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The Impact of Stress on Adrenal Fatigue and Sleep Disorders

The festive season is looming – we can look forward to fun times spent with family, giving and receiving presents, travel, time off work and maybe some relaxing…? But right now the pressure of Christmas can be another stressor along with work deadlines, taking care of the family, paying the bills, studying for exams, trying to keep up with the expectations we have put on ourselves – a relentless juggling act! When you discover you’ve put the milk away in the vacuum cupboard and the kids out with the cat – believe me, its all become too much!

To get the energy to get through these stressful days we justify our consumption of coffee, sugar and alcohol- sending our blood sugar and insulin levels on a roller coaster ride and issuing our liver yet another thumping.

Stress is viewed as a psychological problem, but it has very real physical effects.

The Natural Stress Response

When you encounter a perceived threat – for example a large dog barks at you on a morning walk, your hypothalamus, a tiny region at the base of your brain, sets off an alarm system in your body. Through a combination of nerve and hormonal signals, this system prompts your adrenal glands, to release a surge of hormones, including adrenaline and cortisol, which allow you to respond to the conditions of your daily life in healthy and flexible ways.

Adrenaline (the fight-or-flight hormone) makes your heart pound, your blood rush to your heart and large muscle groups, your pupils widen, your brain sharpen, and your tolerance for pain increase – basically, it prepares you for battle. Modern-day battles are most likely things like pushing your body to keep going when it’s fatigued, dealing with a stressful job, and reacting with quick reflexes to avoid a traffic accident. Think of these adrenaline surges as withdrawals from a bank, to help you get through life’s rough spots. If you have gotten into the habit of withdrawing adrenaline from your account too often, you’ll eventually be overdrawn and your adrenal glands will be overwhelmed. Then, you’ll have too little adrenaline when you really need it.

Cortisol, the primary stress hormone, increases sugars (glucose) in the bloodstream, enhances your brain’s use of glucose and increases the availability of substances that repair tissues.

Cortisol also curbs functions that would be non-essential or detrimental in a fight-or-flight situation. It alters immune system responses and suppresses the digestive system, the reproductive system and growth processes. This complex natural alarm system also communicates with regions of your brain that control mood, motivation and fear.

When the Natural Stress Response Goes Haywire

The body’s stress-response system is usually self-limiting. Once a perceived threat has passed, hormone levels return to normal. As adrenaline and cortisol levels drop, your heart rate and blood pressure return to baseline levels, and other systems resume their regular activities.

Unfortunately, in our current high-stress culture, the stress response is activated so often that the body does not always have a chance to return to normal. This can lead to numerous health problems including Sleep Disruption. Higher and prolonged levels of circulating cortisol (like those associated with chronic stress) as well as chronically lower levels of circulating cortisol (as in adrenal fatigue) have both been associated with Sleep Disruption.

Adrenal Function in Sleep Patterns

Stress and adrenal function affect sleep, particularly the circadian pattern of cortisol secretion by the adrenal glands. Circulating cortisol normally rises and falls throughout the 24-hour daily cycle, and is typically highest at around 8 AM and lowest between midnight and 4 AM. Both high and low nighttime cortisol levels can interrupt sound sleep.

The surge in adrenal hormones adrenaline and cortisol, released by stress makes it more difficult to relax into sound sleep – especially when they remain high or rise and fall irregularly through the night. Frequent or constant stress can chronically elevate these hormone levels, resulting in a hyper-vigilant state incompatible with restful sleep.

If this is the reason for poor sleep, anything that reduces stress and enhances the ability to handle stress may improve sleep. This can include relaxation, breathing and/or meditation techniques, certain yoga postures, healthy lifestyle changes, and stress-relieving life alterations. Refraining from vigorous exercise in the evening and taking time to consciously relax before going to bed may calm the adrenals and help lower cortisol and adrenaline levels.

When the adrenals fatigue, adrenal hormone levels may become low, leading to another possible source of nighttime sleep disruption – low blood sugar. Cortisol plays an important role in maintaining blood sugar (glucose) levels around the clock. Although blood glucose is normally low by the early morning hours, during adrenal fatigue cortisol levels may not stay sufficient to adequately sustain blood glucose. Low glucose signals an internal alarm (glucose is the main fuel for all cells, including brain cells) that disrupts sleep so the person can wake up and refuel.

Low nighttime blood glucose can also result from inadequate glycogen reserves in the liver. Cortisol causes these reserves to be broken down into glucose that is then available to the cells. When low cortisol and low glycogen reserves coincide, blood glucose will most likely drop, disrupting sleep.

Waking between 1 AM and 3 AM may indicate low blood sugar resulting from inadequate glycogen reserves in the liver, low adrenal function and cortisol, or both. This is often the culprit when panic or anxiety attacks, nightmares, or fitful, restless sleep occur between 1 and 4 AM.

If low blood sugar is disrupting sound sleep, supporting healthy adrenal function and dealing with the adrenal fatigue may contribute long term to sound sleep. Also having a healthy snack before bed can help fortify the body’s nighttime energy reserves.

Adrenal Dysregulation

Adrenal dysregulation is a dysfunction in the normal circadian rhythm of cortisol secretion.

As mentioned, throughout this cycle, there are secretions of cortisol with various different amplitudes. The initiation of sleep occurs at the same time with a low hypothalamic-pituitary axis activation. In fact, sleep deprivation is associated with HPA activation. Nighttime awakenings are associated with cortisol release, which is followed by a temporary inhibition of cortisol secretion.

Dysfunction of hypothalamic-pituitary axis can play a role in some sleep disorders. In other cases, HPA axis dysfunction may actually be a result of this sleep disorder, particularly with obstructive sleep apnea. HPA axis hyperactivity can lead to fragmentation of sleep, decreased slow-wave sleep and an overall shortened sleep time. In other words, sleep problems create hypothalamic-pituitary-adrenal axis problems, and HPA axis problems create sleep problems. Both insomnia and obstructive sleep apnea are particular sleep disorders associated with HPA axis dysfunction.

Interventions to normalise HPA axis abnormality, and decrease nightime corticotropin releasing hormone hyperactivity and cortisol can be very beneficial in treating insomnia. The goal should be to treat the hypothalamic-pituitary-adrenal loop to decrease cortisol at night.

Therapeutic Strategies

When utilised correctly, nutritional supplements and botanicals can help manage Stress, Adrenal Fatigue, Dysfunctional Cortisol Production and Sleep Disorders.  Please consult a qualified natural health practitioner to ensure you receive supplements that are suited to your individual needs. 

Cortisol Testing for Adrenal Function

Conventional blood tests, taken at whatever time your doctor has scheduled your appointment, might indicate that your adrenals are normal. However, a better diagnostic approach will test your levels at different times of the day, which is much more likely to reveal an out-of-whack pattern of cortisol secretion.  Saliva tests provide the most accurate indication of cortisol levels.  True Medicine offers saliva hormone testing in conjunction with consultations.