Dr. Lam's Adrenal Line
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For fast reading, scan through the topic headings in BOLD BLACK, important conclusions in BOLD BLUE, and "Must Know" in BOLD RED. To jump to specific sections in this article, click on the respective in the Table of Contents.
Information presented here is for general educational purposes only. Each one of us is biochemically and metabolically different. If you have a specific health concern and wish my personalized nutritional recommendation, write to me by clicking here.
A common cause of insomnia is the malfunction of the Hypothalamus-Pituitary-Adrenal (HPA) axis. Adrenal glands are an integral part of this axis. Insomnia is therefore a classic sign of Adrenal Fatigue.
The main complaints for insomnia include: difficulty falling asleep (sleep onset insomnia), disturbed sleep, being easily woken up at night, difficulty falling back to sleep (sleep maintenance insomnia), feelings of not being rested, leading to tiredness in the morning, starting slower in the morning, and feeling fatigued during the day.
Sleep Onset Insomnia (SOI)
Difficulty falling asleep is called sleep onset insomnia (SOI). It is important that cortisol is at its highest level in the morning and at its lowest level at night for normal sleep to occur, along with waking up refreshed and energized. When the cortisol balance is off, sleep patterns can be affected. High cortisol levels are typical of people suffering from Adrenal Fatigue, especially in the early stages. This happens when the adrenals are on over-drive, putting out excessive cortisol throughout the day in order to deal with the constant stress. Some of the excess cortisol even carries into the night and this will affect the ability to fall asleep, leading to SOI. At the same time, stress triggers the adrenal medulla, which then produces excessive amounts of adrenaline (a hormone responsible for the fight or flight response). A high adrenaline level can independently disturb sleep patterns as the body is on full alert. This state is commonly called being wired. High cortisol and high adrenaline can occur simultaneously and this is common for those who suffer from Adrenal Fatigue.
General tips to help you fall asleep easier:
Sleep in a completely cool, quiet, and dark room. This will enhance melatonin production, an important sleep-regulating hormone. Try to draw and close all the shades and curtains. Even a small amount of light can reduce melatonin output from our brains.
Go to bed and get up at about the same time every day, even on the weekends. Sticking to a schedule helps reinforce your body's sleep-wake cycle and can help you fall asleep more easily at night. Do the same things each night to tell your body it's time to wind down. This may include taking a warm bath or shower, reading a book, or listening to soothing music. Relaxing activities done with lowered lights can help ease the transition between wakefulness and sleepiness.
Remove all electrical appliances, such as night-lights and alarms and put them at least 10 feet away from the bed to reduce EMF emissions, which can alter sleep patterns.
Do not do strenuous aerobics exercise or power yoga after dinner to avoid overstimulation of the sympathetic nervous system (SNS), which is frequently on overdrive in people who already suffer from Adrenal Fatigue.
Turn off your computer, TV, loud music, excitatory video games, and other devices that may trigger an adrenaline rush after 6 p.m. Try reading books in a quiet environment during the evening. If you do have to watch TV, refrain from channel surfing and violence oriented shows.
Avoid adrenal stimulators. It is very important to avoid certain foods and chemicals in order to avoid excessive stress on the adrenal glands. Sugary foods, caffeine and decaffeinated drinks of all kinds are to be avoided. Nicotine, alcohol, allergic foods (histamine is an adrenal stimulant), green tea, and chocolates are common offenders. Herbs and glandular products, unless approved by your health care professional, should also be avoided. Avoid partially hydrogenated fats such as deep fried foods and shortenings as they inhibit steroid hormone synthesis. Also avoid artificial sweeteners, which block the conversion of phenylalanine to tyrosine, needed to synthesize catecholamines in the adrenal medulla. Herbal tea, such as chamomile, is permitted.
Do gentle Adrenal Restorative Exercise, Adrenal Stretching, and Adrenal Rebuilding exercises in the late afternoon to transition the body at the end of a workday to evening. Do not do them in the evening. Low aerobics like long, slow walks should be done in the morning or late in the afternoon. Taking a short walk after dinner is an exception provided the body does not feel drained immediately afterward.
Always go to sleep before 10 p.m. at the latest. If you are tired, go to sleep earlier. Do the Adrenal Breathing Exercises just before bedtime and not at any other time in the evening. This will help with the transition to sleep. You should do this as part of your relaxing bedtime routine.
A small snack of protein and fat (a handful of nuts or cottage cheese) before sleep is good. A light snack before bed can help promote sleep. When you pair tryptophan-containing foods with carbohydrates, this will help to calm the brain down and allows the body to sleep better.
If you don't fall asleep, get up and do something else like Adrenal Restorative Exercises or Adrenal Breathing Exercises. Go back to bed when you're tired. Don't agonize over falling asleep. The stress will only prevent sleep. It is common for many people with Adrenal Fatigue to feel wired and tired at the same time. If your mind is running and cannot stop, use the energy to think positive thoughts. Set aside worries and any negative thoughts, get into the habit of positive thinking at bedtime, and occupy your mind with images of relaxing places or happy events.
A good bed is subjective and different for each person. Make sure you have a bed that is comfortable and offers orthopedic support. If you share your bed, make sure there's enough room for two. Children and pets are often disruptive, so you may need to set limits on how often they can sleep in your bed with you.
Take a natural sleep aid as directed by your health care professional. There are many available, each with its special characteristics. It's common to use multiple sleep aids, but some trial and error is needed to arrive at the right combination for you.
Sleep Maintenance Insomnia (SMI)
Sleep maintenance insomnia is when you are able to fall asleep but tend to wake up in the middle of the night and are unable to fall back to sleep. This is usually due to a number of factors triggering sleep onset insomnia as well as metabolic imbalances such as sugar and insulin dysregulation that happens during sleep. With excessive stress during the day, the body can sometimes fall asleep despite high cortisol and adrenaline levels simply because of the magnitude of physical tiredness. In other words, the physical tiredness often overwhelms the elevated adrenaline and cortisol levels. The body needs a break. It crashes and you go to sleep. You can be wired and tired but also able to fall asleep for a few hours. However, the cortisol and adrenaline remain high during this time, so the body is awakened by these sustained high levels in the middle of the night as the physical tiredness is reduced by a few hours of rest, leading to sleep maintenance insomnia. Once awakened, it is hard to fall back to sleep.
Another factor that contributes to SMI is metabolic dysregulation. Those who suffer from advanced Adrenal Fatigue often have concurrent metabolic imbalances such as insulin dysregulation and hypoglycemia. When blood sugar drops below a certain level during sleep due to lack of glucose supplied from food, it can activate the SNS, leading to adrenaline release and waking up. Blood sugar can be normal by conventional laboratory standards but the body may be extremely sensitive to the roller-coaster ride of the blood sugar level so that even a small drop within normal ranges during the night can trigger awakening. This is often accompanied by symptoms such as heart palpitations, cold sweats, and nightmares.
In addition to practicing the good sleep habits and protocol for sleep onset insomnia, we need to make sure that the glucose level is stabilized throughout the evening to avoid sleep maintenance insomnia. When your blood sugar level falls, healthy adrenals restore the levels back to normal. If the blood sugar levels are not stabilized, there will not be optimal results when attempting to correct the adrenal status. Here are the dietary guidelines to stabilize your blood glucose levels:
Do not skip breakfast. In fact, it should be the biggest meal. You should not wake up feeling hungry, as this is a sign that your blood sugar may be low during sleep. Eat a high quality protein-based breakfast, not just bread and cereal. Eggs are an excellent source of protein and unoxidized cholesterol as long as it is not over-cooked.
Eat every two to three hours during the day if you have hypoglycemia or have a tendency to be weak and dizzy two to three hours after a meal but feel great immediately following a meal. Do not wait until you are hungry. However, do not eat continually either.
Snack only on low glycemic foods such as nuts, seeds, hard-boiled eggs, etc. for sustained energy release along with a small amount of carbohydrate such as carrot to supply instant energy to the body.
Avoid all fruit and carrot juices. Whole fruit such as apple is acceptable.
Never, consume high glycemic fruits and foods without a source of protein and fat to balance them. For example, you can eat a combination consisting of a whole fruit with some almond butter to balance the carbohydrate with protein and fat.
Take the prescribed natural compounds designed to stabilize blood sugar and calm the autonomic nervous system (ANS). Your health care professional will guide you on this.
A bedtime snack is especially important. The portion can be small, but for some, it may be quite a full meal. Your health professional will advise you on the best regiment.
If you wake up in the middle of the night, have another light snack.
Be Patient with Changes
Sleep issues may take some time to resolve, so be patient. Stick with your routine and slowly you will begin to experience the benefits of a good night's sleep.
There is a large variety of sleep aids available. Some of the sleep aids may help while others may not. Each sleep aid nutrient has specific pathways that work best for different people. Gaba, for example, works better for those with Adrenal Fatigue and are adrenal dominant, while 5-HTP is usually more effective for the thyroid dominant type. Because each body behaves differently in response to different types of sleep aid nutrients and the predominance of paradoxical reactions in Adrenal Fatigue, the experienced clinician will employ different combinations of natural compounds for maximum effect. Because of the multiple pathways involved in the sleep mechanism on different parts of the mind and body, some trial and error is usually required.
About The Authors
Michael Lam, M.D., M.P.H., A.B.A.A.M., is a western trained physician specializing in nutritional and anti-aging medicine. Dr. Lam received his Bachelor of Science degree from Oregon State University, and his Doctor of Medicine degree from the Loma Linda University School of Medicine in California. He also holds a Master’s degree in Public Health. He is board certified by the American Board of Anti-Aging Medicine where he has also served as a board examiner. Dr. Lam is a pioneer in using nontoxic, natural compounds to promote the healing of many age-related degenerative conditions. He utilizes optimum blends of nutritional supplementation that manipulate food, vitamins, natural hormones, herbs, enzymes, and minerals into specific protocols to rejuvenate cellular function.
Dr. Lam was first to coin the term, ovarian-adrenal-thyroid (OAT) hormone axis, and to describe its imbalances. He was first to scientifically tie in Adrenal Fatigue Syndrome (AFS) as part of the overall neuroendocrine stress response continuum of the body. He systematized the clinical significance and coined the various phases of Adrenal Exhaustion. He has written five books: Adrenal Fatigue Syndrome - Reclaim Your Energy and Vitality with Clinically Proven Natural Programs, The Five Proven Secrets to Longevity, Beating Cancer with Natural Medicine (Free PDF version), How to Stay Young and Live Longer, and Estrogen Dominance. In 2001, Dr. Lam established www.DrLam.com as a free, educational website on evidence-based alternative medicine for the public and for health professionals. It featured the world’s most comprehensive library on AFS. Provided free as a public service, he has answered countless questions through the website on alternative health and AFS. His personal, telephone-based nutritional coaching services have enabled many around the world to regain control of their health using natural therapies.
Dorine Lam, R.D., M.S., M.P.H., is a registered dietitian and holistic clinical nutritionist specializing in Adrenal Fatigue Syndrome and natural hormonal balancing. She received her Bachelor of Science degree in Dietetics, holds a Master’s Degree in Public Health in Nutrition, and a Master of Science degree in Nutrition from Loma Linda University, in Loma Linda, California. She is also a board-certified, Anti-Aging Health Practitioner by the American Academy of Anti-Aging Medicine. She coauthored with Michael Lam, M.D., the books Adrenal Fatigue Syndrome - Reclaim Your Energy and Vitality with Clinically Proven Natural Programs and Estrogen Dominance and numerous articles on Adrenal Fatigue Syndrome. Her personal research and writing focuses on the metabolic aspect of Adrenal Fatigue Syndrome. She is married to Michael Lam and is an integral part of the telephone-based nutritional coaching team helping people overcome Adrenal Fatigue Syndrome.
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