Do you ever notice how your stress levels impact your sleep? It might be more than just your
racing mind keeping you up. The physiologic effects of chronic stress play a significant role in
your sleep-wake cycles.
Stress, Cortisol, & Insomnia
If you are the type of person who wakes up tired in the morning and then is wide awake come
bedtime, you may be experiencing something known as hypothalamic-pituitary-adrenal (HPA)
axis dysregulation. The HPA axis refers to the complex network of neuroendocrine signalling
that helps you regulate energy and stress. When out of sync, it can interrupt your sleep cycle.
The HPA Axis
The HPA axis is comprised of a signalling network between a region in your brain called the hypothalamus, the pituitary gland (which sits just below the hypothalamus), and your adrenal glands, which are small glands that are located on top of each kidney. These three structures work together to help you respond to stress. The signalling cascade begins when your brain or body perceives or experiences stress. This can be caused by stressful events, illness, or subconscious stress that accompanies the busy pace of modern life. The brain receives stress signals from these various stimuli, which are then transmitted to the hypothalamus – a region in your brain connecting your nervous system to your endocrine system via the pituitary gland. The hypothalamus sends corticotropin-releasing hormone (CRH) to the pituitary gland which causes it to release adrenocorticotropic hormone (ACTH), which is sent to your adrenal glands to stimulate the release of cortisol. This network has a built-in negative feedback system. When sufficient cortisol is produced, these signals are inhibited, thereby ceasing stimulation of cortisol production by the adrenal glands.
What is cortisol & what does it do for me?
Cortisol, lovingly known as “the stress hormone,” is a steroid hormone derived from cholesterol and produced by the adrenal glands. It is classified as a glucocorticoid, named for its ability to increase blood sugar. Cortisol’s main job is to respond to stress, but it has many other functions in the body: helping to maintain blood pressure and cardiovascular function, keeping the immune system and inflammation in check, influencing the central nervous system and behavior, and is involved in metabolism of calcium, bone, protein, fat, and carbohydrates.
Cortisol also has an impact on our energy. In healthy people, cortisol spikes in the morning, outputting 50% of its total production within the first hour of waking. This enhances arousal (energy, alertness), and mobilizes glucose for energy to help us meet the demands of the day. When our HPA axis is thrown off (by stress, overwork, lack of sleep, illness, etc.), and morning cortisol is low, we don’t get the energy benefits. Therefore, we begin to feel fatigued, sluggish and crave salt and sweets to make up for our lack of energy. In contrast, when cortisol is high at night, we can feel ‘wired’ and have difficulty falling asleep, resulting in what we call sleep-onset insomnia. A common pattern of HPA axis dysregulation is low cortisol in the morning and high cortisol at night – a pattern of feeling wired and tired (see figure 2 below).
The Cortisol Curve
Each day, your cortisol output should peak in the morning, and gradually decline over the course of the day in line with your sleep-wake cycle, as in figure 1. When you experience chronic stress, your cortisol levels may stay elevated at night, precipitating insomnia, as in figure 2. Without addressing the wear and tear of chronic stress on your body (aka the allostatic load), cortisol may become hyper-elevated, which can leave you feeling wired, as in figure 3. Or it can be functionally flatlined, which leaves you feeling exhausted, as in figures 4. We assess the cortisol curve by serial salivary hormone samples (morning, noon, evening, and night), which are then sent to the lab for analysis and plotted on graphs for easy interpretation, as pictured.
The Misnomer of Adrenal Fatigue
You may have heard of HPA axis dysregulation referred to as “Adrenal Fatigue”. While it may appear this way, the adrenals do not “give out” or become depleted of cortisol. Rather, the signalling mechanisms within the axis stop telling them to produce cortisol, thereby slowing you down when you won’t do it yourself.
How can we prevent it?
As previously mentioned, the wear and tear of chronic stress will derange the HPA axis if not corrected. Practicing stress management is key to give your body a stress-break so it can find balance. Identifying and admitting your stressors is the first step to reducing them. Whether you are giving all of your time and energy to your career, family, relationships, or recreational activities, setting healthy boundaries and scheduling downtime to renew your energy is crucial for your long-term health. As with all things, a healthy diet, exercise, meditation, and giving yourself a 7-9 hour sleep window lays the foundation for the body to heal and repair.
How can we correct the curve?
As naturopathic doctors, we have many therapies that are useful in helping mitigate the physiologic effects of stress. In addition to addressing the foundations for health (as above), we may prescribe nutrients that are helpful to the adrenal glands (B vitamins, vitamin C, magnesium), herbal adaptogens, adrenal glandular products, or when necessary, synthetic glucocorticoids.
*While the thought of consuming ground up pig adrenal glands might be odd, it is the same premise as eating liver to increase your iron. Using animal glands to replete lost nutrients or hormones is an efficient way to restore balance when indicated.”
Think of this system as an energy bank – you can make small deposits (nutrients, herbs, glucocorticoids, etc) but you have to address the imbalance in your life that is draining your energy (ie. overwork, lack of sleep, chronic illness). Stress-management strategies, getting adequate rest, exercise, healthy relationships, and a healthy diet is essential for maintaining a healthy, cortisol-balanced lifestyle.
**This written article is not a substitute for medical advice. Always consult a health practitioner prior to starting any new health regime to assess whether it’s right for you, especially when it’s affecting critical hormones.
If you are having difficulties with managing stress, insomnia, or low energy, we’re here to help. Book online here or call (604) 670-0590 to make an appointment with one of our naturopathic doctors for an assessment and personalized treatment plan to suit your individual needs.
New to Tandem or to naturopathic medicine in general? We offer 15-minute meet-and-greets so you can decide if we’re the right fit. If not, we’re happy to direct you to one of our colleagues who might be.
Dr. Jacalyn Sieben, ND
Want to book an appointment? Just click the link below:
- Carlos M. Contreras, Ana G. Gutiérrez-Garcia. Cortisol Awakening Response: An Ancient Adaptive Feature. Journal of Psychiatry and Psychiatric Disorders 2 (2018): 29-40. Retrieved from: //www.jpsychiatrypsychiatricdisord.com/articles/cortisol-awakening-response-an-ancient-adaptive-feature.html
- Gilkes, M. (2017). Cortisol production and use by the body. Ausmed Education. Retrieved from: //www.ausmed.com/cpd/articles/cortisol-production-use-body
- Lightman, S. (2016 ). Rhythms within rhythms: The importance of oscillations for glucocorticoid hormones. A Time for Metabolism and Hormones, Research and Perspectives in Endocrine Interactions. Retrieved from: //www.ncbi.nlm.nih.gov/books/NBK453178/figure/ch10/ doi: 10.1007/978-3-319-27069-2_10
- Moyer, K. (2016). Adrenal lecture [Powerpoint]. Nutrition VII Detox and Hormone Health. Boucher Institute of Naturopathic Medicine.
- Powell, D. J., & Schlotz, W. (2012). Daily life stress and the cortisol awakening response: testing the anticipation hypothesis. PloS one, 7(12), e52067. Retrieved from: //www.ncbi.nlm.nih.gov/pmc/articles/PMC3527370/
- Wust S, Wolf J, Hellhammer DH, Federenko I, Schommer N, Kirschbaum C. The cortisol awakening response – normal values and confounds. Noise Health 2000;2:79-88
You might also want to read our previous blog, Seasonal Affective Disorder & The Sunshine Vitamin