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Most people don’t sleep well. You should be able to go to bed, fall asleep within ten minutes, and not wake up until morning, after 7-8 hours. You should feel refreshed upon rising. Sound familiar? Not for most people.

The majority of people get too little sleep or poor quality of sleep. Many people do not go through the necessary 4 stages (plus REM) of sleep to keep them healthy. A sleep study may tell you how you are (or aren’t ) sleeping, but often it does little to address the issue. Medications such as Ambien, Sonata, and Lunesta or herbs such as kava kava or valerian may help you sleep, but if you need them, you really need to investigate why you can’t get the adequate sleep you need on our own. If you’re addicted to melatonin (the sleep hormone made by your pineal gland) too that’s not addressing the problem – taking any hormone for a prolonged period without understanding why you’re not able to make adequate amounts on your own is not healthy.

Can’t Fall Asleep?

This is most commonly due to high cortisol levels at night. Cortisol, one of the hormones secreted by the adrenal glands, should normally be low at night. High levels due to stress will keep you up. Cortisol and melatonin are inversely related to one another. So high cortisol levels mean suppressed melatonin levels, and that hormone needs to elevate at night to provide restful sleep. The stress can be emotional/mental, chemical/nutritional (too much sugar or caffeine are very common – even if you only consume caffeine in the early part of the day that can affect your sleep many hours later), as well as physical (working out too hard, pain & injuries).

Always Wanting to Sleep?

This could be from an adrenal or thyroid issue, carbohydrate intolerance, an undiagnosed food allergy, immune system problems, or an energy production problem (lack of the proper nutrition to make energy – ATP). Often people are more toxic then they are actually tired. Tired is more of a “lack of something” whereas a toxicity will make you feel tired. Not breaking down hormones properly, such as estrogen in women, will result in a toxic liver and her toxic. Insulin from too many carbohydrate foods will make you toxic too. Not eating often and/or not consuming enough protein will make you ammonia toxic – this is very common actually. Ammonia is a byproduct of protein breakdown when protein is converted into sugar to be used for energy. Unhealthy digestive flora will produce ammonia byproducts too. Ammonia will overwhelm your system and make you feel unmotivated, sluggish, and very tired. It’s very common, especially in endurance athletes who don’t consume enough food or recover properly with the right amount of protein and carbohydrates.

Wake Up in the Middle of the Night at the Same Time?

Waking up in the middle of the night at a specific time and always at that time has a lot to do with the acupuncture meridian system 24-hour clock. For example, 3am to 5am is the time for the lung meridian to be more active. Constantly waking up during that time could very well be due to something irritating the lungs – poor air quality, lung congestion, smoking, etc. Waking up earlier than you’d like, say at 5:30am, and you can’t get back to sleep, is related to the large intestine. This could be due to something you ate, or shouldn’t be eating. The most common time someone wakes up at night is between 1-3am as this is when the liver is most active. As mentioned above, the liver can become toxic quickly for a number of reasons – caffeine, hormones, histamine from a food allergy, ammonia from overtraining or an improper diet, and of course medications.

Waking Up Throughout the Night? Tossing & Turning?

Provided you don’t have all your pets on your bed, this is usually due to spikes from the adrenal gland hormone cortisol, a result of too much emotional, nutritional, or physical stress. The number one nutritional stress I would say is too much sugar, a close second is caffeine, even if you only drink coffee/caffeine it in the morning.

Waking Up to Urinate?

This is not normal; not even once to the bathroom. It’s from the hormone aldosterone – discussed more here.

Waking Up Tired?

This could be from all the waking up or could be from a low thyroid function or low adrenal function.


This is most often caused by congestion and/or a weight issue (overfat). Many times the congestion is a result of a food allergy, a fat metabolism issue, or unfriendly yeast/bacteria/fungus living in the digestive tract creating excessive mucous. Too much sugar can be the culprit, because that will make a person gain weight and it is the fuel (food) for all those unhealthy critters that want to nest in your gut.

Teeth Grinding (Bruxism)?

This is usually reported by your significant other, or your dentist when he/she tells you you’re wearing your teeth down and prescribes a night guard. The number one reason for grinding your teeth is too much stress and close to second is bruxism due to a medication. For all about bruxism – see this article here on DRG. Here’s a fun fact: Did you know that when you grind your teeth at night it is around three times more force than what you are possibly able to do while you’re awake? That’s amazing. Remember, a night guard saves your teeth, but it actually doesn’t fix the grinding – which can still result in jaw (TMJ) problems, headaches, neck pain, and other ailments. Women – your TMJ is loaded with estrogen receptors which is why more women have TMJ problems than men. If you’re producing too much estrogen, not properly detoxifying estrogen, or taking estrogen (hormone replacement therapy or birth control pills), you’re much more likely to have a TMJ problem and bruxism!

Growing Pains & Restless Leg Syndrome (RLS)

I put these two “conditions” together because they are very similar – kids get what is referred to as “growing pains” and adults with the same type of sensation are diagnosed with restless leg syndrome. Sure there are various degrees to each condition, but ultimately they are one in the same.

I had growing pains when I was a kid – bad enough that I would head to my parent’s bedroom at night as ask them to beat on my legs hard enough to block the pain. Sure I was “growing” but I wasn’t having pain for that reason. Growing pains is one of those conditions that I love to treat because it is usually so easy to resolve as long as the kid follows the dietary recommendations. It’s like Osgood-Schlatter’s Syndrome – a lot of kids have it and it’s so unnecessary for them to deal with it for months, sometimes years. Growing pains are typically due to either a toxicity or a deficiency. The toxicity often is from hydrogenated “trans” fats which most kids eat a lot of. I did at that age. The toxicity can also be from histamine, which the body makes when there is an allergy – food or environmental. So food allergies are common reasons for this toxicity. Gut toxicity from unhealthy bugs in the digestive tract can also result in growing pains, and this is many times fueled by a high carbohydrate/sugar diet. So since a lot of kids eat a high sugar and hydrogenated fat diet, you can see why they may get those “growing pains.” The other reason is the deficiency. So the other side of the coin here in respect to trans fats are the good fats – meaning a deficiency of healthy fats such as omega 3 (fish, flax, walnuts) and omega 6 (nuts & seeds) fats but especially the saturate fats that are assumed to be unhealthy. I see many kids deficient in these fats because their pediatrician or parents think they are bad for them. Heavy cream, butter, cheese, coconut oil/milk, and to some extent ice cream provide fats kids need, (adults too, but lower amounts). My kids eat a lot of butter, cream, coconut, and whole raw milk. Only once did one of them get “growing pains” and it was because she needed more fat in her diet. If you’ve read about trans fats on my website you know that if you ever take an anti-inflammatory drug (NSAIDs) and feel any improvement, it means you have a fatty acid deficiency and/or a trans fat excess in your diet. Minerals such as calcium, magnesium, and phosphorus that are lacking in the diet can also be the reason for growing pains. Interestingly, these minerals are responsible for healthy bone growth but it is just a coincidence that their deficiency can result in growing pains.

RLS – An adult can have restless leg syndrome due to an imbalance of fatty acids and/or a mineral deficiency as noted above, but sometimes RLS is due to the autonomic nervous system being over-sympathetic or “too hyped up.” There is also a close link with RLS to low levels of the nuerotransmitter dopamine. I discuss this more here. Of course we have to look at stress here – isn’t that ultimately the reason for every ailment? Too much stress in one’s life creates an imbalance between the parasympathetic (relaxed) nervous system and the sympathetic “fight or flight” system. Ultimately prolonged and excessive stress whether from working too hard, exercising too hard, mental/emotional stress, poor dietary habits, pain, and injuries pushes the nervous system too much to the “fight or flight” mode and RLS results. I often use specific minerals, B vitamins, and fats to help calm the nervous system down, as well as dietary and lifestyle modifications to help naturally dopamine levels. Yes, this can be corrected without the latest and greatest drug. Typically before RLS begins or gets very bad there are other warning signs that one might not have realized – a twitchy eyelid – a limb that jumps/jerks as they’re falling asleep – sensitivity to lights and sounds – dizzy when standing up quickly – a razor burn from shaving – and bloodshot eyes.

** The function of the pineal gland, which secretes melatonin, is very important for sleep. While all the other hormonal glands turn themselves down at night for a rest, your pineal wakes up. You can easily measure melatonin levels as well as cortisol levels via saliva through certain labs. Many people take high doses of melatonin for extended periods of time. This is not a good idea – you’ll throw off your hormonal balance. I consider a high does to be over 1mg of melatonin and an extended period of time to be more than 3 days. A lot of people take over 3mg of melatonin for months, even years. Not a good idea. Figuring out why you’re not sleeping is a good idea. Help turn your pineal on at night by eliminating all light sources from your room, including most alarm clocks (cover it up). Also recommended is removing all electronic devices from your bedroom – specifically TVs and computers. Those electromagnetic waves can disrupt hormones. So no TV or laptop in bed – keep your bedroom for two things – sex and sleep, not Sex and the City and Sleepless in Seattle.

My article, “The Power of Sleep”, addresses other common sleep problems.


Leave a comment
  1. Anne Kuczmak permalink

    I was waking up at 3 a.m. and didn’t know what to do to be able to sleep whole night. Dr. Gangemi suggested to me to have a snack before I go to sleep. This has now been a third night that I began sleeping whole night. Such a simple thing changed my sleeping to a full night.

    Anne K.

  2. Linda c permalink

    For 15 yrs I take elavil for surface sleeping with fms. It aggravates my rls to point indeed 3 mg requip nightly, sometimes more. My life is Controlled by rls I’ve trid going off elavil but sleep becomes non restful with multi waking. Tried switching to other anti depressants but same sleeping issues or insomnia. I’m between a rock and a hard spot. What do you suggest?

    Linda c

    • Hi Linda, sorry I can’t make specific recommendations since you are not a patient of mine. RSL is a sign that your nervous system is very imbalanced – too much sympathtic “fight or flight” stress going on. Elavil and similar meds help counterbalance this but don’t actually address the cause. Diet, stress management, and lifestyle changes are necessary.

  3. ramana Vieira permalink

    sounds wonderful as i too wake up around 4:00a.m. and sometimes 3:00a.m. i wonder what kind of snack is good to have before bed?
    And yes i have addressed some sleep issues with lifestyle changes and diet and stress management so this continues to elude me.thank you.

    • Couple eggs or whey protein works well.

      • Rmana permalink

        i do some L tryptophan at night i don’t want the protein to compete.
        what about something like oatmeal or some complex carb?

        and i don’t want to go to bed with a full stomach because of the supplements i take which are what i mentioned.

        so how long before bed is it okay to have the snack or recommended?

        thank you your article and blogs around this issue is the best i have seen,

        • Although taking L-TRY is better than taking a drug you’re still taking a nutrient for a drug-like effect. TRY converts into 5HTP which then converts into serotonin and then finally into melatonin, which is why it helps. That whole thing with the protein competing is a myth. Check out the post I wrote right around Thanksgiving about people blaming turkey for falling asleep. There’s a whole lot of TRY in your protein that you’re eating. If you eat the carb then you’re spiking your insulin and if that makes you sleepy – well, read the post it explains why.

  4. Kristi permalink

    My 2 yr old daughter has been diagnosed with a few food intolerances after doing a dietician guided elimination diet. We have zero additives, preservatives and are gluten and dairy free. Saying that we have been making up for lost vitamins and minerals thru other food sources.
    My daughter still wakes anywhere between 1-3 in the morning and is wide awake for an hour or two. What can possibly be doing this?

    • That’s almost definitely something stressing her liver out. Medications? Supplements? Could be a food allergy…

  5. tom permalink

    Hey Doc,
    I’ve noticed a stressful time with studying will make me have a tiny arm twitch just as I nod off and fast paced thoughts, so I keep waking up. I also noticed that yesterday I trained anaerobically quite hard, didn’t make it home for awhile to get a protein smoothie to balance blood sugar, and again these symptoms took place. I’ve found that most the time, if I get up and stretch for a bit, I can go to sleep. Am I making the right connection that the studying and training hard/low blood sugar are reasons for my difficulty to sleep? Do medications also cause this as a side effect?

    • Yes, that’s exactly what is happening. Sure problems with medications should always be taken into account.

  6. Sam permalink

    Dr, Any suggestions for stopping teeth grinding (Bruxism) in men?

    • That’s a broad topic and one that would be good for a blog post. It has a lot to do with stress – typically emotional stress load and digestive health. Some have made the connection between bruxism and parasitic infections (I don’t see that often though).

  7. Cathryn permalink

    Dear Doc,
    I am almost 53 yrs old and peri menopausal. I was diagnosed with Hashimoto’s when I was 25, although I had an enlarged thyroid from the age of 18 at least. My thyroid was multi-nodular from the age of 18, and I finally had a Total Thyroidectomy sometime in my 30’s. Of course, I was forever on a roller coaster of thyroid meds, up and down, then repeat. I am now on 3 grains of compounded thyroid. My diet is terrible, I am the first to admit that… Usually coffee in the morning, whatever for lunch, maybe some dinner. I do not do HFCS ever, and only use stevia. I was tentatively diagnosed with POTS. I never sleep the night through, I wake every morning around 1 am and toss and turn forever, then finally sleep again around 5. I’m very exercise intolerant right now… I used to dance all night long, now one dance will raise my heart rate to 180.

    I take 200mg topiramate for migraine control, 2000 iu vitamin D3, and 1000 mg vitamin C. I don’t take anything else. I’m wondering if I’m having problems handling the thyroid meds, and why I don’t sleep through the night. My FT3 and FT4 are always in range, my TSH is always suppressed. I have been vitamin D deficient in the past, and had iron deficient anemia, both of which have been corrected.

    I realize it could be a lot do things… Any suggestions as to where to start? The heart issue is just wearing me out. Thank you.

    • 3 grains of thyroid med? That’s either 180mg or 195mg depending on whether you take Armour or NatureThyroid. Of course I can’t advise you on meds, especially on-line, but I will say I’ve never seen anyone take that much, and thyroid meds are the #1 meds my patients take (and most are on Armour). High HR and sleep problems are extremely common with too much thyroid medication (and your TSH is suppressed). So you should look into this with your MD, and since you know your diet is terrible – clean it up! Insulin, estrogen, and cortisol block T4 to T3 conversion – read the info on thyroid on this site.

  8. conor permalink

    Does switching off devices count. Laptops, guitar amps, stereos, mobile phones?

  9. J.spencer permalink

    My 10 year old daughter looks tired every morning despite being in bed no later than 7.30. Often says she can not sleep then of course, does not want to get up. When I go in to check on her I hear her grinding her teeth. She also does some toilet trecking in the night, but not every night. When younger had an amazing memory but at the momment forgets everything. Ive tried baths, stories, reading before bed, no t.v all of which do not seem to make any difference. She has said she often has nightmares or it takes her long periods to get to sleep. What can I do to help her have a good nights sleep.

    • That’s a tough one to advise on without seeing her. I’ve seen kids with similar problems, including night sweats. The first thing to consider is diet – clean it up 100% as I discuss throughout this site.
      The second thing to consider for a 10 yr old girl is hormones; if she’s having her cycle already and if the problems started then or got worse at the start of her menstrual cycle then that would be a hormonal issue.

  10. Mignon permalink

    I was wondering if you could tell me why my Blood Sugar is higher in the mornings than when I go to bed? I have been looking for an answer for this for quite a while. I think it has to do with the liver, but I am looking for a way to correct it. Thanks for any help!

  11. Greg McGowan permalink

    I suffer from HCV, have stage 4 cirrhosis of the liver, have hepatic encephalopathy, high Ammonia levels, thrombus in all 3 hepatic/portal veins. I am awaiting a liver transplant. Due to the symptoms, the “itching”, sleeplessness etc. I was prescribed a few 10mg Ambien.
    I took 1 at 8pm and fell asleep at 8:30pm or so. I awoke at 8am and started my day. At 11am I was pulled over by police and a blood test confirmed the presence of Zolpidem. The Quantitative measurement
    they say was equal to that of a 10mg pill taken an 1.5 hrs prior.
    Where con I get info on the breakdown of Ambien in a decompensated liver and the results it would yield. Thank you. greg

  12. Kim OBrien permalink

    Pretty certain I am your cortisol spike/blood sugar waker upper. Based on the information I read I should get a saliva test to measure my cortisol & estrogen. 1. Can I get this test from my local doctor’s office or is this something I should do through another facility (I live in Massachusetts). 2. What should I be looking for in the test results, i.e. measurements; 3. Once all is tested and levels are received do you have a prescription for resolving these issues? Can I work long distance with your office or do you have local contacts?

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