One of the best ways to get the most out of your health and vitality is to work with – not against – your natural biological clock, especially the circadian rhythm. The circadian rhythm is responsible for the 24-hour internal clock that orchestrates your sleep-wake cycle. In this article, we will focus on how melatonin and cortisol interact within this cycle, and how to transform their relationship from a destructive one to a harmonious one.
Melatonin is your sleep hormone. It’s what tells your body that night has arrived, and it’s time to wind down and go to bed. Although you can sleep without it (or with little of it), it does facilitate the process immensely, and those with a dysregulation in melatonin production often find themselves facing sleep difficulties. It’s produced by various tissues in your body, though mainly by the pineal gland in the brain.
Melatonin production, along with the circadian rhythm in general, is regulated by a part of the brain called the suprachiasmatic nucleus (SN), which is inside your hypothalamus and right above the area where your optic nerve crosses. The SN also communicates with the control center in the brain that regulates cortisol production.
Cortisol is your body’s main anti-stress hormone, and it’s produced by the adrenal glands located atop your kidneys. It plays an important role in functions such as regulating blood sugar and blood pressure levels, maintaining heart and blood vessel functions, suppressing the immune system after it has completed its job, and neutralizing inflammation.
The hormone cascade that results in cortisol being released is called the hypothalamic-pituitary-adrenal (HPA) axis, and it also begins in the hypothalamus in the brain. When the hypothalamus receives information that there is stress in the body, it releases the corticotropin-releasing hormone (CRH). CRH then tells the pituitary gland to secrete adrenocorticotropic hormone (ACTH), which is what stimulates the adrenal glands into producing cortisol.
Once the stress has been neutralized and the HPA axis has done its job, excess cortisol still in circulation is then taken as a signal by the pituitary gland and hypothalamus to stop their production of ACTH and CRH. This is the negative feedback loop that completes the cycle.
But other than sharing a control center in the brain, the HPA is directly regulated by the circadian rhythm because cortisol levels affect how alert you are. It rises and falls at different times of the day in order to give you that awake feeling or allow you to wind down and rest and relax. For example, during the night, melatonin and cortisol should be higher and lower, respectively, so you can sleep.
Melatonin and cortisol interact in a sort of dance to coordinate your sleep-wake cycle. A disruption in either can cause this dance to get out of balance. And one way this disruption occurs is through chronic stress.
Norepinephrine is needed to synthesize and release melatonin by the pineal gland. When all is working well, the SN raises melatonin levels a few hours before bed in order to prepare you for sleep. The balance between melatonin and cortisol, on the other hand, is an inverse one – when melatonin increases, cortisol levels drop, and when cortisol levels rise, melatonin starts to go down.
Stress can show up in various ways – it can be physical, such as what happens when you have an infection, an unhealthy diet, poor sleep, inadequate exercise, or an injury. It could also be psychological, such as facing pressures at work or in your relationship, suffering from a mental health issue, or being unable to process emotions in a healthy way.
And although your body is capable of handling bouts of acute stress here and there, when stress becomes chronic, it takes its toll.
Your NeuroEndoMetabolic (NEM) Stress Response is your body’s global response to stress, and it’s composed of six circuits of organs and systems that work in coordination to neutralize the stress. These six circuits are the Hormone, the Bioenergetics, the Cardionomic, the Neuroaffect, the Inflammation, and the Detoxification circuit. Your adrenal glands are part of your Hormone circuit, and they are the first line of defense against stress.
With chronic stress, your adrenals have to secrete more and more cortisol to keep up with the demand. After a while, however, they can become exhausted and their cortisol output drops. In both cases of dysregulation, your melatonin and cortisol levels are affected, as well as your circadian rhythm in general, and you can develop Adrenal Fatigue Syndrome (AFS).
Symptoms of AFS include fatigue, weight gain, insomnia, brain fog, anxiety, mild depression, loss of libido, infertility, PMS, hair loss, dry skin, hypoglycemia, heart palpitations, food and drug sensitivities, lowered immunity, salt and sugar cravings, and an inability to handle stress, among others.
If you have AFS, your sleep-wake cycle is more vulnerable to disruption than normal because the relationship between melatonin and cortisol is not balanced anymore. You may experience sleep-onset insomnia, where you find it difficult to fall asleep, or sleep-maintenance insomnia, where you can fall asleep initially but have a hard time staying asleep or going back to sleep if awakened in the middle of the night.
For example, those with AFS that don’t get to bed before 10 p.m. might find themselves passing the sleepy phase and becoming more alert between 11 p.m. and 1 a.m. Or, they might go to bed on time and pass that phase where the adrenals get a second wind, only to find themselves waking up around 2 or 3 a.m. because of another cortisol kick.
These two types of insomnia are caused by different patterns of disruption, but both involve the HPA axis, melatonin and cortisol balance, and the circadian rhythm in general.
As you can imagine, stress and adrenal fatigue can really impact your circadian rhythm, and vice versa, a disrupted circadian rhythm can really impact your adrenal glands and bring about or worsen adrenal fatigue. And you cannot recover from adrenal fatigue nor get a balanced circadian rhythm if your melatonin and cortisol are not in balance and you don’t get good quality sleep.
In the beginning stages of AFS, your cortisol levels rise, creating a state that can be described as “wired and tired” – wired because the higher cortisol levels won’t let you relax and they keep you on alert, and tired because you can’t sleep it off and wake up refreshed. With higher levels of cortisol throughout the day and night, your melatonin levels decline and don’t get a chance to go up when needed.
On the other hand, if you’re in the later stages of AFS, your cortisol output may drop completely, leaving you without the needed rise that occurs between 6 and 8 a.m. that helps you wake up and start your day. This can leave you feeling tired even after sleep, and it makes getting through the day a challenge.
A reduction in melatonin production, which is bound to happen when the circadian rhythm is out of balance, can increase inflammation and oxidative stress in your body, which can add to the stress your adrenals have to manage. And if melatonin is not produced at the levels needed, cortisol will take a hit as well.
The longer this imbalance between melatonin and cortisol persists, the more vulnerable you become to chronic inflammation, recurring infections, mental health issues, brain fog, adrenal exhaustion, chronic illness, and, ultimately, a sharp decline in the quality of your life. This is obviously unsustainable and can result in a complete crash.
In order to bring back balance to your circadian rhythm, you’ll need to work with its seven distinct phases, listed below, that take place within 24-hours. If you have problems with a particular time period in your day, some of the supplements below can help balance out that phase of your circadian rhythm, but always talk to your doctor if you are starting something new.
Try to sleep in until 8:30 or 9 a.m. If you wake up feeling wired and tired, try meditating, which can help bring down the high cortisol levels a little bit. If you wake up feeling drowsy, it means your cortisol levels aren’t rising as they should, in which case you can do some Adrenal Circulation and Adrenal Restorative exercises. Eat a high protein breakfast that can fuel you for the day, but avoid a lot of sugar, which can reduce your cortisol levels.
Supplements to try: DHEA, iodine, selenium, glutathione, zinc, pregnenolone, glycine, arginine, adrenal glandulars, thyroid glandulars, and vitamins B5, B5, B12, C, and D.
After breakfast, you should strive to maintain stable blood sugar levels so you don’t experience a crash that then prompts you to eat sugary foods or use stimulants. This could mean you have to have a light snack between breakfast and lunch. Adrenal Yoga exercises and Adrenal Breathing exercises during this time can help bring down any excess cortisol that remained after the morning spike.
Supplements to try: fish oil, magnesium, 5-HTP, GABA, lipoic acid, fermented milk thistle, theanine, and activated charcoal.
For lunch, make sure not to overeat and crash into an afternoon slump. Your meal should be made up of protein, healthy fats, and lots of greens. In general, we recommend following the adrenal fatigue diet for all meals. Take a walk after lunch, and, if possible, a quick nap. You should not be experiencing what is commonly known as a “food coma.” If you do experience this, then either the amount of food or type of food you are eating needs to change.
This is also a good time for a nap if you didn’t take one before. In the beginning stages of recovery, sleeping and resting often are beneficial. You can also have a light snack of soup or broth to stay hydrated and replenish your sodium levels.
Supplements to try: fermented holy basil, chromium, glutamine, marine phytoplankton, and hydrolyzed collagen types 1 and 3.
Dinner should also be mainly composed of proteins and healthy fats in order to avoid waking up from a hypoglycemic episode at night. Also, don’t drink too much water after this point so you don’t wake up to use the toilet in the middle of the night. After dinner, begin to wind down by stretching, relaxing, and spending quality time with loved ones. Stop using electronic devices if you can, and if you must use them, wear blue-light blocking glasses.
Supplements to try: many of the above, as well as taurine, theanine, and phosphorylated serine.
This is when sleep hygiene practices can really help. Make your room cool and dark, turn off your phone, turn on the night light and turn off other lights, and eat a small snack of soaked nuts and seeds.
Supplements to try: the ones listed above as well as melatonin, passionflower, valerian root, and progesterone. If your cortisol levels are usually high before bed, bioactive milk peptides and phosphatidylserine might help. If they’re low, try grapefruit juice or licorice.
Hopefully, with all the recommendations above, your melatonin and cortisol levels should start to regulate and you should be able to get good sleep now. But if you do end up waking up in the middle of the night, you might have to take some of the listed supplements in a time-release form so they sustain you throughout. AFS sufferers often experience a lot of nighttime awakenings, and some feel very hungry upon awakening. It is important to keep a bottle of almond milk or jar of nuts by your bedside to eat when this happens.
Of course, this can be confusing to figure out alone, and you may end up using the wrong supplements, in the wrong doses, or at the wrong time. That’s why it’s best to get individualized support that takes into account your current health condition and your needs. The first thing your healthcare professional should focus on is getting your melatonin and cortisol back in harmony, and your adrenals back into shape.
But this will take time, and you might still suffer a few sleepless nights here and there. Try to be patient, and use adrenal breathing exercises or meditation to calm your mind and reduce stress when you can.
© Copyright 2020 Michael Lam, M.D. All Rights Reserved.
Melatonin and cortisol have an inverse relationship, where when one is higher, the other should be lower, and vice versa. Unfortunately for many people, when that balance is disrupted, the entire circadian rhythm is thrown off and getting good sleep becomes a challenge. Here’s how to fix it.
