Adrenal fatigue
Is adrenal imbalance keeping you from sleep at night?
by Marcelle Pick, OB/GYN NP
In a scene that plays out each night in homes across America, an exhausted woman
who has spent the day bouncing from home to work and back to family or community
obligations, finally climbs into bed for the night, ready for some much needed rest.
She turns off the light, settles in, and waits to doze off. But the thing is...
she just can’t fall asleep. Or she may fall asleep fairly quickly
but then wakes up in the night — like clockwork — fully alert, with
an anxious mind and racing thoughts.
Fatigue-related symptoms of imbalance in the HPA axis
Do you:
- Feel “tired but wired?”
- Struggle with low energy in the afternoon?
- Rely on sugar and caffeine to “get through the day?”
- Feel better after eating your evening meal?
- Get a second wind right before bedtime?
- Take a long time to fall asleep initially?
- Wake in the night with anxiety or dread, and then find you can’t get back
to sleep?
- Feel as if you’ve only just gotten to sleep when it’s time to get up?
- Feel like a “zombie” until you’ve had your morning caffeine?
Ongoing symptoms of daytime fatigue and nighttime insomnia can be clues to an adrenal
imbalance. See our other articles on adrenal
health to learn more.
Do these scenarios sound familiar? If so, you might be asking yourself the question,
If I’m so tired, then why can’t I sleep? There are many different
causes of both fatigue and insomnia, and over the years I have worked with an incredible
number of women who are plagued by this frustrating and debilitating duo. Many patients
are relieved that there may well be genuine physical reasons for their ongoing fatigue
and inability to sleep.
I have found that these companion symptoms can frequently be traced to an imbalance
in the brain-hormone pathways of the hypothalamic-pituitary-adrenal (HPA) axis.
When a woman goes through every day in high gear, she forces her body to operate
for long periods under stress. This type of unrelenting and oppressive stress —
that kind that taxes you both physically and emotionally — hyper-activates
the HPA axis and draws you into a whirling cycle of alertness and sleeplessness.
It seems as if your body has forgotten how to fully let down and restore itself.
Your internal clock
Many cultures and spiritual traditions believe that we are connected on a core level
to the universe itself. In what may be a nod to the truth in this belief, scientists
have found that your brain’s hypothalamus maintains a “master circadian
clock” which regulates adrenal hormone levels (adrenaline, cortisol, etc.)
via the HPA axis. This 24-hour cycle of biochemical, physiological, and behavioral
processes generates regular patterns in body temperature, brainwave activity, hormone
production — even cell regeneration. It’s a natural timekeeper that
is plugged into cycles of approaching daylight, darkness, and seasonal changes,
resetting itself according to the shifts in the earth’s rotation. These circadian
rhythms and your adrenal glands communicate through adrenocorticotropic hormone
(ACTH), which usually keeps cortisol — a wake-up hormone —“gated”
when it’s time for you to sleep and rest.
But as evidenced by the multitude of women lying wide awake when they long to be
sleeping — or nodding off when they’d like to be productive —
this internal clock can be disrupted by ongoing stress of almost any kind. With
our patients at the clinic, we try to uncover the unique fluctuations that a woman
can experience in her circadian patterns. Sometimes while her overall rhythm seems
normal, with peaks and valleys occurring at the “right” times during
the day, her total levels of ACTH and cortisol are too high.
For other women the entire pattern is upside down: her cortisol level is very low
when she wakes up, when it should be at its highest, then goes sky-high in the middle
of the night when it should be low. Yet another group of women experience sudden,
sharp cortisol spikes between 4:00–5:00 AM that wake them up so completely, they
are unable to relax back into sleep. Any one of these patterns leaves a woman exhausted
when she gets up in the morning, with recurring episodes of low energy throughout
her day.
These altered patterns can be manifestation of stress-induced
adrenal imbalance, which is not well understood by many conventional healthcare
providers. For a woman with insomnia, there may be a tendency to prescribe sleeping
medications, anxiolytics (anti-anxiety drugs) or even antidepressants. While it’s
possible to experience effective short-term results with powerful drugs, such pharmaceuticals
can cause additional problems and will delay treatment for the symptoms’ true
causes.
Demystifying stress
Broad effects of stress hormones
Adrenaline: increases the speed and force of your heart’s
contractions
Cortisol: increases blood pressure and blood sugar, while dampening
your immune response
Cortisone: shuts down pain receptors
References
Acute stress — both actual stress and whatever you might perceive or interpret
as stress — triggers a physiological reaction in your body called the “fight-or-flight”
response, and most of you have heard of this. Fear, anxiety, physical threat, or
some other type of stress, sets off a chain reaction in your body that starts with
the release of ACTH by the pituitary gland in your brain. In response to the ACTH,
your body releases cortisol, adrenaline, and cortisone to help prepare for the emergency.
Ideally, a healthy body returns to normal once the threat has passed. But your body
cannot tell the difference between real physical danger, and intense work-related
stress, for example, and the stress response to either of these situations will
be the same.
If you’re like many women today, you may have become used to living under
this canopy of ongoing stress, and now it may be your new “normal.”
But this tells your body to keep maintaining the emergency state, so the HPA axis
adapts to begin delivering higher and higher amounts of stress hormones. You can
picture this happening in your body if you live every day with crushing stress from
work, or your home life, or something else. But your body cannot sustain this long-term
stress response without consequences, including
adrenal imbalance symptoms like fatigue and insomnia, and more.
Riding a topsy-turvy cortisol curve
But cortisol is about so much more than saving your life in dire circumstances.
Cortisol is released by the adrenal cortex (outer layer of the adrenal glands) and
when levels follow their regular arc in a healthy person, output is high in the
morning and low at night. Cortisol is a glucocorticoid hormone, meaning
it affects the metabolism of carbohydrates, but normally, it participates in a wide
array of additional physical reactions and processes.
Cortisol is intended to:
- Moderate cell activity and regulate blood pressure
- Ensure that glucose is properly metabolized and help provide an instantaneous burst
of energy when needed, especially when survival is threatened
- Promote the release of insulin in order to maintain steady blood sugar levels
- Heighten memory functions and lower sensitivity to pain
- Play a key role in the healthy inflammatory response of the immune system
But if cortisol levels stay high for prolonged periods, the natural curve becomes
inverted, causing all sorts of unintended negative effects. Instead of sharpening
your cognitive function, prolonged elevated cortisol levels reduce cognition and
impair memory. Anyone who has ever drawn a blank when they’re put on the spot
has experienced how stress can blitz even our ability to string a few words together.
And rather than regulating healthy blood sugar levels, too much cortisol leads to
elevated blood sugar, or hyperglycemia, and increases your appetite for
refined carbohydrates. This cascades into stored abdominal, or belly, fat, and may
even raise your risk for fatty liver.
Excess cortisol also erodes bone density, breaks down tissue in your muscles and
joints, deranges thyroid function, and dampens immunity. And there are long-term
emotional effects, too, including heightened risks for anxiety disorders and depression.
Extended high cortisol
levels eventually disrupt overall hormonal balance, including the sex hormones,
blunting libido and increasing symptoms of both PMS and perimenopause.
Overworked adrenal glands destroy normal sleep patterns
If nothing changes, women who experience stress-related adrenal imbalance will eventually
become “cortisol dominant.” As they continue to push through their days,
cortisol-dominant women will ultimately begin to suffer adrenal fatigue along with
additional symptoms. They may even end up with extreme adrenal insufficiency, a
medical condition with serious consequences. Women who are on this path often notice
their symptoms worsening into debilitating fatigue and chronic insomnia.
“A ruffled mind makes a restless pillow.”
— Charlotte Brontë
The persistent inability to sleep can begin to haunt your days, and you might worry
about bedtime long before it arrives: What if I can’t get to sleep again tonight?
Or, Oh no, I hope I don’t wake up at 3:00 AM again! And, if you are
magically able to drop off, the fractured sleep you are able to get is probably
not going to be enough. That’s because high cortisol alters normal sleep cycling,
reducing the amount of restorative REM (dream-state) sleep you experience.
A woman who gets to this point becomes embedded in a vicious cycle of daytime fatigue
and nighttime insomnia. Her hormones are measurably out of whack, her symptoms are
getting worse, and her adrenal glands continue to be over-tapped and under-supported.
But wait — it doesn’t have to be like this! Once you become aware that
a fatigue-insomnia symptom pattern is developing, you can take action to restore
your normal cortisol curve, which can prevent additional health problems and help
bring back your natural circadian rhythm.
Breaking the cycle of stress-related fatigue and insomnia
Even though it seems counterintuitive, there is often an upside to the symptoms
you experience. Like many issues that affect health, a fatigue-insomnia cycle is
an early warning sign, even if you’re saying to yourself, I’m managing
just fine, thank you very much. If insomnia and fatigue are your symptoms,
listen to your body. It’s sending you a clear signal that you may be suffering
from adrenal imbalance. You’re getting a literal wake-up call that you’re
heading straight down the path toward stress-related illness.
“Stress” — prompting us all to change
In 1936, the famous Hungarian–Canadian doctor, Hans Selye (pronounced SEL-yay),
developed the first model for what is now widely known as “stress.”
Today we recognize stress — psychosocial, biological, and environmental —
as one of our leading health problems.
When the Chinese created a written-language character for this new word meaning
“stress,” the resulting character, though translated as “crisis,”
actually combines two existing words — “danger” and “opportunity.”
References
Without regular, refreshing sleep you won’t be able to accomplish much during
the day. While you may not be able to change your daily schedule, you can improve
upon many aspects and, at the Clinic, we believe that sleep is one of those things.
W.C. Fields is quoted as saying that “the cure for insomnia is to get a lot
of sleep,” but while going to bed on time is helpful, it’s more complicated
than that.
One of the key steps for reducing insomnia is to try to close down the pipeline
of stimulation that a stressful life exerts on your body and your emotions. Your
insomnia solution won’t just focus on sleep itself. You’ll have to reconsider
how much stress you live with every day, and how you handle it. Then you can turn
your attention to finding ways to quiet the noise in your mind, and reduce the physical
reactions that stress is creating in your body.
Here are the steps I recommend to women who are experiencing stress-related insomnia
and fatigue:
- Be objective. Take a look at your life from 20,000 feet. Shine
a light on the real levels of tension and pressure you live with every day. Have
you gotten used to being stressed-out? Do you thrive on excitement and “need”
to be connected 24/7? Have you been compartmentalizing or carrying any emotional
burdens for a long time? Be honest and compassionate with yourself. This could be
an important opportunity to clear out old emotional connections that may be holding
you back — and keeping you awake at night.
- Consider adrenal testing. if you suspect your insomnia and fatigue
are connected to adrenal imbalance, talk to your healthcare practitioner about having
an Adrenal Stress Index (ASI). This simple saliva test measures
the production of several adrenal hormones, including cortisol and
DHEA, across a 24-hour period, and can effectively diagram your individual
cortisol curve.
- Think plant-based therapy. A
phytotherapeutic approach can help you overcome adrenal-based fatigue and insomnia.
Several medicinal herbs have been well researched and documented to reset the button
on the stress response and restore adrenal balance.
- Eat to support your adrenals. Many of us don’t realize that
what, when, and how we eat can be a help or a hindrance to our adrenal glands. Read
our article on nutrition for healthy
adrenal function to learn eating habits that support normal daily hormone
cycles, so you can enjoy steady all-day energy and experience sounder, more refreshing
sleep.
- Limit caffeine,
sugar, and alcohol intake. Even though many sleepless women rely on caffeine
and sugar to make it through the day, these very ingredients can wreak havoc on
your natural circadian rhythm. And while a nightcap every night might seem helpful
for dropping off to sleep, it can also prompt nocturnal waking several hours after
you consume it and dim your ability to “rise and shine” come morning.
- Be open to finding some unwinding. Try out new methods of relaxation
(see yoga sidebar) to learn which one dovetails best with your personality and lifestyle.
Yoga, guided meditation, listening to peaceful music, massage therapy, and acupuncture
have all been studied as effective treatments for insomnia.
- Exercise to help your body feel tired. If you are leading a fairly
sedentary lifestyle, you may not “feel” tired when it comes time to
turn in. To support your daily adrenal cycle, you can exercise vigorously early
in the day, or take a more gentle approach if it’s close to bedtime. The goal
is to make yourself physically prepared for rest, which can naturally help you fall
asleep more quickly and sleep more soundly.
Make your bed — and sleep in it!
If you’ve been trapped in the bad dream of stress-related insomnia and fatigue,
it may help to know more about why you are awake. This type of awareness helps soothe
the desperation that can sweep over you when you can’t doze off.
Try a more measured approach before you head to bed tonight:
- Stop eating, turn off the television, and shut down your computer two to three hours
before bedtime: relax, unplug, and unwind.
- Head to bed at least 10-15 minutes earlier than usual (aim for no later than 10:00
pm).
- Make sure your sheets, blankets, and pillows are inviting and comfortable —
just the way you like them — and that your bedroom is cool, quiet, and dark.
Darkness is absolutely crucial for inducing sleep in people with insomnia.
- Try to let go of unresolved problems until tomorrow, and as you settle down to sleep,
think of five things for which you are grateful. This simple affirmation can provide
a peaceful transition to sleep.
Prolonged stress is not normal for your body, so it may be time for an honest examination
of how you might reduce stress, and your reactions to it. Be patient and kind to
yourself as you investigate the stressors in your life and discover ways to resolve
them. In the end, this exploration will make a difference in your ability to fall
asleep, and stay asleep.
Something new to try: yoga techniques for insomnia
Research shows that practicing yoga can help insomnia. A small Harvard study showed
that just 30-45 minutes of yoga helped people fall asleep 30% faster and reduced
their nighttime waking by 35%.
Kundalini is an ancient type of yoga based on the concept that there is “coiled
energy” in the spine which connects to the “subtle body’s”
energy centers and channels (chakras and nadis). The scientific community is studying
the Kundalini practices, such as alternate nostril breathing, that are currently
being used to help people manage anxiety, insomnia, and other sleep disorders.
Alternate nostril breathing: People under stress tend to breathe
mostly out of their right nostrils, which is connected to the left
brain and activates the sympathetic nervous system. This channel is responsible
for the classic stress response: dilated pupils, increased core temperature, sweating,
and increased heart rate and blood pressure. Check throughout the day to see what’s
true for you — are you left — or right-nostril dominant, or is your
breath alternating and balanced?
When you want to calm yourself to get to sleep, try gently holding the right nostril
shut with your finger, and breathe deeply and slowly through your left nostril for
at least 3 minutes, either before you go to bed, or if you wake in the night. Then
release your fingers and breathe normally.
This type of breathing is easy to do but it takes some practice to be able to do
it for several minutes. (If you have nasal congestion, try again later.) This technique
can be very effective and calming.
Meditation: While some forms of meditation can increase alertness,
many techniques are calming and relaxing. Try this method used to prepare for meditation:
focus on your breathing. Don’t try to change it — at all — but
rather just notice the inhalation and the exhalation, returning to your breath when
you get distracted by other thoughts. Over the course of a few minutes, this technique
can help clear away worries before bedtime. You can also use it if you wake up and
need help getting back to sleep. Though this is a simple exercise, like most breathing
methods, it takes a little practice before it feels natural. But you can be rewarded
with a sense of calm well-being that can carry you gently into sleep.
References
Our Personal Program is a great place to start
The Personal Program promotes natural adrenal balance with nutritional supplements,
our exclusive adrenal support formula, dietary and lifestyle guidance, and optional
phone consultations with our Nurse–Educators. It is a convenient, at-home
version of what we recommend to all our patients at the clinic.
If you have questions, don't hesitate to call us toll-free at
1-800-798-7902. We're here to listen and help.
We’re always happy to welcome new patients to our medical clinic in Yarmouth,
Maine, for those who can make the trip. Click
here for information about making an appointment.
Related to this article:
References & further reading
on adrenal imbalance keeping you from sleep
Original Publication Date: 10/23/2009
Last Modified:
11/06/2009
Principal Author: Marcelle Pick, OB/GYN NP