Last time we talked about how we get to sleep, and the two hormones we must manage: 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 can 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, resulting in peaceful slumber.

The problem is that most people think stress is one dimensional. 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 what you might experience due to poor posture, physical exertion, or some sort of accident.

We are also plagued by chemical stress when fighting a virus, encountering a bacterial toxin, or eating foods we’re allergic to. 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. That lack of glucose will keep your cortisol elevated at a time when it should begin its long, gradual taper down to the low point that helps induce sleep later in the 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 in the short term. However, it can have long term consequences for the total amount of stress your body is under.

Many of these forms of stress are controllable, some are not. The real question is, what can we do to reduce the effects of stressors we can’t control, so we can get a good night’s sleep?

Our first task is addressing our primary source of stress. In many cases, multiple stressors need to be addressed before change is noticeable. 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. Oatmeal, whole wheat toast with butter, 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 aren’t as good at raising blood sugar levels to start cortisol on its long, day-time decline necessary for sleep to occur quickly.

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.

If your source of psychological stress is out of your control, focusing on the forms of stress you can control is the best way to lower your overall stress and get you to sleep.

Eating the right foods is a very important and easy way to control chemical stress. First, eliminate potential food allergies. Remember, anything that causes your immune system to mobilize is a cortisol producer. Food allergies definitely fall into this category.

Cutting back on foods that are adrenal stimulants (the adrenal glands are where cortisol is produced) is also 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 healthfully as possible to keep our overall stress levels down.

Another common cortisol-elevator I frequently see in patients 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 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 needed 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 sleeping issues as their normal level of ovarian hormones begin a gradual decline around 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.

Male sex hormones also begin to decline in the early 40s. Sleep problems are a common symptom, and adrenal adaptogens like ginseng can often be 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 you 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 stress 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 a qualified professional.

Regardless of your symptoms, the process of identifying and hopefully removing major stressors in your life will help you become healthier overall, and give you a good night’s sleep in the process!