or palpitations can be a sign that your system is overflowing with hormones (hyperthyroidism).

8. Dry skin

Dry skin, if it also itches, may be a sign of hypothyroidism. Changes in the texture and appearance of the skin are most likely due to a slower metabolism (caused by low hormone levels), which can reduce sweating. Skin without enough fluid can quickly become dry and flaky. In addition, the nails become brittle and voluminous longitudinal stripes appear on them.

9. The intestines began to work unpredictably

People with hypothyroidism sometimes complain of constipation. Insufficient work of the thyroid gland causes a slowdown in the digestive process.

On the other hand, too much thyroid activity can cause diarrhea or more frequent bowel movements. These can all be signs of hyperthyroidism.

10. Menstruation frequency has changed

Longer menstrual periods with more discharge and pain can be a sign of hypothyroidism when not enough hormones are produced. Periods between periods may be shortened.

In hyperthyroidism, high levels of TH cause irregular periods of various kinds. Periods are shorter or longer, menstruation can pass in a very small amount.

11. Pain in the limbs and muscles

Sometimes such pain is due to increased work of the muscles and limbs. However, if you feel unexplained and unexpected tingling, numbness, or just pain—in your hands, feet, legs, or arms—this could be a sign of hypothyroidism. Over time, insufficient levels of thyroid hormones can destroy the nerves that send signals from your brain and spinal cord throughout your body. This is expressed in such “inexplicable” tingling and pain.

12. High blood pressure

High blood pressure can be a symptom of thyroid disease. This can be due to both hypothyroidism and hyperthyroidism. According to some estimates, people with hypothyroidism have a 2-3 times higher risk of developing hypertension. According to one theory, low levels of thyroid hormones can slow down the heartbeat, which can affect the force of expulsion of blood and the flexibility of the walls of blood vessels. Both can cause high blood pressure.

13. Freezing temperature

Feeling cold or chilly may have roots in hypothyroidism. The inactivity of the body systems due to low levels of hormones means that there is less energy in the body that is burned by the cells. Less energy equals less heat.

On the other hand, an overactive thyroid causes the cells to burn too much energy. Therefore, people with hyperthyroidism sometimes feel hot and sweat profusely.

14. Hoarseness and strange sensations in the neck

Changes in the voice or a feeling of “lump in the throat” may be a sign of a thyroid problem. One way to check for this is to take a good look at the neck for any signs of an enlarged thyroid gland. You can check your thyroid gland yourself by following these recommendations:

Take a mirror in your hand and, looking at your throat, drink some water. Your job is to watch for any bulges or protrusions in the area of ​​the thyroid gland, which is below the Adam’s apple and above the collarbone. You may have to do this several times to get a feel for where the thyroid is actually located. If you notice any bumps or anything suspicious, see your doctor.

15. Sleep disturbances

Do you want to sleep all the time? This may be due to hypothyroidism. An “underperforming” thyroid can slow down body functions so much that sleeping (even during the day) may seem like a brilliant idea.

Can’t sleep? This may be due to hyperthyroidism. High hormone levels can translate into anxiety and a fast heart rate, which can make it difficult to fall asleep or even cause you to wake up in the middle of the night.

16. Weight gain

Plus two sizes in clothing – there are so many reasons for this circumstance that it is unlikely that your doctor will consider an increase in everything as a symptom of a potential thyroid disease. On the other hand, unexpected weight loss can signal hyperthyroidism.

17. Hair thinning or falling out

Dry, brittle hair or even hair loss can be a sign of hypothyroidism. Low hormone levels disrupt the hair growth cycle and put many follicles into “rest” mode, resulting in hair loss. An excess of thyroid hormones can also affect the amount of your hair. The symptoms of hyperthyroidism that affect the hair are usually expressed as thinning of the hair on the head only.

18. Problems with pregnancy

If you have been trying to get pregnant for a long time without success, it may be due to an excess or lack of thyroid hormones. Difficulty conceiving is associated with a high risk of undiagnosed thyroid problems. Both hypothyroidism and hyperthyroidism can interfere with the ovulation process, which affects the ability to conceive. Thyroid disease also leads to problems that occur during pregnancy.

19. High cholesterol

High low-density lipoprotein (LDL) levels that are independent of diet, exercise, or medication may be related to hypothyroidism. An increase in the level of “bad” cholesterol” can be caused by a “defect” of the thyroid gland and be a cause for concern. If left untreated, hypothyroidism can lead to heart problems, including heart failure.

If you have one or more of these symptoms and suspect a thyroid problem, see your doctor and ask for tests for thyroid stimulating hormone (TTT), free triiodothyronine (T3), free thyroxine (T4), antibodies to thyroperoxidase (ATkTPO) do an ultrasound of the thyroid gland -. Based on test results, symptoms, and examination, you may be prescribed synthetic hormones. There can be some trial and error in testing and prescribing treatments for thyroid disease, so be prepared to visit your doctor several times to ensure the correct dosage is given.