STRESS: The Hidden Culprit in Insomnia & Anxiety

© by Elizabeth Lee Vliet MD and Kathy Kresnik

The “COVID-era” has brought a marked increase in stress-related health problems in my medical practice. Two in particular—insomnia and anxiety—are often medicated with dependency-inducing Rx medicines that can adversely affect memory, balance, and mental clarity.  Yet, natural medicine supplements, behavioral, and lifestyle strategies would fix the problem if people would put all the pieces together as Kathy and I describe in today’s Health Tip!

A good example is my recent patient, a 62-year-old, professional woman with a high stress job who has been a patient of mine for 10 years. She is post-menopausal and I have treated her with FDA-approved bioidentical estradiol after a hysterectomy 10 years ago. Overall, she’s been in good health and has been very stable on her hormone therapy, that also includes thyroid medication. But at her appointment in February, she described having an extremely stressful year with elderly parents and relatives needing extensive care, overseas travel, long work days keeping up with her own career, plus planning for one of her adult children’s wedding. She described having intensified anxiety, insomnia, difficulty concentrating and felt like she just wasn’t doing as well as she had been since we initially stabilized her on the hormone therapy and her health and resilience supplements.  None of her prescription medications needed adjustment at her appointment since all her lab results were in optimal ranges on her current hormone doses. She already had a good meal plan and exercise program. I suggested a few changes in her sleep hygiene habits (see my Health Tip: Dr. Vliet’s Guide to Optimal Sleep).

The big change I recommended was to add our TruInositol™ Complex to help reduce the anxiety and stress-related insomnia.  At her follow up appointment in August, she said “The inositol complex you recommended made a HUGE difference! My anxiety is gone, I am sleeping a lot better, and I also noticed that the increased appetite I had with all the stress is back to normal, so I think the complex was a really helpful addition to all that you have been doing for me.”

The Vicious Cycle: Stress-insomnia-anxiety-more stress!

Stress in your life affects your quality of sleep. Then when you don’t sleep well, you are more anxious and don’t feel well, which in turn adds to your stress and creates more problems sleeping and more anxiety.  It is a terrible and serious vicious cycle that is reinforcing itself. But it is much deeper than that, since there are major physiological connections with the way stress changes your brain and body biochemically, and even structurally.  These changes then affect sleep regulatory pathways and chemical messengers in the brain in adverse ways.

The first step to getting a good night’s sleep is to understand how stress disrupts the brain sleep regulation and metabolic-endocrine pathways that need to be in balance for optimal quality of sleep.   I will briefly explore the effects of stress on the body, then dive deeper into the specifics of how stress disrupts sleep, and the ways I am helping my patients reduce the damaging impact of stress and improve insomnia.

What is Stress?

The formal definition of stress is the body’s normal psychological and physical reaction to stressors, which are the demands or changes in life that trigger the body to respond and adapt.  This is often called the “fight or flight” response, and it means our stress hormones are preparing the body to handle the challenge.  Temporary physiological changes occur, such as increased heart rate, increased in blood pressure, and release of “adrenaline.”  This is referred to as acute stress, which by definition is brief in duration and can be helpful in dealing with specific situations.

A stressor, the “stimulus” to which the body responds, can be positive (e.g., a promotion) or negative (e.g., a job loss).  Stressors can be events in our lives, environmental changes, illnesses, or thoughts (fear or excitement), as well as many other sources of stimuli.  Stressors can be energizing, motivating and stimulating, or they can be sources of fear, apprehension, worry and anxiety.

Positive stress is also called eustress. Eustress helps you get things done. But when stress becomes negative and overwhelming, it becomes distress, especially when persistent over time. Chronic stress is a long-term stress caused by persistent stressors over weeks, months, or longer without adequate relief. The body is continually activating the fight or flight response which leads to extensive damage to the body through prolonged exposure to stress hormones like cortisol and adrenaline. High levels of distress for long periods of time lead to chronic illness and disease. 

Keep in mind: stressors are present all day long, every day of our lives.  We cannot eliminate them and still be alive. The goal is NOT to eliminate all stress. That is impossible. The goal is to control how we respond, and work on addressing the balance of stressors.

How Stress Affects the Body: While acute stress responses are adaptive and protective, chronic stress leads to sustained hormonal and sympathetic activation that damages multiple organ systems and increases disease risks.

• Cardiovascular system: Chronic stress raises heart rate and blood pressure, increasing risk of hypertension, heart disease, heart attack, and stroke. Stress hormones also promote blood vessel constriction, endothelial dysfunction, and increased platelet aggregation, which contribute to thrombosis and atherosclerosis. Stress can also cause unhealthy behaviors such as poor diet, smoking, and low exercise, compounding cardiovascular risk.​

• Brain and cognition: Long-term stress can cause structural brain changes, including shrinkage of regions like the prefrontal cortex and hippocampus. This may impair memory, cognitive function, and emotional regulation, contributing to anxiety, depression, and insomnia. Persistent inflammation and neurochemical imbalance from stress can lead to neuronal damage and loss.

• Immune system: Chronic stress weakens immunity, making the body more vulnerable to infections and slowing healing processes. It also promotes systemic inflammation, which can worsen autoimmune disorders and chronic diseases.

• Musculoskeletal system: Constant muscle tension from ongoing stress often leads to pain, headaches, and musculoskeletal disorders, including chronic pain syndromes. Muscle guarding and atrophy can develop with reduced physical activity due to stress.

• Other effects: Stress disrupts sleep patterns causing insomnia, affects digestive health leading to issues like irritable bowel syndrome, and alters metabolism which can contribute to obesity, diabetes, and weight fluctuations.​

BOTTOM LINE: Chronic, persistent stress via prolonged fight or flight activation causes multi-system damage significantly contributing to adverse long-term health problems and disease risks (including cancers), and significantly impairs quality of life.

How Chronic Stress Affects Sleep:

Chronic stress negatively affects sleep by making it harder to fall asleep, increases night-time awakenings, and reduces sleep quality. Together, these changes are referred to generally as “insomnia.”  The ongoing sleep disruption is then a form of chronic stress that activates the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system, leading to elevated stress hormones such as cortisol and adrenocorticotropic hormone (ACTH). Increased cortisol heightens alertness and delays sleep onset, while ACTH is associated with more frequent awakenings and fragmented sleep patterns. Stress also suppresses the ovarian axis in women and testicular function in men, which in turn add to the endocrine imbalances that impair sleep.

Stress also disrupts the balance and duration of slow wave sleep and REM sleep—crucial phases for restoration and memory consolidation—resulting in reduced deep sleep and REM sleep instability, especially in those with high sleep reactivity. This is the reason people with insomnia describe more problems with memory, concentration and focus on tasks.

Vicious Cycle of Stress and Insomnia:

Stress not only triggers sleep problems but sleep disturbances themselves further activate the body’s stress response systems, creating a feedback loop that perpetuates both stress and insomnia. Individuals under chronic stress often ruminate or experience persistent worry at bedtime, which prolongs the time to fall asleep and fragments sleep throughout the night. With ongoing poor sleep, the ability to handle stress is further diminished, making stress and sleep difficulties mutually reinforcing. Then when people can’t sleep, they often turn to TV or phones and other devices for something to do, and the screen blue lights and flickers make sleep harder to achieve and more fragmented.

Chronic sleep loss due to stress impacts endocrine and metabolic function, impairs learning and memory, and weakens immune system activity. Over time, this cycle can contribute to fatigue, mood disorders, and increased risk for health conditions associated with chronic insomnia and stress.

Important Lab Tests to Assess Nutrient Deficiencies Affecting Stress and Sleep:

I order comprehensive lab testing for my patients to identify specific hormonal, metabolic, inflammatory, and vitamin and mineral deficiencies that can significantly impact stress levels and sleep quality. I also make sure to test for and correct any of these deficiencies. There are several specific stress-related laboratory tests that can be ordered (n addition to the complete list I have included in our LONG COVID and COVID Vaccine Injury Treatment Guide on our website):

• Cortisol Test (Serum):
  Measures cortisol levels directly in blood (I do not use saliva, or urine, as these are less reliable than serum tests drawn at the correct times of day: 8 AM total and free cortisol, 4 PM total and free cortisol assess diurnal rhythm and abnormalities such as elevated or suppressed cortisol, related to nutrient status and adrenal function.

• ACTH Stimulation Test:
  Evaluates adrenal gland response by measuring cortisol before and after synthetic ACTH administration to detect adrenal insufficiency or dysfunction linked to nutrient deficiencies affecting adrenal health.

• Serum and Red Blood Cell (RBC) Magnesium Test:
  Magnesium RBC testing is the best available clinical measure for identifying intracellular magnesium deficiency to guide effective treatment decisions. This measures magnesium levels inside red blood cells, providing a more accurate indication of cellular magnesium stores, which is where most magnesium resides in the body. Serum magnesium measurements are important to assess serum magnesium-calcium ratios that affect many functions, but serum levels often remain normal despite loss of intracellular magnesium, so I check both of these levels to assess magnesium  related to energy production, muscle and nerve function, and metabolic health. 

• Vitamin D (25-Hydroxy Vitamin D)

• Iron Studies (Serum Ferritin)

• B Vitamin Panel (B12, Folate, B1, B2, B3, B6)

• Zinc (serum zinc)

Important Nutrient Deficiencies Affecting Stress and Sleep:

1. B Complex Vitamins Involved in Stress Hormone Regulation

The B Complex group of vitamins is one of the most important group of vitamins involved in stress hormone regulation through their roles in adrenal function, neurotransmitter production (serotonin, dopamine, GABA), and hormone balance. B vitamin deficiencies are a serious contributing factor in increased insomnia and anxiety when we are under stress because the B vitamins play such critical roles in many brain pathways regulating sleep, mood, pain, and cognitive function.  B vitamins are rapidly depleted during times of stress, and people have difficulty absorbing B vitamins as they get older and stomach acidity declines.  Deficiencies in B vitamins are linked to increased psychological distress (anxiety, depression), disrupted stress response and sleep architecture, and symptoms like nocturnal leg cramps that interfere with sleep.  . Low B12 especially affects neurological function and may raise cortisol production indirectly by increasing anxiety and nervous system irritability.

B vitamins are water soluble, and need to be replenished in in our diet or supplements on a daily basis because they are not stored in body fat as we see with Vitamins D, E, and K.

• Vitamin B12 (Cobalamin):
  Critical for nervous system health and HPA axis function, B12 supports cognitive function and mood regulation. Deficiency can impair stress resilience, promote anxiety, and lead to dysregulation of cortisol and other stress hormones.

• Vitamin B9 (Folate/Folic Acid):
  Folate is involved in neurotransmitter production (serotonin, dopamine, epinephrine), DNA repair, and energy metabolism. It supports mood regulation, reducing depression and improving stress coping. Low folate is linked with impaired stress hormone regulation.

• Vitamin B1 (Thiamine):
  Supports energy metabolism, nervous system function, and assists in maintaining a healthy stress response. Thiamine deficiency can impair metabolic and neurological stress responses.

• Vitamin B2 (riboflavin) and B3 (niacin) play complementary roles in stress resilience and sleep quality.  B2 (Riboflavin) is essential for critical stress functions: energy metabolism, antioxidant defense, and adrenal function.  Chronic stress increases oxidative damage and mitochondrial dysfunction, which vitamin B2 helps counteract  by supporting glutathione cycles and minimizing nerve inflammation, which reduces stress-related fatigue and headaches.​Supplementation with B2 has also been shown to help reduce stress, improve sleep quality, and decrease sleepiness, but does not significantly lower anxiety. Vitamin B2 protects brain areas involved in stress response and sleep regulation, especially during recovery from insufficient sleep.​ Higher dietary riboflavin intake correlates with better sleep quality, greater daytime alertness, and reduced feelings of fatigue.​

• Vitamin B3 (Niacin) is vital for NAD+ synthesis, supporting cell energy, DNA repair, and nervous system health, which are all challenged during chronic stress.​ Adequate niacin supports adrenal function, resilience to stress, and emotional regulation through neurotransmitter synthesis (serotonin, dopamine, GABA) and deficiency may worsen depression and anxiety.​ Niacin also plays a key role in tryptophan metabolism. When NAD+ levels are low, tryptophan diverts toward NAD+ production rather than melatonin and lowers sleep quality. Supplementation with vitamin B3 improves sleep efficiency, boosts REM sleep, and reduces fatigue and drowsiness in people with insomnia.​ Niacin’s effect on circadian rhythm and prostaglandin D2 synthesis further supports sleep and recovery following sleep loss.​

• Vitamin B5 (Pantothenic Acid):
  Essential for adrenal gland function, B5 is critical in the synthesis of coenzyme A (CoA), which supports production of adrenal hormones including cortisol, the primary stress hormone. Adequate B5 helps maintain balanced cortisol production and an appropriate stress response.

• Vitamin B6 (Pyridoxine):
  B6 is vital for creating neurotransmitters that regulate mood and stress responses such as GABA, serotonin, dopamine, and noradrenaline. It modulates the nervous system’s excitability and helps influence cortisol regulation. Deficiency may increase anxiety and impair stress hormone balance.

Other Nutrients Critical in Stress Hormone Regulation:

• Vitamin D:
  Low vitamin D levels are associated with increased stress, poor sleep quality, shorter sleep duration, and increased risk of sleep disorders like sleep apnea. Vitamin D also helps regulate mood and circadian rhythms. Deficiency in vitamin D deficiency is associated with elevated cortisol, primarily through dysregulation of the HPA axis and cortisol metabolism, and supplementation has been shown to reduce cortisol levels. Vitamin D also helps regulate serotonin synthesis and has anti-inflammatory and neuroprotective effects, which modulate stress hormone production further supporting the role of vitamin D in managing stress hormone balance. Supplementing supports mood regulation, helps with chronic stress and may improve sleep duration and reduce night waking.

• Magnesium:
  Magnesium deficiency can lead to difficulties falling asleep, restless nights, and increased autonomic arousal associated with stress. Magnesium supports muscle relaxation, calming neurotransmitters (GABA) which helps reduce stress by breaking the cycle of magnesium depletion caused by stress.​ Specifically, magnesium deficiency amplifies the body’s stress reactivity, leading to persistently elevated cortisol and adrenaline levels, which contribute to anxiety, sleep disruptions, inflammation, and metabolic disturbances. Magnesium acts as a natural modulator by suppressing overactivity in stress-related brain regions. Correcting magnesium deficiency through diet and supplementation can help restore balance to the stress hormone system and improves sleep quality without sedative effects.

• Calcium:
  Calcium is essential for melatonin synthesis, the hormone that regulates sleep-wake cycles. Deficiency can impair the body’s ability to signal sleep onset effectively. Best sources of calcium are through food such as dairy for optimal throughout the day.​

• Vitamin C and E:
  As antioxidants, low levels may increase oxidative stress, which negatively affects sleep and exacerbates symptoms of restless legs syndrome and sleep apnea.

• Vitamin A and K:
  Deficiencies may contribute to shorter sleep duration and poorer sleep quality, potentially related to their roles in circadian regulation and antioxidant defense.

• Zinc:
  Zinc deficiency disrupts GABA receptor function, heightening anxiety and stress hormone release. Zinc supports neurotransmitter synthesis and immune response, which are compromised during stress.

• Iron Deficiency (low ferritin): Key Effects from Research Studies:
  Iron deficiency anemia is associated with restless leg syndrome and periodic limb movements during sleep, which disrupt sleep maintenance. Low iron worsens sleep quality and can increase fatigue and stress. Iron deficiency influences the hypothalamic-pituitary-adrenal (HPA) axis and stress hormones primarily by dysregulating the negative feedback mechanisms and amplifying stress responses. This leads to increased anxiety and sleep disturbances linked to elevated cortisol levels and altered adrenal function. Iron deficiency also leads to fatigue and irritability and impairs oxygen delivery to the brain, compounding stress effects.

Impaired Negative Feedback of HPA Axis:
Iron deficiency reduces activity of the glucocorticoid receptor (GR) pathway in the hippocampus, which normally inhibits cortisol release. This impairment weakens feedback suppression, causing prolonged and elevated cortisol (glucocorticoid) levels during stress.

Increased Basal and Stress-Induced Cortisol/Norepinephrine:
Animal studies show iron deficiency leads to higher baseline corticosterone (rodent equivalent of cortisol) and increased norepinephrine (adrenaline precursor) in response to stress. This suggests heightened HPA axis and sympathetic nervous system activity related to iron deficiency.

Neuroendocrine Disruption and Behavioral Changes:
Early life iron deficiency causes long-term changes in neuroendocrine stress responses, including altered cortisol patterns and increased anxiety behaviors. These changes may persist despite iron repletion, indicating developmental programming of the HPA axis.

Stress-induced Interference with Iron Metabolism:
Chronic stress and HPA axis dysregulation can also affect iron absorption and metabolism through inflammatory pathways and hepcidin regulation, creating a bidirectional relationship where stress exacerbates iron deficiency risk. ​

Iron deficiency thus compromises proper HPA axis regulation, causing sustained elevation of stress hormones cortisol and adrenaline, heightening physiological stress responses and potentially contributing to anxiety and sleep disturbances.

In summary, magnesium, vitamin D, iron, and B complex vitamins are the deficiencies that most strongly raise stress hormone levels, particularly cortisol. These nutrients are critical for regulating the nervous system, neurotransmitter synthesis, and hormonal balance, all of which impact the body’s stress response.​

TruInositol™ Complex: A Natural Supplement to Reduce Anxiety and Improve Sleep:

Correcting nutrient deficiencies may not be enough to counteract high and prolonged levels of stress. Remember the patient story at the beginning of this health tip? Even with testing done to measure and optimize her hormone therapy and address the nutrient deficiencies she had at the outset, her chronic stress was still affecting her sleep and leading to intensified anxiety.  She followed my recommendation and found success with the Truth for Health Foundation’s TruInositol™ Complex, an innovative powdered drink mix. It contains a blend of ingredients that supports the body’s natural synthesis of catecholamines, the inhibitory neurotransmitter GABA, hormonal balance, and healthy glucose metabolism.

TruInositol™ Complex is used to promote a calm, relaxed, well-balanced emotional and physiological state. It combines myo-inositol with GABA and several other ingredients to support sleep, mainly through promoting relaxation and calming brain activity, and play a role in regulating neurotransmitters that influence sleep quality.

TruInositol™ Complex Ingredients: 

• Inositol, which used to be known as Vitamin B8, is an overlooked and underappreciated nutrient considered “conditionally essential” because it cannot be synthesized by the body in sufficient amounts for our daily needs.   Inositol has so many brain-body benefits including metabolic health, treating PCOS, improved mental health, nerve function, anti-cancer properties, and sleep regulation. Inositol helps increase GABA levels naturally and supports the balance of other neurotransmitters like serotonin and dopamine, which are essential for relaxation and sleep regulation. Inositol also acts as an adaptogen, promoting calmness and reducing anxiety, which are often barriers to restful sleep.​

Chemically, inositol is a complex sugar alcohol found in foods and can be synthesized to some degree from glucose, but it may become essential to supplement under certain conditions such as illness, stress, or rapid growth. Inositol has a cyclohexanol structure, a six-carbon cyclic polyalcohol that occurs naturally in all living cells which allows for the formation of nine different isomers.  Myo-inositol and D-chiro-inositol are the two most common and the most significant isomers in the human body. Inositol can be found in fruits, vegetables, beans, grains, and nuts but unfortunately, we may not be able to get all we need just from food as more than half of ingested myo-inositol that is absorbed in the gastrointestinal tract becomes lipid bound. The body also produces another 4 grams each day synthesized from glucose, primarily in the kidneys, but also in tissues where it’s needed, such as the brain, liver, ovaries, and testes but this may not be enough under chronic stress conditions.

• GABA (gamma-aminobutyric acid ) an amino acid manufactured in brain cells from glutamate directly inhibits brain activity associated with stress and overexcitement, facilitating the onset of sleep and improving sleep quality. This primary neurotransmitter, abundant in the cerebral cortex, increases the production of alpha waves for a relaxed, yet mentally focused state, while decreasing beta waves that are associated with hyperactivity, nervousness, and fleeting thoughts. Sufficient GABA results in the smooth, calming, regular rhythmic flow of electrical impulses in the brain needed for emotional well-being. Supplementation in humans has shown support for the maintenance of healthy cortisol and secretory IgA levels while under stress, and important for a healthy immune system.

• Taurine (2-aminoethanesulfonic acid).  Taurine is a conditionally essential amino acid that maintains cell volume via osmoregulation (a process that corrects excessive or insufficient concentrations of electrolytes). Taurine also stabilizes cell membranes in the heart and brain. This helps maintain normal function of cardiac muscles, essential for proper heart contractions, enhances exercise capacity, and may protect against coronary heart disease and help reduce blood pressure. In the brain, taurine has neuroprotective effects with a potential therapeutic benefit for neurological disorders like Alzheimer’s, Parkinson’s, and stroke. Taurine is also important in normalizing neurotransmitter activity and influences cognitive processes, mood, behavior, memory, learning, and anxiety. Taurine also protects brain cells from environmental toxins and excitotoxicity which can damage brain cells. Taurine supplementation also increases GABA.

• L-Theanine (N-ethyl-L-glutamine) L-Theanine, provided as Suntheanine®, is protected by more than 40 US and international patents for its various physiological efficacies and L-isomer-specific production processes. A naturally occurring, biologically active, free-form amino acid, L-theanine gives green tea its characteristic taste. Although notable for its relaxation support, L-theanine may also support nerve health and cognition. Theanine lowers glutamate levels by preventing transport of glutamate’s precursor, glutamine. It may also inhibit neurotransmission, cause inhibitory neurotransmission via glycine receptors, and thereby reduce neuronal overstimulation. L-theanine’s ability to relax the mind without inducing drowsiness has been documented by an increase in alpha wave activity during EEG recording.

• Magnesium, which is often referred to as “the relaxation mineral” and mainly found in the brain, bones, and muscles. Magnesium assists in the transmission of nerve impulses and is essential to more than 300 enzymatic reactions in the body. Magnesium supplementation has been shown to support a healthy mood, including during the menstrual cycle when mood changes are common. Magnesium also helps regulate blood pressure, heart rate, bowel mobility, and is critical for bone formation –along with its many other functions.

When Inositol is combined with the amino acid, GABA, research demonstrates the combination has a synergistic effect on sleep improvement:

• A mixture of GABA and l-theanine (another calming amino acid) has been shown to decrease sleep latency and enhance sleep quality by increasing REM and non-REM sleep stages, and improving overall sleep architecture.

• Both compounds help reduce anxiety, stress, and racing thoughts, leading to deeper, more restful sleep.

• This combination not only aids sleep but may also address issues like stress-induced skin concerns, hormonal imbalances (such as PCOS), and mood swings, which often interfere with sleep.

Supplementing with TruInositol™ Complex helps promote relaxation, reduce anxiety, and regulate sleep cycles, especially when stress or neurotransmitter imbalances are involved. In my medical practice, I use the highest quality, reliable supplements I can find and these are the products I carry in our Truth for Health store.

Strategies to Reduce Stress-related Insomnia and Anxiety. There are many behavioral and lifestyle strategies that you can explore to effectively reduce stress-related insomnia. Here is a brief description and a few tips to get you started. (for more details, see my Health Tip: Dr. Vliet’s Guide to Optimal Sleep).

I. Key Lifestyle Strategies that Reduce Stress and Improve Sleep:

• Maintain a Regular Sleep Schedule:
  Going to bed and waking up at the same time daily supports the body’s natural circadian rhythm, helping to improve sleep quality and reduce stress around bedtime.

• Engage in Regular Physical Activity:
  Exercise during the day helps burn off stress hormones like cortisol and adrenaline and promotes the release of endorphins, leading to better mood and improved sleep.

  • The best time to exercise to help improve sleep is generally in the morning or early afternoon. Morning exercise aligns well with the body’s natural circadian rhythm, boosting alertness and helping to advance the internal clock, which promotes earlier and deeper sleep at night. Early afternoon workouts raise body temperature when muscles are naturally more pliant, and as the body cools afterward, it signals readiness for sleep.

  • It is advisable to finish vigorous exercise at least 3 to 4 hours before bedtime to allow heart rate and core body temperature to normalize, preventing interference with falling asleep. Vigorous exercise can raise stress hormones, making it harder to fall asleep and reducing sleep quality. Light exercises, such as yoga or stretching, can be done closer to bedtime to promote relaxation without negatively affecting sleep.

• Practice Stress Management:
  Incorporate relaxation techniques such as meditation, deep breathing, mindfulness, or guided imagery to calm the mind and reduce evening anxiety. Keeping a stress journal, laughter, and connecting socially also help relieve stress.​

• Optimize Sleep Environment and Hygiene:
  Keep the bedroom cool, dark, and quiet with minimal light and noise distractions. Avoid electronic devices at least 30 minutes before bedtime due to blue light disrupting melatonin production.

• Improve Your Diet and Hydration:
  Avoid large or heavy meals, caffeine, nicotine, and alcohol close to bedtime as they can disrupt sleep. Eating a heart-healthy diet rich in fiber, fruits, vegetables, and whole grains supports overall health and may improve sleep quality.

• Limit Daytime Naps:
  Keep naps short (no longer than 1 hour) and avoid late afternoon or evening naps that can interfere with nighttime sleep.

• Plan and Prioritize to Reduce Worry:
  Organize tasks and set priorities during the day to minimize bedtime rumination. Writing down worries and setting them aside can help transition the mind toward sleep.

• A Snack Before Bed -The Best Foods and Evening Snacks for Better sleep center on foods that promote relaxation and support the production of sleep-regulating hormones like melatonin and serotonin. Key ingredients include tryptophan-containing proteins, magnesium-rich nuts and seeds, complex carbohydrates, and antioxidant-rich fruits.​

• High in tryptophan: turkey, chicken, fish, eggs, pumpkin seeds.

• High melatonin foods: tart cherries, pistachios, almonds, walnuts, eggs, milk.

• Complex carbohydrates: whole grains, brown rice, oats.

• Magnesium-rich: nuts, seeds, spinach, avocado.

• Foods and Beverages to Avoid Late Evening

• Caffeine-containing items (coffee, tea, chocolate).

• Alcohol (disrupts sleep architecture).

• Heavy or spicy meals (cause indigestion).

• High-sugar foods that spike blood sugar and disrupt sleep.

II. Core Behavioral Approaches

• CBT-I (Cognitive Behavioral Therapy for Insomnia):
  CBT-I is the most evidence-based intervention for chronic insomnia, particularly when stress or anxiety are contributing factors. CBT-I targets the unhelpful thoughts and behaviors that perpetuate insomnia, retraining individuals to develop healthy sleep patterns and challenge anxiety-driven beliefs about sleep.

• Stimulus Control:
  Go to bed and wake up at the same time every day. Use the bed only for sleep —avoid watching TV, using a phone, or worrying in bed. Leave the bed if unable to sleep after 20–30 minutes, and return only when sleepy.

• Sleep Restriction and Sleep Compression:
  Limit the time spent in bed to match actual sleep time, gradually increasing bed time as sleep becomes more efficient. This helps consolidate sleep and decrease time spent awake in bed.

Relaxation and Mindfulness Practices

• Deep Breathing:
  Slow, deliberate breathing exercises—such as the 4-7-8 technique—lower heart rate and decrease stress hormones, promoting relaxation at bedtime.

• Progressive Muscle Relaxation:
  Alternately tensing and relaxing muscle groups releases physical tension and calms the body.

• Meditation and Mindfulness:
  Mindfulness meditation and guided meditations help redirect focus, reduce rumination, and quiet anxious thoughts before bed.

• Biofeedback:
  Real-time monitoring can help regulate physiological signs of stress and improve self-management of arousal.

Habit and Environmental Adjustments

• Consistent Bedtime Routine:
  Dim lights, disengage from stimulating activities, and shift into relaxing rituals such as reading, journaling, stretching, or herbal tea before bed.

• Sleep Hygiene:
  Maintain a dark, cool, and quiet sleep environment; avoid caffeine, nicotine, and alcohol late in the day; keep screens out of the bedroom.

• Manage Daytime Stress:
  Schedule small, intentional stress relief moments throughout the day—such as midday walks or journaling—to avoid buildup that disrupts sleep.

Cognitive Strategies

• Challenge Catastrophic Sleep Thoughts:
  CBT-I emphasizes reframing anxious beliefs about sleep (“I’ll never sleep” or “I’ll fail tomorrow”), reducing the performance pressure that fuels insomnia.

• Paradoxical Intention:
  Practice remaining passively awake to reduce the anxiety of “trying too hard” to sleep.

• Get Out of Bed if Awake:
  Avoid lying in bed awake for extended periods to prevent negative associations between bed and sleeplessness.

In summary, my key recommendations for reducing the damaging effects of stress and improving sleep include:

1) Test for and optimize nutrient, hormonal, and metabolic deficiencies,

2) incorporate consistent exercise, behavioral and lifestyle strategies to reduce stress and optimize sleep and

3) add supplements as appropriate using high quality premium products.

• TruInositol™

• TruBioD3™

• TruZinc™

• TruMultiV™ with Iron (also contains vitamin B complex)

• TruMagnesium™

CONSISTENCY is the key when implementing these nutritional, behavioral and lifestyle strategies to break the stress-insomnia cycle and promote restorative sleep over time. I encourage you to give all these approaches a diligent effort if you are experiencing any of the stress-related symptoms I described above!

All Truth for Health Foundation Products Meet or Exceed cGMP Quality Standards, the highest quality standard for supplements sold in the USA. For more information, references from studies are listed in the Product Data Sheets for each product, available on our website. Under medical practice regulations, we are unable to answer individual medical questions or make specific individual supplement recommendations for people who are not established patients of Dr. Vliet’s independent medical practice. CAUTION: As always, we urge you to avoid supplements without checking knowledgeable sources to evaluate your medical situation, proper lab tests to verify what is needed, and to make sure to avoid adverse interactions with prescription medicines and other supplements you take.

I encourage you to consider our other natural medicines with our top quality, cGMP-compliant professional formulas for TruImmune™Boost, TruNAC™, TruImmunoglobulin,™ TruC with BioFlav™ (Vitamin C with complete Bioflavonoids), Tru BioD3™, TruZinc™, TruMitochondrial ™Boost and TruProBiotic™ Daily to replenish critical bifidobacteria depleted by COVID shots, viral illnesses, and antibiotic therapy.

To Your good health and improving resilience!

Elizabeth Lee Vliet, MD

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