Sleep Smart: Identifying Underlying Factors

Danielle Huntsman, MS, CNS, LDN

A body that cannot sleep cannot heal. Many factors, from internal root causes to external lifestyle circumstances, can contribute to poor sleep. Supporting sleep quality is an approach to facilitating balance through the entire body.

Underlying Sleep Factors

Multiple underlying factors can contribute to a night of poor sleep or rather, many nights of inconsistent sleep. Poor sleep includes difficulty falling asleep, or waking up multiple times during the night. Additionally, waking up groggy or not well rested may be consistent with poor sleep. When looking at potential internal influences- three factors stand out: psychological effects, glycemic regulation, and disruption in circadian rhythm. In addition, sleep hygiene is an obvious but easily overlooked external factor, which can contribute to poor, sleep quality, and especially trouble falling asleep.

Underlying sleep factors

Glycemic Regulation: are there fluctuations in blood sugar throughout the night?

Blood sugar levels naturally rise and fall within certain limits in healthy individuals. Sleep and glucose regulation appear to have a bidirectional relationship.1,2 An increase in sympathetic nervous activity (and a decrease in parasympathetic nervous activity) and reduced insulin sensitivity result in the disruption of glucose homeostasis and may be related to sleep quality.3 Hormones, which are responsible for glucose regulation, such as cortisol, glucagon and growth hormone are involved. For some individuals, the effects of these hormones can potentially influence normal sleep-wake patterns.3

Psychological Effects: is stress, worry or frustration routinely present?

It is very rare to hear from a patient that despite their high-stress levels, they sleep well. Typically, stress and loss of sleep go hand-in-hand. This can be a short-lived, or long-term issue depending on the source of fear and worry. Psychological stress can vary by individual but typically family, work, or health (or a combination thereof) can be the contributing factors for stress and worry. Increased activity of the autonomic nervous system can affect both the sympatho-adreno-medullary (SAM) and hypothalamic-pituitary-adrenal (HPA) axis systems. The activity or activation of the HPA axis and sympathetic nervous system influences the overall quality of rapid eye movement (REM) sleep.4 This is mainly due to the end result of HPA axis activation: the release of cortisol, noradrenaline, and adrenaline. Neurotransmitters such as GABA, can influence the amount of sleep and quality of sleep, which in turn can be to blame for a loss of sleep.5

Circadian Rhythm: is the normal sleep-wake cycle off balance?

The sleep-wake cycle is the 24-hour cycle of sleeping and waking, typically 7-9 hours spent sleeping and 15-17 hours spent awake. A disruption in the circadian clock is typically the inability to sleep (or stay wake) during this natural cycle. Night shift workers have schedules that are out-of-sync with the traditional biological wake-sleep cycle; it has been shown that night shift workers have changes in the levels of melatonin and cortisol, including significantly lower levels of melatonin and higher cortisol levels.6 This misalignment in the sleep-wake cycle can leave individuals with tiredness and reduced mental performance during the day only to be awake at night.

Sleep Hygiene: are there external factors such as a disruptive environment to blame?

A disruptive sleep environment or external contributors such as electronic screens, bright light exposure, travel, and irregular schedules can all be to blame. It is estimated that 71% of people sleep next to their phones at night.7 Bright lights, surrounding noises, and substantial travel schedules, especially across time zones, can all influence sleep times and sleep quality.8,9

Identifying the primary (or secondary) areas is the first step to finding a solution. A plan, which includes both internal factors as well as pinpointing opportunities for improvement in sleep hygiene, can provide the most favorable outcomes. It can be common for one or more of the above factors to be collectively affecting sleep. To learn more about an integrative approach to better sleep, download the Integrative Quarterly - a publication that brings the latest and greatest research and protocols to provide practitioners with resources at their fingertips.


  1. Knutson K. Sleep Med Clin. 2007 Jun;2(2);187-97.
  2. Copinschi G et al. Front Horm Res. 2014;42;59-72.
  3. Scheen A et al. Am J Physiol. 1996 Aug; 271(2 Pt 1):E261-70.
  4. Somers V et al. N Engl J Med. 1993 Feb 4;328(5):303-7.
  5. Nitz D et al. Am J Physiol. 1996 Dec;271(6 Pt 2):R1707-12.
  6. Mirick D et al. Cancer Epidemiol Biomarkers Prev. 2013;22(6):1079-87.
  7. Groden, C. Fortune. 2015 June. Accessed at
  8. Chellappa S et al. J Sleep Res. 2013 Oct;22(5):573-80.
  9. Munch M et al. Am J Physiol Regul Integr CompPhysiol. 2006 May;290(5):R1421-8.

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