Thyroid conditions and insomnia – what’s the link?

Thyroid conditions are known for making you feel tired. But did you know that your overactive or underactive thyroid could be making it harder for you to fall asleep too? We explain the link between thyroid conditions and sleep disorders and exactly what you can do to get the rest you need.  
 

What is insomnia? 
 

Insomnia is when you regularly have problems sleeping – whether that’s falling asleep or staying asleep. Many people experience short-term (acute) insomnia, which can last for days or weeks (how did you sleep during the heatwave?). But some people have long-term (chronic) insomnia that can last for months, even years.  
 

Why can thyroid conditions cause insomnia? 
 

Your thyroid gland produces the hormones that regulate how your body uses energy. These hormones (thyroxine and triiodothyronine) affect most organs and are vital to: 

• Breathing 
• Digestion 
• Regulating heart rate and body temperature 

Too little or too much of these hormones can throw your body out of whack. So it’s no surprise that thyroid conditions are linked to sleep problems.  

One study of 137 patients with Graves’ disease (the most common cause of hyperthyroidism) found that 66.4% of study participants had difficulty falling asleep [1]. And hypothyroidism isn’t totally out of the hot water, either. 

Hypothyroidism and insomnia may co-occur because the symptoms associated with a thyroid hormone deficiency may contribute to insomnia, like joint and muscle pain, cold intolerance, and increased anxiety. 

An overactive thyroid and insomnia 
 

Hyperthyroidism (an overactive thyroid) is where your thyroid produces too many thyroid-related hormones. Increased thyroid activity and thyroid hormone production are well-known causes of sleep dysfunction.  

Often, the hyperkinetic (motion beyond the usual) features of the condition are responsible for sleep disturbances. Nervousness and irritability can cause arousal, making it difficult to get to sleep. Plus, an overactive thyroid can contribute to conditions like anxiety or depression, which can also impair sleep and are linked to insomnia [2].  

Elevated thyroid hormones are associated with several components of sleep dysfunction, including [3]: 

• Prolonged sleep latency (taking longer to fall to sleep) 
• Difficulty maintaining sleep 
• Excessive daytime sleepiness  

An overactive thyroid can cause [4]:  

• Nervousness and irritability, making it difficult to fall asleep 
• Night sweats and frequent urination, which can disrupt sleep 
• Muscle weakness and feeling tired all the time 

For more information on this condition, have a look at our blog: what is an overactive thyroid? 

Underactive thyroid and insomnia 
 

Hypothyroidism (an underactive thyroid) is where the thyroid does not produce enough hormones. Though no direct biochemical connection has been found between an underactive thyroid and insomnia, they can co-occur.  

If you have an underactive thyroid, you may find it more difficult to tolerate the cold or experience joint or muscle pain at night. And even if a thyroid condition is not directly causing insomnia, the vast range of symptoms with thyroid dysfunction can quite easily exacerbate sleeping difficulties and reduce your ability to get quality, restful sleep [5].  

An underactive thyroid can cause: 

• Joint or muscle pain that disrupts sleep 
• Trouble tolerating cold at night, making it difficult to fall or stay asleep 
• Poor sleep quality, affecting the time it takes you to fall or stay asleep 

For more information on this condition, read our blog: what is an underactive thyroid? 
 

Five tips for better sleep with a thyroid condition 
 

1. Check your temperature  

Having your room at the right temperature when you’re going to sleep is important for anyone, especially if you have a thyroid condition. 

Your thyroid produces hormones that influence how much the blood vessels dilate, which affects how much heat can escape your body. When your body makes too much thyroid hormone, your body temperature rises. With hypothyroidism, the opposite tends to be true. You can find your body temperature decreases (making you more susceptible to the cold).  

Naturally, body temperature peaks in the late afternoon and drops as we head into the evening, kickstarting the production of melatonin to prepare your body for sleep. However, this may not be the case when you have a thyroid condition, so try to keep cool as you head into the afternoon and beyond. 

Optimal sleep temperatures are said to be between 16-18°C. However, you may find that yours falls outside the usual range if you experience night sweats or sensitivity to the cold – and that’s okay. Still, room temperatures over 24°C (71°F) are likely to cause restlessness, and sleeping in a cold room of about 12°C (53°F) will likely make it difficult to fall asleep.  

• According to the Sleep Foundation, an ideal bedroom temperature is around 16-18°C (60-65°F) – remember this may differ slightly for you depending on your condition and comfort.  
• Invest in a room thermometer to keep track of temperatures.
• Change your bedding depending on your temperature and the season.

2. Practise good sleep hygiene 

Sleep hygiene is the habits and practices that form your sleep routine. Good sleep hygiene involves establishing a good sleep routine (like going to bed and waking up at regular times and taking time to wind down).    

Another tip is to only use your bed for sleeping (well, mainly). And only go to bed when you’re ready to sleep. If you’re someone who likes to watch TV in bed or check your emails while you’re tucked up in bed, then you could be setting yourself up to fail. If you get into bed and realise you’re not tired after all, then get out and only come back when you’re ready for some shut-eye. 

It is also good to think about your sleep environment. We have talked about the temperature, but is your room calm and comfortable? Your bedroom should be dark and quiet, so turn off lights or loud sounds (who put that ticking clock close to the bedroom anyway?). And make sure to invest in a comfortable mattress and bedding.  

• Go to bed and wake up at the same time every day.
• Avoid devices before bed and in the bedroom – TV, mobile devices etc.
• Make your bedroom comfortable, dark, and quiet.
• Take time to wind down before bed. You could read in a different room, take a bath, or do some gentle stretching.

3. Eat well during the day 

You may not think so, but a healthy diet is vital for a good night’s sleep. Have you ever been out for a heavy meal and then tried to go to sleep straight after? It can be very uncomfortable (and that’s aside from any meat sweats you may experience).  

Stick to light evening meals before bed to avoid any added discomfort when trying to get to sleep. If you have a thyroid condition, you’ll likely want to pay particular attention to some standout nutrients, like your iodine intake. Too much or too little iodine in your diet can affect your thyroid function. Good iodine sources include fish, shellfish, and dairy products [6]. 

For more information on what you should eat with a thyroid condition, head to our thyroid-friendly diet blog.  

• Avoid heavy meals before bed.
• Know your thyroid-friendly vitamins and minerals.
• Focus on eating whole, unprocessed foods and lean protein.

4. Limit alcohol and caffeine close to bedtime 

So, we probably all know someone who swears their evening alcoholic beverage of choice helps them get to sleep. But drinking alcohol before bed can suppress REM (rapid eye movement), which should kick in about 90 minutes after you fall asleep. As these cycles become shorter for drinkers, it decreases overall sleep quality, resulting in shorter sleep durations and more sleep disruptions [7].  

Likewise, caffeine can also wreak havoc with your sleeping pattern. Don’t be too alarmed, there is a safe amount of caffeine to drink (and some say it could be beneficial to health). Health organisations suggest most people can safely consume up to 300mg of caffeine a day unless you’re advised otherwise (like if you’re pregnant, you shouldn’t consume more than two cups per day [8]).   

Too much caffeine has been linked to worsening or developing insomnia symptoms — this is especially true if you have an overactive thyroid. And consuming caffeine to stay awake may lead to sleeplessness, anxiety, frequent night-time awakenings, and poorer sleep quality [9].  

• Stick to the safe alcohol guidelines and avoid alcoholic drinks close to bedtime.
• Keep an eye on your caffeine intake throughout the day, and don’t go over 300mg of caffeine a day.
• Avoid caffeine just before bed and monitor the link between your intake and insomnia symptoms.

5. Keep active  

You will be glad to hear that exercise can improve sleep for many people and alleviate sleep-related problems, helping you get enough rest. However (what can feel like a kick in the guts), getting enough exercise is not always easy if you have not had a good rest the night before. If you have a poor night’s sleep, you are more likely to get lower levels of physical activity the following day [10].  

Aside from all the other benefits of exercise (like reducing the risk of certain diseases and helping to maintain a healthy weight), moderate-to-vigorous exercise can increase sleep quality by reducing the time it takes to fall asleep. Getting active can also help you to feel more alert throughout the day, reducing the temptation of a nap or even (for some people) the need for sleep medications.  

By helping you to stay at a healthy weight, exercises that decrease your risk of excessive weight gain can make it less likely for you to experience symptoms of obstructive sleep apnoea (OSA) – 60% of OSA cases are attributed to obesity [11].  

But when should you exercise? Exercising right before bed is a hotly debated topic. Many traditional sleep hygiene guidelines say to avoid exercise at least three hours before bed (some say after 2pm). The reason? Exercise increases your heart rate, body temperature, and adrenal levels – which are not conducive to sleep. 

However, other studies suggest that people who exercise at 8pm can fall to sleep just as quickly as people who exercise before. The verdict? If your late evening workout leaves you too pumped to get to sleep, try exercising earlier in the day and see how that feels. Find a routine that works for your lifestyle and sleep style. Just be mindful that exercise could result in trouble falling to sleep or a lighter sleep than usual.  

• Make time for moderate-to-vigorous exercise most days. The NHS activity guidelines recommend at least 150 minutes of moderate-intensity activity a week or 75 vigorous-intensity activity a week.  
• Be aware that exercising close to bedtime could have the opposite effect. Monitor whether this is making you feel too alert to get to sleep. If so, try getting active earlier in the day instead.  

For more tips, head to our ways to improve your sleep blog.  

Taking care of your thyroid health 

Thyroid-related conditions can impact your energy, mood, and weight. To understand more about how a thyroid condition could affect your health and how to manage a thyroid condition, head over to our Thyroid Hub. 

Are you looking for a thyroid blood test? Our thyroid test buying guide looks at the different thyroid tests on offer and what they can tell you about your thyroid health. 

---

References 

1. Stern RA, Robinson B, Thorner AR, Arruda JE, Prohaska ML, Prange AJ., Jr.A Survey Study of Neuropsychiatric Complaints in Patients With Graves' Disease. J Neuropsychiatry Clin Neurosci Spring (1996) 8(2):181–5.   10.1176/jnp.8.2.181  
2. Trzepacz PT, McCue M, Klein I, Levey GS, Greenhouse J. A Psychiatric and Neuropsychological Study of Patients With Untreated Graves' Disease. Gen Hosp Psychiatry (1988) 10(1):49–55.   10.1016/0163-8343(88)90084-9 
3. Sridhar GR, Putcha V, Lakshmi G. Sleep in Thyrotoxicosis. Indian J Endocrinol Metab (2011) 15(1):23–6.   10.4103/2230-8210.77578 
4. Green, M., Bernet, V. and Cheung, J., 2021. Thyroid Dysfunction and Sleep Disorders. [online] National Library of Medicine. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8423342/#B3> [Accessed 18 August 2022]. 
5. Budhiraja R, Roth T, Hudgel DW, Budhiraja P, Drake CL. Prevalence and Polysomnographic Correlates of Insomnia Comorbid With Medical Disorders. Sleep (2011) 34(7):859–67.   10.5665/SLEEP.1114 
6. Bda.uk.com. 2022. Iodine Food fact Sheet. [online] Available at: <https://www.bda.uk.com/resource/iodine.html#:~:text=Iodine%20is%20needed%20for%20the,development%20of%20the%20baby's%20brain.> [Accessed 18 August 2022]. 
7. Sleepfoundation.org. 2022. Alcohol and Sleep | Sleep Foundation. [online] Available at: <https://www.sleepfoundation.org/nutrition/alcohol-and-sleep#:~:text=Drinking%20alcohol%20before%20bed%20can,into%20deep%20sleep%20rather%20quickly.> [Accessed 18 August 2022]. 
8. Bda.uk.com. 2022. Coffee and Health; it’s not just about the caffeine.... [online] Available at: <https://www.bda.uk.com/resource/coffee-and-health-it-s-not-just-about-the-caffeine.html> [Accessed 18 August 2022]. 
9. Sleepfoundation.org. 2022. Caffeine’s Connection to Sleep Problems | Sleep Foundation. [online] Available at: <https://www.sleepfoundation.org/nutrition/caffeine-and-sleep> [Accessed 18 August 2022]. 
10. Sleepfoundation.org. 2022. How Can Exercise Affect Sleep? | Sleep Foundation. [online] Available at: <https://www.sleepfoundation.org/physical-activity/exercise-and-sleephttps://www.sleepfoundation.org/physical-activity/exercise-and-sleep> [Accessed 18 August 2022]. 
11. American Academy of Sleep Medicine. (2014). The International Classification of Sleep Disorders – Third Edition (ICSD-3). Darien, IL.