Sometimes health problems don’t seem serious enough to warrant a doctor visit. Sometimes people have other reasons for their reluctance to seek medical help, including ambivalence about how medicine is practiced. And sometimes, both reasons hold people back from obtaining professional health-care advice for their symptoms. Such was the situation in the case of “Rob,” a teacher in his mid-sixties who had been plagued with sleep problems for the better part of six years. He was stumbling along on just a few hours of sleep each night—typically, he would fall asleep normally, then awaken three or four hours later and be unable to return to sleep. Needless to say his chronic insomnia was taking a toll physically and psychologically. His work was suffering, as he was having trouble maintaining focus on his lessons and students. He found himself forgetting important things, including parts of his lectures, and he had reached the point where he started to wonder if he should consider retirement, though he was reluctant to do so. He was also irritable and chronically tired, as his wife frequently reminded him.


Finally, at his wife’s urging, Rob called Mark A. Stengler, ND, for a consultation about his insomnia. Rob told Dr. Stengler that he had not sought advice from a medical doctor because he didn’t want to take pharmaceutical medications, and he knew that the doctor would likely prescribe sleeping drugs and send him on his way. Rob had attempted self-treatment, trying several supplements known to be associated with better sleep—these included a calcium supplement, as well as 5-HTP and melatonin. He had used each for a while, with so-so results, and then, seeing no significant improvement would move on to another, finding no lasting solution.

EXTRA: For 28 more articles with a wide variety of information on helping you sleep, go to Bottom Line’s Guide to Better Sleep…No Sleeping Pills Needed.

During the consultation Dr. Stengler discovered that Rob was not suffering from high stress other than his frustration about lack of sleep, he ate well and he exercised regularly. Given his general good health and moderate lifestyle, Dr. Stengler suspected Rob might be suffering from something more subtle and often overlooked—a hormone deficiency. He proceeded to give Rob a blood test to determine his level of testosterone and discovered it was not only low but in fact 80% lower than it should have been for a man his age. Other physical symptoms included low libido. His thyroid function was also low, which contributed to Rob’s lethargy, although his growth hormone (IGF-1) was normal. (Low growth hormone can also cause insomnia.)

Hormone deficiencies are often at the root of chronic insomnia in men and women 45 and older, but many medical doctors don’t evaluate hormone levels as a possible cause, says Dr. Stengler. The fact that Rob’s problems began in his early sixties provided an important clue. A particular enzyme, lyase, is one of five enzymes necessary to convert cholesterol to testosterone and was likely responsible, as it is sensitive to both aging and stress. Without this perspective, doctors often end up treating insomnia with sleeping medications (hypnotics) so widely advertised and available that patients come in asking for them—but Dr. Stengler says these drugs fail to address the underlying problem. In Rob’s case it was clear to Dr. Stengler that he needed a bioidentical testosterone, a substance derived from wild yam and soy that is “bioidentical” to the testosterone normally made in both men and women, and therefore potentially much safer than synthetics. Dr. Stengler prescribed testosterone cream for Rob to be absorbed through the skin on the inside of his arm each day. To address the slowed thyroid function he also prescribed a thyroid product called Armour Thyroid for Rob.


Rob felt better almost immediately. Within just a few days his three to four hours of sleep had been transformed to a peaceful eight hours each night. Naturally his energy and mood greatly improved, and his memory also was somewhat better. When Dr. Stengler met with him two months later, Rob reported with great relief that he now slept long and deeply every night.

However, Dr. Stengler offers one caution—even bioidentical hormone replacement carries some risk if not carefully monitored. For example, testosterone use has been associated with prostate cancer risk and so Dr. Stengler checked Rob’s PSA levels after one month, and again after the second. He wanted to be sure that the testosterone supplement was not creating any problems in his prostate and that there were no worrisome changes in prostate size or texture of the prostate gland through a digital rectal examination. Dr. Stengler says he will continue to monitor Rob’s PSA levels routinely, as he does several times a year for all his male patients treated with hormones to be sure that they remain in the normal range, with no abrupt increases. It turned out—as it often does when people seek natural treatments for such issues—the source of Rob’s sleep problems was easy to find and solve, and nothing to lose sleep over.