Having Trouble Falling Asleep? Or Staying Asleep?
Sleep disturbances are a very common complaint I hear from patients of all ages.
“I just can’t fall asleep” or
“I lay there in bed waiting to fall asleep for hours”
“My child doesn’t sleep”
Or I hear, “I just keep waking up all night”
“I can’t stay asleep”
“I can fall asleep, but then I wake back up”
“I wake up tired”
Not being able to sleep has got to be in the top 10 most annoying symptoms to be experiencing.
We need sleep to repair, heal, and function in our day!
People will try almost anything to get sleep.
Melatonin supplements (which I rarely suggest, ever), CBD oil, magnesium, and herbs are all examples of what patients tell me they try to get a good night’s sleep.
Sometimes I hear people will use over the counter meds like Benadryl, Tylenol PM, or prescription sleep meds. Not only do some of these options come with heavy side effects, but none of them are addressing the underlying problem.
So what should you be doing to fix your nights rest?
Like most functional problems in the body, you will have to look at systems in the body and how they work together to fix your problems.
On the topic of sleep you will have to look at:
The relationship of blood sugar handling and your adrenal glands.
You’ll find that this is used to help many areas of your body to function better!
I’ll try to simplify this the best I can, so let’s get started!
Blood Sugar and the Adrenal Stress System
Many times, insomnia and sleep issues are directly related to blood sugar imbalances and how they relate to adrenal function.
Can’t fall asleep – adrenal hyper function (overactive)
Can’t stay asleep – adrenal hypo function (underactive)
Adrenal disorders are probably the most common functional disorders we have today.
What are Adrenal Glands?
The adrenal glands are two small glands that are located on top of your kidneys.
They are known for making the stress hormones cortisol and epinephrine.
Also they secrete sex hormones like DHEA, testosterone, and estrogen.
The main hormone they release is called cortisol.
Cortisol is a stress hormone that is elevated in chronic stress and maintains blood sugar. Epinephrine is elevated more in acute stress.
Many times you may not be aware that your body is experiencing stress. Pain is a stressor, inflammation in the gut is a stressor, skipping meals and taking stimulants is a stressor.
Diets high in refined carbohydrates, artificial sweeteners, and food additives is a stressor.
Compound those effects with the demands of modern society, deadlines, pressures, and now we have an epidemic of adrenal related disorders.
Patients like to tell me, “But I don’t’ feel stressed!?”
-Yes, I know, but if your body thinks it’s stressed, and your adrenal glands are pumping out stress hormone than you’re stressed like it or not.
Can’t fall asleep?
In the initial stages of the adrenal stress response cortisol (or epinephrine) can be elevated at bedtime when it should be low.
In a normal healthy situation cortisol is the highest in the morning and tapers off throughout the day into the evening.
Because we eat. Cortisol has several purposes in the body. One is maintaining blood sugar.
Being a stress hormone, your body needs sugar for fighting and running. Cortisol and epinephrine make that happen.
Your body releases cortisol while in a fasting state to maintain sugar levels.
Our brain and many other cells and tissues in the body require a constant supply of sugar to be a to function and survive in a fasting state.
Sleep is a fasting state. While you sleep cortisol is slowly released to make sugar and is the highest in the morning after you’ve been fasting all night. This is the healthy response.
Any type of stress; mental, physical, or chemical can lead to elevated cortisol levels. Many times it’s a combo of all the above.
Let’s say you’re under some type of stress or emotional event. Maybe you started exercising too intensively for your conditioning. Maybe you have an injury or gut problem going on. Could be anything your body perceives as a type of stress.
In this case your cortisol will be elevated at bedtime, and you’re going to have a pretty hard time falling asleep.
Cortisol excites the nervous system, it’s a stress hormone after all, and you’re going to need to investigate that to be able to fall asleep easily.
This is a reason I don’t suggest fasting for anyone who has over functioning or a fatigued adrenal gland. Fasting causes the already overworked or fatigued gland to work more.
Can’t stay asleep?
With low cortisol from a fatigued adrenal gland your blood sugar will drop in your sleep.
Normally cortisol would be released to balance it. Once the gland becomes fatigued, there’s not enough cortisol there to make sugar to balance the blood sugar.
This is called reactive or secondary hypoglycemia when the stress hormone cortisol is too depleted to maintain blood sugar.
So the adrenals will squeeze out some cortisol and give a sudden spike, or the body uses it’s back up plan, and releases the big guns: epinephrine, to make blood sugar.
Getting a hit of epinephrine in your sleep is a guarantee to wake you up. A sudden spike in cortisol will wake you too.
This presents clinically as the person who has low energy and cannot stay asleep at night.
A typical pattern here would look like someone under chronic stress who is:
frequently skipping meals
eats or drinks lots of sweets/simple sugars
is fueled by caffeine throughout the day
typically is irritated when meals are missed
has low energy and craves sweets during the day
depends on caffeinated beverages to “keep going”.
The result is chronic stress to the adrenal glands and loss of ability to properly maintain blood sugar levels while sleeping.
If this is you, you’ll need to learn to stabilize your blood sugar levels during the day, and support for your adrenal glands!
Some lifestyle changes to help sleep
Avoid adrenal stimulants
It’s important to avoid certain foods and chemicals to avoid excessive stress on the adrenal glands. Normalizing the adrenals requires nutritional support in most cases, but without eliminating adrenal stimulators you’ll get minimal results.
Allergic or high histamine foods (histamine is a major adrenal stimulator)
Partially hydrogenated fats
Flashing lights, TV, too much stimulation in the evening
Gut inflammation/dysbiosis/leaky gut the gut cannot be overstated enough as an adrenal stimulator. This topic is deserving of its own article, but to be brief any inflammation, overgrowth, or food sensitivity which can come fast from diet, medications, or alcohol will keep the body trapped in a state where the gut stimulates the adrenals, and the adrenals wreck the gut and vice versa. They almost always need to be treated simultaneously for success.
Supporting the adrenal glands:
Increase healthy fats like coconut oil, olive oil, and butter
Increase sea salt. Salt is depleted from the body in adrenal fatigue
Take Vitamin “G” riboflavin and niacin
Vitamin C – the body loses a lot of Vitamin C when cortisol is secreted.
Don’t skip meals
Go to bed at night with the lights out completely.
Take the prebiotic Bifidobacterium. Bifidobacterium creates the neurotransmitter GABA from glutamate in the gut. GABA works on the effects of stress on the brain, lowering anxiety, stress, and worry.
Liver if blood iron is not high. Erschoff did numerous studies on lab rats inducing an adrenal exhaustion state. He poisoned them with hormones, radiation, steroids, froze them, heated them, drowned them amongst other ways and recorded enlargement of the adrenal cortex, atrophy of spleen and thymus, stunted growth in the juveniles, weak bones, gastrointestinal and hormonal imbalances- and he would feed them a portion of their diet in desiccated liver powder and would reverse the symptoms. No other method he tried could produce the same results. Not B vitamins or the other vitamins contained in liver. He hypothesized liver as medicinal food had restorative abilities on the adrenals.
Stabilize blood sugar levels
If blood sugar levels are not stabilized, you’ll have minimal success correcting the adrenal status. This is especially true if you have hypoglycemia symptoms: irritability before meals, “lightheaded” and “shaky” when meals are missed or eating relieves fatigue. When blood sugar levels fall, healthy adrenal glands bring the levels back up.
Don’t skip breakfast
Eat high quality protein for breakfast (not protein bars)
Eat every 2-3 hours
Snack with low glycemic foods: nuts, seeds, hard boiled eggs, etc
Avoid all fruit juices
Never consume high glycemic foods without protein
Eat a balanced diet consisting of vegetables, quality grains, lean meats.
Take the prebiotic resistant starch and inulin as they’ve been shown to reduce the hemoglobin A1C, insulin resistance, and blood sugar levels.
Exercise in the aerobic heart range
This is crucial for anyone with increased cortisol, or low cortisol. Aerobic exercise utilizes fat burning instead of anaerobic sugar burning for fuel. This places less demand on the adrenals to make more sugar. Fats explosive movements, weightlifting, running, sprinting, or any form of exercise that cannot be performed for a long duration should be avoided until the adrenals are healthy.
Walking, slow running, or any exercise you can do for a duration is suggested.
Maximum aerobic function, by Dr. Maffetone, is a great formula to keep your heart rate in the aerobic range:
Find your target heart rate. Warm up for 10 minutes at 10 beats below, exercise at the range modifying intensity if your heart rate drops below or goes too high.
For example find a certain distance you want to walk/run, or a certain time frame you have to keep like 30 minutes.
Keeping you heart rate in range you can see how you progress in how fast you could do a certain distance, or how much distance you can accomplish in a set time frame. (Example in 30 minutes you can now do x number of laps on the track, or on the treadmill in 30 minutes you are increasing distance).
Once this plateaus, you’ve reached Maximum aerobic function MAF, and your stress system will thank you.
Deep breathing exercises are useful to switch the body into parasympathetic rest and digest mode by activating the Vagus nerve. Focus on breathing in through your nose, feel your abdomen expand, and exhale non forcibly.
Breathing slowly in and out even for a short duration multiple times throughout the day has benefits. Many people who are stressed out breath very shallow, using only their rib cage and not the diaphragm.
More information adrenal health
In addition you might have to support the adrenal gland if it’s showing too high cortisol, or low depleted cortisol.
There are many supplemental options available, but you’d want to know what your treating.
Saliva testing is the most accurate for cortisol. Saliva testing tests free available hormones, versus blood test that look at hormones already bound.
Also saliva testing is easy, and you do it at home and mail it in.
It also checks 4 different times, to observe the circadian rhythm of cortisol which should be highest in the morning, and lowest at night.
The stages of adrenal stress look like this on saliva lab testing:
As the body faces stress and adapts to stress it goes through three stages.
The first stage is the Alarm Stage.
In the alarm stage the body is faced with some type of stress, the adrenal goes into a hyper functioning state, and pumps out cortisol to manage the demands of stress.
This is reversible with slight changes and will show on a salivary lab profile as having high cortisol/high DHEA.
Heart rate and blood pressure can be elevated here as well.
The second stage is the Resistance Stage.
If the stress is prolonged, the body goes into a Resistance Stage. Some people will go their entire life in the resistance stage.
The adrenals adapt to the pressures of stress by engaging in what’s called “pregnenolone steal”. Pregnenolone is a precursor for cortisol and all the sex hormones: DHEA, testosterone, and estrogens.
During times of stress, the body will steal the pregnenolone (also progesterone) to make more cortisol instead of other hormones. Dhea is the precursor to testosterone and estrogen, and the levels of the 3 can drop as the body shifts more into cortisol production, which is more necessary for survival. (The body is smart)
You will see this stage having high or normal cortisol/low DHEA.
The blood pressure here will go up and start to drop going from laying back to standing temporarily. It’s called orthostatic hypotension. The test for it is called Ragland’s Test (see below)
The third stage is the Exhaustion Stage.
As the body enters the final adaption stage it’s called the Exhaustion Stage. The adrenals can no longer adapt properly to the stress and becomes exhausted. This will show on your labs as low cortisol/low DHEA.
As the body continues in the exhaustion stage you will start to see DHEA come up and you’ll have low cortisol/normal DHEA as the body stops stealing the pregnenolone to make cortisol in the “pregnenolone steal”.
Blood pressure here and heart rate can be low. This can be misinterpreted as a good thing.
Easy in office test for adrenal fatigue
In addition to lab testing, a test I commonly use in office to screen the adrenals is called Ragland’s Test, or the Orthostatic Hypotension test.
Ragland’s Test, which was created by Dr. Ragland in the 1920’s to evaluate Adrenal Gland Function.
First take your blood pressure seated to get a baseline reading
Next lay down for 4 minutes, and take the blood pressure reading again while laying down
Then stand up an immediately retake the blood pressure reading standing this time. Promptness is necessary as we are looking at the immediate change.
Normal response is an increase of 6-10mm going laying down to standing.
A positive adrenal fatigue response is a drop in blood pressure going laying down to standing.
A drop in blood pressure while standing is a sign your adrenal glands are in the second stage of adrenal fatigue. They are unable to constrict your blood vessels fast enough to handle the stresses of gravity.
In the final stage the overall blood pressure tends to be low, with a lower heart rate. This may appear as a “good” sign, but it’s from your stress system being exhausted.
In summary: fix your blood sugar and adrenal glands, and you’ll sleep better!
If you need help with that, contact me:
Dr. Justin Fortier, B.S., D.C.