Medically reviewed by
Dacelin St Martin, MD
Triple board-certified in Sleep Medicine,
Internal Medicine, and Pediatrics.
What is Thyroid Dysfunction? | Hyperthyroidism vs. Hypothyroidism and Sleep |
How Do Sleep Problems Affect Thyroid Dysfunction? |
How Can I Sleep Better if I have Thyroid Issues?
Overview
The thyroid gland is a butterfly-shaped organ located at the base of the neck, just in front of the trachea.
Though small, the thyroid gland plays a vital role in the sleep cycle. The thyroid gland, the hypothalamus, and the pituitary gland regulate the hormones responsible for growth, sleep, and metabolism.
The thyroid gland secretes two hormones, Triiodothyronine (T3) and Thyroxine (T4). These hormones determine how food is broken down or metabolized to release energy for cellular processes. Besides metabolism, thyroid hormones control heart rate, muscle tone, digestion, and brain function.
However, the relationship between the thyroid and sleep isn’t one-sided. Because the thyroid gland is most active during rest and sleep, the quality and quantity of sleep an individual gets can affect the release of these hormones.[1]
What is Thyroid Dysfunction?
We must understand normal thyroid activity to understand thyroid dysfunction and thyroid gland diseases.
The thyroid absorbs tiny amounts of iodine from ingested food and uses these molecules to form T4, the primary thyroid hormone, and T3. These thyroid hormones are then transported through the blood to their target sites. Once broken down, the iodine moiety is stored in the thyroid globules.
However, the control of the thyroid gland comes from the hypothalamus and pituitary glands.
The hypothalamus secretes the thyrotropin-releasing hormone, TRH, which causes the pituitary gland in the forehead to produce thyroid-stimulating hormone (TSH).
The pituitary gland is sensitive to cellular concentrations of T4 and T3. When T4 levels are low, more TSH is produced.
Thyroid dysfunction may be due to overstimulation at the hypothalamic, pituitary, or thyroid levels. It may also be due to an under-secretion of any hormones that regulate thyroid function.
Lastly, thyroid gland problems may be due to the insensitivity of one or more glands. For example, hypothyroidism may result when the pituitary gland becomes insensitive to TRH, or when TSH cannot stimulate the thyroid. [2,3]
Hyperthyroidism vs. Hypothyroidism and Sleep
1) Hyperthyroidism
Hyperthyroidism is defined as a state of increased thyroid activity. It usually goes hand-in-hand with thyrotoxicosis, a form of elevated serum levels of thyroid hormones.
The first manifestation of excessive thyroid hormones is an increase in metabolic rate. People with an overactive thyroid may eat a lot, digest food fast, and quickly get tired. Also, they find it hard to gain weight and sweat more profusely than others.
Hyperthyroidism may make it harder for you to wind down and sleep. Your active metabolism may cause you to feel like urinating multiple times during the night.
Hyperthyroidism is also associated with palpitations, arrhythmia, anxiety, and nervousness, which worsen night waking and general sensitivity.[2] People with hyperthyroidism experience short, unsatisfactory sleep.
2) Hypothyroidism
Hypothyroidism is a result of an underactive thyroid gland. People with hypothyroidism do not produce enough thyroid hormones.
They experience inexplicable weight gain, cold sensitivity, dry skin, constipation, fatigue, dry hair and skin, muscle weakness, muscle aches, depression, lack of motivation, and forgetful memories.
Those with hypothyroidism are often under-performers with little zeal. Hypothyroidism can cause both insomnia and hypersomnia.
When T4 levels drop, the pituitary gland secretes more TSH, signaling the thyroid to produce more hormones. However, in cases where the thyroid cannot produce more T4, such individuals develop hypothyroidism with elevated TSH.
According to one study, people with this manner of hypothyroidism suffer from poor sleep because high TSH adversely affects sleep quality.[2]
In one experiment to define the relationship between sleep deprivation and decreased energy exposure, sleep deprivation in the mice was induced by simply reducing thyroid hormone levels. Thus, hypothyroidism bears a linear relationship with insomnia.[4]
Hypothyroidism need not be clinical before it can disrupt sleep. Research reveals that even subclinical hypothyroidism, which is hypothyroidism that cannot or has not been clinically diagnosed, can cause sleep disorders.[5]
Hypothyroidism can also affect sleep by increasing pain sensitivity, cold sensitivity, muscle aches, and bowel discomfort.
Lastly, people with hypothyroidism often experience fatigue and lethargy, causing them to sleep more than eight hours daily.
How Do Sleep Problems Affect Thyroid Dysfunction?
Your sleep patterns can determine your susceptibility to hyper or hypothyroidism.
According to one study, people who sleep less than seven hours a day are more likely to develop hyperthyroidism, while those with hypersomnia or excessive sleeping habits are more susceptible to hypothyroidism.[6]
Moreover, the symptoms of hypothyroidism may be mistaken for sleep apnea.
How Can I Sleep Better if I have Thyroid Issues?
The first step to getting better sleep following thyroid dysfunction is properly categorizing your dysfunction.
Do not take over-the-counter thyroid boosters without first digging deep into the root cause of your hyper or hypothyroidism.
If you have hypothyroidism, you may take certain medications and supplements that either replace the thyroid hormones you cannot produce or stimulate the cells of your thyroid gland to do the job themselves.
These few tips below may work for people with hyperthyroidism but are more suited to low T4 levels.
1) Have a Pre-Sleep Routine
If you often feel jittery or anxious when you ought to be asleep, try crafting a series of steps to help you wind down for the night, like putting away your phone at least 30 minutes before bedtime.
The artificial light from your devices gives a wrong signal to your circadian center, causing you to stay awake longer. Your pre-sleep routine may involve slow, melodic music, mood lights, and a massage.
2) Regulate your Bedroom’s Temperature
Hyper or hypothyroidism may make you feel hot or cold, respectively. In such cases, invest in an air conditioning system or a heater to keep the room at the optimal temperature while you sleep. Also, a couple of heavy, warm blankets can make you more comfortable and prevent night waking due to a drastic drop in temperature.
3) Do Not Sleep on a Heavy Stomach
Bowel movements are a common reason for sleep latency and frequent waking. Do not eat any heavy meals for at least one hour before bedtime.
It takes your stomach about 2 hours to process food completely, but an empty stomach may also keep you awake. Aim for neither a full nor empty stomach by bedtime.
What’s the Takeaway?
Thyroid dysfunction and sleep have a bidirectional relationship, but cases of sleep disorders from thyroid dysfunction are more common than thyroid dysfunction originating from sleep problems. However, consult your doctor if you have a thyroid problem that makes you sleep too little or too much or think your sleep problems are starting to cause metabolic abnormalities.
References:
- Shekhar, S., Hall, J. E., & Klubo-Gwiezdzinska, J. (2021). The Hypothalamic Pituitary Thyroid Axis and Sleep. Current opinion in endocrine and metabolic research, 17, 8. https://doi.org/10.1016/j.coemr.2020.10.002
- Green, M. E., Bernet, V., & Cheung, J. (2021). Thyroid Dysfunction and Sleep Disorders. Frontiers in endocrinology, 12, 725829. https://doi.org/10.3389/fendo.2021.725829
- Thomas P. Foley; Hypothyroidism. Pediatr Rev March 2004; 25 (3): 94–100. https://doi.org/10.1542/pir.25-3-94.
- Pilcher, J. J., Bergmann, B. M., Refetoff, S., Fang, V. S., & Rechtschaffen, A. (1991). Sleep deprivation in the rat: XIII. The effect of hypothyroidism on sleep deprivation symptoms. Sleep, 14(3), 201–210. https://doi.org/10.1093/sleep/14.3.201
- Song, L., Lei, J., Jiang, K., Lei, Y., Tang, Y., Zhu, J., Li, Z., & Tang, H. (2019). The Association Between Subclinical Hypothyroidism and Sleep Quality: A Population-Based Study. Risk management and healthcare policy, 12, 369–374. https://doi.org/10.2147/RMHP.S234552
- Kim, W., Lee, J., Ha, J., Jo, K., Lim, D. J., Lee, J. M., Chang, S. A., Kang, M. I., & Kim, M. H. (2019). Association between Sleep Duration and Subclinical Thyroid Dysfunction Based on Nationally Representative Data. Journal of clinical medicine, 8(11), 2010. https://doi.org/10.3390/jcm8112010
