Adapted from episode 121 of The Perfect Stool podcast with Dr. Damiana Corca, Doctor of Acupuncture and Chinese medicine and certified functional medicine practitioner and Lindsey Parsons, EdD, and edited for readability.
Lindsey:
Welcome to the podcast Damiana!
Dr. Damiana Corca:
Thank you for having me today. I’m so excited to be here.
Lindsey:
I’m excited to have you, especially since my sleep has been horrific lately. But before we get deep into sleep and my questions, I understand your personal history relates to gut health. So why don’t we start there?
Dr. Damiana Corca:
Yes, a few years ago, I was diagnosed with Hashimoto’s, actually I was a bit self-diagnosed. I just ran some tests, and I thought I’d run the thyroid antibodies, and there they were, very elevated. And it turned out that what made the most difference, besides making some diet changes, was doing a comprehensive stool test. I had a few infections and when I treated them, some with supplements, some with medication, I saw a huge drop in those thyroid antibodies.
Lindsey:
Wonderful. Yeah, that’s a good part of my history, except that mine is an ongoing problem because I have the autoimmune type of SIBO. So, what were the infections you found?
Dr. Damiana Corca:
Blastocystis hominis and H. Pylori, and H. Pylori were very elevated. In all these years of practicing, I’ve never seen them so elevated, and so many of the virulence factors active.
Lindsey:
And those are clear now?
Dr. Damiana Corca:
Sometimes they tend to come back a little bit. It seems like it’s a constant game between my immune system, but I now recognize some of the signs when it comes back. I want to give it a little bit of a supplement or this mastic gum seems to work well. And then the blastocystis hominis, I ended up having to do a couple of rounds of the medication to get it down.
Lindsey:
Let’s talk about the connection between gut health and insomnia. Does one influence the other? Or is it bi-directional? And what are the mechanisms of action?
Dr. Damiana Corca:
I would say it’s bi-directional. From my point of view, I always look at how people can’t sleep. We don’t know which came first. But let’s fix the gut, if that’s the case, so their insomnia can get better. But I think all of us have experienced at some point, if you don’t sleep well or you’re jet lagged, and you start getting nauseated and your stomach hurts and you just don’t feel well. And that’s with the jetlag, since it’s short term, you can see immediately how insomnia itself can cause stomach pain and nausea.
Lindsey:
I definitely know when I’ve had insomnia related to sciatica, I had no appetite, like sleeping was necessary to want to eat.
Dr. Damiana Corca:
Yeah, exactly. Yeah. But for a lot of my practice, in my patients, I see a lot of gut inflammation, food sensitivities, blood sugar imbalances, infections. And some of them are obvious for people, they just maybe didn’t realize there was a connection between their gut and insomnia. They didn’t know what to do exactly. But for some of them it is not that obvious. Just like with me, I did not have many gut symptoms, I just had a little bit of constipation. I had no idea that I had all these infections and that it impacted my immune system to such a level. In fact, only after having that high growth of H. Pylori I thought, do I really have symptoms? And I thought really hard and I thought, I am so used to having some hunger pains if I don’t eat for three, four hours. I’ve had them for so long. I thought it was normal.
Lindsey:
So that was the H Pylori.
Dr. Damiana Corca:
Yes, definitely. So anyways, what I was saying is that sometimes gut symptoms are not as obvious, especially if we’ve had them for a long time and we may get used to them. So sometimes I have patients come in and I point towards those symptoms, because the way they experience insomnia points toward gut symptoms, so I can talk about that. In my book, I talk about the five types of insomnia, one of them is very common with gut issues. It shows up in a very specific way.
Lindsey:
Yeah, let’s definitely get into that in just one sec. But and I was going to say that I do associate H pylori with insomnia and often asked that question, if you’ve had insomnia, because with H pylori, you will have pain on an empty stomach, which is why it would certainly hit in the middle of the night for some people. That’s the only time their stomach ever really empties.
Dr. Damiana Corca:
Yes, yes. Or in the morning. People say they wake up, they feel very hungry, and it almost hurts, and it they have to eat. Yeah,
Lindsey:
I feel that way often, or I should say in my history, I’m the kind of person who feels hunger pangs, but I had virtually no H pylori in my gut when I did test it. So yeah, glad that’s not at least one of my gut issues. So yeah, let’s hear about the five different types of insomnia.
Dr. Damiana Corca:
There are five different types: we have the anxious, the overthinking, the depleted, overtaxed and overburdened. But the one that will lead to digestive issues is overthinking. And in Chinese medicine, we always think about processing food, but also processing emotions and processing mental-emotional stress. And so, I see that connection all the time. And the way this type of insomnia shows up is in two different ways. The most common is with going to sleep just fine, but then waking up around one, two o’clock being wide awake, sometimes worrying about things. But sometimes it’s just whatever the mind gets stuck on, on a random thought of no real importance, and sometimes even a song or just goes from one thing to the other. And that type of insomnia can also be associated commonly with perimenopause and menopause, hot flashes, waking up around that 1-2 a.m. in the morning.
And then the second time that’s quite common is when the person has trouble falling asleep, or the beginning of the night initiating sleep. And they go in a light sleep, sometimes they say they don’t sleep all night at all, or they feel like it takes forever to fall asleep, or they feel like they’re half-awake half asleep all night. When they describe it like that, I treat the gut, even if they don’t have a lot of obvious symptoms. And when I say I treat the gut, even with not a lot of obvious symptoms, it’s because I do acupuncture. So, it’s a little bit easier to use the acupuncture points that correlate to that. So then when it comes to testing, though, if we want to look deeper, we would want to do a comprehensive stool test or look into food sensitivities, or blood sugar balance, whatever the problem may be, even if it’s not obvious. Sometimes, as I said, it could be the case,
Lindsey:
Do you want to go into the other types?
Dr. Damiana Corca:
Yeah, I’ll go briefly. So, these correlate very strongly to digestive issues. The anxious type also has trouble falling asleep. But they’re more wide awake at the beginning of the night, they can read a book, it just takes 2-3 hours, it never really goes late into the night. So one, half an hour, two hours, eventually they go to sleep. That’s the anxious type. And it relates to a dysregulated nervous system, which in essence, all of the time, there is a problem with the nervous system, it can’t settle down, doesn’t allow us to fully settle down and go to sleep, and feel soothed and let go and go into deep sleep. But they show up a little bit differently. So that was the anxious type.
And I see a lot of the stress hormone cortisol spikes a little bit at night, maybe the person tries to go to sleep a little too early, and then they build anxiety around it. So maybe it’s not enough winding down. And it’s just our society with so much stress that they can show up. Then the overtaxed, they typically wake up too early in the morning. Maybe it can start sometimes just half an hour too early, which you’re like, half an hour is not a big deal. But if it gets to be an hour and a half, and the person feels really bad, if that happens, you will feel very tired, even if it’s just 45 minutes or an hour earlier. And then it can get as early as three a.m. sometimes. And that’s just again, the result of too much stress. The body says I’m going to sleep for four or five hours to survive, and obviously can survive very long and very well. But you will survive on that much sleep.
And then the stress response, the activation kicks in and the cortisol goes high again, you wake up and you’re wide awake then. And a lot of people will say, if you have this type of insomnia, that you feel frustrated and anxious, but you can’t go back to sleep or you play a meditation or stay in bed for a while and about two hours later is when you get sleepy again. But then it’s time to get up. And it’s very frustrating. And I can explain why that happens. Why? Sometimes when we wake up, it takes about an hour and a half to two hours. It has to do with how long it takes for the cortisol to break down and clear out of our body once it has been produced. And there are many reasons why that can happen. It doesn’t have to be just mental emotional stress.
And then the depleted type. It typically shows up later in life, definitely above maybe 50s. But more commonly 60s, 70s, 80s. It’s just a general depletion of neurotransmitter, for example, mainly, but also, we’re just not as resilient. Whatever genetic tendencies we have at an older age, that shows up a bit more. And we often see that people sleep less as they get older, even though we need it so badly, especially for dementia prevention, but that does happen. And so looking at which aspects are the most important for this person, whether it’s improving gut health or working with their neurotransmitters directly or improving the nutrition and absorption to just replenish the body. And the good news is we don’t have to have the same levels as we did when we were in our teens or 20s, or 30s. We just have to have enough. The body can do a lot with just enough, whatever that means for each person.
Lindsey:
And how are you testing neurotransmitters?
Dr. Damiana Corca:
I test neurotransmitters in the urine. I have used that test a lot over the years.
Lindsey Parsons
Like a Dutch test or OAT?
Dr. Damiana Corca:
It’s neither, it’s from ZRT. It’s a urine test. I know those, both the Dutch and organic acids testing. I have found the ZRT neurotransmitter testing* the test for a lot of different neurotransmitters and metabolites, such as serotonin and tryptophan, and GABA and glycine, taurine, histamine, dopamine. Those are some of the ones that come to the top of my mind. And now, if we look at the research, there is not a lot of data supporting this type of testing. But there are a couple of studies that have looked into this. For me, in my private practice, I have used that test over and over again, and I recommend it to people. Because I use that to recommend supplements. So, to see certain patterns, and it works, people get better. So, I tell them, rather than guessing, how about we spend $200 for that test and actually gather more information. Just a couple of days ago, I had a patient, two or three different things on that test that showed that B6 may be deficient. So, it’s such an easy thing to try. Of course, we could do a micronutrient test. B6 sometimes is tricky to test, so this way you find the deficiency indirectly, because three different markers were off, like one of the inflammatory markers, I think it was kynurenine. And then there are a couple of things that were low, I believe. That just all pointed towards possibly the same root cause.
Lindsey:
Okay, yeah, I’ve used the ZRT’s adrenals test, the cortisol/DHEA. But I’d never used their neurotransmitters because I see the serotonin and dopamine and epinephrine, norepinephrine on the organic acids test. But I’ll look at that test. That sounds interesting.
Dr. Damiana Corca:
I like it because it also looks at glycine; I often find that to be low. It makes a big difference. And histamine and how it breaks down, like I have seen and also, N-methylhistamine. So, if there is a problem there, and it’s a conversion problem, it tells me. I have found this to be just a little extra information than the organic acid test. And before we move on, I think I didn’t mention the last one. The overburdened one has to do with toxic load. And by toxicity, it could be heavy metals, it could be – and we don’t define it such – but their body shows up in the sense that if we don’t have enough oxygen, so a lack of something, like a sleep apnea. Then it could be also chronic infections like Lyme disease, it could be an H pylori infection. So, it’s overburdened with some infection or lack of something like, like oxygen, in the case of sleep apnea.
Lindsey:
Yeah. Thanks. So, as I listen, I’m trying to place myself and I feel like I’m a combo of some of those, but part of that is that I take things to try and help me sleep, like melatonin, and so that kind of changes the picture. So, without melatonin, it would certainly take me half an hour to fall asleep, but with, in about seven to 15 minutes or so.
Dr. Damiana Corca:
Half an hour, it’s still reasonable, not ideal. So, if it takes half an hour, I would say 20 to 30 minutes, if you’re the type of person that takes maybe longer, a little bit to settle in your bed, it could be okay. So, then what happens if you don’t take anything? What time do you tend to wake up at?
Lindsey:
Oh, I can’t remember the last time I didn’t take anything because I’ve been taking melatonin . . . and I used to take just a milligram sublingual to help me fall asleep but then I’d wake during the night, typically more in the morning hours, yeah, like five, six if I was getting up at eight and now I’m trying to get up at seven so now it’s 5 a.m. that I’m waking up. And I can see on my Apple watch that I have my deep sleep at the beginning of the night, not tons, somewhere between 30 and 45 minutes typically. And then I’m pretty good. Maybe there’s a slight wake up, I have back pain, so I wake up when I move, like I have to wake up to move and shift my two pillows that I have my body wrapped around. But then it really all goes to pieces somewhere around five in the morning where it’s awake, asleep, awake, in and out. Yeah, it feels like very light sleep. I’m just like, I just want the night to be over. It’s just torture at that point.
Dr. Damiana Corca:
Got it. This discomfort, it is pain for you?
Lindsey:
It’s more just painful that I’m trying so hard to sleep and it’s just not working, and I have hot flashes. Yeah, because while I’m on hormone replacement therapy, for other reasons, I can only get to a certain dose and it’s not sufficient to get rid of the hot flashes. I’ve been playing around with different supplements for hot flashes beyond that, but nothing has made enough of an impact to seem worth it. And so every time my partner moves, I get a hot flash. Anytime I think a slightly bothersome thought, by slightly, like just the tiniest iota of bothersome, sends me into a hot flash.
Dr. Damiana Corca:
And that happens at 5/6 a.m. too?
Lindsey:
Oh, yeah. Especially.
Dr. Damiana Corca:
Yeah, temperature dysregulation, that will keep you up. The body says no, we’re going to stay awake. But it’s good to at least go in and out a little bit rather than fully awake.
Lindsey:
Yeah, I’m not fully awake. By the end of the night, if I’ve given eight and a half hours to try and sleep, I might get between seven and seven and a half typically. So it’s not tragic at the end of the day. So I don’t know which type that would make me.
Dr. Damiana Corca:
That would be actually the anxious type. The anxious type, as I said, is more prevalent at the beginning of the night, but also shows early in the morning going in and out of sleep. That type splits in two of them. And you might not necessarily have anxiety, but most people say they just feel uneasy, kind of like you said, I just want this to be over. It’s irritating. And the mind is not fully asleep. You can’t completely let go and go into a deep, deep sleep.
Lindsey:
Yeah, no, I know my dreams. And I’m listening to them. And I’m paying attention to them.
Dr. Damiana Corca:
And yeah, and it’s normal that we have more dreams at the end of the night. And also, it’s normal that you get most of your deep sleep at the beginning of the night. In the morning when that happens, as I said, the anxious type is all about nervous system dysregulation. So for you, we know that one of the causes is the pain and the discomfort. Sometimes people, when they wake up, if it’s pain, they take a little bit of sublingual CBD to just help soothe them. And maybe that would allow you to go back into a deep sleep. I don’t know if you’ve tried that. But then there are the hot flashes. So that’s the tricky thing.
Lindsey:
Yeah, it is tricky. So I’m curious, starting with melatonin, how do you feel about that as an ongoing supplement?
Dr. Damiana Corca:
It can be helpful. It just depends on each person. I especially recommended it for jetlag to help reset your circadian rhythm. And if I see low in tests, so if the person said they’ve been helped by it, 1-3 milligrams seem safe. And generally, we tend to have lower levels as we age. And I understand there is some research that shows in high dosages like 20 milligrams, it’s even used for anti-cancer, for cancer prevention. So I don’t see a big reason not to take it, unless people have too many vivid dreams or they feel unwell or it has an opposite effect.
Lindsey:
Yeah, yeah. That had been my interpretation. But I was curious what you thought. And then I know that GABA is associated with sleep maintenance. Do you use that at all supplementary?
Dr. Damiana Corca:
It’s based on what the test, the neurotransmitter test that I do, what it says. I also like that test because there is a direct relationship between GABA, which is a calming neurotransmitter, and glutamate, which is excitatory. There is a direct highway between these two and they can convert from one to the other. And so that gives really good information. For example, l-glutamine converts into glutamate. And so in rare cases, I have seen where taking l-glutamine powder to improve gut health will make the insomnia worse. So first, I want to test to see for GABA, if it’s helpful. A lot of people have already tried it and know if it helps or not. But I want to see if it’s low indeed and also what the glutamate and l-glutamine are doing. Sometimes it gives me a hint of where the issue is, is it a conversion issue? If it’s a conversion problem, let’s say glutamate is high, then I use rosemarinic acid to convert more towards GABA and then maybe use GABA temporarily. And then it gets better.
Lindsey:
And, and so rosmarinic acid helps produce more GABA then?
Dr. Damiana Corca:
It produces it if the glutamate is high, because then it converts towards GABA.
Lindsey:
Okay and then how do you use GABA, sublingual or do you use capsules?
Dr. Damiana Corca:
I believe they’re capsules, the PharmaGABA seems to be better absorbed. I believe those are capsules. I’ve never actually used them. I use a couple of different brands that I recommend to my patients, but I believe they’re capsules like pharmaGABA, Thorne*.
Lindsey:
Yeah, I’ve tried that. Those tend to be lower dose, aren’t they like 100 or 200 milligrams or . . . ?
Dr. Damiana Corca:
Yeah, they have 100. And I think 250*, I more rarely go to 500 or 750. Because the people that really need them, they can tell a difference. I have maybe one patient in the last year or two that has had to go to 500. Other than that, they seem to do well with up to 250.
Lindsey:
Okay, yeah, I was curious. So I have tried the pharmaGABA, but it was lower dose. And I know those higher dose ones are out there. So I was thinking about trying something a little heavier, because I’m just getting tired of this whole routine and having to spend so many hours in bed in order to get patchy, not long enough sleep.
Dr. Damiana Corca:
Of course, yeah. I can understand that.
Lindsey:
Yeah, what kind of interventions beyond treating the gut and supplementing, I assume you use amino acids, to bring up neurotransmitters or . . . ?
Dr. Damiana Corca:
Yes, I do.
Lindsey:
Like tryptophan?
Dr. Damiana Corca:
Yeah. I do not use tryptophan because it seems to create more inflammation in the long term. And just maybe last year, I decided to use it for one of my patients, and then because she said she was going to be testing. Sure thing, one of the inflammatory markers increased. And so I tend not to use the tryptophan, I use 5-HTP*. It seems to work well.
Lindsey:
And then do you – I wouldn’t think of l-tyrosine and dopamine as something to work on for sleep. Is that playing into it at all?
Dr. Damiana Corca:
That’s tested in that test, too. And especially l-tyrosine. I see it sometimes lowered, and it’s every time people have thyroid issues. And so I often supplement just because they have a thyroid issue.
Lindsey:
Right, right. Because it’s a precursor to the thyroid hormone, right?
Dr. Damiana Corca:
Yes, it is. What was the second? Oh dopamine. Dopamine, sometimes I see low, I wouldn’t say that’s one of the main drivers for insomnia, it can be more often it’s high. Along with PEA, and so usually when I see those elevated, it’s a conversion issue. Typically, it’s harder than other things to bring dopamine down; it’s easier to improve serotonin production than bring dopamine down, but it is possible. And what has seemed to work from my patients, again, based on the clinical pictures, and looking at that test that I usually do, is using SAMe*. And again, I don’t blindly give it to people, it’s if I have a reason, if we have tested. I know we all have tried different supplements; I have done that. But I feel like when people come and see me and pay me money, we better use something to base it on. Unless I have a very strong clinical experience or something and it matches a symptom; then of course, I can recommend something immediately.
Lindsey:
What other interventions do you use beyond supplements to address sleep issues?
Dr. Damiana Corca:
I use acupuncture for my local patients. That’s my first love. I’ve been an acupuncturist for 15 years now. And for a few years, I used acupuncture only to treat insomnia. And then in the last six, seven years, I’ve been using functional medicine along with it. And it’s very helpful. Sleep hygiene, or I call them sleep foundations. A lot of my patients, they’ve done so many things we all know, maybe you’ve done all the right things. But sometimes as I listen, and I get a really good picture of what a person does in the evening, how they do things, we can make sometimes one or two changes that truly make a difference for a person.
One of the simple changes that people have resistance towards, just mainly because they’re taught differently, is taking naps. I’m a very big fan of naps, if they’re done correctly. Six to seven hours before bedtime. Usually that falls between one and 3 p.m. for half an hour, you can put an alarm clock on. And then I don’t call them naps because some people say “Oh, I can’t nap, I can’t sleep, I can’t nap.” I just tell them, you just take a rest. You just take a little bit of time in the middle of the day to just relax and rest and lie down. The act of lying down in the middle of the day is so unusual for the nervous system that the body cannot help but take that as a positive sign. If you think about it, when we’re constantly chased by a lion, or in this society constantly working on things, processing, doing things, sometimes we’re rushing around, working on our computer constantly, whatever it is for each person, when you start lying down, it’s such a strong signal to the nervous system that everything is safe, everything is okay.
And for most people, sometimes it takes a few days and a few times to even be able to drop in a little bit. Some people actually end up dozing off, and some people say they just get deeply relaxed. And the important thing is not to put any pressure that, oh, if I don’t fall asleep, it’s not helpful. It’s not that. It’s just being able to lie down. If you find yourself taking a deep breath, and then another one, it’s great. And everyone will do that if you’re lying down and putting your phone away. A guided meditation can be okay, just get comfortable, put something over your eyes. And a lot of people, we work from home sometimes, nowadays there are a lot of people who can make that happen. And if not, at least over the weekend.
So we have these natural highs and lows. So in the morning, wake up, energy goes high, cortisol goes high. And then we have an actual dip in the afternoon. We’re made for siestas; we just don’t take them. And we have a tiny bit of melatonin being produced. And also, our core temperature drops a little bit. And of course, at night, the core temperature drops more and also the melatonin production is much higher. But all of those cue us to slow down and take a break. And so, when you do that, you’re more likely to sleep better at night. I have at least a handful of patients, and that might not seem like a lot, but those people have said 100% that’s the thing that helped them the most. The other people think it’s helpful, of course. Many times, we have to do multiple things to support the body, but it’s pleasant. And if you have the time to do it, it’s amazing. It’s just my favorite thing to do.
Lindsey:
And if I know for sure I’m not falling asleep for half an hour, should I take an hour or is still just half an hour?
Dr. Damiana Corca:
Still half an hour and even if you know for sure I can’t fall asleep, still use an alarm clock. Because the mind is a funny thing. One part says, “you’re never going to fall asleep.” And the other part says, “What if you fall asleep? So don’t fully relax.” So maybe you can take 40 minutes if you really want to, but I don’t think longer is better.
Lindsey:
That’s an interesting technique.
Dr. Damiana Corca:
Yeah. So that’s just one thing that comes to mind. At the end of my book*, I have maybe the last 50 pages out of 360 that just talks about the sleep foundations, and many of them have a little bit of a twist based on my experience. Partially being kind to the humans. Like the sleep restriction, it can work really well, but also it can be absolute torture for some of us to practice some of the cognitive behavioral therapy.
Lindsey:
Where you don’t allow yourself to nap.
Dr. Damiana Corca:
Yeah. Yeah, exactly. So for me, based on my practice, there is a middle ground. Some of them are very important to do just as it’s advised in this type of therapy or tool. And some of them I feel like there can be some flexibility that actually can be kind, compassionate towards people. Like when you struggle with sleep issues.
Lindsey:
Yeah. So you brought up the core temperature. And for some reason in my head prior to being more in the functional medicine arena, I’d always thought, oh, your temperature must go up while you sleep because I’m cozy warm when I sleep and I’m freezing the rest of the time. And then of course I heard your core temperature was supposed to drop by how much is it?
Dr. Damiana Corca:
How much is it? I can’t remember it. I don’t think it’s a lot, but it’s enough for the body to get that drowsiness, grogginess. That’s why sometimes we take a hot shower, and then we go into a cool room to mimic that. It’s the same thing. I’m assuming it’s a very small drop. I don’t remember right now. I know all about the temperature fluctuations with hormones. Now, I can’t remember how much it is actually.
Lindsey:
I feel like I’ve heard three degrees.
Dr. Damiana Corca:
Something I’m assuming something like that, like I know with progesterone, when we ovulate, goes half a degree to one degree.
Lindsey:
So three would be a lot.
Dr. Damiana Corca:
Exactly. It has to be less.
Lindsey:
Yeah. But at any rate, I have this watch, and it measures your wrist temperature. And invariably, my temperature goes up when I sleep. And maybe it’s the average of course, and I’m having hot flashes. So it may be that it all averages out to higher but . . .
Dr. Damiana Corca:
And that might be, but what’s the temperature in your bedroom?
Lindsey:
Typically, I turn it down. So I shut the heat vents and put the whole house down to 68 or 67. So I feel like that’s reasonably cool. And I’m freezing other members of the house, so I can’t go much further down.
Dr. Damiana Corca:
Yeah, I can’t tell if you close the vents what the temperature is, but maybe monitor it. I’m curious now, actually in the bedroom what’s the temperature at night, and maybe glance at it a couple of times. I put my temperature between 60 and 63, 62. And keep it even everywhere in the house. So I don’t close the vents. So I don’t know. I’m curious how low it actually drops for you.
Lindsey:
Yeah, I’m not sure I have any interior thermometers, but I could get one.
Dr. Damiana Corca:
Yeah, you can probably get a little one and just put it in your bedroom.
Lindsey:
And maybe those oven thermometers would work. They probably don’t go that low, they might only start at 150. But yeah, I would be curious because it certainly feels chilly. I’m in here recording right now.
Dr. Damiana Corca:
So it is yeah. And a simple thing that also you could try just to manage all the hot flashes is to get a – there are all kinds of gadgets you can get – but there is a cooling blanket. I don’t know if that would help a little bit. Because what happens if you use a cooling blanket, if you just, let’s say it gets a little warm to touch when you use it, but if you just flip it, it’s so nicely cold, but then you’re not leaving yourself exposed, and then you’re about to doze off, and then you’re cold. It’s already there, but just enough you give to that cooling effect.
Lindsey:
I’m pretty much fine if I take the covers off, then that’s enough coldness, plenty of coldness. But I do have to put them back on, but it doesn’t take that long. I mean, within a few minutes, I can put it back on. So, I would say the hot flashes, obviously they’re bothersome, but it’s more, I don’t know, it’s not necessarily the hot flashes keeping me awake. Yeah, just the waking up in the first place like that 5 a.m. wake up that feels like I’m much more awake than just the middle of the earlier night wake ups. It feels more.
Dr. Damiana Corca:
Yeah. So it’d be interesting. Have you ever tested your saliva cortisol? And did you five . . .
Lindsey:
I haven’t.
Dr. Damiana Corca:
I would do that, like I would do the cortisol awakening response. I would start the morning, the three morning samples at 7 a.m., but then I would ask them for an extra sample. I use ZRT, and I just ask them for an extra sample for the 5 a.m. And then make sure you count that as a nighttime sample and see how high it is. And I’m assuming it’s higher than it should be, but I try not to assume things and test. And then we have to identify why. Maybe it’s the hot flashes partially, maybe it’s the pain that increases the cortisol and maybe you can work with decreasing cortisol, maybe we can work more with the pain. Maybe the CBD but it’s like definitely something that activates your body. And make sure also that you don’t have sleep apnea. That can show up early in the morning if there is any.
Lindsey:
No snoring or any sign of that at all. Yeah, the pain is tricky. It’s more I just have to stretch my back to make it feel better and keep curving it. I’m like the opposite of everyone else who leans over computers and never arches their back. Mine is like overarched and I have to flex it.
Dr. Damiana Corca:
Right. I get you’re waking up. But then the question is, if you stretch, you should be okay for another couple of hours, right? So you’re not. So I’m wondering if something stressed the nervous system up to that point. And then with cortisol, it takes about 10 minutes to be produced. Once it’s produced, it takes an hour and a half to two hours to fully be lowered in the body so you can get to that baseline, but then it’s time to wake up so it’s too late.
Lindsey:
Yeah, sometimes I’ll just take another melatonin, a sublingual, at that point, if it’s five, and I’m getting up at eight, but now I’m getting up at seven. I feel like that’s a little late to take it at five, but it’s almost better to just do it, but I don’t want to be groggy. It’s a dilemma. So tell me more about your book, The Deep Blue Sleep*.
Dr. Damiana Corca:
Yeah, so the book, what should I say about the book? It’s newly published and I categorize the main types of insomnia and the five types that I just explained a bit earlier. And it’s a great framework, because even as a practitioner, I use that framework and also to explain it to my patients. Because then it allows us to figure out in which direction to go. And that framework actually is originally based on Chinese medicine. In Chinese medicine, functional medicine, we’re all talking about the same thing, we’re just using different terms. In Chinese medicine, we might say the person has digestive issues with a stomach and spleen deficiency, something along those lines. And in western medicine, we see the same correlation.
So that’s actually how I got to that point where again, a patient would come to me and they would say, I sometimes can’t fall asleep all night or it takes many hours, and then I’m in and out of sleep, I don’t really fully sleep. And that’s it. They wouldn’t have any other symptoms. Nothing. Literally no symptoms besides that. And so in Chinese medicine, I will take the pulse and look at the tongue and maybe I will look at the tongue and look at the coating and it will be very thick. And then the pulse quality would show me that oh, they have digestive issues, interesting. So, I will tell them what I see. And I will treat that. And then they would get better. And then later when I learned functional medicine, I realized how this pattern really shows we need to dig deeper. And so food sensitivities, maybe an elimination diet. There was a really good reason besides my diagnosis from Chinese medicine, we would do a stool analysis. And over the years, I noticed that there was a correlation.
Then at the beginning of the pandemic, it was on my mind to write a book. And it was for about six months before that, but I was just exhausted, I was like, I don’t even know when I could make the time. It takes a lot of brain concentration for me to sit down and write. So when the pandemic hit, I thought I had two weeks to be focused. So I thought I would just get down to the layout of the book. And then I had more time. I ended up staying at home maybe three months, and I got maybe 90% of the book done. But right at the beginning of writing the book, I thought, “How do I organize this book?” And I started thinking really hard about all of my patients. And that’s how I came up with those five different patterns. So based on that, then I explained the five different types and where to look. And then I guess the other biggest chapter in the book is about the nervous system, really understanding what it takes for the nervous system to feel safe to settle into sleep. And what stress really means, because stress could come from inflammation, whether it’s gut or other type of inflammation, from food sensitivities, from stress. It can come from not having enough hormones or too much, like low progesterone, high estrogen, or it could be lack of serotonin or GABA or having too much dopamine. Or glutamate, or toxins just constantly irritating the nervous system.
So in essence, it gets down to, okay, the nervous system is stressed, you can’t sleep at night, let’s find out why. If I could break down the why into two very simple terms, it would be you don’t have enough of something to nourish, whether it’s vitamins like B6, or you don’t have enough serotonin or GABA, or you have too much of something like too much cortisol, or a food sensitivity that causes a lot of inflammation, which causes higher cortisol. So in essence, it’s something that’s irritating the nervous system, so something that doesn’t have enough of to have nourished, sustained sleep. And so then the nervous system, the digestion, the hormones, toxins, and infections, and then at the end, the sleep hygiene, sleep foundations, things that we all know quite a bit about, especially if you struggle with insomnia. But I tried to think of my last 14 years of experience and what has worked for people, what’s important.
Lindsey:
Yeah, I was really impressed by the foreword by the reviews from famous functional medicine people at the beginning.
Dr. Damiana Corca:
Yes, I was very fortunate to reach out to a couple of them and they read the book and gave me a review. And then I reached out to a few more and a few more, and they were just kind people. They took a look, they liked what they saw. So they left a review. Yeah, that was awesome.
Lindsey:
So one more question related to supplements. Thinking more about the pharmaceutical type supplements, what would you say is the least harmful over the counter sleep supplement?
Dr. Damiana Corca:
Sleep supplement or sleep medication?
Lindsey:
Medication, not prescription though.
Dr. Damiana Corca:
Oh, people like to take Benadryl. I think that’s the most common one. I always, when it comes to medication, whether it’s over the counter or medication or prescribed, if it helps them in the moment, I would say do not disturb the balance. First, figure out why you have sleep troubles and then taper off with the help of your doctor. So it’s finding that balance. Of course, if you feel like it’s not the right thing for you, then talk to your doctor and come off of that immediately. Or if Benadryl doesn’t work, or it has side effects, or you feel really groggy the next day. And of course, don’t stay on it. But I’m not against pharmaceuticals, they have their place sometimes. And if it helps keep you in a decent place for a month or two or three until the more natural solutions kick in, then that’s very important. Because with natural solutions, sometimes you can see results immediately. But if you think about it, between working with someone, taking some tests, trying something, it just takes a while. Or if it comes to gut health and an elimination diet or doing some tests, it takes time to heal.
Lindsey:
Yeah. So what would be the dangers of using Benadryl long term?
Dr. Damiana Corca:
I believe that the danger is that they say that increases the risk of dementia.
Lindsey:
I believe so, yeah.
Dr. Damiana Corca:
I believe so. Yeah. So I will always remind that to people and I tell them, don’t worry about it right at this moment. It’s just you don’t want to do nothing. Months and years from now, yeah.
Lindsey:
Okay, great. Where can people find you? Do you see individual clients?
Dr. Damiana Corca:
I see individual clients at this moment in Boulder, Colorado, for acupuncture and functional medicine, and then we are telemedicine all over the world. And I have a quiz on my website. Maybe you can take the quiz too. But that quiz, it gives you a number of questions to help you figure out which main type you may be and what the solutions are to that. And then my book is available on Amazon, Barnes and Noble and major bookstores.
Lindsey:
Awesome. Thank you so much for sharing your knowledge with us.
If you are struggling with bloating, gas, burping, nausea, constipation, diarrhea, soft stool, acid reflux, IBS, IBD, SIBO, candida overgrowth, fatigue or migraines and want to get to the bottom of it, that’s what I help my clients with. You’re welcome to set up a free, 30-minute breakthrough session with me. We’ll talk about what you’ve been going through and I’ll tell you about my 3- and 5- appointment health coaching programs in which I recommend lab tests, educate you on what the results mean and the protocols used by doctors to fix the problems revealed. Or if you’re ready to jump in right away or can just afford one appointment at a time, you can set up an 1-hour consultation with me.
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