In the past two years, I have seen a vast increase in patients seeking health for sleep issues. Sleep issues can range from problems falling asleep, problems staying asleep to just not feeling rested when waking in the morning. It’s estimated that 25-30% of adults suffer from some form of insomnia and that this has likely gone up because of the pandemic.
Why the rise in sleep issues over the last 2 years? Primarily because stress hormones such as cortisol can influence one’s ability to fall asleep and stay asleep. Both cortisol and melatonin (a major sleep hormone) secretion vary with your circadian rhythm. Your circadian rhythm is your biological clock and it operates roughly on a 24-hour schedule. So, if something such as chronic stress affects your cortisol levels, it can naturally also influence your sleep.
It is also important to understand that people were not designed to be under chronic stress. Chronic stress refers to experiencing multiple stressors over a prolonged period of time. Think about your day –
· Do you drive in traffic to work?
· Do you have a smart phone and get notifications every few minutes?
· Do you have to juggle your schedule and your kids’ schedule?
· Do you multitask and eat in a rush?
· Are you always on the go?
· Do you worry about paying your bills?
· Do you have strained relationships?
These are all examples of stressors. A single stressor at a single time is not the problem. It’s the combination of stressors constantly experienced through the day. Stress can be physical, mental or emotional and can be positive stress (e.g. a job promotion, exercise, etc.) or negative stress (e.g. financial stress, anxiety, relationship problems). Unfortunately, in modern society, individuals face a multitude of stressors everyday, but biologically, our bodies was not designed to experience stress in this manner.
However, in isolated and acutely stressful situations, we’re rock stars! Our bodies respond to the stress by putting us on high alert, downregulating non-life saving systems such as digestion, healing and regeneration and dealing with the stress at hand. If given adequate time to recover from the stressful event, you return to a healthy baseline. However, if under chronic stress, more and more cortisol is secreted to deal with the high frequency of stressors and you don’t get the opportunity to recover between exposures. This is what we call sympathetic dominance (your sympathetic nervous system is your ‘fight or flight’ system).
The period of elevated cortisol is an example of an adaptation. It is a way to cope (in the short term) with being constantly bombarded with stressors. However, it is not a sustainable adaptation. How long someone can thrive here is very individual and will vary from person to person – some do well for decades, while others only a few weeks or months. At some point, your body can’t keep up with the higher cortisol output and production drops. This predisposes you to burn out or adrenal fatigue. In both scenarios – elevated cortisol or low cortisol, your melatonin levels and circadian rhythm can be affected.
Another way to look at cortisol is that it helps to promote alertness. Have you ever had an impending deadline that kept you highly focused, motivated and driven? You can thank cortisol for that. However, these are not qualities that facilitate sleep. In fact there is an inverse relationship between cortisol and your sleep hormone known as melatonin.
At night time, cortisol typically is dropping as melatonin is rising in preparation for sleep. But chronic stress or stress late in the day can keep your cortisol elevated, which prevents melatonin from rising and can affect your ability to fall asleep. Patients often report feeling ‘tired but wired’, where they are tired and want to go to sleep but they either get a second wind of energy just before bed or their mind starts racing and is difficult to quiet.
Another way cortisol can affect sleep is by waking you up in the middle of the night. If you tend to wake frequently between 2:00-4:00 am then chronic stress and adrenal adaptation have likely shifted your cortisol curve and this is what is causing you to wake up in the middle of the night. Furthermore, if you wake up feeling groggy and have a hard time getting going for the day, this could be explained by having low cortisol levels in the morning if your adrenals just can’t keep up to the demands anymore.
Adrenal health and cortisol levels can also impact other hormones and worsen other causes of interrupted sleep, most notably night sweats experienced by women in peri-menopause and menopause (this is a large topic that I’ll address in a future blog).
Because people spend approximately 1/3 of their lives sleeping, optimizing sleep is very important. When you’re not sleeping well it can impact your daytime functioning and your whole state of well-being. In fact, research has shown the ineffective sleep increases your inflammatory markers and increases your risk of cardiovascular disease, stroke, impaired immunity and mood disorders. However, the answer is not always to take a sleeping pill. If you understand WHY you aren’t sleeping in the first place and you take steps to treat and correct the underlying cause, then you likely will get longer lasting and impactful results.
Although adrenals and cortisol often play a role in sleep issues, it’s important to realize that there could be many other contributing factors (more sleep posts to follow). This is why it always best to work with a qualified health care practitioner.
References:
1. Dopheide JA. Insomnia overview: epidemiology, pathophysiology, diagnosis and monitoring, and nonpharmacologic therapy. Am J Manag Care. 2020 Mr;26(4 Suppl):S76-S84. doi: 10.37765/ajmc.2020.42769. PMID: 32282177.
2. Fernandez-Mendoza J, Vgontzas AN. Insomnia and its impact on physical and mental health. Curr Psychiatry Rep. 2013 Dec;15(12):418. doi: 10.1007/s11920-013-0418-8. PMID: 24189774; PMCID: PMC3972485.
3. Ogilvie RP, Patel SR. The Epidemiology of Sleep and Diabetes. Curr Diab Rep. 2018 Aug 17;18(10):82. doi: 10.1007/s11892-018-1055-8. PMID: 30120578; PMCID: PMC6437687.
4. Hepburn M, Bollu PC, French B, Sahota P. Sleep Medicine: Stroke and Sleep. Mo Med. 2018 Nov-Dec;115(6):527-532. PMID: 30643347; PMCID: PMC6312177.
6. Javaheri S, Redline S. Insomnia and Risk of Cardiovascular Disease. Chest. 2017 Aug;152(2):435-444. doi: 10.1016/j.chest.2017.01.026. Epub 2017 Jan 30. PMID: 28153671; PMCID: PMC5577359.
7. de Almondes KM, Costa MV, Malloy-Diniz LF, Diniz BS. Insomnia and risk of dementia in older adults: Systematic review and meta-analysis. J Psychiatr Res. 2016 Jun;77:109-15. doi: 10.1016/j.jpsychires.2016.02.021. Epub 2016 Mar 8. PMID: 27017287.
8. Fuller PM, Gooley JJ, Saper CB. Neurobiology of the sleep-wake cycle: sleep architecture, circadian regulation, and regulatory feedback. J Biol Rhythms. 2006 Dec;21(6):482-93. doi: 10.1177/0748730406294627. PMID: 17107938.
9. Kalmbach DA, Anderson JR, Drake CL. The impact of stress on sleep: Pathogenic sleep r1eactivity as a vulnerability to insomnia and circadian disorders. J Sleep Res. 2018 Dec;27(6):e12710. doi: 10.1111/jsr.12710. Epub 2018 May 24. PMID: 29797753; PMCID: PMC7045300.