How Can I Get Enough Sleep?

By Dr. Keesha Ewers, PhD, ARNP, IFMCP

The Functional Medicine Approach to Trouble Sleeping

Many of my clients say they have trouble sleeping. They aren’t getting enough restorative sleep and that is impacting their ability to deal with their autoimmune diseases and everyday life. Conventional approaches to sleep issues often focus primarily on the symptom: “I can’t sleep.” Functional medicine asks: “Why can’t you sleep?” to figure out the root causes of your sleep issues.

Functional medicine practitioners know that two people may both struggle with insomnia, but the underlying reasons could be completely different. One person may have an overactive stress response. Another may have blood sugar fluctuations. Someone else may have an inconsistent circadian rhythm, hormonal changes, nutrient deficiencies, medication effects, or an undiagnosed sleep disorder.

That’s why I look at the whole person and consider all the factors that may be affecting sleep. Here are some of the factors I ask my patients about:

1. Circadian Rhythm

Your circadian rhythm is your body’s internal 24-hour clock. If your internal clock is off, all of your body systems can be impacted.

2. Sleep-Wake Schedule

Your body thrives on rhythm and consistency.

Going to bed at 10 p.m. one night, midnight the next, and 9 p.m. the following night can make it more difficult for your circadian system to predict when it’s time to sleep.

I work with my clients to help them create a better sleep routine, with consistent:

Wake-up time
Bedtime
Meal schedule
Exercise routine
Morning light exposure

Even if you had a poor night of sleep, maintaining a consistent wake time can help reinforce your circadian rhythm.

3. Nervous System

One of the most common reasons people struggle to sleep is that their bodies are tired—but their nervous systems are still “on.”

You may recognize this feeling:

Your body is exhausted.
But your brain won’t stop.
You’re thinking about tomorrow’s to-do list.
Replaying conversations.
Worrying about finances.
Planning your next project.
Or simply feeling restless and unable to settle.

This can happen when your nervous system remains in a state of heightened alertness.

From a functional medicine perspective, supporting sleep may require supporting the nervous system—not simply adding a sleep supplement.

4. Evening Light Exposure

Your body uses light as a biological signal.

Bright light in the evening—particularly blue-enriched light from screens—can interfere with the signals that help prepare your body for sleep.

This doesn’t mean you need to live without technology.

Instead, consider reducing your exposure to bright light in the hours before bed.

Try:

Dimming household lights
Using warmer lighting in the evening
Reducing screen brightness
Taking breaks from phones and computers
Avoiding highly stimulating content before bed

If you use screens at night, consider using built-in night modes or blue-light reduction settings.

Even better, create a period of time before bed when you aren’t consuming work-related or emotionally stimulating content.

5. Blood Sugar

Have you ever woken up in the middle of the night feeling hungry, shaky, sweaty, or suddenly wide awake?

Blood sugar fluctuations may be one factor to consider.

Your body works hard to maintain stable blood glucose throughout the night. For some people, eating a highly refined or sugary meal before bed—or going too long without adequate nutrition—may contribute to nighttime disturbances.

A functional approach may include paying attention to:

What you eat at dinner
How much protein you consume
Your carbohydrate intake
Alcohol consumption
Evening snacking
Your individual response to fasting

A balanced evening meal containing adequate protein, fiber, healthy fats, and nutrient-dense carbohydrates may support more stable energy overnight.

The right approach is highly individual.

6. Caffeine and Alcohol Use

Sometimes the habits we use to manage our energy during the day can interfere with our ability to sleep at night. Caffeine has a relatively long half-life, meaning it can remain in your system for hours.

If you’re struggling with sleep, stop drinking coffee for caffeinated drinks earlier in the day. Some people do well with no caffeine after noon. Others may need to stop even earlier.

Alcohol can also affect sleep quality. While alcohol may initially make you feel sleepy, it can interfere with sleep architecture and cause you to wake up in the middle of the night.

If your sleep isn’t restorative, consider reducing or eliminating evening alcohol and see whether your sleep improves.

7. Sleep Environments

Your bedroom should communicate one message to your body:

It’s time to sleep.

Consider creating an environment that is:

Cool
Dark
Quiet
Comfortable

Blackout curtains or an eye mask can help reduce light exposure. Earplugs or white noise may help reduce disruptive sounds.

Keep your bedroom at a comfortable temperature and choose bedding that allows you to regulate body temperature throughout the night.

8. Nutrition and Lifestyle Factors

The body requires adequate nutrients to support healthy nervous system function, hormone production, and energy metabolism.

Depending on your individual needs, nutritional factors that may be relevant to sleep include:

Magnesium
Vitamin D
B vitamins
Iron
Zinc
Omega-3 fatty acids

However, more isn’t always better.

Taking large amounts of supplements without understanding your individual needs isn’t necessarily helpful—and in some cases, it can be harmful.

Functional medicine emphasizes identifying potential deficiencies or imbalances and addressing them strategically. This may involve reviewing your diet, lifestyle, medications, health history, and, when appropriate, laboratory testing.

9. Hormones

Hormonal changes can significantly affect sleep.

This is especially true during periods of hormonal transition, including:

Perimenopause
Menopause
Postpartum changes
Thyroid dysfunction
Changes in adrenal and stress physiology

Hormonal shifts may contribute to:

Night sweats
Difficulty falling asleep
Early morning waking
Anxiety
Restlessness
Changes in body temperature

If your sleep problems began around the same time as other hormonal changes, it’s worth looking at the bigger picture.

10. Sleep Apnea

Sometimes the most important step toward better sleep is identifying an underlying sleep disorder. Sleep apnea can interfere with restorative sleep and may occur even when someone doesn’t realize they’re having trouble breathing at night.

Possible signs include:

Loud snoring
Gasping or choking during sleep
Morning headaches
Dry mouth upon waking
Excessive daytime fatigue
Difficulty concentrating
Waking frequently during the night
High blood pressure

If you suspect sleep apnea, talk with a qualified healthcare professional about appropriate evaluation.

11. Gut Health

The gut and brain are in constant communication through what is often called the gut-brain axis. Your digestive system interacts with your nervous system, immune system, hormones, and metabolism.

For some people, digestive symptoms and poor sleep occur together.

If you’re experiencing:

Bloating
Constipation
Diarrhea
Reflux
Food sensitivities
Irregular digestion

It may be worth exploring whether gut health is part of the larger picture. A functional approach may consider dietary patterns, digestive function, stress, microbiome health, and other factors that could influence both digestion and sleep.

12. Physical Activity

Regular physical activity can support healthy sleep. Movement may help regulate stress, improve metabolic health, support mood, and reinforce healthy circadian rhythms. You don’t need an intense workout to benefit.

Try:

Walking
Strength training
Yoga
Mobility work
Cycling
Swimming
Outdoor activities

If possible, incorporate movement into your day rather than relying entirely on one workout. A morning walk in natural light can be especially beneficial because it combines two important circadian signals: light and movement.

A Functional Medicine Sleep Checklist

If you’re struggling with sleep, start by asking:

Circadian Rhythm

☐ Do I get natural light in the morning?
☐ Do I maintain a consistent wake-up time?
☐ Do I get outside during the day?

Evening Routine

☐ Do I have a consistent wind-down routine?
☐ Do I dim the lights at night?
☐ Do I reduce stimulating screen use before bed?

Nutrition

☐ Am I eating enough protein and nutrient-dense foods?
☐ Do I notice a connection between certain foods and my sleep?
☐ Am I consuming caffeine too late in the day?
☐ Does alcohol affect my sleep?

Nervous System

☐ Do I feel calm and relaxed before bed?
☐ Do I have a way to process stress?
☐ Do I regularly practice relaxation or mindfulness?

Sleep Environment

☐ Is my bedroom cool?
☐ Is it dark enough?
☐ Is it quiet?

Underlying Factors

☐ Have my sleep problems changed alongside hormonal changes?
☐ Do I have digestive symptoms?
☐ Do I snore or wake gasping?
☐ Have I considered whether an underlying health issue could be affecting my sleep?

The Bottom Line: Better Sleep Starts With the Bigger Picture

Sleep is not an isolated process. It’s connected to your circadian rhythm, nervous system, hormones, metabolism, nutrition, environment, movement, and overall health. That’s why the functional medicine approach to sleep looks beyond the question:

“What can I take to help me sleep?”

Instead, we ask:

“What is preventing my body from sleeping well in the first place?”

Sometimes the answer is as simple as inconsistent light exposure or a disrupted sleep schedule. Other times, the underlying issue may involve stress, hormones, blood sugar, nutrient status, gut health, medication effects, or an undiagnosed sleep disorder.

When you identify the factors that are keeping your body from resting, you can begin creating the conditions your body needs for deeper, more restorative sleep.

When to Seek Professional Support

If you’ve consistently struggled with sleep despite making lifestyle changes—or if your sleep problems are significantly affecting your energy, mood, memory, or daily life—it may be time to look deeper.

Consider working with a qualified healthcare professional who can help evaluate the bigger picture, including:

Hormonal health
Nutritional status
Blood sugar regulation
Thyroid function
Stress physiology
Digestive health
Medications and supplements
Sleep disorders

The right approach depends on your individual history, symptoms, and health goals.

Your sleep is information.

Listen to what it’s trying to tell you.