Last time we talked about how we get to sleep and two of the more
important hormones in our body when it comes to that topic: cortisol
and serotonin. In a nutshell, stress raises our cortisol levels, and
also lowers our serotonin levels.

Low serotonin and good, restful sleep generally don’t go together.
So what do we do? Address the stress! If we can eliminate or control
the things that elevate cortisol, the serotonin in our brain will do its
job, bringing about peaceful slumber.

The problem is most people think of stress in one dimension.
Wrapping your head around the idea of psychological stress is pretty
easy. Our language is full of clues: being “stressed out” or a “stress
ball” are terms people use to refer to someone under a lot of mental
or emotional strain.

We intuitively know that this kind of stress can have very real, physical
effects. Having a “tension headache” is a not so subtle physical
manifestation of a more nebulous psychological state.

There are other forms of stress. Structural stress is a concept that
goes far beyond the realm of just the building engineer. Our bodies are
under structural stress from poor posture, physical exertion, or an
accident of some sort.

We are also plagued by chemical stress when we’re fighting off a
virus, encounter a bacterial toxin, or eat foods to which we’re allergic.
Mobilize your immune system for any reason, and you’re under stress.
Cortisol levels rise appropriately.

Other forms of stress are not as well known. Simply not eating
breakfast deprives your body of a needed, early source of fuel. The lack
of glucose keeps your cortisol elevated at a time when you want it to
begin its long, gradual taper down to the low point that will help
induce sleep later that evening.

The decline of our sex hormones — what begins in our 40s for both
males and females — will also produce a high baseline level of cortisol
until our bodies figure out how to handle this shift in our physiology.
This adjustment is generally complete shortly after menopause in
women, and at an equivalent time in men.

Intense exercise also elevates cortisol. That regular racquetball
game or spinning class may leave you spent and relaxed, short term.
It can have long term consequences for the total amount of stress your
body is under, however.

Many of these forms of stress are controllable, some are not. The
real question is, what can we do to mitigate them so that their
detrimental effects are minimized and we can get a good night’s sleep?

Our first task is to address the the culprit that is our primary source
of stress. In many cases, multiple sources need to be addressed before
a noticeable change is observed. Some are more simple to fix than
others. We’ll start with the most straightforward, and move on to the
more complex.

If you’re not regularly eating breakfast, having a small to medium
amount of good, whole grain foods in the morning is a healthy way to
raise your blood sugar levels. Whole wheat toast with butter, oatmeal,
or a non-sugary, whole grain cereal are good examples. A piece of
fruit will do the trick, too.

High protein breakfasts are filling, but don’t do as good a job at
raising your blood sugar levels in order to start cortisol on its long,
day-time decline necessary for sleep to ensue easily.

Removing yourself from a source of constant psychological stress is
frequently the best way to address such issues from a health
standpoint. If that’s not possible, relaxation techniques, low-intensity
exercise, or meditation are good mediators.

Ultimately, if you consider your source of psychological stress out
of the realm of your control, focusing on the forms of stress you can
control will be the best way to lower your overall stress and get you
to sleep.

Eating the right foods is a very important, controllable form of
chemical stress. Job one here is eliminating foods to which you might
be allergic. Remember, anything that causes your immune system to
mobilize is a cortisol producer. Food allergies definitely fall into this
category.

Once that’s done, cutting back on foods that are adrenal
stimulants — the adrenal glands are where cortisol is produced —
is often helpful. The worst offenders seem to be red meat, shellfish,
salt, and greasy foods. Eating “comfort foods” or generally ignoring
any internal urges to “eat healthy” is what often happens to many of
us when we’re under psychological stress.

Stress in any form — be it psychological, chemical, or structural — is
cumulative. Times of psychological strain are when we need to eat as
well as possible to keep our overall level of stress down.

Another common cortisol-elevator I see in the office is intense
physical exertion, be it exercise at the gym or clearing your garden.
Anything that significantly elevates your heart rate or causes you to be
out of breath is most likely going to be what exercise physiologists
consider anaerobic exercise.

“Anaerobic” is a term meaning “without oxygen”, and it implies that
your body has to resort to alternative metabolic pathways to create the
energy you need to perform a task. These alternative methods of
energy production are cortisol stimulants. If you regularly exert
yourself to the point of huffing and puffing, add that to your list of
controllable stressors, and back off a bit!

Many people do have cortisol-raising factors that are much harder to
control, however. Women in their 40s often suffer sleep trouble as their
normal level of ovarian hormones begin a gradual decline towards
menopause, which usually occurs in the early 50s. Until the body
adapts to this new state — that is, after menopause is complete —
they need an alternative to help them handle stress and sleep in those
in-between years.

Patients we see with this type of pattern frequently benefit from a
low-dose, natural hormone supplement or an adrenal adaptogen. An
adaptogen is a substance that elevates function when it is depressed,
and reduces function when it’s elevated. An adrenal adaptogen can
lower cortisol levels that originate from the adrenal glands when they
are too high.

Herbs like licorice and rhodiola have been used for this purpose for
centuries. Low dose, natural hormones can also calm cortisol
production in the adrenal glands at a time when the body is searching
for additional sources of hormones as the ovaries decline.

Males are not immune from this pattern, either. Male sex hormones
also begin to decline in the early 40s. Sleep trouble, among other
symptoms, can often ensue. Adrenal adaptogens like ginseng can
often be very beneficial in helping a sleepless male while he adapts to
this new life stage. There are many different types of ginseng, so
finding the right kind that works for a particular individual is key.

Nutritional deficiencies can also impact your ability to sleep. A
lack of vitamin B6 hinders your ability to produce serotonin from its
precursors. For that matter, a simple lack of the serotonin precursor
tryptophan, an amino acid, will directly affect how much serotonin
you can manufacture. These are chemical stressors — without these
vital nutrients the body has to adapt, if possible, and pull resources
from another system in order to function.

Clearly, there are numerous options to evaluate in order to
determine how to get someone to sleep better. My role as a doctor is to
help people evaluate which areas seem to be the biggest factors for
them personally. Individually, our goal is to be as healthy as possible,
eliminating stress and providing our bodies with the raw nutrients it
needs to thrive.

Keep in mind that this scenario is not the only thing that can affect
your ability to sleep. Sleep is a very complex activity, as far as our
brains are concerned, and should be revered as such. Other hormonal,
environmental, or physical factors are possible, and should be
evaluated by someone qualified to do so.

Regardless of the symptoms you experience, going through the
process of identifying and then hopefully removing big sources of
stress in your life will help you to become much more healthy over all,
and in the process give you a good night’s sleep!

Welcome to the first issue of Vibrant Health, a regular e-newsletter covering health topics as diverse as you! We’ll start off exploring something that we all do, just not as regularly or peacefully as some of us would like: sleep! Know someone who’d like to sign up? Send them to www.collinsdc.com/list/?p=subscribe. Enjoy!

- A. Chandler Collins, D.C.

Aid for the Sleepless

So why can’t you sleep? The numbers of people affected by sleeplessness are legion and the causes are numerous. Aside from the obvious causes of sleeplessness — a noisy environment, being sick, stuffed up, or otherwise uncomfortable enough to cause you to have trouble relaxing — there seems to be a large number of people out there who have trouble sleeping that can’t really nail down what’s causing it.

I’ll offer a common scenario for why many people seem to have trouble sleeping. It’s not the only explanation by any means, but we see it walk in the office frequently enough that it warrants special attention.

Part of the problem is what we seem to accept as “normal”. I can’t tell you how many times I hear people say something to the effect of, “Oh yes, I sleep fine. I get up two or three times a night, but it’s no big deal.” Folks, getting up two or three times a night is not normal. It may be common, but it is definitely not normal.

Part of our task here, then, is to understand what a true, normal sleep pattern really looks like, both from a practical and a physiological standpoint. Once we have that firmly established, figuring out where one individual is straying from this path is a much easier task.

For normal sleep, the most obvious thing to point out is that we should sleep through the night without interruptions. Many people assume that they wake up a couple of times a night because they have to go to the bathroom, and not the more likely explanation, which is that after they have awoken they notice an urge to empty their bladder. In other words, their usual pattern of waking up several times a night provides their body the opportunity to urinate. If they were sleeping more soundly the need to visit the bathroom would be less pressing.

Getting to sleep should also be relatively effortless. Overly long rituals of relaxation, or worse, self-medication with prescription, over-the-counter, or over-the-bar depressants should not be necessary. If you regularly climb into bed, shut your eyes, and then toss and turn for an hour or more before finally falling asleep, something is not right. You should then be able to stay asleep for six hours or more. Anything less is probably inadequate.

So what makes us sleep? There are lots of ideas and plenty of research in the area. Probably one of the most well-known theories, and one that seems to hold true clinically, is that a hormone in your brain called serotonin is largely responsible for sleep. As long as the brain pathways for this hormone are working properly, sleep ensues. A question the sleepless might ask, then, is what would interfere with the ability of the brain to produce or utilize this hormone?

Let’s go back to the obvious. We all intuitively know that we can’t sleep when we’re “stressed”. Why would that be? Sure, your brain may be busy processing all the thoughts and feelings surrounding the object of your worries, but there still has to be some mechanism by which your body temporarily suspends the sleep-inducing serotonin system in your brain so that you can go on sleeplessly figuring out how to solve your problems.

That’s where another hormone called cortisol comes in. Cortisol is known as the “stress hormone”. It is released throughout our bodies when we are under any type of stress, be it psychological, chemical, or structural. It is also one of our primary blood sugar hormones. This means that any time we don’t have enough blood sugar to fuel our activities, cortisol is utilized to raise our blood sugar levels so that we can handle whatever tasks our bodies are presented with.

Cortisol levels are highest right after we wake up — that is, right after we’ve finished (hopefully) 6-8 hours of sleep, during which time we typically wouldn’t eat or drink. Cortisol is secreted to keep feeding your brain and other vital organs with the blood sugar, or glucose, they need to survive. Normally, cortisol levels are highest right after you wake up, and then begin to lower right after you eat breakfast and give your body its first jolt of glucose.

What does this have to do with sleep? Well, we know that serotonin is associated with sleep. We also know that we can’t sleep when we’re stressed. It just so happens that serotonin levels happen to be inversely related to higher levels of stress and thus, higher levels of cortisol. This means that anything that might raise your cortisol levels will correspondingly lower your serotonin levels, interfering with your ability to sleep.

Interestingly, part of cortisol’s normal, 24-hour cycle involves a spike in its levels around 3 in the morning, give or take an hour. This is a very common time for people with sleep trouble to awaken. It seems that if you have something that abnormally elevates cortisol during the day, that extra spike that comes along mid-evening can lower your serotonin to the point that you wake up at night.

Those with high daytime levels of cortisol are easy to spot. Remember, cortisol is a blood sugar hormone. Part of the problem, however, seems to be that the energy we derive from blood-sugar produced by cortisol tends to be edgy and anxious. The high cortisol producers of the world then typically crave sugar or alcohol late in the evening. The alcohol and sugar give a quick jolt of glucose to rapidly drop cortisol levels. This then helps to remove the edginess and allows serotonin to rise and sleep to ensue.

Lack of sleep is frequently not the only symptom. Low levels of serotonin affect us in a number of ways. Perhaps the most well known consequence of inadequate amounts of serotonin is depression. Serotonin is the hormone that popular anti-depressants like Prozac and Zoloft work on. Their job is to artificially elevate serotonin so that your mood is not adversely affected. Your gastrointestinal tract function is also almost entirely dependent on serotonin for healthy, regular function. Sleeplessness and a sluggish gut thus frequently go hand in hand.

All of a sudden we have a plan of attack for figuring out how to sleep better. If we can narrow down the main things that tend to raise our cortisol levels, we can reduce the total amount of stress our bodies are under, raise our serotonin levels, and put us back on the road to a good night’s sleep.

Luckily the culprits are relatively clear. Essentially, anything that increases our levels of stress, in any form, will also raise cortisol levels. Our task is to find and treat the actual culprit of depressed serotonin levels so that getting to sleep by artificial means is unnecessary.

Next time, we’ll talk about the myriad ways our serotonin levels get disturbed and, more importantly, what we can do about it!