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Sleep Disturbances, Cortisol and Adrenal Function


October 23, 2009 | Published by

Sleep Disturbances, Cortisol and Adrenal Function

People are becoming more aware of the ravages of stress and how it leaks into every corner of their lives. Of course, increased stress means increased sleep disturbances for many. Less sleep means they experience more stress the day after. This pattern continues in a vicious cycle, making stress and sleep loss in terms of hours and quality intimately interconnected.
image of insomnia by Flickr user petitefoxIf stress has somewhat depleted the adrenal glands, which is often the case, people under stress do not wake feeling rested.

Cortisol, an adrenal hormone, is needed to allow that person to wake feeling refreshed and bouncing out of bed in the morning. It is also important to induce an alpha wave, a requirement for the first phase of sleep. If cortisol is low, falling asleep is difficult. Cortisol is also necessary to maintain good blood sugar levels throughout the day and night. If cortisol is low during the day people wake feeling tired and often need coffee, cola and other caffeinated beverages to get going and to keep going during the day.

This over consumption of caffeine not only causes blood sugar to rapidly rise and then precipitously fall an hour and a half later, but also tends to interfere with sleep that night. The resulting lack restful sleep creates more stress the next morning and perpetuates the cycle of low cortisol and difficulty sleeping. This low adrenal function is a frequent occurrence in both sleep disturbance and inadequate response to stress. During adrenal fatigue, a condition where the adrenal glands are not able to keep up with the demands placed on them, people often have problems managing their stress and sleeping well.

The Connection Between Poor Sleep and Adrenal Function

There can be several reasons for sleeplessness with adrenal fatigue. If you are waking between 1:00 and 3:00 AM, your liver may be lacking the glycogen reserves needed for conversion by the adrenals to keep the blood glucose levels high enough during the night. Blood sugar is normally low during the early morning hours but, if you are experiencing adrenal fatigue, your blood glucose levels may sometimes fall so low that hypoglycemic (low blood sugar) symptoms wake you during the night. This is often the case if you have panic or anxiety attacks, nightmares, or sleep fitfully between 1:00 and 4:00 AM. To help counteract this, have one or two bites of a snack that contains protein, unrefined carbohydrate, and high quality fat before going to bed, such as half a slice of whole grain toast with peanut butter or a slice of cheese on a whole grain cracker.
login to sleep by Flickr user Frits Ahlefeldt-LaurvigBoth too high and too low nighttime cortisol levels can cause sleep disturbances. To determine if this is a problem for you, simply do a saliva cortisol test at night and compare your night sample levels with your own daytime levels and with the test standards for those times. To do the night test, take a saliva sample at bedtime, another if you wake up during the night and a third when you wake up in the morning. Write the time each sample was taken on the vial and in your notebook on a separate sheet of paper.

If cortisol is the culprit, your cortisol levels will be significantly higher or lower than normal for those times. If your nighttime cortisol levels are too low, you may sleep better when you exercise in the evening, before going to bed because exercise tends to raise cortisol levels. If your nighttime cortisol levels are too high, try doing one of the relaxation or meditation exercises to calm you down before going to bed. The specific yoga posture called the alternate leg-pull can be quite helpful in getting to sleep or returning to sleep. This is a basic yoga posture that almost any yoga book or video will describe but an instructor is preferable because there is some subtlety to doing this posture.

Things You Can Do to Improve Your Quality of Sleep:

  • Above all, go to bed before 10:30 PM and stay in bed until 9:00AM as often as possible, even if it is just on the weekends. It is amazing how restorative sleeping until 9:00 AM is for the adrenals.
  • Be sure to get enough physical exercise during the day. Try varying the kinds of exercise you do, their intensity or when you exercise. Many people have told me swimming at night helps them sleep.
  • Certain postures in yoga, tai chi and qi gong can also be helpful. Check with a teacher of these disciplines to find out which postures or exercises would specifically help you.
  • Avoid coffee, caffeine containing beverages and chocolate because they act as stimulants. These can interrupt sleep patterns and increase morning lows. Even if they are consumed early in the day, they can disrupt sleep and make the next morning harder to negotiate.
  • Some people are photosensitive and watching television or looking at at computer screen keeps their melatonin from rising and inducing sleep. If you are having difficulty going to sleep and usually are staring at a TV or computer screen late at night, try having an 8:00 PM limit on these visual stimuli.
  • If your cortisol levels are low late at night, try exercising in the evening, as exercise raises cortisol levels and may afford you a sound night’s sleep.
  • There are particular nutritional supplements that can be beneficial. Often melatonin (0.3-1.3 mg) taken 30 minutes before bedtime helps establish normal sleep patterns. Calcium citrate (500mg) taken with 50 mg of 5-hydroxytriptophan (5HTP) at night before retiring is also relaxing and helps many people sleep throughout the night. Trace mineral tablets taken at the evening meal also help relax the body. Adrenal extracts taken ½ hour before bedtime often help those with adrenal fatigue fall asleep and remain asleep. If your adrenal fatigue is moderate or severe, try this one first.
  • The hypothalamus is very important in regulating sleep. Although accurately testing hypothalamic function is complicated, a simple test you can do yourself is to try taking one to four tablets of hypothalamus extract and 10-40mg of manganese before bedtime and see if your sleep improves. Sometimes the hypothalamus tablets need to be combined with the adrenal extracts to normalize sleep.
  • There are also several herbs commonly used to promote better sleep such as hops (whole plant), catnip (leaves), valerian (root) and licorice (root). Although not known as a sedative, the herb ashwagandha can help indirectly through its ability to normalize cortisol and sex hormones, both of which can produce sleep disturbances.
  • During the day, you will probably notice that you have particular times when you feel more lethargic, cloudy headed, tired or have other symptoms of adrenal fatigue. Try to schedule your breaks so that when these occur, you can physically lie down for 15-30 minutes. Lying down is much more restorative than sitting for the person with adrenal fatigue.

If none of these help and your life is being deleteriously affected by lack of or interrupted sleep, check your local area for the location of the nearest sleep center. Several cities around the country have these centers that specialize in helping individuals determine the cause of their sleep disturbances.

Image Credits: Woman tossing and turning in bed by Flickr user stephanie-anne; Login to sleep cartoon by Flickr user hikingartist

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  • Stephanie Clifton says:

    Hi … may I ask a question to someone who sees many Adrenal Exhaustion sufferers please ?
    I have had AE for more than 20yrs. For the last 10yrs or so I have had discomfort in my left side & for the last 2yrs or so I have also had discomfort in my right side [ this feels as if my skirt is too tight, but it is not ] I have had an abdominal scan twice, both were negative. Do other AE sufferers get side aches / pains which are continual, though sometimes worse than others .. and do you have any idea why, apart from assuming it’s indigestion [ the possible cause being long-term low body temperature & insufficient metabolism ] ? The aches are very specific, at lowest rib / waist level towards the front ? Thanks for reading my question.

    • Luc says:

      Stephanie, I have had this problem intermittently over the years and it’s always at certain points in my monthly cycle. It began after i had ovary poblems and i have found no relief apart 🙁

    • Cindi says:

      I have that too!! I had no idea it had anything to do with the adrenal exhaustion, but apparently it does…

  • Sandy says:

    Stephanie….you may want to check out the symptons of Wilson’s Syndrome (not disease)……I’ve had so many myself. One can have aches and pains with low body temperature just like elevated body temperature….I have fibromlyalgia and chronic fatigue….my body temperature was at 96.5 to 97.1. Once I got my body temperature back up… helped my pain. I’m on Reverse T-3 Therapy (Fibro and Fatigue Center did lots of blood work to figure it out) which has really helped mine pain and energy.

    • Rosemary says:

      May I ask what your RT3 therapy is? I have Adrenal Fatigue, plus Hashimoto’s Autoimmune, and RT3. They’ve put me on Levothyroxine and Liothyronine…and just recently upped the Levo and halved the Lio. Symptoms never change.

  • Stacie says:

    I have AF, advised I am in a late stage scenario as I waited a very long time before seeking treatment. However, now I am and I have learned to avoid any and all stimulants. Even the iodine and things I was taking for my thyroid are too stimulating. I am treating with Dr. Lam and he advises at this time while repairing and healing the adrenals not to take glandulars, thyroid assistance, ashwaganda or anything that is the least bit stimulating as we have to heal the adrenals first. Just thought I would pass this along. I buy raw nuts online to ensure they are not CA pasteurized and soak them overnight and eat a handful of almonds and or walnuts before bed to help my blood sugar. I am just starting to sleep heavy and sound but cannot quite get enough sleep b/c I have to wake up for work. I wake and it is like my body is screaming for more. I am told this is normal and my body is just healing and I just need more sleep. Wish I could sleep til 9 am each day but work calls. Best of luck to you.

    • adrenalfatigue says:

      Hi Stacie,

      Dr. Wilson and Dr. Lam do differ in their approach to supporting the adrenals during adrenal fatigue. Dr. Wilson recommends using glandular extracts, which he included in the Adrenal Rebuilder, but what makes this formula unique is that it’s a glandular extraxt supplement formulated to remove hormones. The hormonal content in other glandular extract supplements is what tends to be stimulating. Dr. Wilson also recommends using ashwagandha, which he included in the Herbal Adrenal Support Formula, though not as a stimulant. Something to keep in mind is people may react to herbs in different ways, so not everyone is able to take every herb successfully. It would certainly be great if we could all sleep in until 9 every day, but as you said, duty calls. The important thing is to ensure you’re getting enough rest. Getting to bed early and planning for a full night’s rest is important, especially when dealing with adrenal fatigue. Hope this helps, and I wish you the best in your health and recovery.

      Dr. Wilson’s Adrenal Fatigue Team

    • Dave says:

      Stacie, just wondering, if you have been advised to refrain from taking Adrenal Glandulars & Ashwaganda, what is it that you DO take that is working for you?? I have severe insomnia and Adrenal Fatigue and am curious as to what your supplement protocol is, if you don’t mind sharing.

    • SHiva says:

      Hi Stacie,
      I want to discuss with you about your AF.PLease add me in skyp ktk.camry (ID)

  • Kendra says:

    I believe I have moderate adrenal fatigue and am young, 31, and seemingly healthy. I have been suffering from insomnia for 10 years, but it has gotten much worse the past two years. I also have a lot of anxiety, and the sleep and the anxiety have become a vicious cycle in which the two feed off of each other. I only recently learned about adrenal fatigue and am excited to start healing, but after reading Dr. Wilson’s book and all of his recommendations, I am feeling very overwhelmed. There’s so much, where do I start? And what simple things can I do to most help my sleep? Does anyone have any direction?

    • Hi Kendra,

      It’s completely understandable to be feeling a little overwhelmed right now. You might want to start by visiting for more information about adrenal fatigue, take the Adrenal Fatigue Questionnaire to help determine if you do have adrenal fatigue, and to identify your next steps.

      Many people find that taking a herbal supplement such as the Herbal Adrenal Support Formula helps promote calm during the night and get restful sleep. Following Dr. Wilson’s recommendations about diet, reducing and managing stress, and general lifestyle changes can also help alleviating your anxiety to break this anxiety/insomnia cycle.

      We hope this information helps!

      -Dr. Wilson’s Adrenal Fatigue Team

  • John says:

    Hi Team –
    I am wondering if someone could recommend a next step for me here with a specific sleeping issue – I’ve used Dr. Wilson’s products and his book has helped me enormously. I am 29, male, have had a lot of stress/trauma in my early 20’s especially.
    I am using gentle things like licorice and magnesium; I am able to sleep for 5-6 hours, but then I start to wake up and have an uncomfortable erection and the urge to urinate. I am *sometimes* able to get back to sleep, and sometimes not; the urge to urinate comes back, even though I’ve already gone. This only happens during a sleep cycle (in other words, it doesn’t happen at all during the day). I have tried many sleep aids including recently hypothalamus extract and manganese, which made me too wired and seemed to exacerbate this issue.
    I’d be grateful for any suggestions or thoughts you might have.
    Thank you !

  • Darlene says:

    I’d be interested in the team’s response to John’s question. I have a similar problem, although I’m a female. I awake about 5 or 6 hours to go to the bathroom. Sometimes I can go back to sleep and sometimes not. Sometimes, after I wake up, I have the urge to urinate about every hour before I actually have to get up. So no sleep. It’s a maddening syndrome. It doesn’t happen every night, but often enough that it’s a problem. Any ideas for us frequent urinators?

    Thank you!

    • Darlene says:

      I should also say, I don’t drink fluids about 2 hours before bed.

      • shiva says:

        Try to open the windows before u sleep.If you have a free circulating fresh air,u wont wake during the nights and will not get frequent urination.
        Else, try some yoga postures.Both worked for me.

  • Anne says:

    Where can I find the tablets of hypothalamus extract mentioned at the end of the article?

  • Will says:

    My comment is concerning Manganese toxicity. The article suggests the use of “10-40mg of manganese” prior to sleep. I have read on WebMD that the upper limit for Manganese is 11mg per day. Is 40 mg safe?
    Thank you.

    • Hi Will,

      That amount of daily supplemental manganese is safe to take. Our bodies are different and tolerance certainly varies, though you will find many manganese supplements in those dosages that are safe to take. I hope this helps-thanks for writing and let us know if you have any follow-up questions.

  • sheanean harman says:

    I’ve been having a bugger of a problem for about 12 years now. As I was drifting off to sleep my heart started flipping out felt like it was fibrilating and I had a massive adrenaline rush that surged from the center of my body all the way to my head. I’ve had this problem everything, everytime I try to fall asleep at night. Sometimes as many as 15 times until I finally push past it and get to sleep. Once I get to sleep I’m fine and I sleep through the night. Magnesium has helped to accomplish sleeping through the night. Melatonin seems to work but make me feel very laggy the next morning. I have had several tests and none of them have been very conclusive as to why I have this particular issue. I had a tilt table test and was very reactive to the adrenals adrenaline that they injected. I’ve had a few attacks during the day once when I was driving. It sent me to the emergency room where they told me I was having an anxiety attack cause buy a bad combination of drugs. ( the bad combination of drugs was a sudafed for my constantly stuffy nose and M&M’s. The “crash” happened 6 hours later, and lasted for a total of 10 hours and wiped me out for 2 weeks. Anxiety attacks don’t do that ) anxiety medicines don’t control these attacks. Later I was diagnosed with multiple sclerosis, gastroparesis, pre diabetes and hypoglycemia. I can tolerate caffeine as they cause me to have the jitters a few hours later and they also cause breast fibroids and uterine fibroids. I have noticed that the issue is worse when I eat in gluten. It doesn’t make sense to me but my heart with flip out from having gas in my stomach. I also notice that was the worse this adrenal issue gets, the harder it is for me to lose weight, I actually gained weight and I experience cystic acne . I am taking adrenal support with Ashwahanda, iodine, licorice and b 6. I’m also taking a good quality multivitamin and multimineral, alpha lipoic acid, pregnenolone, multiple B vitamins, chromium and kelp. Some days it seems it’s working but then I start having these issues more frequently when I’m trying to fall asleep. Starting to cause worry again. I have had a 24 hour cortisol test , but it was the type that they take the medial number from the entire collection . Years ago my thyroid and adrenals were scanned and appeared healthy. I do smoke and have tried to quit a million times. It just seems harder for me then most people. I think it causes an extreme drop in cortisol. I read about irritation causing the adrenals to over act. I know that gluten is an issue and I’m sure smoking is too. I’m just not sure where to go from here. I’ve come closest to success with Chantix, but it makes me violently ill sometimes and coming off of it caused severe depression. I think I need 4.cortisol test so that I can see what my cortisol all is doing through the day. I have tried moranga fruit, Magnolia, Graviola, and l-arginine and all four cause my blood pressure to drop so low that my adrenals woke me up to a scary 79/42 range each time. I suspect The beta blocker had some to do with that, but even off of them, I experience a serious slow down and weakness of my heart function. The basic thyroid test was .93. I’m really a calm person. Minimal worries, except for this. MS, in my opinion, is a result of this issue. Cognitive issues, muscle weakness, thin hair, brittle nails without the “moons” I use to have, weight gain, cold and heat intollerance, nerve spasms, tingling in my hands, fatigue. I used voice for this message, so excuse the random typos I may have missed.

    • Hi Sheanan,

      First, thank you for writing. It certainly seems like you have your hands full, and I can understand wanting to find relief. Eliminating foods that make you feel worse from your diet can make a big difference in how you feel, as well as provide some relief to the digestive system. Caffeine, and tobacco even more so, can negatively affect your health in many ways. Addiction can make it very difficult to stop. Have you tried tobacco help lines or support groups? Often times these services are free and are provided by people who know and have often experienced addiction themselves. If you’d like direction on finding a practitioner who can help with cortisol levels and other issues, we may have someone in our database who can help. You can access our list here:
      I hope this helps–please let us know if you have any follow up questions or if any other information would be helpful.

    • Vivien says:

      Have you had your Vitamin B12 levels checked? I’d recommend the book “Could it Be B12? An Epidemic if Misdiagnosis” by Sally Pacholok. A number of your symptoms ring bells for me with regard to low B12 – MS, nails with no moons, stomach problems, possible gluten sensitivity, cognitive issues, tingling . . . I know you say you take B vitamins, but, if you have pernicious anaemia, it wouldn’t be anyway near enough. My husband has to have regular B12 injections and we’ve had to do a lot of research ourselves and push the doctor for adequate treatment, as the reference range for the blood test is quite inadequate. After doing loads of research, I came across Sally Pacholok’s book and all the information was there.

  • shiva says:

    I am not getting deep sleep after i made a crash diet for 2 weeks.SInce 4 years,i have this issue.
    I tried ashwagndha at night,my mind was totally out of control throughtout that night,foggy thinking.
    In my opinion,Yoga or medidation or oil bath (South indian Ayurveda) works for this Adrenal fatigue for getting enough sleep.But you try atleast for a month to sstart getting the results.

  • anjelita says:

    Does having other issues cause slow healing of the adrenals. I have been exposed to mold toxins and i dont know what to treat first the mold toxin or my adrenals. And i must say most of you are brave to try some remedies i have been nervous in the past to try different. Herbs and remedies,im nervous about how my body may react .

    • Hi Anjelita,

      That is a great question. Other body burdens can certainly have an effect on recovery. In some situations they can be treated simultaneously, while other times one area may need immediate attention before working on another. For example, with some thyroid problems you can support both the adrenals and thyroid simultaneously. Some digestive issues need to be addressed before anything else, since it interferes with the processes of digestion and nutrient absorption. Are you currently working with a practitioner?

  • kim says:

    Hi there,

    I was diagnosed with borderline adrenal fatigue, am taking vit c magnesium vit b, and adrenal rebuilder, my problem is i am now sleeping worse than i ever had, its been about 2 months and i am thinking of stopping the glandulars, i still have quite a few left, but im not sure if its causing this terrible waking on the night cant get back to sleep and hard to fall aslerp….any suggestions?

  • JRS says:

    I have been battling AF for a few years and just read Dr. Wilsons book and have purchase the Adrenal Rebuilder which I am taking. However, I also have no thyroid and am in menopause. Just a few months ago I added a very small (less than 5 mg) of Cytomel to Synthroid – and that along with some stressful events have thrown me into an AF crash. I’ve had to take time of work just to try to heal.
    My worst symptoms were this impending doom and depression – that I was able to successfully treat with inositol. Even though it slightly bothers my acid reflux. The way it’s helped my depression is worth the discomfort.
    Now what I haven’t been able to resolve is the pounding heart and insomnia I have begun to encounter. Reading this article I don’t know if my blood sugar or high cortisol. I have just ordered a saliva test – and hopefully that will lead me in the right direction.
    Last night I tried taking PS with some melatonin. The PS seemed to help the pounding heart beat. Since PS lowers cortisol can I assume it’s high cortisol that is keeping me up at night ? 5 mg of melantonin did not help me sleep thru the night. So I will try taking adreanal at bedtime which I haven’t tried before. My other question is – can I take your adrenal rebuilder with PS at night ?? Your response is very much appreciated and please accept our thanks for providing such invaluable information. It’s ashame that we dont have enough doctors to help with this awful infliction.
    thanks again

  • Debra Short says:

    My test for salivary cortisol was borderline normal and a bit on the low side during the day, but the last one at 3am (I’m a night owl) was 6.8. I am weak and sick/shaky feeling all day, and recovering from recurrent pericarditis now for 2.5 yrs. Is this higher cortisol at night part of adrenal fatigue, from a severe long lasting illness? Any advice?

    • Adrenal Fatigue Team says:

      Hi Debra,

      That’s a good question. It could be either or a combination of those things. Recurrent, traumatic or long-lasting illnesses are a huge stress to the body, and can certainly be a factor in bringing on adrenal fatigue. Are you currently working with a practitioner?

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