People with Adrenal Fatigue Syndrome (AFS) often have problems with sleep. For some, the problem is waking up at 3 AM every night and not being able to get back to sleep for a long time. Others struggle with a frustrating pattern of waking every two to three hours before dozing off again, never getting a full stretch of deep sleep. Others with AFS can only sleep a few hours after going to bed, and once they awaken, returning to sleep is impossible.
All of these poor sleep patterns are symptomatic of AFS, and the name for this sleep condition is Sleep Maintenance Insomnia, or SMI. AFS arises when the body is no longer able to handle stress effectively and the adrenals start to weaken. As this happens, sleep can often be interrupted. People with SMI may also experience waking up at 3 AM every night, heart palpitations, heavy sweating, and disturbing dreams when they awaken. This makes the condition of SMI particularly disruptive and stressful for the person experiencing it. Let us take a look at the physiological model that regulate sleep when a person is under stress. The NeuroEndoMetabolic (NEM) Stress Response is important in evaluating SMI because of its systemic view of looking at symptoms. The NEM stress response is your body’s way of dealing with stress globally. Chronic stress takes a toll on many organs, not only the adrenals. One of the circuits which play a key role in sleep is the neuroaffective circuit, which consists of the Central Nervous System (CNS), Autonomic Nervous System (ANS), and the gut, also known as the second brain. These three systems play a big part in regulating sleep. Conventional medicine tends to look at these systems separately, thus overlooking potential solutions to both AFS and SMI. We will be discussing this stress response and its systems in a little more detail later.
Main Causes of Waking Up at 3 AM Every Night
There are many possible causes of SMI as it relates to adrenal fatigue. But first, it is important to determine if there is a structural cause of the problem. Lung and airway obstructions can potentially cause waking up at 3 AM every night, disrupted sleep, and a doctor should first rule out any problems such as obstructive sleep apnea.
Once other causes have been ruled out, SMI usually arises either from one of a few dysregulation: neurotransmitter, hormonal, autonomic, or metabolic. The first cause is due to a disruption in the biological, circadian rhythms, caused by imbalanced levels of neurotransmitters such as GABA, serotonin, etc. Cortisol dysregulation, and elevation, at night is a possible hormonal cause of SMI. Cortisol is typically highest in the morning and decreases as the day goes on, with lowest levels at night. Cortisol levels then rise steadily toward the end of the sleep cycle, causing a person to wake up. During sleep, cortisol levels need to remain low, or the person is likely to wake up. With AFS, cortisol levels can start to increase at night, often times waking you up.
If you are in a flight or fight mode, as many advanced AFS sufferers are , the ANS is often imbalanced. They frequently are in a states of reactive sympathetic response, where excessive adrenaline floods the body. The ANS has 5 branches, but is mostly regulated by the sympathetic and parasympathetic nervous systems. These hormones and neurotransmitters provide energy for daily activity and increase in times of emergency and stress.
Metabolic issues, such as reactive hypoglycemia, can also trigger SMI. When your blood sugar drops below a certain threshold, an alarm will sound in your body, signaling that you need to eat something to maintain your blood sugar. This can lead you to wake up. In AFS, the body is unable to maintain adequate blood sugar levels.
A Mixed Bag
During AFS and SMI, many of the components or triggers, of sleep disruption mentioned above, come into play at the same time. For example, the normal cortisol curve pattern is disrupted. Chronic stress causes the sympathetic nervous system to become overstimulated during the day. This state of overdrive can persist into the night, waking up at 3 AM every night or awakening every few hours, can be the result. Thus it is important to help the body calm down not only at night, but also during the day. In order to truly understand a patient’s cortisol levels, it is sometimes necessary to take samples during the night when the person is in a sleep cycle. Otherwise, a true picture of what is going on eludes detection. Besides cortisol, norepinephrine, and epinephrine, major hormones and neurotransmitters involved in the ‘fight or flight’ response, may be elevated during the night in people with SMI. High amounts of these chemicals are responsible for the symptoms of sweating and heart palpitations upon awakening.
Calming the body down
It is very hard to get rid of the sympathetic system when it’s on overdrive, but there are a few tips to trick your body into calming down. Adrenal breathing is a great way to turn on the parasympathetic system. However it’s important to note that adrenal fatigue sufferers might not be able to take full deep breaths and it might be better for them to take 50% of a breath to start off with. The reason why the parasympathetic system can get turned on is because of the vagal plexus, near the diaphragm, is being activated when the diaphragm is opened up with deeper abdominal breaths. When you wake up at night and your heart is pounding and you feel wide awake, try to lay down and take deep breaths until you’re able to calm down again. Doing this before sleep and when you wake up can be a great tool for combating SMI. Phosphatidylserine is an amino acid and supplement that may help to reduce cortisol levels at night as well, thus aiding waking up at 3 AM every night. Consult your health practitioner before starting supplementation.
Balancing Blood sugar
Not to be forgotten is the metabolic component that can complicate matters. Hypoglycemia is a common symptom often seen in the setting of adrenal fatigue. This typically affects people in the day time, where they will have to have a snack every 2-3 hours in order to maintain their blood sugar or risk feeling unwell. However, just as it happens in the daytime, it can also occur at night, albeit slower, due to lower energy expenditure at night. Hypoglycemia can occur due to a congested liver, lowered function of the pancreas, deregulation of insulin production, or by poor dietary choices and habits. Deregulation of liver, pancreas, and kidney function can produce stress which then affects the adrenals and the production of cortisol, resulting in a downward spiral of symptoms, one being waking up at 3 AM every night. Some people find that snacking on nuts or protein at night can help them fall back to sleep for longer periods of time because it curbs the insulin spikes which wakes up the body to produce energy.
The Importance of Sleep
The lack of proper amounts of sleep, and lack of a good diet, are two of the most damaging forms of stress on the body, leading to many health problems. Getting good sleep means getting at least five hours of uninterrupted sleep in order for the brain to reach the deepest levels of electrical activity known as delta waves. Without a nightly recharge of these brain waves, a person awakens feeling like they never went to sleep. Whether the pattern is waking up at 3 AM every night and not being able to go back to sleep, or falling asleep and waking every two or three hours, if the five to six hour limit of sleeping is not reached, brain function cannot be optimal. So, resolving sleep issues is important for this reason alone.
Sleep is also a time when metabolic functions change and slow down. Some of these metabolic changes help regulate appetite. Appetite is controlled by the hormones ghrelin and leptin. Leptin is stored in and released from fat tissue, and it inhibits appetite and increases energy. Ghrelin, on the other hand, is a hormone made in the stomach which increases appetite and lowers energy levels. Studies have shown that sleep deprivation causes an almost 20 percent decline in leptin and an increase in ghrelin levels of as much as 28 percent. This means that lack of sleep makes people hungrier. Another study showed that less sleep correlated with higher BMI, possibly due to the fact that hungrier people eat more.
Another important effect of not sleeping is a decrease in immunity. Studies show that people who are deprived of sleep from 3 AM-7am experience a 30% drop in immunity and a 50% drop in immune function from 10pm-3 AM. Not sleeping one night could cause a drop in immunity for up to 4 weeks. So it’s very important to get regular sleep everyday.
Resolving problems with the cortisol and insulin curves is crucial for stopping or reducing the symptoms of SMI. This leads to improvements in metabolic balance connected to appetite, weight gain, and insulin levels, and these changes then further augment the improvements in the sleep cycle. As your stress gets under control, the sympathetic overtone should improve and the hypoglycemia symptoms should go away. Make sure to contact, an AFS literate, health provider who can differentiate between the different causes of SMI and tackle the root problem. Most self navigation, with sleep aid, failed because of the lack of understanding concerning the root issue. Superficial patches to force the body to sleep can be of temporary benefit, but are seldom the long term solution. In fact, it has been found that they can make matters worse over time.
Shahrad Taheri,1,¤ Ling Lin,1 Diane Austin,2 Terry Young,2 and Emmanuel Mignot 1,*Short Sleep Duration Is Associated with Reduced Leptin, Elevated Ghrelin, and Increased Body Mass Index. PLoS Med. 2004 Dec; 1(3): e62. Published online 2004 Dec 7. doi: 10.1371/journal.pmed.0010062
Luciana Besedovsky,1,2 Tanja Lange,1,2 and Jan Born1,2. Sleep and immune function. Pflugers Arch. 2012 Jan; 463(1): 121–137. Published online 2011 Nov 10. doi: 10.1007/s00424-011-1044-0
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