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Insomnia and Adrenal Fatigue: Why Can't I Sleep When It's Time to go to Bed?

Neuroaffect Circuit

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

Insomnia and Adrenal Fatigue can leave you feeling tired in the morning.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 or Adrenal Fatigue Syndrome (AFS), but it’s easy to overlook this as a potential cause of your sleeplessness. Understanding more about the body and the possible causes for sleeplessness can help you identify and solve the issue, whether your sleep onset insomnia and adrenal fatigue are related or not.

What Happens During Sleep

Your body is tired and ready to rest after a long day, but it’s still working when you go to sleep. It spends this time rejuvenating and clearing 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 high enough cortisol levels in the morning, waking becomes difficult.

This is part of the circadian rhythm and goes on automatically. During the day, high cortisol levels help you handle stress and perform your duties of daily living. These levels peak around 10 a.m. and decline to their lowest point at around 10 p.m. You’re supposed to feel sleepy around this time and go to bed. However, this can be a problem if you have sleep onset insomnia.

What is Sleep Onset Insomnia?

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 the text book sleep onset insomnia definition, an inability to fall asleep despite your physical tiredness. These issues can be chronic and ongoing, or acute and short term. And the symptoms of sleep onset insomnia will vary depending on how it presents for you. It’s important to understand what your body is saying when this happens. If you have an eventful day and feel tired at the end of it, you should be able to sleep

This type of insomnia can be caused by imbalances in the autonomic system, with more favor towards the sympathetic system and means that your body is still filled with the stress hormones from the day and is unable to calm down enough to fall asleep. This state is often described 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 sleep onset insomnia are decreased serum melatonin, elevated core body temperature, increased body and brain metabolic rates, and over-activation of the HPA axis.

Some common symptoms of sleep onset insomnia are:

  • Irritability
  • Depression
  • Anxiety
  • Problems with concentration
  • Mood swings
  • Low sex drive
  • Fatigue
  • Increased clumsiness

This is not the only type of insomnia that you may experience.

Maintenance Insomnia

Sleep maintenance insomnia (SMI) occurs 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, but can’t go back to sleep. This type of insomnia can often 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 the fast is broken in the morning. People with insomnia and AFS tend to have symptoms of hypoglycemia every two to three hours throughout the day and night, although laboratory glucose levels remain normal. As you fall asleep, your body gets hungry and depletes its glucose stores quickly. With glucose depleted, cortisol has to be 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. This is a common cause of 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 interfere with memory formation during the night, creating insomnia amnesia. It is very important not to stop taking sleeping pills without the advice of your doctor, as cutting them out cold turkey can be dangerous.

The Danger of Sleeping PIlls

You might be templed to turn to sleeping aids or pills when you have trouble sleeping. This can help force sleep but doesn’t solve the problem. Additionally, these pills can cause a new problem as they often don’t last long in people with sleep onset insomnia and adrenal fatigue. You could get to sleep for a few hours if you take a pill, but your overactive adrenal glands are still running on full speed and have not calmed down enough to stay asleep. This means that you’re likely to wake up in a few hours. Strong medications may be more effective, but they are often accompanied by a hangover when you wake in the morning.

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Why Can't I Sleep?

Insomnia and Adrenal Fatigue maybe preventable if you read the proper signs.Sleep onset insomnia and Adrenal Fatigue can be closely related. It’s all down to the fact that your body is producing more cortisol in the evening even though it shouldn’t. This is the reverse of what should occur. This error can be the result of increased stress during the day which causes more adrenaline that the body has to burn off naturally. It can also be the result of too much stimulation of the sympathetic “fight or flight” system paired 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 recently released in your body and is keeping you awake. This is a signal that your biological rhythm is disrupted.

Adrenal fatigue Syndrome (AFS) is not the only reason for sleep onset insomnia though, so identifying the causes of 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.

Sleep Onset Insomnia and Adrenal Fatigue

The adrenal glands play a big role in sleep regulation by way of cortisol, a hormone that they secrete. These glands have a limit to 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, as cortisol output drops the body i experiences fatigue at even slight stressor or during daily routines. Clinically you will become fatigued, presenting with symptoms such as reactive hypoglycemia, salt and sugar cravings, exercise intolerance and low libido. Collectively, this clinical picture is known as AFS and it can lead to sleep onset insomnia and adrenal fatigue.

In the later stages of adrenal fatigue, the neuroaffect 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. These circuits are inflammation, detoxification, hormonal, cardionomic, metabolic, and neuroaffect. Every circuit works synergistically with the others to reduce stress in an orchestrated response.

The neuroaffect 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 the 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 processes 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 can also occur due to overexertion of the autonomic nervous system.

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Relieving Sleeplessness

Stress often leads to sleep problems, but reducing stress when you can’t sleep can be difficult. It can turn into a vicious circle of sleeplessness and stress that makes it hard to function. There are many supplements available that might help regulate your adrenal glands and alleviate sleep onset insomnia as well we other lifestyle changes that will help including:

Excluding caffeine and alcohol from your diet can help with 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.
  • Make sure that you’re eating a healthy, balanced diet.

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. Just make sure that you don’t overbreathe, which can trigger sleep onset insomnia and adrenal fatigue.

There are also 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 require only 0.5mg.

There are also some herbs and glandulars that can be helpful, but these are sometimes problematic because the body can respond differently from the desired outcome. The weaker the body, the more often this is the case. For example, in most cases valerian is calming, but in some people it can worsen insomnia.

Using hormones to encourage sleep and alleviate sleep onset insomnia demands special care. Natural progesterone, for example, has a sedative effect which is dose-dependent. It can also cause paradoxical reactions, behaving as a stimulant 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 are more common with this disorder and may lead to worsening sleeping patterns. For example, people with AFS often experience wakefulness when they take magnesium(especially in transdermal form), and hangovers from melatonin. These reactions often have have to do with improper dosages, the delivery systems, and a failure to recognize the body’s constitution.

Sleep aids, medications and hormones have to be metabolized by the liver. Those with weak bodies because of AFS usually have congested livers, where metabolism is slowed and 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 this 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.

Conclusion

If you already suffer from adrenal fatigue, any sleeping problems such as sleep onset insomnia 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 sleeping problems without addressing the underlying adrenal or endocrine function doesn’t help, so it’s important to look at the whole metabolic and hormonal picture if you want to recover. If you struggle with insomnia, here are some ideas that might help:

  1. Improve your sleeping habits by ensuring that your room is cool and dark, that you go to sleep at the same time, and set up relaxing bedtime rituals.
  2. Have a light snack before bed such as nuts to alleviate problems caused by your metabolism and hypoglycemia.
  3. Make sure you visit your doctor to investigate the multitude of reasons for insomnia and to discuss whether you should try natural sleep aids.

If you need to discuss your sleep onset insomnia and adrenal function, then talk to our team on +1-626-571-1234 or click on the banner below to use the Ask The Doctor system.

© Copyright 2020 Michael Lam, M.D. All Rights Reserved.

Insomnia and Adrenal Fatigue can cause you to wake up tired.

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