Insomnia – one of the most frequent complaints around the world, but also one of the least understood. Part of the reason for the lack of understanding is because most people with insomnia have other medical or psychological conditions that confuse the symptom picture. Recent research has begun investigating how neurotransmitters function in insomnia.
Since insomnia is one of the complex of symptoms found in Adrenal Fatigue Syndrome (AFS), cortisol levels must be considered as a causative factor. However, if cortisol imbalances can be ruled out, there are other possibilities, many also implicated in AFS. They include metabolic dysfunctions such as reactive hypoglycemia or neurotransmitters function imbalances.
Newer research into insomnia investigated the role of dopamine – for a neurotransmitters function in sleep. A report published in the Public Library of Science in 2012 showed dopamine to play a role in controlling sleep regulation. By influencing the pineal gland, dopamine assists in keeping the circadian rhythm adjusted to the optimum level for people. The pineal gland uses light gained through the retina to synthesize melatonin. This hormone, released at night, promotes sleep and helps keep the body’s metabolic activity regular during sleep. Dopamine receptors emerge in the pineal gland only when the end of night sleep approaches. At that time, dopamine inhibits the production of melatonin and prepares the body to wake up.
Another recent study conducted at Rush University Medical Center (2014) showed a connection between disrupted circadian rhythms and inflammatory-related or mediated illnesses, especially those in the gut system. This connection becomes clear in people who ingest a high-fat, high sugar diet. The research also suggested a positive effect of adding prebiotics or probiotics to the diet. This addition appears to mitigate the influence of disrupted circadian rhythms.
Insomnia is defined as difficulty in falling asleep, staying asleep, early morning awakening, or not having a restful quality of sleep. Anywhere from 35 to 40 percent of adults around the world complain of some form of insomnia. Around seven percent of cases are considered chronic, severe, or both. Recurrent problems with insomnia can also be complicated by concurrent anxiety and/or depression.
Insomnia can be described as primary or secondary. Primary insomnia often is caused by a learned response to some outside influence. Secondary insomnia is often caused by more internal factors. Finding that underlying disorder is the focus for secondary insomnia.
Most frequently, the conventional approach to treatment for insomnia has been either psychologically or pharmacologically based. There are any number of potential psychological practices that attempt to change habits or beliefs as a means of decreasing insomnia. On the pharmacological end, benzodiazepines, some types of antidepressants, and antihistamines are the medications of choice. There are some significant drawbacks to use of these medications for insomnia.
As mentioned above, current research is looking at other approaches to deal with this major issue of insomnia. Cortisol is only one possible cause. Normally, levels of cortisol are highest in the morning, serving to wake up the body. They also are lowest at night, helping the body to sleep. If cortisol levels are normal, these other causative factors have to be considered. This article will focus on neurotransmitters function.
Neurotransmitters are chemicals in the body that enable neurons to communicate with each other. The neurotransmitters in your brain cause heart beats, breathing, digestion, and can affect many other aspects of behavior. When they operate in balance, the body works as it should. If they get out of balance, symptoms can range from those that cause discomfort at least to severe illness at worst. Some researchers believe that over 80 percent of Americans have neurotransmitters that are out of balance in some way. Stress, eating the wrong foods, toxins in the environment, and genetics are all possible reasons for this imbalance.
Two kinds of neurotransmitters function in the body. Excitatory neurotransmitters function by stimulating neurons in the body to fire. Inhibitory neurotransmitters function to help the body to relax and calm the brain’s activities. They help in creating balance, but can be depleted easily if the excitatory neurotransmitters function becomes overactive.
Neurotransmitters are also involved in sleep. Although scientists don’t know a great deal about how neurotransmitters function activity affects sleep and waking, research is beginning to delineate some of the ones implicated in sleep and in insomnia.
There are several options for how neurotransmitters function that are involved in helping people sleep normally. As long as how these neurotransmitters function is in balance, going to sleep and staying asleep happen naturally. However, when an imbalance occurs, insomnia often results.
Research has found strong connections between inflammation in the nervous system and several conditions, including insomnia. Often, stress is the stimulus for this inflammation due to the secretion of cortisol by the adrenal glands when the body is under stress. In our chronically stressed world, the adrenals are constantly stimulated to secrete cortisol, potentially resulting in adrenal gland fatigue as is seen in Adrenal Fatigue Syndrome. This constant stimulation can result in an imbalance in cortisol levels - causing insomnia. Because the adrenals convert progesterone to cortisol, more imbalance in other systems of the body result. The metabolic system and immune system may be compromised and blood pressure may increase. With overly high levels of cortisol, glucose will be released but not consumed. This leads to it being stored as fat, especially around the middle of the body. Mood fluctuations and insomnia also result.
Another hormone secreted by the adrenals is DHEA. This, too, can be converted to cortisol. When the body is stressed normally, cortisol and DHEA are both typically elevated, but return to normal when the stressor is resolved. With continuing stress, DHEA will stay within normal limits or even go up as cortisol output increases. When stress continues, DHEA tends to decrease with its increased conversion to cortisol. Fatigue sets in, but other neurotransmitters function may be released in excess, such as norepinephrine. This causes a stimulatory response and insomnia.
What is the effect of this condition of cortisol imbalance on how other neurotransmitters function? One of the neurotransmitters that has a definite effect on sleep and insomnia is serotonin. In addition to being involved with sleep, serotonin is also considered an antidepressant neurotransmitter. Regarding its effect on sleep and insomnia, serotonin is converted to melatonin which is a substance that helps the body go to sleep more than helping stay asleep. With decreased amounts of serotonin in the body to be converted to melatonin, initial insomnia results. Cortisol inhibits serotonin functioning. Thus, with increased cortisol present when the body is stressed and decreased serotonin available for conversion to melatonin, insomnia becomes a significant problem.
Serotonin is manufactured in the gut system from the amino acid tryptophan. This is the amino acid present in turkey, which explains the drowsiness often felt after a big dinner. There are supplements that can increase serotonin levels and thus positively affect melatonin levels also. Sam-e, 5-HTP, and L-tryptophan have been shown in several human studies to increase serotonin levels.
In the two-step conversion of L-tryptophan into serotonin, 5-HTP is also synthesized. Some practitioners of alternative health have seen success in taking supplemental L-tryptophan for insomnia. It is important to take L-tryptophan under the supervision of a health care provider who is aware of its effect on serotonin. If the levels of serotonin get too high, there may be an elevation in morning levels of melatonin, leading to drowsiness during the day. High levels of serotonin may also contribute to seasonal affective disorder and may lower the sex drive. It may also have an effect on prescription medications.
Another supplement that can affect the serotonin neurotransmitters function, and thus sleep, is Sam-e. S-adenosyl methionine (Sam-e) comes from the amino acid methionine, found in all the cells of the body. It is involved in the synthesis of serotonin. As with L-tryptophan, too much Sam-e could lead to too high levels of serotonin with the drawbacks mentioned above.
More than one supplement to boost serotonin levels should not be taken at one time. Too much serotonin is not good for anyone.
Another one of the neurotransmitters that affects sleep and insomnia is GABA or gamma aminobutyric acid. A large deficit of GABA is the first known brain chemistry deficiency associated with insomnia. Low levels of GABA may come with low levels of serotonin/melatonin or may cause sleep problems on its own. GABA is mostly found in the brain, unlike other neurotransmitters that may be found in other areas of the body. For example, serotonin can also be found in the gut system.
GABA is very significant in insomnia. Healthy people who have insomnia have been shown by research to have up to thirty percent less of this neurotransmitters function than normal sleepers according to a study published in the journal Sleep.
Low levels of GABA tend to make the sufferer feel anxious and unable to relax. Its effects on sleep include being unable to get into the deep sleep needed during the beginning of the night to allow the body to recover from the stresses of the day, waking easily during the night, and having restless sleep. It’s even possible for a person’s immune system to be sensitive to one of the precursors of GABA and maybe even to GABA itself.
Thus, if the body is overwhelmed by stress and has an ineffective immune system because of this, the GABA neurotransmitters function may not be at correct levels – leading to insomnia. This is even more likely because low levels of GABA can bring on a decrease in serotonin as well. Along with insomnia, this process may cause irritability and difficulty thinking rationally, both indicators of Adrenal Fatigue Syndrome (AFS).
When making any changes in levels of neurotransmitters or trying to balance them, it’s important to keep a couple of things in mind. First, this may take some time. Of major importance is taking plenty of time in making these changes. All changes of this kind must be done under the supervision of a well-trained medical professional. Which brings up the second thing to keep in mind – all systems of the body must be evaluated and kept working in balance.
This is the unique viewpoint of the NeuroEndoMetabolic (NEM) model of stress response. Too often, conventionally-trained professionals will try correcting decreased neurotransmitter levels by focusing only on the one that is deemed to be low. As has been shown above in this article, neurotransmitters function in balance at their optimum working level. Making large changes in one of them may lead to problems in other systems of the body. The metabolic and immune systems will be strongly affected by neurotransmitters function that is out of balance. Only by keeping all body systems and their interactions in mind can a remedy be most effective.
When considering increasing levels of neurotransmitters, testing to determine current levels should be the first step. Unfortunately, there aren’t any well-accepted medical tests that provide this information. Some practitioners use urine testing, others test blood levels, and still others use spinal taps to get the information they need.
Even if tests are used to assess the level of the neurotransmitters function, the results of these tests can’t tell how a person will respond to efforts to increase neurotransmitters function levels. Also, neurotransmitters function levels fluctuate from time to time during the day, and possibly hour to hour. Thus, many tests would have to be done at different times of the day in order to get any idea of the levels for a person.
One of the neurotransmitters, GABA, doesn’t cross the blood-brain barrier except in very small amounts. Because of this, high doses of supplements would be needed in the hope that sufficient amounts would get to the brain. Some physicians prescribe medications that work to increase GABA levels. These drugs do cross the blood-brain barrier, but may bind to receptors others than GABA ones which would lead to side effects. There are some natural compounds that affect levels of GABA, and these may be effective.
Making a difference in how neurotransmitters function requires supervision by a professional who knows what to look for and how to use substances appropriately in the effort. Balancing neurotransmitters is the key to beneficial changes. This is a complex and delicate process. It isn’t something an individual should take on by him/herself.
© Copyright 2017 Michael Lam, M.D. All Rights Reserved.