By Dr. Leigh Siergiewicz
Why are you waking up between 2:00-4:00 a.m. every night?
This question is incredibly important to answer and it is related to your overall health. Around this time, we are supposed to be in REM sleep with our brains and bodies doing very important cleanup and repair work. Frequent interruptions in the early morning hours are a sign that your metabolism and hormones need support so that you can reduce your risk of developing diabetes and other chronic diseases. Solving this problem can improve your day-to-day energy levels, memory, cognition, stress management, and long-term health.
One of the most common reasons for early morning wake-ups is low blood sugar. If you wake up between 2:00-4:00 a.m. feeling fully alert for seemingly no reason, what you ate during the day likely caused a blood sugar spike that led to a very low blood sugar drop around 2:00 a.m. Alcohol in the evening is a common reason for this, but an imbalanced diet alone can cause the problem.
Cortisol dysregulation from chronic stress can also cause waking at this time – this makes your heart race and leaves you feeling amped up when you’d rather be asleep. Cortisol is supposed to be high in the morning, to wake us up, and to decline as the day goes on. Under chronic stress, the normal curve becomes erratic and the highs and lows are at the wrong times. Dysregulated cortisol often causes daytime fatigue and difficulty getting to sleep, as well as 2:00 a.m. wake-ups. I often order a saliva test that looks at cortisol four times in a day to see what an individual’s cortisol curve is doing.
Many people are unaware that they have blood sugar imbalances or pre-diabetes. A single fasting glucose test doesn’t give much useful information. A hemoglobin A1c test is a 3-month average of your blood sugar, and a fasting insulin level can tell us whether insulin resistance is a problem. A prescription continuous glucose monitor that tests your blood sugar every 5 minutes for 10 days is immensely valuable in learning to prevent blood sugar spikes and crashes.
For women, estrogen and progesterone imbalances can contribute to waking, but often their contributions are related to imbalances of cortisol and/or insulin. (This is why some women go through menopause with little difficulty, while others need lots of support). As we age and estrogen declines, our blood sugar gets more difficult to manage because estrogen helps improve insulin sensitivity. A mild blood sugar problem becomes exacerbated during perimenopause. Chronic stress creates too much cortisol, which causes progesterone to decline. Progesterone is not just a pregnancy hormone; it keeps us asleep when we want to be. Hormone testing isn’t always necessary, but when done correctly it can help people see the whole picture to understand their health better.
For women who are still having regular cycles, estrogen and progesterone need to be tested on particular days (day 3 for estrogen and 7 days before menstruation begins for progesterone). Getting them tested on any random day doesn’t provide as much useful information.
There are some changes that anyone can make to help themselves feel more stable throughout the day and to sleep all night. Individual fine-tuning may be necessary to fully solve the problem, but here are some basic starting points.
Try to eat at least 100 grams of protein every day. This is a big adjustment for a lot of people, but once you get in the habit, it’s not so hard. That means between 30-40 grams at three separate meals. Read labels and add up your grams. An egg has only 6-7 grams, so eating two for breakfast isn’t enough. Have three eggs with Greek yogurt, cottage cheese, sausage, or protein powder in a smoothie.
If your morning starts with minimal protein and mostly carbs, you will increase your blood sugar and it will crash by mid-morning, causing more hunger and an all-day spike and crash cycle that continues in the middle of the night. When I eat around 35 grams of protein for breakfast, I can completely forget about food until 1:00 p.m.!
Eat two more palm-sized servings of fish or meat, and some cheese or nuts for snacks. Don’t eat carbs alone, as this causes a larger blood sugar increase. If you have a meal with chicken, potatoes, and broccoli, eat the chicken first, then the broccoli, then the potato. Eating the potato first (or alone) would cause a much more significant blood sugar increase. For some people, a very small protein snack at bedtime is necessary to prevent a blood sugar drop-off in the middle of the night. A spoonful of nut butter or a piece of cheese can help you stay asleep.
Walking after meals can help pull glucose into your muscles instead of causing a blood sugar spike. Increasing overall muscle mass is extremely important for metabolic health because larger muscles are more metabolically active. Low muscle mass increases the risk of many chronic diseases and poor health outcomes. I go to Vashon Strong right in town because nothing makes it easier to build muscle than having a fun group and an instructor. I immensely appreciate that I don’t have to come up with exercises myself; I just show up at class time and receive guidance.
For cortisol management, help re-set your cortisol curve back to normal by reminding your body what time it is. Shortly after getting up, even if the sun isn’t up yet, go outside and look at the dawn light or face the sun. Don’t wear glasses, contacts, or look through windows; give your eyes and skin the natural sunlight they expect. During the day, take breaks to go outside and remind your biology what time it is with some sunlight, and again in the evening. Even just a few short breaks can make a big difference for people who are used to being inside all the time. The first and last lights you see in a day should not be an artificial screen.
Coffee should be saved for after your protein breakfast. Let your wake-up cortisol do its thing before you push it with caffeine. When your body is properly fueled, it won’t overshoot cortisol when it receives caffeine. Don’t have any caffeine after noon.
Waking up every night in the early morning hours is a solvable problem. Properly nourishing your body with enough protein, building muscle, and getting natural sunlight can help you adequately rest. These suggestions are a starting point; some people require a few months of troubleshooting to help their bodies re-set to sleeping for 7-8 hours straight. Fixing this problem is worth the huge quality of life improvements from getting adequate rest.
Dr. Leigh Siergiewicz, betalunanaturopathic.com, 253-330-8708.
