Biological Rhythm Disruptions and Adrenal Fatigue Syndrome

By: Michael Lam, MD, MPH; Justin Lam, ABAAHP, FMNM


Adrenal fatigue can affect your Biological RhythmOur biological rhythm (BR) 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. 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 clock that regulates these rhythms.

There are external factors that can have an influence on our biological rhythm, for example, sunlight and certain drugs like caffeine that can affect our sleep schedule. Disorders can also develop when our natural biological rhythm 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 rhythm 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 rhythm disruptions secondary to hormonal and neurotransmitter (NT) dysregulation.

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

Biological Rhythm 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 rhythms (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 rhythms 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 Rhythm Disruptions

Animals, plants, cyanobacteria and fungi have all been observed having biological rhythms. Even though these different biological rhythms are internally controlled, there are some external factors that can influence their regularity.

Factors that can alter the biological rhythm 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), over abundance 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 BR. The onset could be gradual or acute. The classic presenting complaint is insomnia, indicating a disrupted BR. 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 rhythm 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 rhythm disruptions when examining their patient complaining of insomnia, it is hardly ever recognized as a vital problem until the biological rhythm disruption becomes severe and entrenched. Such is the case when associated with advanced AFS.

The most common presenting complaint from patients suffering from biological rhythm disruption is insomnia. Instead of trying to determine the root cause of the sleep disturbance and restore proper biological rhythm 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.

Inevitably, stronger prescription sleep medication is used to induce sleep over time. Without solving the underlying biological rhythm 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 rhythm 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 rhythm 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 rhythm 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 BR, we first need to review how our internal master clock is involved.

The Master Clock

Your biological rhythm can be affected with Adrenal Fatigue

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.

Neurotransmitters 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 rhythm of mammals are:

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

Seven Clinical Temporal Biological Rhythms

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

Awakening Rhythm This occurs from 6 – 9 a.m. We stop secreting melatonin by about 7:30 a.m. 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 8:30 a.m.

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 9 a.m. However, a much better time for this would be before 7 a.m.

Morning Rhythm This occurs from 9 a.m. 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 10 a.m. 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, biological rhythm disruption tends to be more pronounced from 11 a.m. to noon, with symptoms indicating an imbalance such as:

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

Lunch Rhythm This occurs from noon to 2 p.m. 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.

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

The key is mid-afternoon between 2 to 4 p.m. 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 2 p.m. 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 5 p.m. This is the time of day when people are least likely to have a heart attack while exercising.

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

As light begins to dim, the process of Dim Light Melatonin Onset (DLMO) begins around 9 p.m. 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.

Sleep Onset Rhythm This occurs from 10 p.m. to 2 a.m. 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.

Rapid 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 2 a.m.

Sleep Maintenance Rhythm This occurs from 2 to 6 a.m. The body is now on automatic cruise control, resting and rejuvenating. The lowest body temperature is reached at about 5 a.m. Cortisol levels start rising at around 2 to 3 a.m. 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 6 a.m.

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 4 a.m. 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 rhythm disruptions during this phase can lead to liver and extracellular matrix congestion.

Insomnia—the Classic Biological Rhythm Dysfunction

A man suffering from insomnia from Biological Rhythm Disruption

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 rhythm phases throughout the day, making adjustments to stay in sync with our various activities, whether we are awake or asleep.

Our 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 rhythms 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

Biological Rhythm Rebalancing Principles

Rebalancing Biological Rhythm with Adrenal Fatigue

Biological rhythm disruptions may present classically as insomnia, but the underlying circadian disruption is a twenty-four seven phenomena. Restoring biological rhythm balance must start with understanding of the physiology behind the seven phases of biological rhythm during the day, starting in the morning and continues to bedtime. At each phase, specific steps need to be taken in terms of personalized supplementation, diet, and lifestyle modulations tailoring to each body’s specific clinical neurotransmitter volume, hormonal balance, receptor function, toxic load, body sensitivity, and assimilation capacity at that point in time to rebalance proper BR. The goal is to restore neurotransmitter balance to a state appropriate for that phase during that specific time of day to mimic the natural cycle as closely as possible.

Because most are already weak physically at this time from long standing insomnia, any rebalance has to progress slowly, especially in the beginning. Those who are in advanced stages of AFS are particularly vulnerable. Paradoxical or exaggerated reaction is common and has to be avoided. Expert close guidance and monitoring is required. Immediate adjustments are made in real time if possible. The rebalancing process usually takes a few months in experienced hands.

Five Reasons Why Self-Directed Programs Fail

Self-directed programs can fail due to Biological Rhythm complications

Proper biological rhythm balance, especially in cases of severe insomnia, requires a comprehensive plan addressing the needs of each of the seven temporal biological rhythm phases of the day in order to maintain an overall daily rhythm that is natural, stable and consistent. This requires extensive clinical experience. Even in the best of hands, some trial and error is required due to the lack of accurate laboratory tests for guidance in addition to each body’s unique setting.

Many have tried self-navigating through a variety of natural compounds but failed to restore biological rhythm properly. Here are five common reasons for failure:

First, most are not versed in understanding the specific physiological pathway of each nutrient, resulting in the wrong choice. For example, taurine has NT inhibitory effects, but it is also a natural diuretic and increases excretion of water from the body. Taking it at nighttime may help sleep. However, it can also lead to increased awakenings due to frequent urination. Another example is 5-HTP. It tends to work better in the evening while GABA is better during the day. Proper selection of nutrient timed specifically for each phase will greatly enhance success.

Second, the approach of using targeted single nutrients works only in the mildest of cases. For example, melatonin alone may work well in early stages of AFS when biological rhythm disruption is mild. By the time biological rhythm is suspected in a setting of advanced AFS, insomnia is already well entrenched. Many have already been put on sleep medications by their physicians after failure of sleep aids. Different nutritional cocktails specific for the needs of each of the seven temporal biological rhythm phases of the day is usually required in order to reset the biological rhythm properly, especially in the beginning.

Thirdly, dosage requirements vary greatly from person to person. Melatonin at 3 mg may work well for one person but is completely inadequate for another who may do much better at a lower dose of say, 0.3 mg, or a higher dose of 30 mg. In other words, some compounds, like melatonin, are not linear in their dose response curve. More is not necessarily better.

Fourthly, certain compounds are more effective when taken by various delivery methods. For example, sublingual melatonin is more effective, especially in high doses, than capsules or pills because they contain less inert substances called binders and fillers required during the manufacturing process. Excessive binders and fillers can trigger vivid dreams and nightmares in those who have a sensitive pineal gland.

Lastly, proper timing is required to maximize the effectiveness of each natural compound. For example, the phosphylated form of phosphatidylserine (PS) is more effective to lower cortisol at night as compared to the nonphosphylated form. However, there is a four to six hour lag period from time or intake to bio activation. As such, it should be taken at dinnertime well before bedtime to be most effective.

In addition to the above five parameters, blind supplementation without considering to the constitution, stage of AFS, receptor site response, GI assimilation state, sleep medication dependency, extracellular matrix pollution and liver burden are common clinical mistakes resulting in improper dosage and clinical failure. A successful comprehensive biological rhythm rebalancing program is highly intricate and requires extensive clinical experience in both biological rhythm and AFS. Because dosage varies so widely from person to person, a detailed clinical history is key to assessing the right starting dose and combination of compounds. Most self-directed programs fail not because of the lack of tools but due to operator inexperience, resulting in a worsening outcome over time. Conversely, we are happy to report that most cases of biological rhythm and severe insomnia can be improved with natural compounds, when properly structured and executed.

Summary

Biological rhythm is a natural phenomena occurring in all healthy living mammals. Disruption can be caused by a variety of factors ranging from stress, neurotransmitter imbalance, and hormonal dysregulation. The classic presentation of biological rhythm disruption is insomnia. There are seven temporal biological rhythm rhythms during the twenty-four hour day. Their proper balance is critical to a healthy sleep cycle at night. Those suffering from chronic insomnia need to pay attention to these seven temporal phases for complete healing. Natural compounds are available to help, but few people are versed in understanding and planning a complete program to properly rebalance the BR. Thus, most self-navigation efforts fail. Yet with proper supervision and guidance, even the most severe cases of biological rhythm disruption can find improvement.

© Copyright 2014 Michael Lam, M.D. All Rights Reserved.