How to Sleep Better With Graves’ Disease

Sleep can feel frustratingly out of reach when you’re living with Graves’ disease. That’s because the symptoms of Graves’ hyperthyroidism — anxiety, a racing heart, feeling overheated — are almost exactly the opposite of what typically leads to a good night’s sleep.

Those symptoms arise when the body makes too much thyroid hormone, a condition called hyperthyroidism, and they can definitely interfere with the ability to fall asleep, stay asleep, and get good-quality sleep, says Caroline Nguyen, MD, an endocrinologist and an associate professor of medicine at Keck Medicine of USC in Los Angeles.

The good news: “Sleep usually improves as Graves’ disease is treated,” says Dr. Nguyen. But that can take weeks or months, and there may be other health issues contributing to poor sleep.

Here’s what to know about getting a better night’s sleep when you have hyperthyroidism.

Take Your Thyroid Medications as Prescribed

Graves’ hyperthyroidism is treated with an antithyroid drug, which slows down the production of thyroid hormone, says Nguyen.

“To improve symptoms, including those interfering with sleep, treating the Graves’ disease itself is the priority, [because] that’s the underlying trigger,” she says.

Antithyroid medication is not the same as thyroid hormone replacement, which is used for an underactive thyroid. “With Graves’ disease, the body is making too much thyroid hormone, so the goal is to bring those levels down,” Nguyen says.

“Someone with very active hyperthyroidism may need more time to get thyroid levels into a normal range than someone with a milder case,” Nguyen says.

There are other ways to improve sleep during that period, says Nguyen.

“When patients are very hyperthyroid and have symptoms like racing heart, palpitations, tremors, anxiety, and heat intolerance, we often consider giving a beta-blocker,” she says.

Beta-blockers don’t address the root cause of Graves’, but they can slow down the heart rate. “If you don’t have that sensation of the racing heart, that can improve the quality of sleep,” says Nguyen.

Aim to Stay Cool

Heat intolerance is one of the biggest nighttime issues for people with Graves’ disease, Nguyen says. “People with Graves’ disease may feel hot in temperatures they used to tolerate,” she says.

These tips can make your sleep setup cooler.

• Sleep in a cool room, if possible. A bedroom temperature of about 65 to 68 degrees F is often considered reasonable for sleep, though people with thyroid disease may need a temperature outside that range to feel comfortable.

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• Use a fan. Moving air can make the room feel cooler, especially if you can’t lower the thermostat, says Nguyen.
• Choose breathable bedding. Nguyen recommends airy, breathable sheets. If you’re shopping for bedding or a mattress pad, look for lightweight or cooling materials that won’t trap heat.
• Wear lightweight pajamas. Breathable sleep clothes can help with the heat intolerance that can come with Graves’ disease, she says.
• Keep water nearby. Hyperthyroidism can cause night sweats and frequent nighttime urination, both of which can disrupt sleep. Keeping water by the bed can make it easier to cool down after a sweaty awakening without fully waking yourself up.

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Calm the Anxiety

Too much thyroid hormone can leave your body feeling revved up, restless, and on alert. That’s one reason Graves’-related anxiety is different from ordinary bedtime worry: Your mind may be tired, but your body still feels switched on.

Treatment for Graves’ disease is still the main fix for this type of anxiety, but calming practices may help you get through the nights when symptoms are still active, says Nguyen.

Try these wind-down habits.

• Write down tomorrow’s worries or tasks. If your brain keeps cycling through what you need to do, putting it on paper can be part of a calming bedtime routine.
• Dim the lights and put electronics away. Avoiding electronic devices for up to an hour before bed and winding down with quiet activities can support better sleep hygiene.

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• Practice slow breathing. “Breath work can be helpful for the anxiety component,” says Nguyen. For example, take slow breaths in, holding for a few counts, and then slowly breathe out, she says.
• Try not to turn sleep into another source of pressure or worry. “With Graves’ disease, it can be super helpful to know this is part of the condition. As you treat the condition, this will also get better, but it will just take some time.”

Have a Daily Routine That Optimizes Sleep

Good sleep hygiene isn’t enough to counter untreated hyperthyroidism’s effect, but it can be part of your overall management plan.

Nguyen recommends the following good sleep habits.

• Keep a regular bedtime and wake-up schedule.
• Minimize daytime naps.
• Get daylight exposure during the day to support the body’s sleep-wake cycle.
• Exercise, but not too close to bedtime.
• Avoid alcohol in the evening.
• Avoid caffeine in the afternoon and evening.
• Don’t eat too close to bedtime: Heavy meals near bedtime can be disruptive to sleep.

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Address Thyroid Eye Disease Symptoms That Interfere With Sleep

For some people, Graves’ disease affects the tissues around the eyes, causing inflammation, swelling, and pain.

“This can make eyes irritated, and dry,” says Nguyen. There are eye drops and ointments that can help, she adds.

The most important nighttime issue is whether your eyelids fully close while you sleep. “If part of your eye remains open to the air, it increases your risk of corneal abrasion,” says Nguyen.

If you have thyroid eye disease symptoms, ask your doctor about:

• Nighttime lubricating eye drops or ointments
• Whether your eyelids are closing fully during sleep
• Whether taping, an eye shield, protective eye wrap, or a sleep mask is safe for you
• What symptoms to watch out for, such as significant pain, redness, worsening irritation, or changes in vision

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Get Checked for Sleep Disorders

If your Graves’ disease is being treated and your sleep still isn’t improving, it may be time to look for another cause, says Nguyen.

Sleep apnea should also be considered if symptoms point in that direction, Nguyen says.

“If there’s a component of sleep apnea — where you occasionally wake up gasping for air or have loud snoring — it would be worthwhile to get evaluated for that independently if it’s not improving after your Graves’ is improving,” she says.

People with Graves’ disease can also have large goiters (enlarged thyroid glands), says Nguyen. “Trouble breathing or swallowing should be discussed with your doctor,” she says.