Can’t Fall or Stay Asleep? Your Sleep Questions Answered

0:00You're doing what you're supposed to do. You're in bed for seven, eight hours, and yet you wake up feeling unrefreshed, foggy, like you could go right back to sleep. Now, in most cases, it's not about how long you're sleeping. It's about the quality of that sleep.

0:25Welcome to Office Hours. This is our dedicated one-on-one space to go deeper, get clear, and explore what truly moves the needle for your health. I'm Dr. Mark Hyman, and each week, we're going to pull back the curtain and share the insights, the research, the lessons that don't always make it into our conversations with guests. Because at the end of the day, you are the CEO of your own health. And for many of you, your family's health too. And you might not feel it all the time, but you have far more power and agency than you realize. I'm glad you're here. this episode is brought to you by function health empowering you to live 100 healthy years with over 160 lab tests for just 365 dollars a year and use the code mark 2026 to get 50 off your membership sleep you know is one of the most important foundations of your health and honestly one of the most frustrating now if you struggle to fall asleep if you struggle to state of sleep, if you wake up feeling exhausted, I promise you, you're not alone.

1:20And I want to know, despite what social media tells you, poor sleep isn't just caused by one bad habit or one missing supplement. It's the result of a few biological systems that are out of sync. So in today's office hours, we're going to slow things down. We're going to answer the most common questions about sleep, what's actually going on in your body, and what helps in real life. Now, this isn't about perfect sleep routines. It's about understanding your sleep patterns and giving your body what it needs to rest and to repair. Now, here's why sleep breaks down. This is the big picture. Sleep problems usually come from a few things.

1:53First is circadian rhythm disruption. Now, your body runs on this internal clock that's guided by light, by darkness, by consistent timing, which is really hard, particularly for me because I travel all over the place. And when that clock is off because of late nights, because of screens, because of irregular schedules or not getting morning light, your sleep becomes harder to initiate and it also becomes harder to sustain it through the night the next thing that often occurs that screws up sleep is your nervous system being overactive if your body's stuck in this stress response if you're always on right if you've got high cortisol high adrenaline your body doesn't think it's safe to power down right because your body's in stress you're chasing a running from a tiger right or you're fighting or fleeing now you might feel exhausted, but your brain stays alert.

2:40And that's why so many people feel tired all day and wired at night. We call that tired and wired. I have felt that, I promise you, it's awful. The next thing that often screws up sleep is your blood sugar being unstable. Now, blood sugar instability is a common overlooked cause. Now, if your blood sugar drops overnight, guess what happens? It's a life-fitting emergency and your body releases stress hormones. And that brings your blood sugar back up, which is fine, except your cortisol is high and your body's like, oh, danger, or it's wake up time because in the morning your cortisol goes up naturally.

3:13And that often occurs between two and four in the morning and then mind races, you're really alert. And this is true for people often have high insulin, they eat big meals, they kind of have a big spike in their blood sugar, their insulin spikes, and it crashes. And then you often get this. I had a guy who would have night sweats because as a patient, and obviously he wants to go through menopause and you'd have cancer or TB, which are the other causes. And it was because he had hypoglycemia in the middle of the night and that causes night sweats and light-thropping emergency. The next big thing that screws up sleep are hormone imbalances.

3:46Now, these play a big role in your sleep quality. And there's a lot of hormones that revolve. Cortisol, as we just mentioned, that's stress hormone. Melatonin, which we know affects sleep and is important for sleep initiation. Progesterone, estrogen, sex hormones. And we know a lot of women through menopause often have sleep disruption and thyroid. It can often, if it's too high, it can make you not sleep if it's too low. It can make you sleep too much or actually paradoxically cause insomnia. So all these hormones are like this incredible, beautiful symphony of molecules that should be imbalanced.

4:19When they're out of balance, they screw you up. And they all influence when you feel sleepy, how deeply you sleep, how rested you feel in the morning. And in these shift, right, They shift during perimenopause, menopause, chronic stress. All these things can disrupt sleep. The next big category of things that disrupt sleep are actually two different categories. One is inflammation and the other is nutrient depletion. Inflammation is a big factor because almost all brain dysfunction, whether it's depression or autism or Alzheimer's or schizophrenia or anxiety, whatever you want to call a brain dysfunction is usually linked in some way or another or caused by inflammation.

5:00And that includes sleep disruption. So that's a big one. And there's a lot of causes for it. And often people don't realize what they are. They can be toxins and allergens and infections and the microbiome changes and inflammatory diet and stress. I mean, it's a whole list of things that cause inflammation. The other thing is nutrient depletion. That's the big one. And a lot of people are nutritionally efficient. In fact, at Function, where we test everybody for a lot of nutrients that your doctor usually does not test for, like omega-3 fats and B vitamins, homocysteine, methylcic acid, B12, folate, vitamin D, and many others, we find that almost 70 % of our population, which is generally health-seeking people, 70 % have a nutritional deficiency at the level that the RDA considers a nutritional deficiency disease, not what's optimal, but just what's enough to get scurvy or rickets.

5:58So we're talking a massive amount of nutritional deficiency or insufficiency in the population, probably over 90%. So when you have low levels of nutrients like magnesium and over 45 % are low in magnesium, and we do test that, iron affects sleep. If your iron is low, then we check your ferritin level, which is really important. Again, your doctor usually never checks this, it's on the function panel, and your ferrant level is less than 45, even though the normal, quote, normal is 16, you're going to have sleep issues. It's one of the big hidden causes of insomnia, and a lot of the population has iron deficiency up to half, especially children and many others.

6:35B vitamins, also a big role in sleep, and omega-3s. All these affect your nervous system and your brain and affect your ability to sleep. So really important to focus on these things. Now, sleep isn't something you force. It's something that happens when the body feels supported and safe. And that's the key here. All right. So let's get to it. What are the most common sleep questions? Number one, why can't I fall asleep even when I'm tired? And trust me, I've experienced this, so I get it. Here's the thing. You get really tired. You're exhausted all day. You finally get into bed. Instead of just passing out and drifting off, your mind turns off.

7:11Or maybe it just never turned off. Thoughts raised. Your body feels tired. Your brain went shut down. Now, what's usually happening here is that your body's physically tired, but your nervous system is still in the on mode, right? You can't turn your brain off. Your anxiety, your stress response is automatic. And the thing about our society is that almost everything going on, whether it's our jobs, our relationships, our diet, obviously, which causes tremendous amount of stress in our system. Our inflammatory, high-sugar processed diet literally raises cortisol. Even if you're meditating all day long and you eat that, you're going to have high cortisol.

7:49All the stresses in the world, wars and traumas and just the news that makes me stressed. So pretty much everything going on is automatically making your nervous system unhijacked. And it takes deliberate effort to turn on your relaxation system. It's not something that happens automatically. It's an active process. I do it every morning. I do breath work. I do meditation. It's work. I mean, it's relaxing, but it's work. It's not just going to happen automatically. Whereas stress, you don't have to do anything. It's just there. So what happens when you have high stress levels? Well, cortisol is a stress hormone.

8:26That goes up at night. Normally, cortisol should go down at night. Your body has a basically a biphasic rhythm where it's up in the morning and down at night, except when you're screwed up and then it goes up at night and down in the morning and you're all messed up. So cortisol is basically not functioning right. But when you have chronic stress, when you're having regular schedules, when you're not having bedtime early enough, when you're staying up really late, or if your blood sugar swings because you're eating lots of carbs and sugar, it can screw up that whole rhythm. And that makes cortisol go up when you're trying to go down, right?

9:00When you're trying to go to bed, it goes up. So what happens? Well, your nervous system gets stuck in the on mode. When your nervous system is overactive, because your day is packed with stimulation, with stress with constant mental inputs, your body doesn't automatically know how to shift down at night. Even though you're tired, your system doesn't really feel safe to let go, even though you might think you are. So learning how to regulate your nervous system and manage your stress response is a really important part of just being alive and a human that we naturally did, you know, living in the woods, watching the sunset, the sunrises, and not having constant chronic stress.

9:34There's a book by a great scientist, I love Robert Sapolsky, called Why zebras don't get ulcers essentially the idea is that i actually was in africa a couple years ago and i saw i literally saw this you see a lion chasing a bunch of zebras they go crazy they're running as fast as they can their hearts are racing they're gonna die they're scared as hell and then the lion catches one of the zebras and then it's literally laying there dead and then the lion's eating the zebra and all the other zebras are just hanging around the lion while it's eating the zebra they're just they know it's not their turn so they're just relaxed so it's an acute stress, their stress hormones go up, they discharge them, they run, and then they're fine.

10:13We don't do that. We just stay in chronic stress mode. The other big thing is blue light and mental stimulation, right? So blue light and mental stimulation are also playing a big role. Now, when you're on screens, when you have bright lights, when you're dealing with work emails at night, or even having an intense conversation with your partner or spouse, that can really cause trouble. That can suppress melatonin, and it basically signals the brain that's all daytime, right because when you raise cortisol that's daytime and when you have all this mental stimulation and we have blue light it's daytime so our there's actually a great book i read called lights out years ago just talking about the initial light bulb being the cause of the rise of chronic disease including heart disease diabetes and many other things because of how it affects our nervous system and our hormones and so forth everything that's really common that causes trouble is not going to bed at the same time and not waking at the same time it's one of the most important things, and I'm really crappy at this, but it's one of the most important things if your sleep's not good, to get your sleep right.

11:10If you have inconsistent sleep timing, it matters more than most people really know. So going to bed and waking up at different times, especially on weekends, makes your whole internal clock confused and harder for your body to recognize when it's time to sleep. So given all that, what actually helps you sleep better? Well, going to bed and waking up at the same time every day. 10 and 6 are good, 9 and 5, 11 and 7, whatever works for you is really important. Next is getting morning sunlight. You've heard this before, but I can't overemphasize the importance of getting at least 15 minutes of morning sunlight, even if there's clouds out, within half an hour to an hour of waking up.

11:49Now, you're, you know, in the North pole and there's no light, they have full spectrum light boxes you can use. But aside from that, unless you live in Sweden or Norway or somewhere in Greenland, probably you can get mornings on light. Downshift at night. Do breath work, do stretching, yoga, take a hot bath. My favorite is Epsom salt bath, lavender oil, which has magnesium and lavender actually lowers cortisol. They've studied this. Johnson & Johnson has a baby bath with lavender in it because it works. or your scortisol comes with maybe take magnesium at night, magnesium glycinate, or 3 and E.

12:24These are great forms of magnesium to take at night. So if you're tired and wired, your body isn't broken, it's just dysregulated. So when you focus on calming your nervous system and supporting your natural rhythms, then falling asleep is going to get a lot, lot easier. Second big question is, why do I wake up at 2 at 4 in the morning, like between 2 and 4 in the morning, and why can't I fall back asleep? Well, this was by far the most common sleep question that you all submitted, and for good reason. Waking up between 2 and 4 in the morning, often with a racing mind or a sudden test of being alert, is incredibly common.

12:55And the important thing to understand is this. Most of the time, it's not insomnia. It's your body sending a signal. And what are those things? Well, the causes for this are blood sugar drops. We talked about that. But blood sugar drives a lot of wakefulness in the middle of the night because if your blood sugar drops, your dinner's too low in protein or fat, and you had sugar alcohol in the evening, and your blood sugar dips. And then what happens? Your insulin goes up. and your cortisol goes up, and you're off to the races. Then you've got hypoglycemia, and you've got stress hormones going up, and basically your blood sugar becomes normal, but you're awake.

13:29The second is cortisol spikes. Now, cortisol naturally starts to rise early in the morning to wake you up, but chronic stress can push that rise earlier than it should right into the night. Instead of being at 6 in the morning, it's at 2 to 4 in the morning. Alcohol, another big one. It helps you maybe fall asleep, but it screws up your sleep architecture. I have an aura ring and I know that when I you know drink and I don't actually anymore I don't remember last time I had a drink I always see even a little bit actually screws up my sleep so it's not worth it so small amounts of alcohol fragment sleep and they trigger this early morning waking as soon as the alcohol goes down your system then stress hormones kind of bounce up and you get you know wake in the middle of the night the next is hormone shifts perimenopause menopause now for many women these hormone shifts especially during perimenopause and menopause are a big contributor to waking up in the middle of the night.

14:17It can be just waking up. It can be hot flashes. These hormones affect blood sugar. They affect your temperature control. They affect cortisol. All those can disrupt your sleep in those early morning hours. So what helps fix all that? Well, a good dinner with protein and fat, not a carb-rich dinner. I mean, it can have carbs, but you can't just have carbs alone, and you don't want to be eating tons of sugar at night. Late night sugar or alcohol, also bad news. Even any alcohol, you want to give yourself probably at least four hours before bed. Magnesium can help as well, as I mentioned. And those stress responses that we talked about, how do you deal with your stress load throughout your life?

14:57Look at your life as a whole. Where can you cut out things that are stressful? Where can you introduce things that are helping you relax? Not just bedtime habits, but just throughout your life. So the key takeaway is this. If you wake up in the middle of the night, it's often metabolic or hormonal, not a personal failure, or simply insomnia. When you address these underlying signals your body's sending, then your sleep starts to repair itself. All right. The next question we get is, why do I sleep seven or eight hours, but I still wake up feeling exhausted? It's a really common and kind of a confusing sleep question.

15:26You're doing what you're supposed to do. You're in bed for seven or eight hours, and yet you wake up feeling unrefreshed, foggy, like you could go right back to sleep. Now, in most cases, it's not about how long you're sleeping. It's about the quality of that sleep. One of the major causes of not feeling refreshed in the morning is not getting enough deep sleep or REM sleep. Now, these stages are when your brain and your body repair, when they regulate hormones, when they consolidate memory, when they clear up inflammation. It's an amazing system that your brain has to heal and repair, but if you're not having quality sleep, it's not doing it.

15:58If your sleep is fragmented or shallow, you can get plenty of time in bed and you don't feel restored. The next thing that can cause poor quality sleep is inflammation. Now chronic inflammation is driven by stress, by poor diet, which is what most of us hate in America, our gut problems, poor microbiome health, infections, toxins, all these things can drive inflammation. And they can interfere with sleep architecture and they make sleep less restorative. I know when I had mercury poisoning in my 30s, I could not sleep at all. And I needed drugs. It was terrible. And I knew that it was the mercury once I figured it out, but it was kind of scary.

16:36And so toxins and all these things can drive inflammation in the brain that really interrupts sleep. The next thing is hidden sleep issues that you might not really have, especially if you live alone, which is sleep apnea, which means you don't breathe at night for short periods of time. Your sleep is interrupted by periods of non-breathing, whether you just hold your breath. Snoring, you don't breathe for a bit you've seen people like this and these are really common that can be caused by nasal congestion allergies by mouth breathing sleep apnea these all affect your oxygen delivery and they can fragment sleep even if you don't think you're waking up at night your sleep scrappy and then of course there's nutritional deficiencies hormonal issues things like iron b12 thyroid issues they can cause persistent fatigue and it just might be a clue that there's something wrong that you need to track and that's why we have function and function health and you Go to FunctionHealth.com, and it's now only$1 a day,$365 a year.

17:30You can get a full panel that looks at all these things that we're talking about, including iron, ferritin, B12, thyroid, and many, many other factors, magnesium, all that affect your sleep. And these can make you feel exhausted no matter how many hours of sleep you get. So what helps fix this? Well, track your sleep trends, not just one night, so you see what's happening. If you're a nasal breather, you've got nasal congestion, sinus issues, allergies, It could be your diet, food sensitivities, environmental allergies, mold. Check it out. Check your labs. You know, always good to get a baseline.

17:59Alcohol. If you're really not feeling the rest of the morning, just cut out alcohol for a while and see how you do. The key takeaway is this. If you're sleeping enough hours, but you're still waking up exhausted, your body's asking for deeper repair, not more time in bed. When you focus on sleep quality and your underlying health, then your energy often starts to come back. Many cancers aren't caught early enough. and our healthcare system is built for reactivity. You feel something, you go in, you get tested, but so much could be developing quietly before symptoms even show up. And that's exactly why I'm so excited about what's now available through function, scans.

18:34One scan that can look for signs of hundreds of potential conditions across up to 14 organs, including early signs of cancer before you might even feel a thing. Now, this is about finding what could otherwise go unnoticed while there's still time to do something about it. Combined with Function's 160 lab tests, this is a powerful way to check your health, your labs, your scan, your data. Because the goal was never to live longer in a hospital. It's to live well for 100 healthy years. You can now add scans to your Function membership for an additional cost by visiting functionhealth.com slash scans to learn more about it and get started.

19:12That's F-U-N-C-T-I-O-N health.com slash scans to learn more today. And if you're one of the first 1 ,000 people this week, use the code MARK2026 for a$50 credit toward your$365 a year membership. That's functionhealth.com slash mark and use the code MARK2026 today. Next big question I got was, what supplements actually help with sleep? Now, supplements can be helpful, but only when they're used in the right context. They work best to support, not as a substitute for healthy sleep habits and circadian rhythms. that's why they're called supplements not replacements okay now here's here's uh the most helpful ones magnesium probably about 45 percent of the population is low in magnesium so what causes us to be low we don't need magnesium rich foods like greens and beans nuts and seeds we do a lot of things that cause us to lose magnesium alcohol sugar stress caffeine all that causes us to deplete magnesium it's one of the most consistently helpful nutrients for sleep and you can use forms like magnesium glycinate or threonate helps relax the nervous system quiets your brain at night the next is l-theanine now that comes from green tea and that's why there's tea ceremonies and green tea can be relaxing does have caffeine but this is without the caffeine so l-theanine is a great option especially if your mind races at night It helps promote a calm, relaxed state.

20:41It doesn't cause you to be too sedated, but it makes you calm. The next one is glycine. Most people haven't heard of it, but it's an amino acid, and it can really help support sleep quality. It can help lower your core body temperature, promotes deeper sleep, more restorative sleep for some people. It's a great hack. Low-dose melatonin and short-term only. I don't recommend melatonin regularly, but it can be helpful in certain situations, and dose and duration matter. Low dose, even half a milligram, can be used short-term, and it can help reset your circadian rhythm, especially if you're traveling.

21:09Like I just flew to South Africa. So I did one dose of melatonin last night to help reset my circadian rhythm jet lag. So if you're traveling or you have a schedule disruption, it can help. And more is not necessarily better and not really for a long-term solution. All right. What should you avoid? As I mentioned, melatonin is good in low doses, not high doses. So high doses taking over a long time can really disrupt your body's natural production and it can lead to grogginess, vivid dreams, and remount sleep issues. So you don't want to stay away from doing that. And then, you know, random stacking supplements without a plan.

21:42So you can take lots of sleep supplements. You can be taking everything on the market and it may not help. So you want to work with someone if you're really struggling to find out the cause and then not just supplements as a pile on to fix it all. So here's the takeaway. Supplements support sleep, but they don't replace the foundations of sleep hygiene. And if the basics aren't in place like light exposure in the morning, avoiding blue light at night, regulating stress response, balancing with blood sugar, having a cool environment in your bedroom, having dark blackout shades, having low noise or noise canceling or earplugs.

22:18All those things really make a difference. No supplements are going to fix the problem if you don't address those things. But if you use them thoughtfully, then the right supplements help make sleep easier and more restorative. What are the quick takeaways that good sleep actually requires? Well, I want to kind of go over the basics here. Here's the big idea. Sleep isn't about being perfect. It's about a few key systems that work together, and small, consistent habits matter more than a bunch of hacks. Great sleep starts the minute you wake up, not when your head hits the pillow. So what are the five pillars of good sleep?

22:52Number one, light exposure. Morning sunlight helps reset your circadian rhythm. That means getting outside if it's cloudy or without sunglasses, without contacts, and letting those sun rays hit your retina and work on your brain to properly regulate your hormones through your pineal gland. And then at night, low light exposure. Now, that sometimes means changing the light bulbs in your house. Candlelight's cool. I like that. But, you know, there's a lot of ways to do this, but make sure you deal with this bright evening light, which is not good. It makes your body think it's still daytime. The next key takeaway here is stabilize your blood sugar.

23:33And this is true for everything and every disease, period. If you know my work, you know all about this. You're running about it for 30 years. Balance your blood sugar. That means lots of protein, fat, and fiber, low refined starches, low sugar. I'm not a no guy. I'm a low guy. And especially at night, at dinner, don't eat a ton of starch and sugar without properly balancing with fat and protein, and obviously don't eat a lot of refined starch and sugars. So also don't eat sugar before bed and don't drink at night. Also, don't have late night sugar and alcohol, bad news. The third big idea here is to learn how to regulate your nervous system.

24:11Stress happens, relaxation doesn't, right? Your sleep happens when your body feels safe. So learning how to regulate your stress response throughout the day matters. And it can be simple. It can be a simple breath practice in the morning, meditation, some gentle yoga, stretching. It can be meditation later at night or what Andrew Huber calls a non-sleep deep rest or often it's called yoga nidra, which is essentially an ancient practice to do a body scan and reset your nervous system. Whatever works for you. I take a hot bath, have some salt, lavender oil, get a massage, get your feet rubbed if you're lucky enough.

24:46Whatever it is, learn how to downregulate your nervous system at night. The fourth big idea is get your hormones in balance. Cortisol, melatonin, progesterone, estrogen, thyroid, these all affect sleep. And if they're out of whack, you need to know. Functionhealth.com is a great way to check all these. And if they're out of whack, there's some simple things you can do to fix them. If you need to see a doctor, sometimes you need to get hormone replacement or thyroid, that's fine. And if your hormones are really messed up, you really need to get those fixed. And the fifth big idea is be consistent, don't be perfect, right?

25:18Try to sleep and wake at the same time every day. You know, consistency is one of the biggest sleep hacks there is. So try your best. I try to get in bed at 10, I wake up at 6.37. Really important, if I can do it, that's my favorite way to live life. And of course, sometimes I'll stay out at night, I'm going to a wedding this weekend, I'll be partying, but not on a regular basis. So what's the quick return on investment here? What are the quick wins? If you do nothing else, start here. Morning sunlight, within half an hour, an hour waking up, eat protein dinner to make sure your blood sugar doesn't crash, reduce alcohol in small amounts, and try to consistently sleep in the same sleep window, including weekends.