Adrenal health

Is adrenal imbalance keeping you from sleep at night?

by Marcelle Pick, OB/GYN NP

• Your internal clock
• Disruptive sleep — and much more
• Breaking the cycle of stress-related fatigue and insomnia
• Make your bed — and sleep in it!

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.

Do these scenarios sound familiar? There are many different causes of both fatigue and insomnia, and my patients are relieved when I tell them there may well be genuine physical reasons for these symptoms. For some, fatigue is the result of sleep apnea, and if you have problems with snoring, I suggest exploring this avenue. But the physical imbalance I often find hindering sleep is adrenal dysfunction, which typically begins with stress.

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. To help prepare for the emergency, your body releases the stress hormones cortisol, adrenaline, and cortisone. Ideally, a healthy body returns to normal once the threat has passed. But 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 hyper-activates your adrenals and can draw you into a whirling cycle of alertness and sleeplessness.

Instead of reaching for the sleeping pills, let’s take a closer look at what might be at the core of your insomnia — and help you get back to sleep.

Your internal clock

It’s not surprising that many cultures and spiritual traditions believe we are connected on a core level to the universe itself because scientists have found that your brain’s hypothalamus maintains a “master circadian clock” which regulates adrenal hormone levels (adrenaline, cortisol, etc.). 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.

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.

Disrupted sleep — and much more

If nothing changes, women who experience stress-related adrenal imbalance can eventually become “cortisol dominant.” High cortisol alters normal sleep cycling, reducing the amount of restorative REM (dream-state) sleep you experience, but it also participates in a wide array of additional physical reactions.

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

When cortisol is too high or too low — as I’ve seen in many stressed-out women — any of these physical systems can be affected, which means your overall health can suffer.

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. You’re getting a literal wake-up call that you’re heading straight down the path toward stress-related illness.

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.

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.
• 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. You’ll find that your caffeine and sugar staples may be wreaking havoc on your natural circadian and cortisol rhythms.
• 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.
• Explore natural sleep support. For some women, adding calcium and magnesium before bed can help. You might also explore calming herbs like chamomile, kava kava, valerian, and passion flower. Or you can talk to a practitioner about agumentation with natural sleep molecules like phosphatidylserine, 5HTP, or melatonin. A combination approach like the one we offer in our Personal Program has been helpful for many women to reset their sleep patterns. In addition, yoga, guided meditation, listening to peaceful music, massage therapy, and acupuncture have all been studied as effective treatments for insomnia.

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.

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Last Modified Date: 04/15/2011
Principal Author: Marcelle Pick, OB/GYN NP