Can Your Thyroid Gland and Thyroid Hormones Cause Sleep Disorders?

Thyroid gland dysfunction like hypothyroidism or hyperthyroidism may contribute to sleep disorders like sleep apnea and insomnia
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Hormone problems can wreak havoc on health. The thyroid gland can be particularly important in how it impacts sleep. How can thyroid dysfunction, including conditions like hypothyroidism and hyperthyroidism, cause sleep problems? Consider its role in snoring, obstructive sleep apnea, night sweats, insomnia, and other symptoms. Discover how blood testing may reveal the cause and how treatments, including resolving hypothyroidism with thyroid replacement, may help.

Thyroid Gland Problems: Hypothyroidism vs. Hyperthyroidism

Hypothyroidism refers to the inadequate secretion of thyroid hormones by the thyroid gland in the neck. This is sometimes referred to as having an underactive thyroid. When hypothyroidism is present, there may be changes within the upper airway that lead to difficulties breathing during sleep. It may require treatment with a medication that acts as thyroid hormone replacement.

Hyperthyroidism refers to overproduction of the thyroid hormones by the thyroid gland. This may occur due to hyperfunctioning nodules or a thyroid goiter, Graves' disease, or thyroiditis. Surgery or treatment with radioactive iodine may be required to correct the condition.

Hypothyroidism Symptoms

When the body's release of thyroid hormone is too low, health problems may quickly ensue. There are a number of symptoms that can make a diagnosis of hypothyroidism more likely. These include:

  • Sensitivity to cold
  • Constipation
  • Dry skin
  • Brittle nails
  • Hair loss
  • Unexplained weight gain
  • High cholesterol
  • Irritability
  • Sexual dysfunction
  • Slow heart rate
  • Irregular uterine bleeding

It is important to note that not all of these symptoms must be present to make the diagnosis.

Hyperthyroidism Symptoms

In the other extreme, when the thyroid gland is producing too much thyroid hormone (sometimes called an overactive thyroid), different symptoms may be present. These include:

  • Excess sweating
  • Heat intolerance
  • Warm skin
  • Excessive hunger
  • Weight loss
  • Mood swings
  • Panic attack
  • Irritability
  • Hyperactivity
  • Restlessness
  • Nervousness
  • Abnormal heart rhythm
  • Fast heart rate
  • Palpitations
  • Fatigue
  • Insomnia
  • Irregular menstruation or short and light menstruation
  • Abnormal protrusion of eyes or puffy eyes
  • Diarrhea
  • Hair loss
  • Muscle weakness
  • Tremor

As before, not all of these symptoms must be present for the condition to be diagnosed.

Thyroid Dysfunction and Sleep Problems

Both hypothyroidism and hyperthyroidism may have impacts on sleep, including:

Obstructive Sleep Apnea

Like hypothyroidism, obstructive sleep apnea is a relatively common disorder in the general population. Patients with obstructive sleep apnea often experience symptoms including excessive daytime sleepiness, apathy, and feeling lethargic. These symptoms are also common in hypothyroidism, making the two disorders difficult to tease apart based on a patient's history and physical examination. 

In addition, patients with hypothyroidism may be at greater risk for developing obstructive sleep apnea, due to multiple factors involving respiration, such as a decreased ability to respond to chemical changes within the blood and even damage to the nerves or muscles involved in breathing. In addition, hypothyroidism may contribute to obstructive sleep apnea through enlargement of the tongue (called macroglossia) or disruption of the muscles that control the upper airway. Finally, patients with hypothyroidism are at risk for obesity, another factor that contributes to obstructive sleep apnea. 

Insomnia

Some people with hypothyroidism and sleep apnea will experience insomnia. Sleep apnea may cause disrupted breathing that leads to sudden arousals from sleep. This may be characterized by frequent awakenings during the night, especially towards morning during REM sleep. Sleep may be light and unrefreshing.

Due to the poor quality of the sleep, the time in bed may be extended. Going to bed early, or staying in bed too late, may lead to problems falling asleep at the beginning of the night. If the time in bed exceeds the amount of sleep that is needed to feel rested, chronic insomnia may ensure.

As such, it may be important to look for sleep apnea if insomnia symptoms are experienced in the context of thyroid dysfunction.

Night Sweats

In the context of the difficulty regulating the body's temperature in hyperthyroidism, night sweats may occur more frequently and these may be disruptive to sleep. Menopause is commonly associated with night sweats. There may also be a role for sleep-disordered breathing in causing this phenomenon.

Diagnosis and Treatment

Thyroid problems are relatively easy to diagnose and treat based on the results of blood tests measuring various indicators of thyroid function. For those already diagnosed with hypothyroidism and symptoms of sleep apnea, a sleep study can help determine whether sleep apnea is present. During a sleep study, healthcare providers will monitor your sleep either in a lab or at your home using portable home sleep apnea testing equipment. 

Patients with symptoms of sleep apnea who are either referred for testing or have been officially diagnosed may wish to ask their physicians to order a blood test to analyze their thyroid levels, especially if their symptoms persist despite appropriate sleep apnea treatments. Sleep apnea is most commonly treated with continuous positive airway pressure (CPAP) therapy. Alternatives include oral appliances from dentists, surgery, positional therapy, and weight loss.

If you have some of the above listed symptoms, it may be time to speak with your doctor about getting a blood test to evaluate the function of your thyroid. Generally, it can be helpful to evaluate the thyroid-stimulating hormone (TSH). If this is abnormally elevated, suggesting that the thyroid is not working properly to produce enough thyroid hormone, the levels of T3 and T4 may also be tested. The TSH level may be abnormally low with high T3 and T3 levels in the context of hyperthyroidism.

Fortunately, if hypothyroidism is causing sleep apnea or breathing difficulties, it will improve with thyroid hormone replacement. This is typically taken as a pill called Synthroid (levothyroxine). There are also natural alternatives, derived from animal sources, such as Armour thyroid. As noted above, surgery or radioactive iodine may be used to treat hyperthyroidism, and thyroid replacement may be needed subsequently to provide what the body can no longer produce.

A Word from Verywell

It is very common to have thyroid problems and these issues may negatively impact sleep. It is also very common to have sleep apnea. There may be a relationship between the two conditions. If you have persisting symptoms, despite a normalization of your thyroid hormone levels on blood testing, consider the role of sleep apnea. It may be helpful to have a sleep study after an evaluation by a board-certified sleep specialist. If sleep apnea is discovered, and effectively treated, you may enjoy both improvements in your health and well-being.

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Article Sources
  • Skatrud J et al. "Disordered breathing during sleep in hypothyroidism." Am Rev Respir Dis 1981;124:325.