Unspecified Insomnia and Fatigue
Muhammad Usman Naeem, Abdul Ghani MD
Insights
1 out of every 10 young patients I see at my clinic experience either insomnia, fatigue, or both. Most of these patients do not have any underlying disorders like sleep apnea, cushing’s disease, or any other chronic illness. In fact, many of these patients visit the clinic due to weight gain or depression. Many of these patients have poor lifestyles and diets. Some work overnight shifts, while others do not get sufficient sleep or consume processed foods throughout the day. In this paper, we will delve deeper into the impact of foods and lifestyle on fatigue and insomnia.The romantic relationship between sleep and the gut
The gut and your sleep are connected. Maintaining the delicate balance of bacteria in your gut is essential to promote restful sleep. Disrupting the sleep cycle can lead to metabolic damage. Recent studies show that sleep deprivation affects levels of important metabolites, disturbing the body’s internal clock and metabolism [1]. Just like you, the bacteria in your gut have their circadian rhythms. These rhythms can influence your internal clock and impact genes regulating wakefulness and sleep. When your body’s circadian rhythms are disrupted, such as traveling across time zones or by staying up late, it can alter the composition and behavior of gut bacteria. This misalignment of circadian rhythms can contribute to obesity. A study in mice showed that disrupting sleep patterns altered their gut bacteria, leading to increased inflammation, damaged colon linings, and insulin sensitivity [2].FOODS THAT DISRUPT SLEEP
Two of the most common drinks in American society are the leading reason for poor sleep. In this section we will discuss the effect of caffeine and alcohol on sleep.- Alcohol
Alcohol is a good sedative. It puts you to sleep faster. However, it affects the normal sleep cycle once you are asleep. Alcohol can expedite the transition to deep slow-wave sleep, it impairs the quality of sleep during N3, and the person feels fatigue upon waking [3]. Moreover, alcohol suppresses the REM cycle, leading to low cognitive performance. Drinking alcohol also alters gut bacteria, increasing inflammation in the brain and the gut. The withdrawal effect from alcohol also activates the amygdala (emotional part of the brain) exacerbating anxiety. - Caffeine
I had a patient with type 2 diabetes and hypertension (both under control) who complained of insomnia and fatigue. Initially, I recommended that the patient take otc melatonin, considering the possibility that his diabetes might be the cause, as well as his age. However, the melatonin didn’t work, and he continued to have the same complaints. Upon further discovery of the patient’s lifestyle, I learned that he was drinking coffee twice a day. I advised him to cut down his coffee intake. After a follow-up two weeks later, the patient was able to sleep better simply by cutting down on his coffee consumption. Drinking caffeine can interfere with sleep, leading to less alertness the next day. This is known as the “sleep sandwich” effect. Nearly 28 % of Americans sleep fewer than six hours per night [4]. Caffeine affects the adenosine receptors in the brain, which are linked to sleep, alertness, and cognition. Numerous studies have demonstrated that caffeine can significantly disrupt sleep. In 2013, Christopher Drake and his colleagues administered 400 mg of caffeine (equivalent to about 4 cups of brewed coffee) to three groups of people either just before bedtime or three to six hours prior. All the groups that received caffeine experienced disrupted sleep compared to those who received a placebo [5].
Eat to Sleep
The quality of your sleep depends on your diet. Recent studies shows that low protein intake (less than 16% of energy from protein) was tied to poorer sleep quality and difficulty falling asleep, while higher protein intake (more than 19%) was linked to difficulty maintaining sleep [6]. Instead of aiming for the precise 16-19 percent energy from protein, it’s best to consume a moderate amount of protein. High-glycemic-index carbohydrate meals can help you fall asleep faster but may lead to less satisfying sleep. High-sugar, high-saturated-fat, and low-fiber diets can also result in lighter, less restorative sleep, affecting slow-wave and REM sleep important for memory consolidation. It’s important to follow a healthy, whole-foods diet like the Mediterranean eating pattern and consider how your food choices can impact your sleep. Research indicates that a diverse diet can improve sleep, so aim to include a variety of foods in your meals to benefit your sleep and overall health.Foods that help you sleep right
Just avoiding alcohol and caffeine or putting away your phone well before sleep sometimes is not enough. Some patients are lacking fish in their diets. We need to improve our diet by adding food that aids in healthy sleep. In this section, we will review food that aids in good quality sleep.- Melatonin
Melatonin produced in the brain, regulates the circadian rhythms. Research shows that melatonin can be very useful for jetlag and help people fall asleep [7]. Melatonin can also be beneficial for individuals experiencing seasonal depression by regulating their sleep patterns. Melatonin can be naturally found in everyday foods. Food sources include rice, milk, eggs, fish, rolled oats, nuts (pistachios), fruits (grapes), and a variety of vegetables (cucumber, tomatoes, and broccoli). Melatonin capsules can also be found OTC. - Omega-3 fatty acids
Omega-3 is anti-inflammation and can increase sleep efficiency and REM cycle [8]. It protects the brain from memory impairment. Recent research shows that omega-3s can improve sleep. In a study on fifty depressed patients, those who took omega-3s showed improvements in anxiety, emotional control, depression, and sleep compared to those on a placebo [9]. The best source of omega-3 is salmon. Patients can also take omega-3 capsules three times a day. - Cherries
Cherries contain vitamin C and polyphenols which promote sleep and are anti-inflammatory. Tart cherry juice is a preparation that has been shown to reduce insomnia. In 2018, a study found that cherry juice increased sleep time and efficiency, indicating its potential as a sleep aid. This is attributed to its ability to increase tryptophan availability and reduce inflammation [10]. - Tryptophan
When tryptophan reaches the brain, it induces drowsiness. Tryptophan boosts the levels of melatonin and serotonin in the blood, both of which promote sleep. Some foods, like turkey and mashed potatoes, are rich sources of tryptophan, which can help you sleep. Other sources include cheese, and peanut butter on whole-grain toast.
The mystery behind unspecified fatigue
Fatigue is a common symptom that can have many causes, making it difficult to diagnose and treat. In this section, we will delve deeper to learn about fatigue underlying due to unhealthy diet, poor sleep habits, and lack of exercise.- Unhealthy diet
Unhealthy eating habits can lead to tiredness by failing to supply the body with sufficient energy. Everyone is busy working and has no time to cook, resulting in a reliance on fried fast food for meals. However, fried foods are difficult to process as they are high in fat. They can hinder the body’s ability to derive energy from food. Processed food also increases inflammation which decreases the body’s energy levels. When there is inflammation in the body, less energy is available to the brain. This is because low-grade inflammation switches off a metabolic process in the chemical pathway that produces energy. As a result, not only is there lower energy but there is also an increase in harmful free radicals that can reduce insulin sensitivity and damage brain tissue.
Fatigue can also result from low-calorie diets. Some patients are attempting to lose weight but are not consuming enough protein, carbohydrates, and minerals, which results in a lack of energy for the body. Remember you are on a diet not your brain. - Sedentary lifestyle
A sedentary lifestyle can also lead to fatigue. When you’re not moving, you are not releasing endorphins. Insufficient physical activity can also lead to decreased attention and can cause muscle weakening, resulting in reduced blood circulation. As a result, cells may receive inadequate nutrients and oxygen, leading to fatigue. Just working out 30 minutes a day can aid in reducing stress, boost energy levels, and improve well-being and health. - Sleep
Poor sleep hygiene can also lead to fatigue. Sleeping excessively or insufficiently can both disrupt body’s rhythms. Sleep disorders like insomnia can cause long-term exhaustion.
Food that fights unspecific Fatigue
- Anti-inflammatory Foods
To fight unspecific fatigue, we need to decrease inflammation and for that, it is crucial to consume a diet that fights inflammation. 60% of the brain is fat [11]. To function optimally, it needs at least 2-3 g total of docosahexaenoic acid and a continuous source of omega-3 fatty acids every day. Maintaining the proper balance of omega-3s to omega-6s is dependent on reducing omega-6 fatty acids [8]. Omega-6s is pro-inflammation. These fatty acids are present in mayonnaise, safflower, fast foods, peanuts, sunflower, soy, and grapeseed. A diet abundant in vibrant, non-starchy vegetables introduces polyphenols, which combat inflammation through various mechanisms. - Zinc and Magnesium
Boosting zinc levels can help prevent fatigue. Research shows that around 17.3% of global population is at risk of zinc deficiencies because of their dietary habits [12]. Chickpeas are a good source of zinc.
Magnesium relaxes the nervous system and decreases inflammation. Magnesium can prevent lactate accumulation during exercise, this helps to alleviate tiredness. Food sources rick in magnesium include edamame, boiled spinach, dry roasted almonds, cashews, and cooked black beans. - Curcumin
Just 100 mg of curcumin can improve fatigue. Curcumin is not only antioxidant and anti-inflammatory but it is also anti-fatigue which is does thru through glucose and lipid metabolism. - Vitamins
Most patients that I see with unspecified fatigue have vitamin deficiencies. Vitamins play a vital role in energizing and protecting the brain. It’s best to bolster vitamin levels through natural sources. That means a balance of fish, fruits, meat, vegetables, eggs, and fruits. Below are some specific vitamins that fight fatigue.- Pyridoxine (Vitamin B6): Lack of vitamin B6 can disrupt the links between brain cells, reducing the effective processing of information, resulting in fatigue. Vitamin B6 deficiency may also result from chronic alcoholism.
- Thiamine (vitamin B1): Decreased vitamin B1 levels alter the activity of mitochondria. Reducing mitochondria activity reduces energy production as the mitochondria are the energy factory of cells.
- Vitamin D: Vitamin D helps in the production of brain tissue and nerve growth. Lack of vitamin D leads to inflammation.
- Cobalamin (Vitamin B12): Lack of b12 leads to fatigue. If a patient is feeling fatigued, they can get blood work for B12. If it’s positive, they can get monthly B12 shots.
- Vitamin C: Lack of vitamin C leads to fatigue as it is a crucial antioxidant of the brain.
We are what we eat and how we live
If you are experiencing unspecified insomnia and fatigue, follow the dietary strategies we’ve
discussed. It’s also essential to adopt a healthy lifestyle for example have good sleep hygiene.
Keep a steady sleep routine and ensure enough time for sleep. Refrain from using your phone
before bed and have a quiet and dark room. Avoid taking extended naps during the day, as they
can interfere with your ability to sleep at night.
Citation list
- Chaput, J.-P., McHill, A. W., Cox, R. C., Broussard, J. L., Dutil, C., da Costa, B. G., Sampasa-Kanyinga, H., & Wright, K. P. (2022). The role of insufficient sleep and circadian misalignment in obesity. Nature Reviews Endocrinology, 19(2), 82–97. https://doi.org/10.1038/s41574-022-00747-7
- Poroyko, V. A., Carreras, A., Khalyfa, A., Khalyfa, A. A., Leone, V., Peris, E., Almendros, I., Gileles-Hillel, A., Qiao, Z., Hubert, N., Farré, R., Chang, E. B., & Gozal, D. (2016). Chronic sleep disruption alters gut microbiota, induces systemic and adipose tissue inflammation and insulin resistance in mice. Scientific Reports, 6(1). https://doi.org/10.1038/srep35405
- Park, S.-Y., Oh, M.-K., Lee, B.-S., Kim, H.-G., Lee, W.-J., Lee, J.-H., Lim, J.-T., & Kim, J.-Y. (2015). The effects of alcohol on quality of sleep. Korean Journal of Family Medicine, 36(6), 294. https://doi.org/10.4082/kjfm.2015.36.6.294
- Krueger, P. M., & Friedman, E. M. (2009). Sleep duration in the United States: A cross-sectional population-based study. American Journal of Epidemiology, 169(9), 1052–1063. https://doi.org/10.1093/aje/kwp023
- Drake, C., Roehrs, T., Shambroom, J., & Roth, T. (2013). Caffeine effects on sleep taken 0, 3, or 6 hours before going to bed. Journal of Clinical Sleep Medicine, 09(11), 1195–1200. https://doi.org/10.5664/jcsm.3170
- Tanaka, E., Yatsuya, H., Uemura, M., Murata, C., Otsuka, R., Toyoshima, H., Tamakoshi, K., Sasaki, S., Kawaguchi, L., & Aoyama, A. (2013). Associations of protein, fat, and carbohydrate intakes with insomnia symptoms among middle-aged Japanese workers. Journal of Epidemiology, 23(2), 132–138. https://doi.org/10.2188/jea.je20120101
- Herxheimer, A., & Petrie, K. J. (2002). Melatonin for the prevention and treatment of jet lag. Cochrane Database of Systematic Reviews, 2010(1). https://doi.org/10.1002/14651858.cd001520
- Bowden, J., & Sinatra, F. A. C. C., C. N. S. ,. Stephen T. (2020). The great cholesterol myth, revised and expanded why lowering your cholesterol won’t prevent heart disease–and the statin-free plan that will. Quarto Publishing Group USA.
- Wani, A. L., Bhat, S. A., & Ara, A. (2015). Omega-3 fatty acids and the treatment of depression: A review of scientific evidence. Integrative Medicine Research, 4(3), 132–141. https://doi.org/10.1016/j.imr.2015.07.003
- Losso, J. N., Finley, J. W., Karki, N., Liu, A. G., Prudente, A., Tipton, R., Yu, Y., & Greenway, F. L. (2018). Pilot study of the tart cherry juice for the treatment of insomnia and investigation of mechanisms. American Journal of Therapeutics, 25(2). https://doi.org/10.1097/mjt.0000000000000584
- Dighriri, I. M., Alsubaie, A. M., Hakami, F. M., Hamithi, D. M., Alshekh, M. M., Khobrani, F. A., Dalak, F., Hakami, A. A., Alsueaadi, E. H., Alsaawi, L. S., Alshammari, S. F., Alqahtani, A. S., Alawi, I. A., Aljuaid, A. A., & Tawhari, M. Q. (2022). Effects of omega-3 polyunsaturated fatty acids on Brain Functions: A systematic review. Cureus. https://doi.org/10.7759/cureus.30091
- Wessells, K. R., & Brown, K. H. (2012). Estimating the global prevalence of zinc deficiency: Results based on zinc availability in national food supplies and the prevalence of stunting. PLoS ONE, 7(11). https://doi.org/10.1371/journal.pone.0050568
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