Insomnia & Sleep Disorders
"Taking more than 30 minutes to fall asleep most nights"
What is Chronic Migraine?
Insomnia is a chronic sleep disorder characterized by persistent difficulty falling asleep, staying asleep, or achieving restorative sleep despite adequate opportunity and circumstances. It involves dysregulation of the sleep-wake cycle, often driven by hyperarousal of the central nervous system, circadian rhythm disruption, or underlying physiological imbalances. This condition affects 10-30% of adults worldwide and significantly impacts physical health, cognitive function, and emotional wellbeing when left untreated.
Healthy Function
What your body should do
Healthy sleep follows a precise circadian rhythm governed by the suprachiasmatic nucleus (SCN) in the hypothalamus. The sleep-wake cycle operates on a 24-hour clock regulated by light exposure, with melatonin secretion beginning 2-3 hours before bedtime in response to dim light. Sleep architecture cycles through NREM stages 1-3 (light to deep sleep) and REM sleep every 90-110 minutes, with 4-6 complete cycles per night. Deep NREM sleep (slow-wave sleep) facilitates physical restoration, cellular repair, and glymphatic clearance of metabolic waste from the brain. REM sleep supports emotional regulation, memory consolidation, and cognitive processing. A healthy adult requires 7-9 hours of sleep with 15-20% deep sleep and 20-25% REM sleep for optimal function.
When Things Go Wrong
Signs of chronification
- Pain threshold lowers over time
- More frequent attacks
- Brain stays in alert mode
- Medication stops working
How This Develops
Understanding the biological mechanisms helps us target the root cause
Point 1
Understanding the mechanism helps us target the root cause rather than just treating symptoms.
Recognizing All Symptoms
Chronic migraine affects multiple systems. Understanding your symptoms helps us identify the underlying mechanisms.
Physical Symptoms
12 symptoms
- Difficulty falling asleep (sleep onset insomnia)
- Frequent nighttime awakenings (sleep maintenance insomnia)
- Early morning awakening with inability to return to sleep
- Non-restorative sleep despite adequate time in bed
- Daytime fatigue and exhaustion
- Morning headaches or grogginess
- Muscle tension and physical restlessness
- Gastrointestinal discomfort at night
- Increased pain sensitivity
- Frequent urination during the night (nocturia)
- Restless legs or periodic limb movements
- Teeth grinding (bruxism) during sleep
Cognitive Symptoms
10 symptoms
- Racing thoughts at bedtime
- Difficulty concentrating during the day
- Memory problems and forgetfulness
- Brain fog and mental sluggishness
- Reduced problem-solving ability
- Impaired decision-making
- Slower reaction times
- Difficulty learning new information
- Reduced creativity and mental flexibility
- Preoccupation with sleep and worry about not sleeping
Emotional Symptoms
10 symptoms
- Anxiety about sleep and bedtime
- Irritability and mood swings
- Depression and low mood
- Heightened emotional reactivity
- Feeling overwhelmed by daily tasks
- Social withdrawal due to fatigue
- Decreased motivation and interest
- Sense of hopelessness about recovery
- Panic attacks at night
- Emotional dysregulation and volatility
Metabolic Symptoms
11 symptoms
- Weight gain and difficulty losing weight
- Increased appetite and carbohydrate cravings
- Blood sugar instability
- Insulin resistance
- Elevated cortisol levels
- Hormonal imbalances (cortisol, melatonin, growth hormone)
- Reduced leptin and elevated ghrelin (hunger hormones)
- Impaired glucose tolerance
- Elevated inflammatory markers
- Compromised immune function
- Thyroid hormone conversion impairment
Conditions That Occur Together
These conditions often coexist with chronic migraine due to shared mechanisms
Anxiety Disorders
Hyperarousal from anxiety activates the sympathetic nervous system and HPA axis, elevating cortisol and norepinephrine that prevent sleep onset and maintenance; creates anticipatory anxiety about sleep itself
Depression
Depression disrupts circadian rhythm and REM sleep architecture; insomnia and depression share neurotransmitter imbalances (serotonin, dopamine) and create a bidirectional worsening cycle
Chronic Pain
Pain signals activate the reticular activating system, maintaining cortical arousal; inflammatory cytokines from pain disrupt sleep centers; poor sleep lowers pain threshold, creating vicious cycle
Adrenal Dysfunction
Elevated evening cortisol from HPA axis dysregulation prevents melatonin production and sleep onset; disrupted cortisol rhythm causes early morning awakening with inability to return to sleep
Gut Dysbiosis
Intestinal permeability increases systemic inflammation (IL-6, TNF-alpha) that activates brain wake centers; gut bacteria produce 90% of serotonin, affecting melatonin synthesis; SIBO causes nighttime discomfort
Thyroid Dysfunction
Hyperthyroidism increases metabolic rate and sympathetic tone, preventing sleep; hypothyroidism causes sleep apnea and non-restorative sleep; both disrupt thermoregulation needed for sleep
Sleep Apnea
Recurrent breathing disruptions cause microarousals that fragment sleep architecture; oxygen desaturation triggers sympathetic activation; creates sleep maintenance insomnia even after apnea treatment
Blood Sugar Dysregulation
Nocturnal hypoglycemia triggers cortisol and adrenaline surges that wake the brain; insulin resistance affects orexin neurons that regulate wakefulness; poor sleep worsens glucose metabolism
Conditions to Rule Out
These conditions can present similarly but have distinct features
Sleep Apnea
Non-restorative sleep, daytime fatigue, frequent awakenings
Sleep apnea shows witnessed breathing pauses, loud snoring, gasping; confirmed by elevated AHI on polysomnography; oxygen desaturation events present
Restless Legs Syndrome (RLS)
Difficulty falling asleep, frequent awakenings, daytime fatigue
RLS causes irresistible urge to move legs with uncomfortable sensations; symptoms worsen at rest and improve with movement; low ferritin often present
Circadian Rhythm Sleep-Wake Disorder
Difficulty falling asleep, daytime sleepiness, non-restorative sleep
CRSWD shows normal sleep quality when allowed to sleep at preferred times; delayed sleep phase causes inability to sleep until very late; melatonin rhythm shifted
Narcolepsy
Excessive daytime sleepiness, disrupted nighttime sleep
Narcolepsy includes cataplexy, sleep paralysis, hypnagogic hallucinations; MSLT shows rapid sleep onset and REM periods; different pathophysiology (orexin deficiency)
Chronic Fatigue Syndrome
Persistent fatigue, unrefreshing sleep, cognitive difficulties
CFS features post-exertional malaise and widespread pain; primary complaint is fatigue rather than sleep disturbance; sleep studies may show normal architecture
Medication-Induced Insomnia
Difficulty falling or staying asleep
Clear temporal relationship to medication initiation; common culprits include SSRIs, steroids, beta-agonists, decongestants, stimulants; improves when medication discontinued
Substance-Induced Sleep Disorder
Sleep onset or maintenance difficulties
Associated with alcohol, caffeine, nicotine, or drug use; alcohol causes initial sedation followed by fragmented sleep; caffeine has long half-life affecting sleep
What's Driving Your Migraines
Identifying the underlying causes allows us to target treatment effectively
Chronic Stress and HPA Axis Dysregulation
45% - Persistent activation of stress response elevates cortisol and norepinephrine, creating physiological hyperarousal that prevents sleep onset and maintenanceComprehensive stress inventory, salivary cortisol rhythm testing, ACTH levels, assessment of life stressors and coping mechanisms
Circadian Rhythm Disruption
35% - Irregular sleep schedules, shift work, jet lag, and blue light exposure suppress melatonin production and misalign the biological clockSleep diary analysis, melatonin level testing, assessment of light exposure patterns, evaluation of work schedule and travel history
Gut Dysbiosis and Leaky Gut
25% - Intestinal permeability increases inflammation affecting sleep centers; gut bacteria imbalances reduce serotonin and melatonin productionComprehensive stool analysis, zonulin testing, food sensitivity panels, SIBO breath testing, assessment of digestive symptoms
Nutrient Deficiencies
30% - Deficiencies in magnesium, vitamin D, B-vitamins, iron, and zinc impair neurotransmitter synthesis and sleep regulationFull micronutrient panel, RBC magnesium, ferritin, 25-OH vitamin D, organic acids test for B-vitamin status
Blood Sugar Dysregulation
20% - Nocturnal hypoglycemia triggers stress hormones that wake the brain; insulin resistance affects sleep-wake regulating neuronsContinuous glucose monitoring, fasting insulin, HbA1c, glucose tolerance test, assessment of nighttime eating patterns
Neurotransmitter Imbalances
25% - Altered GABA, serotonin, dopamine, and orexin levels disrupt the sleep-wake switch and prevent transitions to sleep statesOrganic acids testing, neurotransmitter metabolite assessment, amino acid panel, evaluation of mood and cognitive symptoms
Environmental and Lifestyle Factors
30% - Poor sleep hygiene, bedroom environment, caffeine and alcohol use, irregular schedules, and lack of physical activityDetailed sleep hygiene questionnaire, bedroom environment evaluation, substance use history, exercise patterns, screen time assessment
Hormonal Changes
20% - Menopause, perimenopause, menstrual cycle fluctuations, and andropause cause temperature dysregulation and hormonal shifts that disrupt sleepHormone panel (estrogen, progesterone, testosterone, FSH, LH), assessment of menopausal symptoms, menstrual cycle tracking
Chronic Infections and Inflammation
15% - Low-grade infections (EBV, Lyme) and chronic inflammation elevate cytokines that activate wake-promoting brain regionsViral panels, inflammatory markers (CRP, IL-6, TNF-alpha), assessment of infection history, evaluation of inflammatory symptoms
Key Laboratory Markers
These biomarkers help us understand your specific migraine mechanisms
What Happens If Left Untreated
Understanding the consequences helps you make informed decisions about your health
Cardiovascular Disease
2-5 yearsChronic insomnia increases risk of hypertension by 3-4x, coronary artery disease by 45%, and stroke by 54% through sympathetic overactivation and inflammation
Type 2 Diabetes and Metabolic Syndrome
1-5 yearsSleep deprivation impairs glucose metabolism and insulin sensitivity; increases risk of diabetes by 28% and promotes weight gain through appetite hormone disruption
Cognitive Decline and Dementia
5-15 yearsPoor sleep prevents glymphatic clearance of amyloid-beta and tau proteins; chronic insomnia increases Alzheimer's risk by 53% and accelerates cognitive aging
Mental Health Disorders
6-24 monthsInsomnia increases depression risk by 10x and anxiety disorders by 17x; creates bidirectional worsening cycle that becomes increasingly difficult to break
Immune Dysfunction
OngoingSleep deprivation reduces natural killer cell activity by 70%, impairs antibody response to vaccines, and increases susceptibility to infections and cancer
Accidents and Injuries
Immediate and ongoingSleep deprivation causes impairment equivalent to blood alcohol of 0.05-0.10%; responsible for 100,000+ motor vehicle accidents and 1,550 deaths annually
Chronic Pain Syndromes
1-3 yearsPoor sleep lowers pain threshold and increases pain sensitivity; insomnia sufferers 2x more likely to develop chronic pain conditions
Hormonal Disruption and Infertility
1-5 yearsSleep deprivation suppresses growth hormone, testosterone, and reproductive hormones; reduces fertility and accelerates aging processes
Time Matters
Don't wait for symptoms to worsen. Early intervention leads to better outcomes.
How is Chronic Migraine Diagnosed?
Comprehensive evaluation to identify triggers, contributing factors, and appropriate treatment
Comprehensive Sleep Assessment
Purpose:
Detailed evaluation of sleep patterns, quality, and contributing factors
Sleep efficiency, sleep latency, wake after sleep onset, sleep architecture, identification of sleep disruptors
Salivary Cortisol Rhythm (4-point)
Purpose:
Assess HPA axis function and circadian cortisol pattern
Elevated evening cortisol, blunted CAR, or flattened curve indicating hyperarousal and stress dysregulation
Melatonin Profile
Purpose:
Evaluate circadian rhythm and melatonin production
Low evening melatonin indicating circadian disruption; delayed melatonin onset suggesting phase delay
Comprehensive Blood Panel
Purpose:
Identify metabolic, hormonal, and inflammatory contributors
Thyroid function, blood sugar markers, inflammatory markers, complete metabolic panel, CBC
Micronutrient Testing
Purpose:
Identify deficiencies affecting sleep neurochemistry
Magnesium, vitamin D, iron/ferritin, B-vitamins, zinc levels critical for sleep regulation
Organic Acids Test
Purpose:
Evaluate mitochondrial function, neurotransmitter metabolism, and nutrient status
B-vitamin status, neurotransmitter metabolites, oxidative stress markers, gut microbial metabolites
Gut Microbiome Analysis
Purpose:
Assess gut health impact on sleep through gut-brain axis
Dysbiosis patterns, inflammation markers, bacterial imbalances affecting neurotransmitter production
Continuous Glucose Monitoring (CGM)
Purpose:
Identify nocturnal blood sugar fluctuations disrupting sleep
Nighttime hypoglycemia events, glucose variability, relationship between meals and sleep quality
Hormone Panel
Purpose:
Evaluate sex hormones and their impact on sleep
Estrogen, progesterone, testosterone, DHEA-S levels affecting sleep quality and thermoregulation
Inflammatory Markers
Purpose:
Assess systemic inflammation affecting sleep centers
Hs-CRP, IL-6, TNF-alpha levels that activate wake-promoting brain regions
Our Integrative Approach
A comprehensive, phased approach to treat chronic migraine at its source
Comprehensive evaluation and immediate sleep environment optimization
Comprehensive evaluation and immediate sleep environment optimization
Calm hyperarousal and establish healthy sleep pressure
Calm hyperarousal and establish healthy sleep pressure
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Address underlying physiological imbalances
Address underlying physiological imbalances
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Consolidate gains and prevent relapse
Consolidate gains and prevent relapse
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Supporting Your Treatment
Evidence-based lifestyle modifications to enhance treatment effectiveness
What Success Looks Like
Sleep onset latency <20 minutes
Sleep efficiency >85% (time asleep/time in bed)
Wake after sleep onset <30 minutes total
7-8 hours of restorative sleep nightly
Morning energy levels 7+/10 without caffeine
Elimination of daytime fatigue and sleepiness
Normalized cortisol rhythm on salivary testing
Improved mood and cognitive function
Reduced or eliminated sleep medication dependence
Sustained sleep quality during stress periods
Resolution of nighttime awakenings
Improved metabolic markers (glucose, inflammation)
Frequently Asked Questions
Ready to Find Relief from Chronic Migraines?
Our integrative approach has helped hundreds of patients find lasting relief from chronic migraines. Schedule your comprehensive assessment today.