The minute I saw Jessica, it was clear she was seriously sleep deprived. Not only did she have deep, dark circles under her eyes and sallow skin, but when she tried to tell me what was wrong, she kept losing her train of thought. I’d ask a question and she’d drift off mid-sentence, unable to tell me exactly why she’d come to see me.
When I asked about sleep, she sighed and said “I wake up so often in the night – if I can even fall asleep at all. I’ve basically given up on being well rested.”
It’s not uncommon for women to come to me feeling this way. They tell me they’ve tried but still spend hours lying awake before sleep comes, or toss and turn all night, waking frequently. Sleep medications make them feel worse – groggy and unfocused, but still unable to sleep.
In the past few months, this problem is plaguing even more women. Clients who don’t typically have sleep difficulties have told me that since the pandemic hit, their sleep has varied widely. Sometimes, it’s all they can do to drag themselves out of bed; one friend said she sleeps every afternoon and she never used to nap.
More common, however, is what my friend Betty told me recently. She’s long had difficulty sleeping, but now, it’s nearly impossible. As soon as she turns off the light and lays her head on the pillow, anxious thoughts bombard her. She’s doing a good job of managing her life through the pandemic during daylight hours – mostly by focusing on what needs to get done.
But the quiet of the night floods her mind with the questions she doesn’t have time to think about during the day. Will her job continue to be secure? How are the kids faring through all of this? What will her aging mother do if she has to remain inside much longer? Why is the world such a mess? How will this all play out for the economy and the political scene? With all that noise, it’s no wonder she can’t sleep!
And not only are these anxious thoughts disrupting her sleep patterns, but they’re certainly increasing her stress level, which raises cortisol levels, which makes sleep difficult. It’s a crazy cycle that MUST be broken.
Why sleep matters
Lack of quality sleep is certainly frustrating, as Jessica’s lamenting demonstrates, but beyond the annoyance of trying and failing to sleep, there can be serious physical and psychological consequences.
Chronic sleep deprivation can impact conditions like heart disease, diabetes and stroke. It can cause memory loss, fuzzy thinking, and slower cognitive processing.
Mood is likely to suffer when sleep deficit is constant, prompting irritability, anxiety and depression. And, of course, there’s the inevitable sleepiness and exhaustion that come from lack of sleep.
All of these mental and physical impacts are bad enough, but sleep deprivation can impact productivity in the workplace as well, and with all the tough decisions about layoffs that companies are having to make, now is not the time to be less focused and unable to perform necessary tasks.
On top of all that, there’s evidence that chronic lack of sleep can actually be dangerous. Reaction times are slower, and decision making becomes more difficult, both of which can contribute to an increase in accidents. In fact, data from the National Sleep Foundation shows that lack of sleep leads to tens of thousands of traffic accidents and other injuries every year! An expert panel in 2016 determined that sleeping less than 2 hours in a night and then driving are too sleep deprived to drive a car. Research has long demonstrated a connection between sleepiness and work-related injuries. In fact, workers who are overtired are 70% more likely to be involved in an accident at work.
And, like I said before, lack of sleep can cause major imbalances in hormones, especially cortisol, which is produced by the adrenal glands when your body is under stress. Not sleeping is a form of stress that your body needs to deal with.
Physiology of sleep
Sleep is regulated, in large part, by the HPA axis. A growing body of research suggests that there is a reciprocal relationship between sleep and HPA activity. Let’s take a look regular sleep patterns, and the impact that cortisol can have on these.
Normal sleep patterns include cycles of light sleep, deeper slow-wave sleep, and REM sleep. Slow wave sleep, which is where muscle recovery and restoration of the body occurs, often accounts for much of the first half of the night, while REM sleep, which allows for restoration of the mind, is more prevalent in the second half of the night. With each cycle of sleep, the period of REM sleep lengthens.
Cortisol is secreted during sleep. Levels begin to increase 2-3 hours after sleep onset and rise into the early morning and early waking hours. Cortisol peaks around 9 am, and levels slowly decline throughout the day. But when the body is under stress, cortisol levels remain high, which can lead to a decrease in short-wave sleep and prompt frequent waking.
Sleep deprivation and/or reduced quality of sleep result in functionally significant activation of the HPA axis. Hyperactivity of the HPA axis can lead to disturbed sleep. Again, it’s a vicious cycle.
Stress, adrenals and sleep
What does all of this have to do with the adrenal glands and adrenal dysfunction? These tiny glands that sit on top of your kidneys have big responsibilities. And when they are working overtime all kinds of problems can result.
Stress of any kind – good, bad or neutral – kicks your body into action, activating a physiological response to perceived danger. Your sympathetic nervous system prepares your body by sending messages to several glands and organs, including your adrenals. Because these adrenal glands are responsible for managing the stress response, stressors prompt the release of hormones like adrenaline and cortisol.
When this stress response is constantly engaged, those normal cortisol patterns I talked about are disrupted. And that may send your body the wrong message to be alert and awake when you should be sleeping.
Both high levels and low levels of cortisol can impede natural sleep patterns. Low levels can lead to a dip in glucose, which can send up an alarm telling your body it needs to refuel. This can lead to waking in the early morning hours, between 1 AM and 4 AM.
If adrenal dysfunction is preventing quality sleep, there are many natural ways to reduce stress and promote health balance. Let’s take a look at my top recommendations for healing the adrenals and improving sleep.
Tips to Balance Adrenals and Get Some Sleep
Getting to a point where adrenal balance is so skewed that sleep patterns are also disrupted takes time. And because lack of sleep contributes to this imbalance, it will take time to break that cycle. But it IS possible, with some lifestyle changes, stress relief strategies, mineral and herbal support, and other natural solutions. You’ll need to be gentle with your body (and yourself) as you work to reclaim balance. Here’s some tips on how to relax, restore balance, and finally get some sleep!
Pay close attention to your sleep environment
The bedroom should be used for two things only: sleep and sex. Set this room up as a sanctuary and fiercely protect the peace it can offer. That means leaving electronics of any kind out of the room; setting a comfortable temperature that’s not too warm or too cool (60-68 degrees is recommended); and keeping lighting soft.
Set a relaxing, consistent bedtime routine
Just as environment matters, so too do that activities you choose right before bed. If you’re watching a movie with high intrigue and tension, it’s unlikely you’ll be able to switch off the light and get right to sleep afterwards. Turn off electronics an hour before bed and choose a book instead. Set up a meditation practice or try some deep breathing techniques as you wind down. Don’t try to work until it’s time for sleep – give yourself the transition time you need to make that shift. Try not to engage in anything too stimulating that might result in a “second wind.”
Establishing consistent bedtimes (ideally before 11 pm) and wake times, even on weekends, can also keep your circadian rhythms on the right track.
Have established stress relief strategies throughout the day
As valuable as meditation and mindfulness are, if you’re on full throttle all day long and only give yourself a short period of time to relax in the evening, your body won’t be able to keep up. Stress relief needs to happen on a regular basis, and will probably take a conscious effort at first. One of the best ways to relieve stress is to find an activity that brings you joy. What that is doesn’t matter. You could love reading, writing, dancing, gardening, or sitting on a beach watching the waves. Connecting with loved ones may be what feeds your soul. What matters is that you can get so engaged in the activity you aren’t thinking about anything else, giving your mind time to truly relax.
Exercise – but gently
Exercise can be great stress relief and can also help use excess energy so your body will be ready for sleep. But you have to be careful if your adrenals are already overworked; vigorous exercise can make the problem even worse. If you’re struggling with adrenal issues, now is not the time to take up marathon running or 50-mile bike rides. Start with a walk, yoga, or a gentle spin around town on a bike.
Strive for optimal nutrition
Your adrenals, like the rest of your body, relies upon you having the essential minerals and nutrients you need. If you aren’t eating well, you’re depriving your body of the fuel it requires. Fresh, whole fruits and vegetables, lean meats, and healthy fats are all essential dietary components to heal your body – and keep it healthy. Since it’s difficult to get everything you need from diet these days, I always recommend a high-quality multivitamin complex, and targeted supplementation as needed. Working with a healthcare professional can identify deficiencies and help you know exactly what your body needs. Vitamin B6, panthothenic acid, and vitamin C are often depleted with adrenal dysfunction, and calcium, magnesium, potassium, manganese and zinc are important in supporting proper adrenal function.
The timing of your meals can also promote healthy balance and sleep. Try to stop eating at least three hours before bedtime, although you may need a light snack that contains protein and healthy fat. Certainly avoid a big meal to late in the evening. I recommend making your mid-day meal the heartiest.
Alcohol and caffeine are best avoided, especially late in the day. I suggest keeping caffeine intake to before noon and reducing alcohol consumption (especially near bedtime) as much as possible.
Try some herbal support
Instead of turning to prescription sleep aids, consider supporting your body with herbs. A wide range of botanicals, including American ginseng, Asian ginseng, astragalus, eleutherococcus, Holy basil, rhodiaola, and licorice can support the HPA axis, helping to balance cortisol levels.
Ashwagandha and Magnolia have also shown promise in regulating stress and promoting healthy sleep.
Jessica tried my suggestions and was happy to report that in just a few weeks she’d noticed a big difference. Her adrenals weren’t entirely healed yet, but she’d set up some great supports to help her get there. And the best news of all – she’d slept through the night for an entire week!
Understanding the connections between adrenal dysfunction and sleep disruption allows you to make the best choices for your personal situation. And remember, you don’t have to do it alone. I have a wealth of articles on stress, adrenals, hormones, sleep and much more in my health library, and I’m just a phone call away if you want a personal consultation to examine what’s happening for you.
To set up a telephone consultation, call my practice at 1-800-540-5906.
Reviewed by Dr. Mark Menolascino, MD