Our Biological Clock and Adrenal Fatigue Syndrome – Part 1

By: Michael Lam, MD, MPH; Dorine Lam, RDN, MS, MPH


Adrenal fatigue can affect your biological clockOur biological clock (BC) refers to the natural rhythm that certain bodily functions and activities follow. This includes our body temperature, level of alertness; sleep schedule, and endocrine activity. The biological clock or biological rhythm usually repeats in predictable cycles of time. The menstrual cycle, for example, occurs every twenty-eight days. Rhythms that follow a twenty-four hour cycle are often referred to as circadian rhythms, such as our sleep–wake cycle. Our brain helps maintain and control our internal biological clock that regulates these rhythms.

There are external factors that can have an influence on our biological clock, for example, sunlight and certain drugs like caffeine that can affect our sleep schedule. Disorders can also develop when our natural biological clock is interrupted or disturbed. They include:

  • Sleep disorders, insomnia
  • Mood disorders, depression and seasonal affective disorder
  • Shift-work disorders
  • Jet lag
  • Metabolic imbalances

Adrenal Fatigue Syndrome (AFS) is a neuroendocrine condition brought on by stress. The main symptom is fatigue despite normal laboratory tests. As AFS progresses through its four stages from mild to severe, biological clock disruptions tend to be more pronounced. Most advanced AFS suffers therefore have severe insomnia. In advanced stages of AFS, many sufferers are simply unable to fall asleep (also called sleep onset insomnia or SOI) or stay asleep (also called sleep maintenance insomnia or SMI) because they feel both wired and tired. In very severe cases, catnaps are the only way the patient can get any sleep, which means they can end up being sleep deprived for days at a time. Scientific research has revealed that a great many of these cases are caused by biological clock disruptions secondary to hormonal and neurotransmitter (NT) dysregulation.

This paper examines the role biological clock plays in insomnia in a setting of advanced AFS and suggests natural approaches and solutions.

Biological Clock Basics

Chronobiology is an area of biology examining periodic or cyclic occurrences in living organisms and their synchronization with universe and solar related rhythms. These cycles are called biological clock (BR). Research in this area involves the study of other fields such as neurology, space medicine; sleep medicine, endocrinology and psychology. This is not the same as biorhythm, which is really just a pseudoscience attempting to explain cyclic variations in the behavior of humans based on emotional and physiological cycles, and has nothing to do with chronobiology.

The duration and timing of biological activity in organisms varies among many of the essential biological processes. The most vital rhythm in chronobiology would be the circadian rhythm. This is roughly a twenty-four hour cycle indicated by physiological processes in all these different living organisms. Circadian rhythms control:

  • Endocrine rhythms
  • Sleep timing
  • Performance
  • Behavior

All this is regulated and controlled by the circadian clock, which is a collection of nerves in the region of the brain known as the hypothalamus. Other forms of biological clocks include:

  • Tidal Rhythms – Often seen in marine life, they follow a roughly 12.4-hour cycle from low tide to high tide and back.
  • Infradian Rhythms – These cycles last longer than twenty-four hours, as the yearly migration of birds or the reproduction cycles of certain animals and of course the human’s female menstrual cycle.
  • Gene Oscillations – Certain genes are expressed more during specific hours of the day.
  • Ultradian Rhythms – Cycles lasting less than twenty-four hours, as the REM sleep cycle that lasts ninety minutes, or the three-hour cycle that produces growth hormones.

Biological Clock Disruptions

This Panda sleeping in a tree is living its life according to its biological clock Animals, plants, cyanobacteria and fungi have all been observed having biological clocks. Even though these different biological clock are internally controlled, there are some external factors that can influence their regularity.

Factors that can alter the biological clock greatly include changes in light brought about by seasonal transitions, changes in work schedule involving different sleep schedules, severe or unrelenting stress, jet lag, toxic overload, neurotransmitter imbalances, and receptor site disorders. The factors also cover chronic conditions such as dysregulation of the neuroendocrine system or Adrenal Fatigue Syndrome, dysregulation of the autonomic nervous system, which includes an over abundance of norepinephrine (known as sympathetic overtone), overabundance of adrenaline (known as reactive sympathetic response), and polluted extracellular matrix. These factors reach into areas of glucose intolerance, metabolic syndrome, reactive hypoglycemia, excessive metabolic build-up from liver congestion, improper detoxification, reaction to retoxification, unresolved stealth infection, aging, weight loss, pregnancy, OAT axis disruption, HPA axis dysregulation, paradoxical results from medication and/or natural remedies including herbs, excessive or prolonged use of antibiotics, pH imbalance, caffeine, severe infection, and weak constitution.

Just about any condition that brings about an imbalance in internal homeostasis could trigger a disruption in biological clock. The onset could be gradual or acute. The classic presenting complaint is insomnia, indicating a disrupted biological clock. Some have reported a sudden case or onset of insomnia after experiencing an extremely stressful event or after taking a course of antibiotics. Others have reported a slow gradual onset that spans months when their sleep pattern became slightly disrupted but over time gradually worsen.

Disorders in biological clock can affect sleep–wake cycles, body temperature, the release of hormones and other vital bodily functions. They have been associated with:

  • Sleep disorders such as insomnia
  • Mood disorders such as depression, anxiety and bipolar disorder
  • Obesity
  • Metabolic syndrome
  • Diabetes
  • Seasonal affective disorder, a form of depression

Since very few clinicians are looking for biological clock disruptions when examining their patient complaining of insomnia, it is hardly ever recognized as a vital problem until the biological clock disruption becomes severe and entrenched. Such is the case when associated with advanced AFS.

The most common presenting complaint from patients suffering from biological clock disruption is insomnia. Instead of trying to determine the root cause of the sleep disturbance and restore proper biological clock as the ultimate long-term solution, most try to self navigate at first with sleep aids, such as melatonin or over-the-counter antihistamine. When the sleep aids fail stronger medications are taken. This usually works for a while, but eventually the body develops tolerance as well as dependency.

To make matters worse, most sufferers of chronic insomnia invariably have low energy during the day. They are frequently prescribed stimulants to increase energy to help them make it through the day after the effects of coffee diminish. These compounds include DHEA, testosterone, vitamin B12, pregnenolone, and various herbs like green tea, rhodiola, maca, ashwagandha, and ginseng. Coffee intake has usually already become a habit by now. Patients are usually hyped up throughout the day but later wired and unable to calm down and relax at bedtime.

This woman taking medication may in fact be disturbing her biological clock even in the effort to regain it.Inevitably, stronger prescription sleep medication is used to induce sleep over time. Without solving the underlying biological clock disruption, sleep forced on by medication only lasts a few hours and sufferers now awaken frequently in the middle of the night unable to return to sleep. Those with weak constitutions may have metabolic disruptions in the middle of the night because of biological clock imbalances. They awaken after a few hours of sleep experiencing heart palpitations, perspiration, and anxiety. In severe cases, visits to the ER with extensive workups only result in being pronounced well and sent home. Typically sufferers wake up in the middle of the night and are not able to return to sleep easily and when morning dawns they do not feel at all refreshed or ready to take on the new day. They drag themselves through the day only to repeat the same insomnia cycle the following night.

Left unattended, biological clock disruptions become more severe and chronic intractable insomnia becomes the norm. Many resort to only taking catnaps during the day and remain awake throughout the night for the most part. By now prescription, sleep medications don’t continue to work well and many have reached their maximum dosage. The patient is also typically maxed out on stimulants during the day. With no other options, their doctor concedes defeat and abandons the patient. By now their biological clock is severely disrupted. Fortunately, this clinical picture is not a frequent occurrence as it represents extreme situations. Unfortunately, sufferers in this state are left with no options and nowhere to turn for help. To restore biological clock, we first need to review how our internal master clock is involved.

The Master Clock

There happens to be a master clock inside our brain that coordinates all our biological cycles to make sure they are synchronized. This is made up of a grouping of nerve cells called the suprachiasmatic nucleus (SCN). It contains approximately 20,000 nerve cells and can be found in the hypothalamus.

This is where the production of melatonin is controlled, which is the hormone that helps to bring on sleep. The SCN can be found right above the optic nerves. These nerves send messages from the eyes to our brain, which means the SCN gets information regarding incoming light. At night there is less light so the SCN instructs the brain to produce more melatonin to make us sleepy. Therefore more melatonin is produced and secreted at nighttime and ebbs during daytime. The presence of melatonin gives the brain the information it needs about the length of nighttime.

Your body's biological clock can be affected with Adrenal FatigueNeurotransmitters play a very big part in how the SCN functions in our brain. The strength of our circadian rhythms depends on how accurately our biological clock is functioning and how well it is integrated into the actions of thousands of separate cellular clocks contained within. Neurotransmitters are working in all areas of this system, during the input of information, within the clock itself, and in the efferent output needed for normal functioning of the clock.

The phase markers used to measure the timing of the biological clock of mammals are:

  • Core body temperature
  • Heart rate
  • Melatonin
  • Cortisol
  • Production of red blood cells

Seven Clinical Temporal Biological Clocks

Our daily circadian rhythm can be broken down clinically into seven sub-rhythms that follow one another.

1. Awakening Rhythm

This occurs from 6 – 9am. We stop secreting melatonin by about 7:30am. It is the body’s natural way of saying it is time to get up. To facilitate the awakening process, cortisol, an important anti-stress hormone secreted from the adrenal glands, rises during the early morning hours. Cortisol levels are at their peak around 8:30am.

Our heart rate and blood pressure rises as well in the early morning hours while our output of norepinephrine increases. This allows us to stand up from a horizontal position and move around physically so we can begin our day productively.

Our GI tract also has its active phase after awakening. The large intestine acts to let go physically as well as emotionally. Most can expect a bowel movement by around 9am. However, a much better time for this would be before 7am.

2. Morning Rhythm

This occurs from 9am to noon. Most adults are busy at work during this time, with drawdown on our brainpower and physical reserve, depending on our activity. This is when our testosterone is at its highest output, which means we are on full alert by 10am. Traditional Chinese medicine claims the spleen pulls the needed nutrients from our food, transforming it into energy that is sent to other organ systems throughout our body during this time frame. If we experience bloating after meals, loose stools, low energy and crave sweets these symptoms indicate an imbalance. People who are weak or have AFS may become tired and anxious in the late morning hours.

Typically, a biological clock disruption tends to be more pronounced from 11am to noon, with symptoms indicating an imbalance such as:

  • Heart palpitations
  • Shortness of breath
  • Cold hands and feet
  • Insomnia
  • Anxiety

3. Lunch Rhythm

This occurs from noon to 2pm. Most people look forward to lunch as a time to replenish their energy. After lunch, our small intestine starts working to help food assimilation. If the person has ingested too many carbohydrates at lunch, causing metabolic dysfunction, they could experience a food coma and start feeling sleepy after the meal.

If you have not consumed enough water throughout the morning, you will likely feel dehydrated during this part of the day. When you are out of balance, certain physical conditions may develop which can include bloating with gas or even vomiting and a duodenal ulcer.

Our heart and heartbeat are influenced by what part of the biological clock cycle our bodies are at.

4. Afternoon Rhythm

This occurs from 2 to 6pm. You are likely to experience a mid-afternoon slump in energy and focus and this typically occurs between the hours of 3 to 5pm. if you are weak.

The key is mid-afternoon between 2 to 4pm. After the immediate energy surge has exhausted itself, as in the case of AFS, fatigue returns. Your blood sugar levels may be within the normal range, but you feel lethargic. Those with metabolic issues may experience reactive hypoglycemia. During this time of day you can easily feel a drop in energy, especially if you have not consumed enough water and are dehydrated. When this imbalance occurs you may feel a burning sensation when urinating, develop a yeast infection or even urinary incontinence.

Our body is most coordinated at about 2pm. This is when our body’s cardiovascular system is performing most efficiently. Our muscles have warmed up and our level of stress is decreasing as the day’s end approaches. Our greatest muscle strength occurs around 5pm. This is the time of day when people are least likely to have a heart attack while exercising.

5. Dinner Rhythm

This occurs from 6 to 9pm, around dinnertime. The body reaches its highest temperature at 7pm. while the neurotransmitters responsible for carrying out the day’s activities are still going strong. Cortisol is gradually declining since mid-morning and continues.

As light begins to dim, the process of Dim Light Melatonin Onset (DLMO) begins around 9pm and can be detected in blood or saliva. Melatonin’s most prominent metabolite can be detected in the morning urine. Both DLMO and the midpoint, time wise of melatonin being present in the blood and/or saliva have been commonly used as circadian markers.

6. Sleep Onset Rhythm

This occurs from 10pm to 2am. You are now suppressing any bowel movement as you begin your sleep cycle. During sleep, you cycle back and forth between REM and non-REM periods of sleep. Your lowest cortisol levels occur around midnight.

You begin with non-REM sleep then you experience a shorter time of REM sleep. The cycle then repeats. During REM sleep you will typically have dreams.

Non-REM sleep occurs in three different phases. Each phase lasts from five to fifteen minutes. You experience all phases before achieving REM sleep.

  • Phase 1 – Although your eyes are shut, it’s still easy to awaken you. You will be in this phase for five to ten minutes.
  • Phase 2 – You are in a light slumber. Your heart rate has slowed down and your body temperature has dropped. Your body is preparing for a deep sleep.
  • Phase 3 – This is when you are in a deep sleep. It’s more difficult to awaken you during this phase. If someone does wake you up, you will be disoriented for several minutes.

During the phases of deep non-REM sleep, your body repairs and regrows bone and muscle tissue, while the immune system becomes stronger.

A woman sleeping soundly because she has a well adjusted biological clockRapid Eye Movement (REM) sleep is a stage of sleep when your eyes are quickly moving in different directions. This doesn’t occur during non-REM periods of sleep. Typically, people enter REM sleep around ninety minutes after first falling asleep. Each of the later REM sleep phases lasts longer, and the last one of the night can last up to an hour. Your breathing and heart rate becomes quicker.

During REM sleep your brain increases in activity so you are able to have more intense dreams.

Most people when allowed to sleep for as long as they want will sleep for approximately nine hours. Age affects sleep however, for example newborns sleep twice as much as adults do. There are differences in the individual sleep requirements of people, and studies on twins reveal these differences may be in part genetic. As you age, you tend to sleep more lightly and not get as much deep sleep.

Your body should be completely immersed in your sleep cycles as the night continues on, reaching your deepest sleep around 2am.

Sleep Maintenance Rhythm

This occurs from 2 to 6am. The body is now on automatic cruise control, resting and rejuvenating. The lowest body temperature is reached at about 5am. Cortisol levels start rising at around 2 to 3am with levels continuing to climb throughout the balance of the night until we awaken in the morning. Our level of alertness is at its lowest from 4 to 6am.

Metabolic dysfunction such as sugar imbalances, excessive stress, anger and resentment can cause excessive neurotransmitter (NT) releases, waking you up. If you’re not sleeping at this time, you can quickly become deficient. You may find that you wake up between 2 to 4am. if you have repressed anger or long standing resentment. Symptoms of liver imbalances include irregular menstruation, anemia, chronic fatigue, and headache. According to traditional Chinese medicine, liver cleansing takes place during this time. biological clock disruptions during this phase can lead to liver and extracellular matrix congestion.

Insomnia: The Classic Biological Clock Dysfunction

According to the World Health Organization, a full 40 percent of the population worldwide suffers from some form of sleep disorder. Along with disruptions in sleep, or the inability to sleep, these circadian rhythm disturbances can change our body mass index as well as cause behavioral disorders.

Fundamentally we process incoming information on two different levels. Our conscious mind processes information in a serial manner, which is fairly slow. However, because we are aware and able to focus we are able to act voluntarily, performing functions like problem solving, moving our muscles, and communicating verbally with others.

When we are unconscious our mind is still processing incoming information and we can perform tasks that are familiar to us automatically. In this state our senses and neural pathways continue to rapidly register stimuli on multiple tracks simultaneously without us being consciously aware or knowing that all of this is going on. This is how we digest food and regulate sleep. Because our body continues to run due to our autonomic nervous system, we are thus able to maintain our biological clock phases throughout the day, making adjustments to stay in sync with our various activities, whether we are awake or asleep.

A man suffering from disrupted biological clock and insomnia from Adrenal FatigueOur biological clock is very sensitive to internal and external cues so it can become easily desynchronized from a number of different factors:

  • Social or lifestyle factors like shift work
  • Mutations in our clock’s genes leading to aberrant regulation
  • Impaired or desynchronized neurotransmitters

Many aspects of our molecular clock regulate the levels of neurotransmitters in our system, including the level of serotonin. A malfunctioning clock can thus lead to impaired neurotransmission. And the converse is true in that impaired neurotransmission may affect our molecular clock’s synchronization. Whether a malfunctioning molecular clock is cause or effect is up for debate. However, many psychiatric conditions and disorders, including depression, bipolar disorder and schizophrenia are linked to disruptions in circadian rhythms.

When psychiatric disorders are treated with pharmaceutical drugs the medications prescribed often entail restoring balance to the patient’s dysfunctional neurotransmission systems. However a better outcome might possibly be achieved by addressing the dysfunction also existing in the patient’s molecular clock.

If our neurotransmitters are disrupted or dysregulated, combined with a neuroendocrine dysregulation such as that of Adrenal Fatigue Syndrome, our health can suffer due to the normal biological clocks being disrupted, with symptoms such as:

  • Anxiety
  • Moodiness
  • Easily irritated
  • Tendency toward bipolar behavior
  • Mild anger
  • Panic attacks
  • Feeling wired but tired at the same time
  • Insomnia

Read Part 2 | Part 3

© Copyright 2015 Michael Lam, M.D. All Rights Reserved.


Dr. Lam’s Key Questions

There are many reasons, such as low sperm count, poor sperm quality, anatomical or genetic defects. Usually, a doctor’s visit is necessary. Due to the many possible causes, a complete workup is necessary.

Males and females have different sets of hormones. So their imbalance would be different. As a result, the treatments would be different also.

In general with the aging process, it could start around 25-30 years old after peaking in the early twenties. Every hormone has its own decay curve. Replacement usually is not necessary until later on in life unless under special circumstances.

Nausea and fatigue during the first trimester and later periods of pregnancy are common because of the changes happening in the body. If you have kept up a nourishing diet and supplementation during and after delivery, your body should be healthier than before you are pregnant. For Chinese philosophy, the 40 days after deliveries are the best time to rebuild the body.


Biological clock

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23 Comments

  • Mimi says:

    Didn’t realize there are so many rhythms connected with the biological clock!

  • Tommy says:

    Great information, many thanks for Dr.Lam for having great articles!

  • Jen says:

    I’ve been sleeping early and still having trouble waking up early and not feeling tired. What’s going on with me?

  • Porshe says:

    It seems that I can only fall asleep if the television is on. If my husband turns it off in the middle of the night I will wake up and have to turn it back on. Is the television causing my sleep issues even though it’s what lulls me into sleep? (i.e. causing more harm that it is helping)

    • Dr.Lam says:

      Your body may be so used to the stimulatory effect of TV that it has become dependent. A more detailed history is needed.

      Dr.Lam

  • Becca says:

    I started having trouble sleeping some years ago and I started taking Melatonin at night to help. It did help, but then I had to take more and more and if I didn’t have it I could not get to sleep. My doctor had to prescribe me Trazadone, then I got addicted to that! I wish someone would have enlightened me about the underlying issues instead of just watching as I continued to mask the problem and eventually created an even bigger problem for myself.

  • Brendan W. says:

    This article makes so much sense to me! I am a habitual coffee drinker (obviously am way too sluggish in the AM) then at night, I feel so wired that i have to take a sleeping pill just to fall asleep. I need to really work on fixing my biological rhythm, thank you for the wonderful insight.

  • James says:

    Can having a mood disorder affect the Biological clock?

  • Farrah says:

    How important is the quality (not quantity) of sleep when you’re recovering from AFS?

  • Reese says:

    Can quitting caffeine upset the body’s metabolism?

  • Dolly says:

    Didn’t realize how many factors impact our biological rhythms…thank you for sharing!

  • Ben says:

    could an irregularity w. my biological rhythm be the basis for mood disorder?

  • Freddy says:

    Dr. Lam,

    Great article. Thank you. I have been suffering from chronic sleep disruption for 10 months now and more than likely adrenal dysfunction. My testosterone levels are very low. I’m 34 and out of work. I tested my cortisol at 3:30 am and they were out of range. Probably from the chronic sleep disruption. I’m falling asleep faster now, but waking up after 3:00 am, then falling asleep again for a hour. Between 5 and 8 am, I wake up multiple times. It’s like I get micro sleeps (less than 30 minutes). It’s very debilitating and leaves me exhausted the next day. I am going through temazapam withdrawal. I hope that’s causing it. I also noticed my pulse is lower at the beginning of the night (low 50s), but higher after 3:00 am (60 – 62) and my heart pounds. Is my high cortisol and low testosterone causing the awakenings and pounding pulse?

  • Beverly Anne Sanchez says:

    This is in reply to “Craig” … I have been adhering to Dr. Lam’s protocol since I began his treatment several years ago. Unfortunately, I had to stop his treatment, although his office did make most of his protocol affordable with small timely payments. However, this website, his staff and everything else added to it costs a lot of money to have up. His protocol, and the protocol of many others now in the field, stipulate that recovery is not an easy, one, two, three matter but largely depends, I would dare say, on how well we personally can adhere to it. His articles alone are loaded with recovery information, so I urge you to stick with Dr. Lam if only via his website information. Good luck.

  • Craig says:

    I’ve been reading your stuff for the last 6 months that I’ve been at home dealing with afs and I’m definitely going through the sleep problems . I have more anxiety when I take .25 mg of melatonin at night then when I don’t take any. You definitely have the symptoms right on the money !!
    But it seems like all you do is give all the symptoms and like most of us who read your stuff most of it freaks us out and makes us more worried about how down and frustrated we really are ! Can you please at least give us who can’t afford to buy your program and all your supplements some things that we can do to help our situation!! At least all the other websites give you ideas to try , not just you’re never going to get better unless you call me !
    You seem like a very smart guy but are you in for the money or because you actually want to help people get their life back ?
    Everyone has a different case and I understand that you can’t help everyone all at the same time or get everyone’s issues ironed out without working with someone for awhile so you can figure out what their body needs.
    But I think you should write an article about the basics,and where a person who has hit rock bottom and is trying to rap their heads around what is happening could start .
    Like changing their diet -what and how to eat basic foods to start with because the liver and guts are slowing down and what specifically you can try to do to get the body to balance.
    And how to help the body to move through the healing process .
    How to help sleep things to try.
    What to do if you have problems with metholaytion of vitamins for Neurotransmitters
    Or paradoxicall effects of herbs and vitamins what can you do to help the body get what it needs .
    How to help the body through crashes. if you could just explain some simple things you can do to help buffer a crash .
    I guess what I’m saying is the people who are down and reading this are looking for answers and help most of us are just normal working class people who are just trying their best to get by .most of us don’t have the means to go out of our insurance network to get the help we really need . I completely understand that you can’t give dosage info and certain things because that’s just not fair to ask. But there are basic things that you know is a great place to start and what to pay attention to and what to do if you can’t get to a doctor that works in this field . I mean no disrespect here with anything I have said. But like most who are reading this we are just looking for some answers. And like me are beyond frustrated.

    • Dr.Lam says:

      My book contains many tips on the pros and cons of each possible compound to use. You can try on your own, especially if your situation is mild. Vit C, vit B, DHEA , glandular and herbs are commonly used. The dosage varies from person to person and there is no way to fit everyone into a mold that works because what works for one person may backfire for another if you are in the advanced stages, and that is what I try to emphasize, that you should seek your own doctor if you are very weak or sensitive.

      There is no shortage of protocols and dosage recommendation on the internet and various books that you can read and try . People who come to me are in advance stages and they are very fragile and weak.Thus extreme care is needed. If you are not in that category, you can try to self navigate on your own. Just take the case of melatonin. It is not a dose dependent compound. Some people do well with smaller dose as compare to others. In your case, low dose actually makes you more anxious. These are not the norm, but it is true in your case. We see that often. All we can do is to give a range as best we can and give the warnings in articles that are designed for general education and NOT for you to rely on as recovery plan. For a specific plan you should see your doctor as only with that will you get the right program fitting for the body.

  • jeff walter says:

    Will you be addressing/ describing some solutions?