Office Hours: Can't Fall Asleep? Your Sleep Questions Answered

Mark Hyman, MD

Dr. Mark Hyman is leading a health revolution—one focused on using food as medicine to support longevity, energy, mental clarity, happiness, and so much more. Mark Hyman, MD is a practicing family physician and an internationally recognized leader, speaker, educator, and advocate in the field of Functional Medicine. He is the founder and director of The UltraWellness Center, Founder and Senior Advisor for the Cleveland Clinic Center for Functional Medicine, a sixteen-time New York Times best-selling author, and Board President for Clinical Affairs for The Institute for Functional Medicine. He is the founder and chairman of the Food Fix Campaign, dedicated to transforming our food and agriculture system through policy.

He is a co-founder and the Chief Medical Officer of Function Health. He is the host of one of the leading health podcasts, The Dr. Hyman Show with 150+ million downloads. Dr. Hyman is a regular medical contributor to several television shows and networks, including CBS This Morning, Today, Good Morning America, The View, Fox, and CNN.

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Full Transcript

Automatically generated. Please forgive any typos or errors in the following transcript. It was generated by a third party and has not been subsequently reviewed by our team.

Dr. Mark Hyman
You're doing what you're supposed to do. You're in bed for seven, hours, and yet you wake up feeling unrefreshed, foggy, you could go right back to sleep. Now, most cases, it's not about how long you're sleeping, it's about the quality of that sleep.

Dr. Mark Hyman
Welcome to Office Hours. This is our dedicated one zero one space to go deeper, get clear, and explore what truly moves the needle for your health. I'm doctor Mark Hyman, and each week, we're gonna pull back the curtain and share the insights, the research, the lessons that don't always make it into our conversations with guests. Because at the end of the day, you are the CEO of your own health. And for many of you, your family's health too.

And you might not feel it all the time, but you have far more power and agency than you realize. I'm glad you're here. This episode is brought to you by Function Health, empowering you to live a 100 healthy years with over a 160 lab tests for just $365 a year. And use the code Mark twenty twenty six to get $50 off your membership.

Dr. Mark Hyman
Sleep, you know, is one of the most important foundations of your health. And honestly, one of the most frustrating. Now if you struggle to fall asleep, you struggle to stay asleep, if you wake up feeling exhausted, I promise you you're not alone. And I wanna know, despite what social media tells you, poor sleep isn't just caused by one bad habit or one missing supplement. It's the result of a few biological systems that are out of sync.

So in today's office hours, we're gonna slow things down, we're gonna answer the most common questions about sleep, what's actually going on in your body, and what helps in real life. Now this isn't about perfect sleep routines, it's about understanding your sleep patterns and giving your body what it needs to rest and to repair. Now, here's why sleep breaks down. This is the big picture. Sleep problems usually come from a few things.

First is circadian rhythm disruption. Now your body runs on this internal clock that's guided by light, by darkness, by consistent timing, is really hard particularly for me because I travel all over the place. And when that clock is off because of late nights, because of screens, because of irregular schedules or not getting morning light, your sleep becomes harder to initiate and it also becomes harder to sustain it through the night. The next thing that often occurs that screws up sleep is your nervous system being overactive. If your body's stuck in this stress response, if you're always on, right, if you've got high cortisol, high adrenaline, your body doesn't think it's safe to power down, right?

Because your body's in stress, you're chasing a running from a tiger, right? Or you're fighting or fleeing. Now you might feel exhausted but your brain stays alert and that's why so many people feel tired all day and wired at night. We call that tired and wired. I have felt that, I promise you it's awful.

The next thing that often screws up sleep is your blood sugar being unstable. Now blood sugar instability is a common overlooked cause. Now if your blood sugar drops overnight, guess what happens? It's a life threatening emergency and your body releases stress hormones and that brings your blood sugar back up which is fine except your cortisol is high and your body's like, oh, danger or it's wake up time because in the morning your cortisol goes up naturally and that often occurs between two and four in the morning and then your mind races, you're really alert. And this is true for people who often have high insulin, they eat big meals, they kind of have a big spike in their blood sugar, their insulin spikes and it crashes and then you often get this.

Had a guy who had night sweats because as a patient and obviously he wants to go through menopause and he'd have cancer or TB which are the other causes, and it was because he had hypoglycemia in the middle of the night and that causes night sweats and a life threatening emergency. The next big thing that screws up sleep are hormone imbalances. Now these play a big role in your sleep quality. And there's a lot of hormones that are involved. Cortisol as we just mentioned, the stress hormone.

Melatonin which we know affects sleep and is important for sleep initiation. Progesterone, estrogen, sex hormones. And we know a lot of women through menopause often have sleep disruption. And thyroid, it can often, if it's too high, can make you not sleep. If it's too low, it can make you sleep too much or actually paradoxically cause insomnia.

So all these hormones are like this incredible beautiful symphony of molecules that should be in balance. When they're out of balance, they screw you up. And they all influence when you feel sleepy, how deeply you sleep, how rested you feel in the morning. And and these shift, right? They shift during perimenopause, menopause, chronic stress, all these things can disrupt sleep.

The next big category of things that disrupt sleep are actually two different categories. One is inflammation and the other is nutrient depletion. Inflammation is a big factor because almost all brain dysfunction, whether it's depression or autism or Alzheimer's or schizophrenia or anxiety, whatever you want to call a brain dysfunction, is usually linked in some way or another or caused by inflammation. And that includes sleep disruption. So that's a big one.

And there's a lot of causes for it and often people don't realize what they are. They can be toxins and allergens and infections and the microbiome changes and inflammatory diet and stress. I mean there's a whole list of things that cause inflammation. The other thing is nutrient depletion. That's the big one.

And a lot of people are nutritionally efficient. In fact, at Function where we test everybody for a lot of nutrients that your doctor usually does not test for like omega three fats and b vitamins, homocysteine, methylolic acid, b twelve, folate, vitamin D and many others, we find that almost seventy percent of our population, is generally health seeking people, seventy percent have a nutritional deficiency at the level that the RDA considers a nutritional deficiency disease. Not what optimal, but just what's enough to get scurvy or rickets. So we're talking a massive amount of nutritional deficiency or insufficiency in the population. It's probably over ninety percent.

So when you have low levels of nutrients like magnesium and over forty five percent are low in magnesium and we do test that, iron affects sleep if your iron is low and we check your ferritin level, which is really important. Again, doctor usually never checks this, it's on function kennel. And your ferritin level's less than 45, even though the normal, code normal is 16, you're gonna have sleep issues. So one of the big hidden causes of insomnia and a lot of the population has iron deficiency, up to half, especially children and many others. B vitamins, also a big role in sleep and omega threes.

All these affect your nervous system and your brain and affect your ability to sleep. So really important to focus on these things. Now sleep isn't something you force, it's something that happens when the body feels supported and safe. And that's the key here. Alright, so let's get to it.

What are the most common sleep questions? Number one, why can't I fall asleep even when I'm tired? And trust me, I've experienced this so I get it. Here's the thing, you get really tired, you're exhausted all day, you finally get in bed, instead of just passing out and drifting off, your mind turns off or maybe it just never turned off. Thoughts raise, your body feels tired, your brain went shut down.

Now what's usually happening here is that your body's physically tired but your nervous system is still in the on mode, right? You can't turn your brain off. Your anxiety, your stress response is automatic. And the thing about our society is that almost everything going on, whether it's our jobs, our relationships, our diet obviously, which causes tremendous amount of stress in our system, our inflammatory high sugar processed diet literally raises cortisol. Even if you're meditating all day long and you eat that, you're gonna have high cortisol.

All the stresses in the world, you know, wars and traumas and I mean just the news, it makes me stressed. So pretty much everything going on is is automatically making your nervous system un hijacked. And it takes deliberate effort to turn on your relaxation system. It's not something that happens automatically, it's an active process. I do it every morning, I do breath work, I do meditation, it's work.

I mean it's relaxing, but it's work. It's not just gonna happen automatically. Whereas stress, you don't have to do anything, it's just there. So what happens when you have high stress levels? Well cortisol is a stress hormone, that goes up at night.

Normally cortisol should go down at night. Your body has a basically a biphasic rhythm where it's up in the morning and down at night except when you're screwed up and then it goes up at night and down in the morning and you're all messed up. So cortisol is basically not functioning right. But you know, when you have chronic stress, when you're having regular schedules, when you're not having bedtime early enough, when you're staying up really late, or if your blood sugar swings because you're eating lots of carbs and sugar, it can screw up that whole rhythm and that makes cortisol go up when you're trying to go down, right? When you're trying to go to bed, it goes up.

So what happens? Well your nervous system gets stuck in the on mode. When your nervous system is overactive, you know because your day is packed with stimulation, with stress, with constant mental inputs, your body doesn't automatically know how to sort of shift down at night. Even though you're tired, system doesn't really feel safe to let go even though you might think you are. So learning how to regulate your nervous system and manage your stress response is a really important part of just being alive and human that we naturally did.

You know, living in the woods, watching the sunset, the sunrises, not having constant chronic stress. There's a book by a great scientist I love, Robert Sapolsky, called Why Zebras Don't Get Ulcers. Essentially the idea is that I actually was in Africa a couple years ago and I saw I literally saw this. You see a lion chasing a bunch of zebras, they go crazy, they're running as fast as they can, their hearts are racing, they're gonna die, they're scared as hell, and then the lion catches one of the zebras. And then it's literally laying there dead and then the lion's eating the zebra and all the other zebras are just hanging around the lion while it's eating the zebra.

They're just, they know it's not their turn. So they're just relaxed. So it's an acute stress, their stress hormones go up, they discharge them, they run and then they're fine. We don't do that, we just stay in chronic stress mode. The other big thing is blue light and mental stimulation, right?

So blue light and mental stimulation are also playing a big role. Now when you're on screens, when you have bright lights, when you're dealing with work emails at night, when you're having an intense conversation with your partner or spouse, that can really cause trouble. That can suppress melatonin and it basically signals the brain that it's all daytime, right? Because when you raise cortisol that's daytime. And when you have all this mental stimulation and we have blue light it's daytime.

So there's actually a great book I read called Lights Out years ago, just talking about the initial light bulb being the cause of the rise of chronic disease, including heart disease, diabetes, and many other things because of how it affects our nervous system, our hormones and so forth. The other thing that's really common that causes trouble is not going to bed at the same time and not waking at the same time. It's one of the most important things, and I'm really crappy at this, but it's one of the most important things if your sleep's not good to get your sleep right. If you have inconsistent sleep timing it matters more than most people really know. So going to bed and waking up at different times, especially on weekends, makes your whole interclock confused and heart rate.

Your body recognize when it's time to sleep. So given all that, what actually helps you sleep better? Well going to bed and waking up at the same time every day. Ten and six are good, nine and five, eleven and seven, whatever works for you is really important. Next is getting morning sunlight.

You've heard this before but I can't overemphasize the importance of getting at least 15 of morning sunlight even if there's clouds out within half an hour to an hour of waking up. You know, you're you know, in the North Pole and there's no light, they have you know, full spectrum light boxes you can use. But aside from that, unless you live in Sweden or Norway or somewhere in Greenland, you know, probably you can get mornings on. Downshift at night. Do breath work, do stretching, yoga, take a hot bath.

My favorite is Epsom salt bath, lavender oil which has magnesium and lavender actually lowers cortisol. They've studied this, Johnson and Johnson has a baby bath with lavender in it because it works, it reduces cortisol, calms the baby. Take magnesium at night, magnesium glycinate or three and eight, these are great forms of magnesium to take at night. So if you're tired and wired, your body isn't broken, it's just dysregulated. So when you focus on calming your nervous system and supporting your natural rhythms then falling asleep is going to get a lot lot easier.

Second big question is why do I wake up at two at four in the morning? Like between two and four in the morning and why can't I fall back asleep? Well this was by far the most common sleep question that you all submitted and for good reason. Waking up between two and four in the morning often with a racing mind or a sudden test of being alert is incredibly common. And the important thing to understand is this, most of the time it's not insomnia, your body sending a signal and what are those signals?

Well the causes for this are blood sugar drops. We talked about that but blood sugar drives a lot of wakefulness in the middle of the night because your blood sugar drops, your dinner's too low in protein or fat and you had sugar alcohol in the evening and your blood sugar dips. And then what happens, your insulin goes up and your cortisol goes up and you're off to the races. Then you got hypoglycemia and you get stress hormones going up and basically your blood sugar becomes normal but you're awake. The second is cortisol spikes.

Now cortisol naturally starts to rise early in the morning to wake you up, but chronic stress can push that rise earlier than it should right in the middle of the night. So don't think at six in the morning, it's at two to four in the morning. Alcohol, another big one. It helps you maybe fall asleep, but it screws up your sleep architecture. I have an Oura Ring and I know that when I you know drink and I don't actually anymore, I don't remember the last time I had a drink, I always see even a little bit actually screws up my sleep.

So it's not worth it. So small amounts of alcohol fragment sleep and they trigger this early morning waking. As soon as the alcohol goes down to your system then stress hormones kind of bounce up and you get awake in the middle of the night. The next is hormone shifts, perimenopause, menopause. Now for many women these hormone shifts, especially during perimenopause and menopause are a big contributor to waking up in the middle of the night.

It can be just waking up, it can be hot flashes. These hormones affect blood sugar, they affect your temperature control, they affect cortisol, all those can disrupt your sleep in those early morning hours. So what helps fix all that? Well, a good dinner with protein and fat, not a carb rich dinner. I mean it can have carbs, but you can't just have carbs alone and you don't want be eating tons of sugar at night.

Late night sugar or alcohol also bad news, even any alcohol you want to give yourself probably at least four hours before bed. Magnesium can help as well as we mentioned and those stress responses that we talked about. How do you deal with your stress load throughout your life? Look at your life as a whole, where can you cut out things that are stressful, where can you introduce things that are helping you relax, not just bedtime habits but just throughout your life. So the key takeaway is this, if you wake up in middle of the night, it's often metabolic or hormonal, not a personal failure or simply insomnia.

And when you address these underlying signals your body's sending then your sleep starts to repair itself. Alright, the next question we get is why do I sleep seven or eight hours but I still wake up feeling exhausted? It's a really common and kind of a confusing sleep question. You're doing what you're supposed to do, you're in bed for seven or eight hours and yet you wake up feeling unrefreshed, foggy, like you could go right back to sleep. Now in most cases it's not about how long you're sleeping, it's about the quality of that sleep.

One of the major causes of not feeling refreshed in the morning is not getting enough deep sleep or REM sleep. Now these stages are when your brain and your body repair, when they regulate hormones, when they consolidate memory, when they clear up inflammation. It's an amazing system that your brain has to heal and repair, but if you're not having quality sleep it's not doing it. If your sleep is fragmented or shallow, you can get plenty of time in bed and you don't feel restored. The next thing that can cause poor quality sleep is inflammation.

Now chronic inflammation is driven by stress, by poor diet, which is what most of us see in America, are gut problems, poor microbiome health, infections, toxins, all these things can drive inflammation. And they can interfere with sleep architecture and they make sleep less restorative. I know when I had mercury poisoning in my thirties, I could not sleep at all. And I needed drugs, it was terrible. And I knew that it was the mercury once I figured it out.

But it was kind of scary and so toxins and all these things can drive inflammation in the brain that really interrupts sleep. The next thing is hidden sleep issues that you might not really have, especially if you live alone, which is sleep apnea, which means you don't breathe at night for short periods of time. Your sleep is interrupted by periods of non breathing, whether you just hold your breath. Snoring, you don't breathe for a bit, you've seen people like this. And these are really common.

It can be caused by nasal congestion allergies, by mouth breathing, sleep apnea. These all affect your oxygen delivery and they can fragment sleep even if you don't think you're waking up at night, your sleep's crappy. And then of course there's nutritional deficiencies, hormonal issues, things like iron, b12, thyroid issues, they can cause persistent fatigue and it just might be a clue that there's something wrong that you need to track. And that's why we have Function and Function Health and you go to functionhealth.com and it's now only a dollar a day, $365 a year to get a full panel, it looks at all these things that we're talking about including iron, ferritin, b12, thyroid and many many other factors, magnesium, all that affect your sleep. And these can make you feel exhausted no matter how many hours of sleep you get.

So what helps fix this? Well track your sleep trends, not just one night so you see what's happening. If you're a nasal breather, you got nasal congestion, sinus issues, allergies, it could be your diet, food sensitivities, environmental allergies, mold, check it out. Check your labs, you know, always good to get a baseline. Alcohol, if you're really not feeling rest in the morning, cut out alcohol for a while and see how you do.

The key takeaway is this, if you're sleeping enough hours but you're still waking up exhausted, your body's asking for deeper repair, not more time in bed. When you focus on sleep quality and your underlying health, then your energy often starts to come back.

Dr. Mark Hyman
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You can now add scans to your function membership for an additional cost by visiting functionhealth.com/scans to learn more about it and get started. That's functionhealth.com/scans to learn more today. And if you're one of the first 1,000 people this week, use the code Mark twenty twenty six for a $50 credit toward your $365 a year membership. That's functionhealth.com/mark and use the code mark twenty twenty six today.

Dr. Mark Hyman
Next big question I got was what supplements actually help with sleep? Now supplements can be helpful, but only when they're used in the right context. They work best to support not as a substitute for healthy sleep habits and circadian rhythms. That's why they're called supplements not replacements, okay? Now here's the most helpful ones.

Magnesium. Probably about forty five percent of the population is low in magnesium. So what causes to be low? We don't need magnesium rich foods like greens and beans, nuts and seeds. We do a lot of things that cause us to lose magnesium.

Alcohol, sugar, stress, caffeine, all that causes us to deplete magnesium. It's one of the most consistently helpful nutrients for sleep and you can use forms like magnesium glycinate or threonate, helps relax the nervous system, quiets your brain at night. The next is L theanine. Now that comes from green tea and that's why there's tea ceremonies and green tea can be relaxing without caffeine, but this is without the caffeine. So L theanine's a great option especially if your mind races at night.

It helps promote a calm, relaxed state, doesn't cause you to be too sedated but it makes you calm. The next one is glycine. Most people have heard of it but it's an amino acid and it can really help support sleep quality, can help lower your core body temperature, promotes deeper sleep, more restorative sleep for some people. It's a great hack. Low dose melatonin and short term only.

I don't recommend melatonin regularly but it can be helpful in certain situations and dose and duration matter. Low dose, even half a milligram can be used short term and can help reset your circadian rhythm, especially if you're traveling. Like I just flew to South Africa, so I did one dose of melatonin last night to help reset my circadian rhythm, jet lag. So if you're traveling or you have a schedule disruption it can help. And more is not necessarily better and not really for a long term solution.

All right, what should you avoid? As I mentioned melatonin is good in low doses not high doses, so high doses taking over a long time can really disrupt your body's natural production and it can lead to grogginess, vivid dreams and remail sleep issues. So you'll want to stay away from doing that. And then no random stacking supplements without a plan. So you can take lots of sleep supplements, you can be taking everything on the market and it may not help.

So you want to work with someone if you're really struggling to find out the cause and then not just supplements as a pile on to fix it all. So here's the takeaway. Supplements support sleep but they don't replace the foundations of sleep hygiene and if the basics aren't in place like light exposure in the morning, avoiding blue light at night, regulating stress response, balancing with blood sugar, having a cool environment in your bedroom, having dark blackout shades, having low noise or noise cancelling or earplugs. All those things really make a difference. No supplements are gonna fix the problem if you don't address those things.

But if you use them thoughtfully then the right supplements help make sleep easier and more restorative. What are the quick takeaways that good sleep actually requires? Well I want to kind of go over the basics here. Here's the big idea. Sleep isn't about being perfect.

It's about a few key systems that work together and small consistent habits matter more than a bunch of hacks. Great sleep starts the minute you wake up, not when your head hits the pillow. So what are the five pillars of good sleep? Number one, light exposure. Morning sunlight helps reset your circadian rhythm.

That means getting outside even if it's cloudy, without sunglasses, without contacts and letting those sun rays hit your retina and work on your brain to properly regulate your hormones through your pineal gland. And then at night, low light exposure. Now that sometimes means changing your light bulbs in your house, candlelight's cool, I like that. You know there's a lot of ways to do this but make sure you deal with this bright evening light which is not good, it makes your body think it's still daytime. The next key takeaway here is stabilize your blood sugar.

And this is true for everything and every disease period. If you know my work you know all about this. You've been writing about it for thirty years. Bounce your blood sugar. That means lots of protein, fat and fiber, low refined starches, low sugar.

I'm not a no guy, I'm a low guy. And especially at night, at dinner don't eat a ton of starch and sugar without properly balancing out fat and protein and obviously don't eat a lot of refined starch and sugars. So also don't eat sugar before bed and don't drink at night. Also don't have late night sugar and alcohol, bad news. The third big idea here is to learn how to regulate your nervous system.

Stress happens, relaxation doesn't, right? Your sleep happens when your body feels safe so learning how to regulate your stress response throughout the day matters. And it can be simple, it can be a simple breath practice in the morning, meditation, some gentle yoga, stretching. It can be meditation later at night or what Andrew Huberman calls a non sleep deep rest or often it's called Yoga Nidra which is essentially an ancient practice to do a body scan and reset your nervous system. Whatever works for you, I take a hot bath, Epsom salt, lavender oil, get a massage, get your feet rubbed if you're lucky enough, whatever it is, learn how to down regulate your nervous system at night.

The fourth big idea is get your hormones in balance. Cortisol, melatonin, progesterone, estrogen, thyroid, these all affect sleep and if they're out of whack you need to know. Functionhealth.com is a great way to check all these and if they're out of whack there's some simple things you can do to fix them. If you need to see a doctor sometimes you need to get hormone replacement or thyroid, that's fine. And if your hormones are really messed up, you really need to get those fixed.

And the fifth big idea is be consistent, don't be perfect, right. Try to sleep and wake at the same time every day. You know consistency is one of the biggest sleep hacks there is so try your best. I try to get in bed at ten, I wake up at 06:30, seven. Really important if if I can do it, that's my favorite way to live life And of course sometimes I'll stay out at night, I'm going to a wedding this weekend, I'll be partying but not on a regular basis.

So what's the quick return on investment here? What are the quick wins? If you do nothing else, start here. Morning sunlight and then half an hour, an hour waking up. Eat protein dinner to make sure your blood sugar doesn't crash.

Reduce alcohol, even small amounts. And try to consistently sleep in the same sleep window, including weekends. And use magnesium because that's the easiest best sleep hack. Now just remember sleep is not a luxury, it's a biological requirement. If you're struggling with sleep it doesn't mean you're broken, means your body needs some help.

So get curious, don't be frustrated, small changes done consistently can really transform how you rest, how you feel, how you recover. And I'd love to hear from you. What sleep questions do you want answered next? What's been the hardest things for you about sleep? Office Hours is our space to get clear, to ask better questions, to take control of our health together.

You're the CEO of your own health and better sleep changes everything.

Dr. Mark Hyman
Thanks for joining me for Office Hours. I love diving into these topics with you. Remember, you are the CEO of your own health, and every choice you make can move you closer to healing and vitality. I wanna keep these episodes as relevant and useful as possible. So tell me, what do you want to explore next?

What questions are you wrestling with? What breakthroughs are you chasing? Share your ideas in the comments on social media or through the link in the show notes. I'm listening. Until next time, keep taking charge, keep asking questions, and keep showing up for your health.

Dr. Mark Hyman
If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Doctor Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review, and subscribe to The Doctor Hyman Show wherever you get your podcasts.

And don't forget to check out my YouTube channel at Doctor Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on The Doctor Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic, and Function Health where I am chief medical officer. This podcast represents my opinions and my guests' opinions.

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