Insomnia and Adrenal Fatigue: Why Can’t I Sleep When It’s Time to go to Bed?
The question “Why can’t I sleep?” unfortunately doesn’t always have a simple answer. Many people lead active lives with hectic schedules and don’t focus on nutrition when they are busy. If you do this, you might think it’s normal to have sleep problems. However, it’s different when you’re not able to sleep even though you’re tired. This could be related to adrenal fatigue, but it’s easy to overlook this as a symptom. Understanding more about the body and the possible causes for sleeplessness can help you identify and solve the issue, whether your insomnia and adrenal fatigue are related or not.
What Happens During Sleep
Your body is tired and ready for rest after a long day, but it is still working when you go to sleep. It needs time to rejuvenate and clear toxins without interference. The adrenal glands first reduce cortisol output to allow you to go to sleep, and in the middle of the night start a process of pumping out more cortisol that reaches its peak in the morning. Without a high enough cortisol in the morning, waking becomes difficult.
This circadian rhythm of cortisol being replenished during the night to replace that lost from use during the day goes on automatically. A high cortisol level helps you handle stress during the day and perform our duties of daily living. It peaks around 10 a.m. and declines to its lowest point at around 10 p.m. You’re supposed to naturally feel sleepy around this time and go to bed.
Issues With Sleep
This is where you may run into problems. You might stay up later than you should because you don’t want to go to bed, even though you’re tired. Worse yet, you might not be able to sleep if you try. You might feel tired physically, yet still feel wide awake mentally. This is called sleep onset insomnia (SOI). It’s important to understand what your body is saying when this happens. If you had an eventful day and are tired at the end of it, you should be able to sleep.
Upon realizing that one has trouble sleeping, many people turn to sleep aids or sleeping pills. This can help force sleep but doesn’t solve the problem. Additionally, they can cause a new problem as they often don’t last long in people with insomnia and adrenal fatigue. You could get to sleep for a few hours if you take a pill, but the overactive adrenal glands are still running on full speed and have not been calmed down enough to stay asleep. This means you’re likely to wake up in a few hours. Strong medications may be more effective, but they are often accompanied by hangover on waking in the morning.
Why Can’t I Sleep?
Insomnia and Adrenal Fatigue could be related, because your body might produce more cortisol in the evening, even though it shouldn’t. This is the reverse of what the physiological response should be. This could be attributed to increased stress during the day, causing more adrenaline that the body has to burn off naturally, or too much stimulation of the sympathetic “fight or flight” system with the inability to switch on the parasympathetic calming system. If you feel too energized to sleep, this may mean that another burst of cortisol was released in your body and is keeping you awake. This is a signal that your biological rhythm is disrupted. Adrenal fatigue is not the only reason for insomnia though, so identifying the problem can help you prevent it in the future. Related causes or components might involve the following:
- Metabolism dysregulation, such as glucose low.
- Hormonal imbalances such as excessive estrogen.
- Neurotransmitter imbalances such as lack of GABA, serotonin.
- Other adrenal issues such as cortisol dysregulation and resulting compensatory sympathetic nervous system overstimulation.
- Taking medication such as Adderal.
- Taking glandular supplements and herbs such as rhodiola, Maca, green tea and ashwangandha.
- Excessive intake of vitamins B and C.
- Excessive intake of minerals including zinc, copper, selenium.
- Excessive systemic inflammation.
Insomnia and Adrenal Fatigue
The adrenal glands play a big role in sleep regulation by way of cortisol, a hormone that they secrete. The adrenal glands have a limit for how much cortisol they can produce as a response to stress, so there may not be enough cortisol to handle stress if it’s persistent or excessive. Over time, the body is conditioned to experience fatigue at even slight stress or daily routines as cortisol output drops. Clinically one becomes fatigued, presenting with symptoms such as reactive hypoglycemia, salt and sugar cravings, exercise intolerance and low libido. Collectively, this clinical picture is known as adrenal fatigue syndrome (AFS) when accompanied by normal conventional medical test. Among other symptoms, this can lead to imbalances causing insomnia and adrenal fatigue.
In the later stages of adrenal fatigue, the neuroaffective circuit of the entire neuroendometabolic (NEM) stress response system becomes increasingly dysregulated. The NEM stress response is the body’s way of handling stress and is a total body response. It consists of six major components or circuits. Each circuit is focused on a primary anti-stress response, utilizing selected organs and systems. They are inflammation, detoxification, hormonal, cardionomic, metabolic, and neuroaffective. All circuits work synergistically with each other to reduce stress in an orchestrated response.
The neuroaffective circuit, which consists of the brain, gut, and autonomic nervous system, is but one pathway by which your body regulates stress through the NEM system. In advanced stages of adrenal fatigue, the brain, gut and nervous system are all trying to regulate mood and stress. This can lead to inflammation of the GI tract, an overload of a neurotransmitter called norepinephrine, and over-activation of the autonomic nervous system. You might not be familiar with the process happening inside your body, but you may know what it feels like. Depression can stem from inflammation of the GI tract, while insomnia, anxiety and panic attacks result from too much norepinephrine. Feeling your heart pounding rapidly occurs due to overexertion of the autonomic nervous system.
Categorizing Your Insomnia
Adrenal fatigue messes with the systems that regulate sleep and can cause insomnia, but insomnia is a broad term with different patterns and types. Insomnia can be divided into sleep onset insomnia and sleep maintenance insomnia. Sleep onset insomnia occurs when you have difficulty falling asleep at the beginning of the night, around 9 to 10 p.m. when you should be able to. This could be caused by imbalance of the autonomic system, with more favor towards the sympathetic system. Your body is still filled with the stress hormones from the day and is unable to calm down enough to fall asleep. Most describe the feeling as being tired, but too wired to fall asleep. If you frequently experience this, you might have trouble concentrating during the day due to the lack of sleep, and get irritated easily. Your sleeping problems might also be aggravated by anxiety because you get increasingly worried and nervous when it takes more and more time to fall asleep. Other causes of insomnia and adrenal fatigue are decreased serum melatonin, elevated core body temperature, increased body and brain metabolic rates, and over-activation of the HPA axis.
Sleep maintenance insomnia (SMI) happens when you fall asleep but wake up repeatedly during the night. Alternatively, you could wake up too early in the morning to start your day, even though you also can’t go back to sleep. This type of insomnia could be attributed to metabolic or neuroendocrine dysfunction. Sleep is an extended fast that the body goes through every night. That is why we call the day’s first meal breakfast, because we are breaking the fast in the morning. Insomnia and Adrenal Fatigue sufferers tend to have symptoms of hypoglycemia every two to three hours throughout the day and night, although laboratory glucose levels remain normal. As the sufferers fall asleep, the body gets hungry and depletes its glucose stores quickly. With glucose depleted, cortisol has to start being produced in order to provide the body with sugar to function. As cortisol rises, the body wakes up thinking it’s morning and time to eat, and that’s one reason for sleep maintenance insomnia.
Another reason for waking up in the middle of the night is a rebound effect from taking sleeping pills, which tend to only last for a few hours. Studies have shown that sleeping pills do not create sleep, but actually interfered with memory formation for being awake at night, therefore creating amnesia for insomnia. The sleeping pills curb the sleep threshold temporarily, but do nothing to decrease the actual stress hormones or cortisol that is boiling underneath. It is very important not to stop any sleeping pills without the advice of your doctor, as cutting them out cold turkey could cause more rebound insomnia and adrenal fatigue, which could be dangerous.
Stress often leads to sleep problems, but reducing stress can be difficult, as losing sleep can cause more stress and make it harder to function. There are many supplements that might help you regulate your adrenal glands that you can research in order to find the products that work best for you, but here are some solutions that could assist everyone. The most obvious answers are to eat healthy and exercise, you may also benefit from these suggestions and reduce your insomnia and adrenal fatigue:
- Don’t check the time at night when you wake up, as it exacerbates insomnia.
- Rule out sleep disorders like sleep apnea.
- Let go of thoughts and accept them.
- Don’t drink caffeine or alcohol later in the evening.
- Set up bedtime rituals.
- Find a soothing activity like meditation, yoga, or breathing.
- Sleep in a completely dark room.
Sleep Aids – As good as they sound?
You can also change the way you react to sleeplessness by staying calm and utilizing adrenal breathing exercises to encourage serenity until you’re ready to sleep. Do make sure you do not overbreathe, which can trigger insomnia and adrenal fatigue.
There are many natural sleep aids available on the market. Some are good, many are not productive. Even the best compound, however, has to be properly delivered, dosed and adjusted to be beneficial. There is no one-size-fits-all approach possible, because each body is unique in its assimilation, reaction, and response to sleep aids. For example, most people use 3mg of melatonin for sleep, but some require up to 30mg to get the same effect, while others requires only 0.5mg, meaning 3mg may be too much. Herbs and glandulars in particular are problematic because the body can respond differently from the desired outcome. The weaker the body, the more prominently this is seen. For example, valerian is calming but can cause worsening insomnia. The use of hormones needs special care. Natural progesterone, for example, has a sedative effect which is dose-dependent. Some people, however, exhibit paradoxical reactions, as it tends to behave stimulatorily by occupying estrogen receptor sites, since both hormones are chemicals that are structurally very similar.
Use these with caution in advanced stages of adrenal fatigue, as paradoxical reactions may sometimes occur and lead to worse sleep. For example, magnesium can cause wakefulness instead (especially in transdermal form), while melatonin can cause hangovers. Many of these have to do with improper dosages, delivery systems and failure to recognize the body’s constitution.
In addition, sleep aids, medications and hormones have to be metabolized by the liver. Those with weak bodies usually have congested livers, where metabolism is slowed but not pathological. Liver function is normal, but the body is not able to get rid of metabolic byproducts quickly. Overloading the body with sleep aids and hormones such as natural progesterone may worsen the liver congestion, leading to symptoms such as fatigue, anxiety, brain fog, heart palpitations, and pain of unknown origin. In severe cases, adrenal crashes may be experienced.
Always consult your adrenal fatigue-literate practitioner if you feel you have stress-related sleep issues.
If you already suffer from adrenal fatigue or any neuroendometabolic stress dysfunction, any sleeping problems that develop could be related. Fortunately, recognizing what is happening and why can help you combat insomnia, so that you can have a good night’s sleep over time. Trying to mend the insomnia without addressing the underlying adrenal or endocrine function would not help, so it’s important to look at the whole metabolic and hormonal picture.
If the problem is metabolic and due to hypoglycemia, eating nuts or good protein before you fall asleep and when you wake up might be the solution, although it is still important to find out why your are becoming hypoglycemia at night. If the problem is due to hormonal imbalance, you have to tackle the adrenals and the autonomic and central nervous systems first before trying to fix the sleep by taking sleeping pills or supplements. There are a multitude of reasons for insomnia, so it’s important to find a doctor who will uncover the “why” behind the insomnia rather than just trying to cover up the symptoms. A detailed history by an alert practitioner familiar with adrenal weakness is the key.
© Copyright 2016 Michael Lam, M.D. All Rights Reserved.
Dear Dr Lam,
I have known you since 2002 or so and have been following your articles. Self diagnosis is very dangerous but I know I am in the advanced stages of AFS. I have had lots of mental and physical stress. Your article is like a story of me on what is Adrenal Fatigue. Thanks