By Datis Kharrazian, DC, MS, CCN
Many people have a hard time sleeping, especially in today’s active society. Medications to address insomnia carry heavy side effects and are not tolerated well by most people. In addition, medications do not address the underlying causes of insomnia.
In many cases, insomnia is directly related to blood sugar imbalances, in particular to adrenal function. Clinically, patients with adrenal hypofunction typically will be able to fall asleep, but cannot stay asleep. With adrenal hyperfunction, patients often are unable to fall asleep. Therefore, both adrenal hypo- and hyperfunctions have an impact on insomnia. These patients need to learn how to stabilize their blood sugar levels during the day and take some non-stimulatory support for their adrenal glands, as will be discussed later in this article.
Adrenal hormone levels can be measured by using an adrenal salivary index (ASI). The ASI consists of having the patient collect several samples of saliva during the day; those samples are sent to a lab for assessment. The lab will then map out the circadian levels of cortisol and confirm hypo- or hyperfunction. This test is very accurate and the cost is reasonable.1,2 However, even with symptoms of insomnia, subjective indicators often are sufficient to apply conservative nutritional and lifestyle therapy.
Let us discuss adrenal hypofunction first. This pattern usually occurs in individuals who frequently miss meals and consume lots of simple sugars and caffeine throughout the day. They typically complain of irritability (when meals are missed) and low energy, and crave caffeine to keep them going. The end result is chronic stress to the adrenal glands with a loss of function to maintain blood sugar levels, especially when they are asleep.
The body depends upon a constant supply of glucose to keep the body functioning properly. When the body is asleep, it requires a constant supply of glucose from stored glucose in the form of glycogen, which is kept in supply in the liver and the muscle. On average, the body loses 60 percent of its glycogen levels after an overnight fast from sleeping. A healthy person has plenty of cortisol to stabilize their blood sugar levels during the night.3,4 However, if a person has blood sugar problems, they are not able to tolerate an overnight fast and their body will go into a stress response when blood sugar levels drop. This will cause the adrenal glands to secrete epinephrine and norepinephrine to try to mobilize glucose.5-8 The release of these stimulatory hormones will cause the person to wake up during the night.
Now let’s discuss patients who cannot fall asleep. These people typically have elevated cortisol, especially at night.9 Cortisol, a hormone that is released by the adrenal cortex, helps stabilize blood sugar levels during the day. Cortisol is released during the day in between meals, when blood sugar levels need to be maintained. When blood sugar levels drop, the body releases cortisol to maintain blood sugar levels.10,11 It does this by releasing glucose from stored glycogen levels. The normal circadian release of cortisol is high in the morning, with levels that drop as the day goes on. An abnormal circadian release of cortisol is when the levels stay high all day. When the levels are high at night instead of normally low, a person will not be able to fall asleep, due to the excitatory effect cortisol exerts on the nervous system.12
The only reason for a physiologically abnormal circadian of cortisol is the body being placed in an alarm or stress reaction. An alarm pattern will place extra demands on the body that the adrenals will have to compensate for. If a person is having severe episodes of emotional or mental stress, for example, the body needs extra glucose to meet the metabolic activity caused by this type of stress; to compensate, the body releases cortisol to increase systemic glucose levels and produce more ATP for the extra demands.
Many other physiological patterns can cause elevations in cortisol, such as food sensitivities, which can activate the gut-associated lymphoid tissue and place the body in an alarm pattern. Also, pathogenic organisms, including parasites and other inoculations, can elevate levels. The bottom line is that any type of stress – mental, physical or physiological – can lead to elevated levels of cortisol; often, it is a combination of factors that contributes to the dysfunctional pattern.
Steps to Address Insomnia
There are three steps required to fix these patterns. The first step is to support the patient’s adrenal glands with nutritional supplements. The second step is to help them stabilize their blood sugar levels during the day. The third step is to have them perform relaxation techniques to manage their stress response.
Let’s discuss the first step, which is related to taking nutritional supplements. One of the most effective supports for this pattern is adrenal adaptagens. Adaptagens are plant compounds that have a normalizing impact on the hypothalamus-pituitary-adrenal feedback loop. When used with patterns that have elevated ACTH and cortisol, adaptagens decrease their output. When used with patients who have adrenal hypofunction, adaptagens tend to improve the response to secrete ACTH and cortisol. The most important adaptagens for the adrenals include Panax ginseng, Siberian ginseng, ashwagandha, rhodiolia, Boerhaavia diffusa, pantethine, and holy basil leaf extract.13-23
These patients also require nutritional support to stabilize their blood sugar. This support should be in the form of B vitamins, chromium, vanadium, inositol, L-carnitine, alphalipoic acid, magnesium, and niacinimide to improve the blood sugar balance and support adrenal function.24-30
The second and most important step is for the patient to learn to stabilize their blood sugar levels during the day. The patient should never skip breakfast and should eat a breakfast that is protein dominant. For example, the worst breakfast they can eat is a bowl of cereal with toast and juice. This type of breakfast has a very high level of sugar and will cause severe stress to the adrenal glands, especially after the body has been in a state of fasting from time spent sleeping. An ideal breakfast is a high-quality protein shake or some type of meat. The patient also should avoid adrenal stimulants such as candy, soda, fruit juice, coffee and allergic foods. Instruct the patient to eat every two to three hours, consuming low-glycemic foods such as nuts, seeds, hard-boiled eggs or vegetables. Frequent meals with low-glycemic foods take the load off the adrenals and allow them to recover.31 This, in addition to appropriate nutritional supplements, can have a profound regenerating impact on these dysfunctional patterns.
The final step is related to performing simple exercises to reduce the stress response. It should be noted that stress will always impact blood sugar levels, and blood sugar imbalance will always decrease a person’s ability to deal with stress. Too many times, insomnia is blamed solely on excessive stress. Stress may be the trigger, but if the adrenal glands are supported during the stress response, the patient may not suffer from the physiological side effects such as insomnia. Let’s discuss two simple exercises that should not take more than five minutes per day to perform, but will have profound impacts on physiology.
The first exercise involves positive mental imaging. This exercise requires the person to think about the stressful events of the day. They are required to place themselves back in the moment while utilizing as many senses as possible. Once the stressful event has been established, they re-create the scenario while adding humorous and cartoon-like features to the people in the scene. For example, if they had a negative experience of being scolded by their boss, they picture their boss with a big clown nose and goofy ears until the scenario becomes humorous in their minds. They are required to go through all the stressful images of that day, incorporating positive imagery into each one of those scenes.
The second exercise is a muscle contraction/relaxation-type of activity. The exercise starts by having the person lie on their back in a quiet area and close their eyes. The technique requires that they contract a group of muscles for two seconds. They start with their facial muscles and go up and down their body with different muscle groups, such as their quadriceps, hamstrings, calves, toes, abdominals, pectorals, triceps, fingers, etc. They do these exercises until they have gone through each muscle two or three times. When finished with the exercise, they lie on their back and take long, deep breaths as long as desired.
In conclusion, insomnia is typically caused by some type of stress response. This stress response will have an adverse impact on the adrenal glands and blood sugar stabilization. This will cause a vicious cycle that needs to be corrected by identifying and minimizing the stress, and taking appropriate nutritional supplements, such as blood-sugar stabilizing products and adaptagens. Not only will correcting this pattern improve sleep patterns, but it also will improve the patient’s physiology. Once the appropriate support and lifestyle changes are implemented, the patient will also notice elevated and stable moods, improvement in energy levels, and enhanced feelings of vitality and general wellness.32
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- B. Kahn, et al. Salivary cortisol: a practical method for evaluation of adrenal function. Biological Psychiatry 1988;23:335-349.
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- Avakia EV, Evonuk E. Effects of Pannax ginseng extract on tissue glycogen and adrenal cholesterol depletion during prolonged exercise. Planta Medica 1979;36:43-48.
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- Mingrone G, Greco AV, Capristo E, et al. L-carnitine improves glucose disposal in type 2 diabetic patients. J Am Coll Nutr 1999;18:77-82.
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- Fruehwals-Schultes B, et al. Adaptation of cognitive function to hypoglycemia in healthy men. Diabetes Care 2000 Aug;23(8):1059-66.
|Dr. Datis Kharrazian earned a Bachelor of Science degree from the University of the State of New York, a Masters of Science in Human Nutrition from the University of Bridgeport, and a Doctor of Chiropractic degree from Southern California University of Health Sciences. He instructs postgraduate courses sponsored by Bridgeport and conducts seminars across the country. Dr. Kharrazian has completed extensive postgraduate training in sports medicine; he is a certified chiropractic sports physician and a certified strength and conditioning specialist.