October 30 2019

Is Keto Insomnia a Common Problem?

By Mark Sisson
25 Comments

When I did my first earnest attempt at a keto diet a few years ago, one of the benefits I quickly noticed was improved wakefulness and energy during the day. I chalked this up to sleeping better on keto.

It turns out that I might have been one of the lucky ones. While plenty of people report improved sleep, a fair number also complain of insomnia, sleep disruptions (waking frequently during the night), and generally poor sleep once they go keto.

Can a keto diet really impact sleep quality? What might be the mechanism behind a correlation? And how does one work around any potential effect?

I’ve written a lot about sleep over the years, and I don’t intend to rehash what I’ve already written. Rather, I want to explore why a very-low-carb ketogenic diet specifically might impact sleep. I’ll link to some of my past posts at the bottom for those interested in improving overall sleep hygiene.

What is “Keto Insomnia?”

Insomnia disorder, as defined in the DSM-5, involves the following:

  • Difficulty falling asleep, difficulty staying asleep, and/or waking too early without being able to fall back to sleep
  • Symptoms occur at least three nights per week for at least three months
  • Sleep problems are not explained by other illness, medication, and so on
  • Distress and/or impaired ability to function in daily life

Acute insomnia is similar, but it’s short-term and might be attributable to a specific trigger, such as a stressful event, major life change, or travel.

People who complain about “keto insomnia” seem to mean one of two things:

  • Sleep disruptions that occur during the transition phase—the days or weeks immediately after starting keto (acute)
  • Sleep issues that start after being keto for a few months or longer (might be acute or chronic)

It can be hard to know whether the latter are actually related to keto at all. However, if diet is the only obvious change these folks have made, keto seemingly takes the rap.

Why Might Keto Mess with Your Sleep?

On possible clue is this oft-cited study in which participants experienced decreased REM and increased slow-wave sleep when following a keto diet. Decreased REM sleep can contribute to the subjective experience of insomnia. However, total sleep was not impacted. This study was also small, involving 14 participants who followed a keto diet for just two days.

Other than that, however, there’s not much to go on. A couple studies found no change in sleep quality among healthy adults following a keto diet, and a handful of others reported improved sleep quality (in epileptic children and obese adolescents).

Moreover, the team at Virta Health recently released their findings after one year of treating diabetic and prediabetic patients with keto diet interventions. Their patients enjoyed significant improvements in sleep quality and daily functioning compared to baseline and compared to individuals who didn’t go keto.

All together, the research so far suggests that when it comes to sleep, keto is neutral-to-positive for healthy adults and beneficial for individuals struggling with certain health conditions. Of course, the data are still quite sparse.

A somewhat larger, but still limited, body of research has looked more generally at how the macronutrient composition of one’s diet affects sleep. To be blunt, the results of these studies are all over the map. There’s tremendous variation from study to study in terms of how diets were constructed or measured, food timing, other relevant dietary factors such as total calorie intake and fiber content, as well as what aspects of sleep were assessed and how. Depending on which study you’re reading, consuming fat, protein, or carbohydrates might seem to help, hurt, or have no effect on sleep.

In short, there’s no compelling scientific explanation for when or why keto would harm your sleep. I know this is no comfort to those of you who are experiencing sleep disruptions now, however. Let’s turn to some things you can try if you’re not in the camp of good sleep while keto.

Possible Solutions

Despite the dearth of research, it’s possible to make some reasonable guesses about what might be causing your sleep issues. Of course, before trying any of the supplement suggestions below, consult your doctor. Likewise, get help if your sleep is so poor that you are having trouble functioning.

First, the obvious: basic sleep hygiene. These are the things I harp on all the time, like avoiding blue light at night and honoring a consistent bedtime. Sure, you probably didn’t change any of these when you went keto. However, it might be that something about keto eating—like getting less tryptophan to your brain (I’ll explain in a minute)—is making you more sensitive to poor sleep habits. Refer to my other sleep posts linked below for more details.

Check your electrolytes. Especially if you’re new to keto, electrolytes are the most likely culprit for sleep issues. You want to aim for the following daily:

  • 3-5 grams of sodium on top of what you get from food
  • 3-5 grams of potassium
  • 500 mg of magnesium

Most keto newbies drastically underestimate how important electrolytes are, not just for sleep but for energy, workout performance, and avoiding the keto flu. Check out this post for more details.

For sleep issues, start with magnesium. Make sure you’re including plenty of magnesium-rich foods such as leafy greens, dark chocolate, and hemp seeds in your diet.  You can also supplement with magnesium—the glycinate form is preferred for sleep—starting with 100-400 mg as needed.

Also consider adding a mug of warm bone broth to your evening routine. Besides being soothing, it’s a great way to get sodium and the amino acid glycine. Glycine is the most abundant amino acid in collagen. Supplementing with 3 grams of glycine before bed has been shown to improve sleep.

You can also supplement collagen for its many benefits. Aim for at least 10 grams at night. Maybe whip up a batch of Chocolate Collagen Pudding (sweetened with stevia or monk fruit for keto).

Make sure you’re neither too hungry nor too full at bedtime. As you adjust to your new way of eating, try to avoid extremes of hunger in the evening. If you’re practicing intermittent fasting, make sure your fasting window isn’t leaving you stuffed or famished at when it’s time to hit the hay.

Dial back the caffeine. Is it possible you’ve been a little too enthusiastic about fatty coffee since going keto?

Get your stress in check. We all know that stress is a sleep killer, and I see stress running high in the keto community. Micromanaging macros, worrying about which foods are and are not “allowed,” trying to do too much too soon—keto folks can really get themselves worked up. If this sounds familiar, you need to take a step back and work on stress reduction.

Try adding a small amount of high-glycemic carbs to your dinner. Wait, what? Am I really telling you to eat more carbs on keto? Yes, for a good reason.

As you probably know, melatonin is the hormone primarily responsible for regulating your sleep-wake cycle. The amino acid tryptophan is a precursor of melatonin. In the brain, tryptophan converts to 5-HTP, then serotonin, then melatonin. To get into the brain, tryptophan relies on protein transporters, which also carry other amino acids across the blood-brain barrier. When there is too much traffic—that is, too many other amino acids trying to use the protein transporters—not enough tryptophan can get across.

Insulin shuttles those competing amino acids into muscles, leaving the roads clear for tryptophan so to speak. By adding some high-GI carbs to your last meal of the day, you bump up insulin and facilitate this process.

Now, I wouldn’t recommend this as your first option if you are brand new to keto. However, if you’re one of those people who is suddenly struggling with sleep after being keto for a while, this is worth trying. Michael Rutherford, NTP, Primal Health Coach, and moderator of our Keto Reset Facebook group says his clients have had good results adding ~20 grams of carbs to their last meal of the day. Potatoes or sweet potatoes are good choices.

If you just can’t bring yourself to eat more carbs, you can also supplement with tryptophan. A dose of 250-500 mg is a good place to start, increasing as needed. Chris Masterjohn recommends taking tryptophan on an empty stomach and as far as possible from other sources of protein.

Another possible workaround is to supplement with 5-HTP, which is a common ingredient in sleep aids. Rutherford advises his clients to start with 100 mg of 5-HTP taken 30-60 minutes before bed. Be cautious with this supplement if you have depression or anxiety.

Skip the middlemen and supplement melatonin. Melatonin supplementation is somewhat controversial. It’s not my first choice—I’d rather you start by addressing sleep hygiene and tweaking your diet—but I’m not opposed to supplementing as needed.

Doses as low as 0.5 mg can be effective, although as much as 5 mg is generally regarded as safe. I recommend starting at the bottom end, since lower doses are closer to normal physiological levels. Take melatonin at least an hour after eating your last food of the day.

Get your thyroid and cortisol levels checked. If none of your self-experimentation works, or if you’re having other signs of thyroid imbalance, get your thyroid function and cortisol levels checked. While I don’t believe keto is inherently bad for thyroid or adrenal health, it’s certainly worth a trip to your doc.

What’s your experience? Are you sleeping like a baby on low-carb/keto—or not? Have you found any solutions other than those suggested here? Comment below, and have a great week, everyone.

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More sleep tips from Mark’s Daily Apple

7 Ways You Might Be Inadvertently Sabotaging a Good Night’s Sleep

10 Natural Sleep Aids: What Works and Why

Does “Sleep Hacking” Work?

How to Manufacture the Best Night of Sleep in Your Life

The Definitive Guide to Sleep

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References

Herrera CP, Smith K, Atkinson F, Ruell P, Chow CM, O’Connor H, Brand-Miller J. High-glycaemic index and -glycaemic load meals increase the availability of tryptophan in healthy volunteers. Br J Nutr. 2011 Jun;105(11):1601-6.

Levenson JC, Kay DB, Buysse DJ. The pathophysiology of insomnia. Chest. 2015;147(4):1179–1192.

Peuhkuri K, Sihvola N, Korpela R. Diet promotes sleep duration and quality. Nutr Res. 2012 May;32(5):309-19.

Riemann D, Spiegelhalder K, Nissen C, Hirscher V, Baglioni C, Feige B. REM sleep instability–a new pathway for insomnia? Pharmacopsychiatry. 2012 Jul;45(5):167-76.

Silber BY, Schmitt JA. Effects of tryptophan loading on human cognition, mood, and sleep. Neurosci Biobehav Rev. 2010 Mar;34(3):387-407.

St-Onge MP, Mikic A, Pietrolungo CE. Effects of Diet on Sleep Quality. Adv Nutr. 2016 Sep 15;7(5):938-49.

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25 thoughts on “Is Keto Insomnia a Common Problem?”

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  1. Surprised Mark didnt suggest resistant starch as a solution. Helped me a lot and makes deep sleep so much easier…

  2. Great post, Mark! I’m a 36-year old avid fitness and nutrition enthusiast and after 2-3 years of being keto, I was experiencing this. Sleep hygiene is huge! Getting away from screens at least an hour before bed (yes, this includes the phone) and replacing it with reading (fiction more so than non-fiction), and some basic mindfulness or breathing practice was the biggest differentiator for me. Additionally, upping the healthy carbs at dinner time, supplementing magnesium, and drinking a cup of tea (valerian or chamomile, or 1 of each in the same cup), have helped me get back consistently strong sleep cycles. When my sleep starts getting interrupted again, I can usually point to one of these areas I’m missing in. While this seems like a chunk, it’s more about keeping my last hour of the day “sacred and routine”.

  3. I don’t do keto but I found that I sleep really poorly on a VLC diet. Adding some extra carbs at dinner solved the problem.

  4. Could you please address Keto diet and thyroid/adrenal issues? Have heard from several sources that keto is not
    a good solution. I only have some borderline concerns in this area. Re: sleep, yes also had that issue and am taking CBD products which help a lot. I tried various herbal products, but the CBD works better. Thanks, you are always so very informative and appreciate.

  5. My sleep pattern changed – although I’m not sure if it’s directly because of the lower carbs or because of the disruption from trying to shift my sleep schedule. Previously I’d be up late, until 2 AM or so, and then dead sleep for 7.5-8 hours. Now I usually wake up once or twice in the night. I’m always able to fall right back asleep, and get up rested as usual after 7.5-8 hours. It feels odd after nearly 40 years of dead-to-the-world sleeping, though. Also, not sure if it’s related, but my dreams tend to be more frequent and much stranger.

    1. I don’t know if there’s a correlation either, but I find that when I dream frequently/remember my dreams more my sleep is significantly worse. I sleep much better when I have no recollection of any dreams.

  6. I find my sleep best in either a good state of ketosis (1+) or after eating plenty of carbs. I infrequently, however consistently experience insomnia if I make a mistake with my evening carb intake and knock myself into a low level state of ketosis. The insomnia only occurs in this low level state of ketosis, as eating lots of carbs in the evening or being in a solid state of keto will cause me to sleep great. Typically, my sleep is fantastic while eating keto, it only occurs on these occassional nights where I find myself in this low level of keto.

  7. I didn’t have this issue for my first two-year stretch of keto in my mid-20s (or maybe I did, but sleeping less didn’t acutely affect me as much as it does now). However, from my late 20s onward (now 31) it became very difficult to fall asleep in the first place while keto, and I would get a max of 5-6 hours with 1-4 wakings. My sleep hygiene was good, my electrolytes taken care of, and I was exercising regularly.

    A friend had encountered the same issue and used nighttime carbohydrates to fix it. I always tried to minimize my carbs well below what was necessary so I was hesitant, but once I added some to my routine at night (often a serving of carbier nuts and blueberries), I solved the issue from the first night. Definitely something to that one, at least for some of us.

  8. I typically find my sleep gets disrupted when I am in a low state of keto, lets say less than 1 mm. If I eat a carb heavy dinner or I am in a solid state of keto, I will sleep like a beast. If I happen to eat just enough carbs to put myself into a low state of keto (i.e. 0.5), I likely will experience insomnia. My sleep in keto is normally fantastic, I just have a few triggers that might cause issue if not monitored.

  9. In my opinion, it’s quicker digestion, and the fact that years of undigested food is making it’s way thru the intestines. It takes a lot of energy to accomplish this.
    If someone is carrying around the average 37 lbs of undigested food, this will require the body to work very hard to let it go… pun. I know the few times I’ve accidentally eaten grains, they were in things, I’ve had lost sleep due to my digestion having to work overtime.

    1. That’s a myth, the body does not store years of undigested food. Check snopes dot com.

  10. I have definitely experienced keto insomnia, which goes hand in hand with keto temper. I agree that carbs at night and electrolytes help, but I’ve never found a satisfactory solution, aside from eating 50-75 g of carbs a day.

    I’d be very interested to hear Mark’s thoughts on the ancestral foundation for electrolyte supplementation. I’ve found electrolytes to be the most helpful thing on keto, but it requires shocking amounts of salt (over a tablespoon in addition to my normal dietary intake). How can we justify this from ancestral standpoint? Did pre-agricultural humans lick salt crystals all day? Did they drink ocean water?

  11. Hi Mark, interesting post. One thing I think would be very interesting is to explore this issue with a control for changes in alcohol consumption as part of people going keto (or even generally just consuming more healthily). Reduction in alcohol consumption and insomnia is a well known combination and so maybe it’s not the keto per se, but the wider habit change.

  12. I sleep much better while keto. If I let my electrolytes get unbalanced though, it can be a problem. I’d suggest that if people think melatonin is the issue, just try it first. Then you know, and you can try other more normal means of getting it. I mean, there’s no point working on getting tryptophan in to the brain (and risking too many carbs) if melatonin isn’t the issue.

    The key for me seems to be calming the adrenals / HPA axis. I don’t seem to have a good foolproof method for that.

  13. Doesn’t dark chocolate contain caffeine? I can imagine that some people only started eating dark chocolate when they were on a keto diet.

  14. Funny you mentioned to drink bone broth (for the glycine) to help with sleep. I have been keto-carnivore for 9 months and recently realized that the high level of histamines in bone broth was giving me insomnia. I can eat most foods that contain a moderate level of histamines, but canned fish and long-cooked bone broth have derailed my sleep on carnivore.

  15. I have issues sleeping on a Keto diet.

    I assumed it is caused by hypoglycemia, because when I wake up, I have other symptoms of low blood sugar. Eating more carbs before bedtime helps.

    I am borderline prediabetic and I often wonder if insulin resistance in my body makes it harder for my body to adjust to ketosis. My plan is to drop carbs over time to see if a gradual reduction of systemic insulin prevents hypoglycemic events.

  16. I’ve had problems sleeping on a low carb diet. Also painful cramps mostly in the back (ouch). Even adjusting for a number of factors and supplementing with magnesium, melatonin, etc., found it best to have carbs at dinnertime. Sweet potato or white rice usually does the trick. Sometimes I wonder if men adjust better to vlc/keto than women (at least women Mark’s age!). That’s the only n=1 that I can comment on.

  17. Many people on keto are in a caloric deficit, whether intentional or not. Many people who are not intending to eat below maintenance calories do, because the diet is so satiating, it can be difficult to eat enough, especially when doing whole foods, no-treat, dairy free/paleo keto.

    Caloric restriction/dieting raises cortisol, which notoriously hurts sleep. Ask any serious dieter and sleep abnormalities are super common.

    So for anyone not sleeping well on keto and Mark’s suggestions don’t work – eat more, even if you’re not hungry – especially if you’re doing keto for reasons other than fat loss.

  18. I havent encountered this personally but I made an interesting connection on a podcast on sleep I was listening to. In his interview on Dr. Peter Attia’s podcast, Dr Matthew Walker (author of Why We Sleep) points out that the only time sleep deprivation is observed in nature is when animals are under conditions of starvation, essentially signaling to the animal to stay up and forage longer and over a wider area. He was making a point about sleep deprivation increasing ghrelin and decreasing leptin, spiking the hunger signals we receive. But if you look at it the opposite way, if we would have encountered ketosis during the “famine” part of our feast or famine type existence, wouldn’t it make sense that the signals to stay up and search for food would be upregulated when we were in ketosis? May be oversimplifying this type of mechanism, but seemed like a more primal reason for the phenomenon.
    (source: https://podcastnotes.org/2019/06/17/sleep-7/ however the whole three part series linked in the intro is worth listening to)

  19. When one eats carbs, tryptophan transport through the blood-brain barrier is enhanced. When one avoids carbs, tryptophan transport can be competitively inhibited by other large neutral amino acids. Lowered brain tryptophan inhibits serotonin-mediated sleep (and melatonin synthesis). Although tryptophan and 5-HTP can help minimize this, it often takes grams of tryptophan or hundreds of mg of 5-HTP to create a subjective effect. And inflammation-mediated IDO catabolizes both tryptophan and 5-HTP, obstructing their effects. But there is a solution (pun intended). Predigested collagen protein can greatly reduce the dose of tryptophan or 5-HTP by (1) solublizing the tryptophan for faster absorption, and (2) decreasing the ratio of large neutral amino acids to glycine, lysine and proline, which do NOT compete against the tryptophan transporter. Merely dissolve 250 mg of tryptophan in mildly warm water with 2 (or 3) tsp of predigested collagen peptides. It might take 10-20 minutes to fully dissolve. And it works best on an empty stomach. For me, I get a ten-to-one dose reduction with tryptophan (250 mg predissolved tryptophan is better than 2000 mg not dissolved).

  20. When it comes to blue light and it’s affect on circadian rhythm – the body recognises it as daytime – we mustn’t forget that most led and fluorescents have a high blue light content, not just smart phones, tv’s and computers.
    Halogen bulbs are a better choice and incandescent are the best if you can still find them! (Though it’s increasing hard as we move to smart technology)
    It’s true also that sources of electromagnetic pollution affect the circadian rhythm (and most other biochemical processes which are of course electromagnetic by nature, including the absorption of minerals, Mark)
    Also important is being outside when the sun is rising and setting so your biochemistry is in touch with the suns natural cycle.
    Including a consideration of these factors in a sleep hygiene regime is essential.

  21. Could all this be too much worry from being obsessed with checking if they are doing the keto diet “right” ?

  22. When I was super low carb my sleeping suffered, and I started gaining weight. Turns out that being below 75g carbs a day aggravated a thyroid condition I didn’t know I had. It took a couple of years, but now I am taking NDT, progesterone oil, carbs hovering 150-200g, and Natural Calm before bed, and my sleeping has returned to normal, and my weight is finally coming off.

    Never stop searching. You never know what could be going on.