Keto insomnia: Causes and remedies

From the desk of Luis Villaseñor

While low-carb or ketogenic diets are often-times used to better peoples’ sleep quality, I still get the occasional question about insomnia on keto. Some percentage of people have trouble falling asleep and staying asleep on a low-carb diet.Whatever your diet, insomnia is deeply frustrating. You can’t think your way out of it. You can understand the value of sleep, but that knowledge doesn’t switch off your brain.Worrying over the consequences of insomnia—next-day drowsiness, elevated blood pressure, dysregulated hunger hormones—only makes it worse. The more stressed you are, the more trouble you’ll have falling asleep.Insomnia has many potential causes, and not all of them are easily addressed. If the insomnia is caffeine-related, that’s a simple fix. But if it’s related to stress or a medical condition, that’s trickier.What about keto insomnia, in particular? That certainly narrows things down.If someone tells me they’re not sleeping well on keto, there are a few places I look first. (<a href="https://drinklmnt.com/blogs/health/what-are-electrolytes-and-why-are-they-important" target="_blank" rel="noopener noreferrer">Electrolytes</a> are the very first place). But I also like to start with the basics: caffeine intake, light exposure, and stress management.Preventing insomnia is a holistic endeavor. It’s rarely ever just one cause and remedy.Preventing insomnia on keto requires an even more detailed investigation. More things can go wrong. That’s why I wrote this article.<h2>What Is Insomnia?</h2>Insomnia is a sleep disorder characterized by trouble falling asleep, staying asleep, or both. Another hallmark of insomnia is feeling foggy and unrefreshed upon waking.Insomnia is the most common sleep disorder. According to the <a href="https://www.psychiatry.org/patients-families/sleep-disorders/what-are-sleep-disorders" target="_blank" rel="noopener noreferrer">American Psychiatric Association</a> (APA), about one-third of adults have insomnia symptoms, and 6-10% qualify for the official diagnosis.The official diagnosis requires having three nights of poor sleep per week for at least three months. It also must cause “significant distress” or other functional problems, according to the APA.There are different categories of insomnia. Issues falling asleep are called onset insomnia, while issues staying asleep are called maintenance insomnia.Temporary cases are called acute insomnia, while longer cases are called chronic insomnia. When chronic insomnia has an obvious cause (drugs, health condition, etc.) it’s called secondary insomnia. When the cause is unknown, that’s called primary insomnia.<h2>What Causes Insomnia?</h2>You could write a book about what causes insomnia. People have. If you want to understand and improve your sleep, pick up Why We Sleep by Dr. Matthew Walker. I highly recommend it. It’s important to note that I don’t agree with Dr. Walker on all points of the book, but there is a lot of really good info to be found there that can help a great deal of people!This blog is a deep dive into keto insomnia. But before we brave that dive, we have to swim in the shallows for a minute.Here’s a rapid-fire list of potential insomnia causes.Insomnia Causes<ul><li style="font-weight: 400">Consuming caffeine or other stimulants</li><li style="font-weight: 400">Stress or trauma</li><li style="font-weight: 400">A long list of medical conditions </li><li style="font-weight: 400">Jet lag</li><li style="font-weight: 400">Medications</li><li style="font-weight: 400">Pain</li><li style="font-weight: 400">Poor sleep hygiene</li><li style="font-weight: 400">Lack of physical activity</li><li style="font-weight: 400">Electrolyte imbalances</li></ul>I’ll expand on a few of these. Caffeine, for instance, is one of the first things I suspect in cases of insomnia.Caffeine stays in the body longer than most people think. Its half-life is <a href="https://www.ncbi.nlm.nih.gov/books/NBK223808/" target="_blank" rel="noopener noreferrer">around 5 hours</a>, but it can stay in circulation for 10 hours or more in slow metabolizers. That cup of coffee after lunch could be keeping you up at 10 PM. This one is, however, highly individualized and needs to be considered as part of a larger picture.Insomnia is also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6732697/" target="_blank" rel="noopener noreferrer">linked</a> with many health conditions. These include sleep apnea, depression, anxiety, obesity, heart disease, and menopause. If you believe your insomnia is caused by a medical problem, talk to your doctor about the best course of action.Sleep hygiene is the last factor I’ll mention. Lots to chew on here. If the room is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3427038/" target="_blank" rel="noopener noreferrer">too warm</a> or too light, for instance, it can impair restful sleep.Light exposure is the key to good sleep hygiene. Most people know that screens at night aren’t good for sleep. Screens emit light (especially blue light) that <a href="https://pubmed.ncbi.nlm.nih.gov/30311830/" target="_blank" rel="noopener noreferrer">shuts down</a> the production of your sleep hormone, melatonin.Instead you want blue light exposure in the morning, ideally from the sun. Morning sunlight resets your circadian rhythm (your wake/sleep cycle) and sets you up for high levels of melatonin at night.Our society has the light exposure equation backward. We avoid the sun all day and stare at screens all night. Then we wonder why we can’t sleep.<h2>Keto Insomnia: Causes</h2>If you’re not sleeping well on keto, you’re not alone. Insomnia is a common symptom of <a href="https://drinklmnt.com/blogs/health/what-causes-keto-flu-and-6-keto-flu-remedies" target="_blank" rel="noopener noreferrer">keto flu</a>.Keto flu symptoms like headaches, low energy, cramps, and sleep disturbances usually hit people when they first transition to keto, but not always. They can persist. Let’s review what might be causing insomnia on keto.<h3>#1: Transitioning From Carbs</h3>The function of <a href="https://drinklmnt.com/blogs/health/ketogenic-diet-what-you-need-to-know" target="_blank" rel="noopener noreferrer">the keto diet</a> is to get you utilizing more fat for energy—especially at low intensities and at rest. This fat comes from either dietary sources or from body fat.Before going keto, most people rely on glucose (from carbs) for brain fuel. In the absence of ketones, glucose is the only available energy substrate for the brain.When you transition to keto, your body needs time to upregulate enzymes and pathways to utilize greater amounts of fat/ketones from circulation than it has previously. Glucose levels often fall, and your brain is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858534/" target="_blank" rel="noopener noreferrer">low on fuel</a> for a few days. This can cause a variety of symptoms, including insomnia.Insomnia is also a symptom of sugar withdrawal. High-glycemic refined carbs have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2235907/" target="_blank" rel="noopener noreferrer">similar neurological effects</a> as addictive drugs. When you go off them, you feel it.<h3>#2: Too many bathroom trips</h3>The keto diet has a diuretic effect. It causes increased fluid loss through urine. Why? Because restricting carbs <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5858534/" target="_blank" rel="noopener noreferrer">suppresses the hormone insulin</a>. With less insulin around, your kidneys retain less water.All those pee breaks, unfortunately, increase the likelihood of insomnia. The more you wake up, the more likely you’ll stay up. Waking up to pee also torpedos your sleep efficiency, or the percentage of the night you’re actually sleeping.<h3>#3: Low electrolytes</h3>Along with fluids, you also lose more electrolytes like sodium and potassium on keto.To make matters worse, people who eat keto tend to undershoot dietary electrolyte intakes. They don’t consume enough salt for <a href="https://drinklmnt.com/blogs/health/is-sodium-good-or-bad-for-you" target="_blank" rel="noopener noreferrer">sodium</a> or eat enough leafy greens for potassium and magnesium.The resulting electrolyte deficiencies can cause sleep disturbances. Consider the following:<ul><li style="font-weight: 400">Being low on sodium <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951800/" target="_blank" rel="noopener noreferrer">boosts the release</a> of norepinephrine, a stimulating hormone that can keep you up at night.</li><li style="font-weight: 400">Lower intakes of potassium have been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3866235/" target="_blank" rel="noopener noreferrer">associated</a> with greater daytime sleepiness.</li><li style="font-weight: 400">Magnesium supplements show <a href="https://pubmed.ncbi.nlm.nih.gov/21226679/" target="_blank" rel="noopener noreferrer">promise</a> for treating insomnia.</li></ul>From what I’ve seen, inadequate electrolytes are the number one cause of persistent keto flu symptoms. Insomnia included.<h2>Can Keto Improve Sleep?</h2>This article is about keto insomnia, but a ketogenic diet can also be a sleep aid.For one, a low-carb diet helps minimize blood sugar fluctuations that can result in hunger. If you wake up in the middle of the night feeling ravenous, it’s hard to get back to sleep. By restricting carbs, keto can help reduce these <a href="https://drinklmnt.com/blogs/health/what-causes-carb-cravings-and-5-ways-to-control-them" target="_blank" rel="noopener noreferrer">nighttime cravings</a>.Researchers have also explored how a keto diet impacts sleep cycles. One 2008 study, for instance, found that a keto diet boosted deep sleep (the sleep stage crucial for memory formation, wound healing, and <a href="https://pubmed.ncbi.nlm.nih.gov/25947369/" target="_blank" rel="noopener noreferrer">cleaning the brain of plaques</a>) in non-obese men.It should be noted, however, that the keto group had less rapid eye movement (REM) sleep. Is the tradeoff worth it? We don’t know.Moving on, the keto diet <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2367001/" target="_blank" rel="noopener noreferrer">has been shown</a> in clinical studies to increase levels of GABA, a calming brain chemical that promotes relaxation. This boost in GABA—and the attenuation of an excitatory compound called glutamate—likely explains why keto <a href="https://pubmed.ncbi.nlm.nih.gov/17241208/" target="_blank" rel="noopener noreferrer">improves sleep in epileptic children</a>.Finally, a keto diet may improve sleep indirectly by stimulating weight loss. Being overweight or obese is a risk factor for sleep apnea, a harmful condition of breathing obstruction linked to insomnia.Multiple studies <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716748/" target="_blank" rel="noopener noreferrer">suggest</a> that keto is effective for fighting obesity. And as obese people lose weight, sleep quality generally <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5782363/" target="_blank" rel="noopener noreferrer">improves</a>.<h2>Tips for Preventing Insomnia on Keto</h2>If you can’t sleep on keto, first examine what might be causing it. Are you super stressed? Getting enough electrolytes? Drinking more caffeine? Something else?Once you’ve brainstormed potential causes, you may find some simple fixes. For instance, low electrolytes are a primary cause of keto flu symptoms, and it’s not a complicated remedy: Simply consume plenty of <a href="https://drinklmnt.com/blogs/health/electrolyte-rich-foods-and-when-to-supplement" target="_blank" rel="noopener noreferrer">electrolyte-rich foods</a> and supplement when necessary. It also means using <a href="https://science.drinklmnt.com/electrolytes/does-salt-help-with-hydration/" target="_blank" rel="noopener">plenty of salt</a> (or drinking electrolyte water) for sodium.You may also need a few days on keto to fat-adapt. Consider using <a href="https://pubmed.ncbi.nlm.nih.gov/21226679/" target="_blank" rel="noopener noreferrer">melatonin</a> or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6031986/" target="_blank" rel="noopener noreferrer">GABA</a> supplements if you’re struggling with the transition.But don’t stop with the keto tips. I recommend taking a holistic approach to better sleep. Here are some sleep hygiene tips that apply to almost everyone:Sleep Hygiene Tips<ul><li style="font-weight: 400">Get ~30 minutes of sunlight early in the day to reset your circadian clock</li><li style="font-weight: 400">Minimize blue light at night to maintain melatonin levels</li><li style="font-weight: 400">Avoid stressful stimulation (like email) at night</li><li style="font-weight: 400">Consider a meditation or yoga practice to manage stress. Mindfulness meditation has been shown to <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2110998" target="_blank" rel="noopener noreferrer">improve sleep quality</a>.</li><li style="font-weight: 400">Don’t drink caffeine in the afternoon, and consider switching to decaf options in the morning.</li><li style="font-weight: 400">Eat a high-protein breakfast. It’s been shown to <a href="https://pubmed.ncbi.nlm.nih.gov/23705838/" target="_blank" rel="noopener noreferrer">boost melatonin secretion</a> at night when combined with proper light exposure.</li><li style="font-weight: 400">Don’t eat late at night. It sends wake-up signals to your body.</li><li style="font-weight: 400">Keep your room cool. Most experts recommend 65 to 70 degrees Fahrenheit.</li><li style="font-weight: 400">Keep your room as dark as possible.</li><li style="font-weight: 400">Be active every day. Increased physical activity is associated with a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5385214/" target="_blank" rel="noopener noreferrer">decreased risk </a>of insomnia.</li></ul>Follow these tips and you’ll be in the top 1% of sleep hygiene pros. Your body and mind will thank you for it.