Adrenal fatigue can have a significant impact on sleep.  The main cause being that in adrenal fatigue the adrenal glands release cortisol in a dysfunctional manner.  The adrenal glands release cortisol in a 24-hour diurnal curve.

In a perfect scenario:

• Cortisol is highest in the morning and will slowly decrease over the afternoon.
• At night cortisol is supposed to be low that way we fall asleep.  

In adrenal fatigue, the cortisol is not secreted correctly causing trouble sleeping. As you might have read in my other posts on adrenal fatigue, there are several types of sleep disruption.  I call them the Vampire, the Ghoul, and the Poltergeist. I do not mean to make light of adrenal fatigue, as it can compromise a person’s life dramatically. But I find it easier to remember the concepts when I can create easily relatable themes. In this post, I am going to describe the three common disrupted sleep patterns and give you 11 tips to improve sleep with adrenal fatigue.

Three common patterns of sleep disruption in adrenal fatigue:

The Vampire: Trouble Falling Asleep:  This is the most common pattern seen in adrenal fatigue.  The cortisol is too high at night, making it difficult to fall asleep. Consequently, the cortisol is low in the morning.  This causes trouble waking up and fatigue in the morning.

You might be a Vampire, or I am sure you know several.  These are the people that come alive at night but are exhausted in the mornings.  They can stay up and burn the midnight oil. But forget morning meetings, they are either still in bed or cognitively incoherent.

The Ghoul: Waking up in the middle of the night:  These people have no trouble falling asleep. But they cannot stay asleep.  They will sleep hard to 2-4 hours and then will be wide awake in the middle of the night.  It will take 1-3 hours to fall back asleep. And during that 1-3 hours, you can find them roaming the house, looking at their phones and pondering every possible stressor in their and their family’s lives.   And by the time they do fall asleep, their morning alarm rings shortly after that. Their cortisol pattern is low in the evening. But the middle of the night the cortisol spikes causing them to wake up for 1-3 hours in the middle of the night.

The Poltergeist: Waking up multiple times in the night:  These people fall asleep fine. But they find themselves waking up 3-6 times a night.  It is irritating and even anxiety provoking to wake up so many times in the night. The second you fall asleep, disturbingly only to wake up 45 min to an hour later for no reason.  It not like the dog woke you up, or there was some loud party next door. The Poltergeist is just annoyingly being woken all night long for no good reason. Then come morning they are exhausted and feel like they did not get restful sleep.  This disrupted sleep pattern is because the cortisol is bouncing up and down all night.

The goal here is to re-establish the proper diurnal curve of cortisol.  Bringing the cortisol down at night and keeping it low all night so you can get a good night’s sleep.

11 Tips on How to Improve Sleep with Adrenal Fatigue

To start I have to state the “disclaimer”…this is not meant for medical advice, please ask your doctor and if your doctor doesn’t know, get a new doctor, and this information is intended for educational purposes only, etc.

1. Balance blood sugar at night: Cortisol helps to raise blood sugar.  If our blood sugar drops while we are sleeping, your adrenal glands naturally release cortisol.  This increase of cortisol will cause you to wake up in the middle of the night. A lot of people eat dinner early, at 5:30-630 pm.  If your last meal was at 6 pm, by the time 2 am hits your blood sugar can drop causing the cortisol to rise to keep your blood sugar from getting too low.  Having a small bedtime snack of protein can maintain your blood sugar level all night. Protein sources such as nuts, hard boiled egg, small protein shake are great ways to balance your blood sugar at night.  You want something small (about 100 calories) and consisting mainly of a protein source.

2. No intense exercise after 12 pm:  Exercise, especially cardiovascular exercise raises cortisol.  If you exercise after 12 pm noon, your cortisol will rise causing elevated levels at night.  Exercise is very healthy for adrenal fatigue and health. But keep your workout to the morning.  Walking is one of the best activities for adrenal fatigue. It is not stressful to the body and will not raise cortisol like intense cardiovascular exercise.  Doing intense metabolic conditioning can be detrimental to adrenal fatigue. Hardcore cardio will rapidly spike cortisol.

This not only disrupts sleep but also causes an imbalance in insulin and glucose.  ‘Shelley’ a patient of mine is a perfect example. Every night after work, Shelley would go to the gym to do a spin or boot camp class.  She complained that not only did she have trouble sleeping at night, she also couldn’t lose weight. In fact, she kept gaining weight, especially in the belly.  Shelley complained that she was tired all the time. And she was always late for work in the morning because she kept pressing snooze on her alarm. Even though Shelley tried to eat healthily, the carb cravings were insatiable.  I convinced Shelley to stop exercising altogether. This was to help get the cortisol levels regulated. Between the cessation of the intense cardio, hormone balancing and adrenal supplementation Shelley started to feel better. She slept better and started waking up earlier.  She began walking in the morning before work. The cravings decreased, and she lost weight.

3. Raising Phosphatidylserine levels at night: Phosphatidylserine helps to reduced cortisol levels.  When taken at night phosphorylated serine can help you fall asleep and stay asleep. It is not habit forming and often once you start to restore the natural diurnal curve of cortisol, you will not need to continue taking it.  You can get phosphatidylserine from foods, with the highest food source being soy lecithin. But many people do not like taking soy and cannot tolerate it. There are phosphatidylserine products that are derived from sunflower seeds. Or you can get phosphorylated serine that is soy-free. Both phosphorylated serine and phosphatidylserine are natural over the counter supplements. A good quality phosphorylated serine is Seriphos by Interplexus. If you are looking at a product for Phosphatidylserine and it does not say soy-free.  Then you can assume that the phosphatidylserine is derived from soy.

4. Raise GABA:  By raising GABA helps for staying asleep.  GABA is easily found at your local health food.  But unfortunately, GABA is a huge molecule and is not absorbed through the digestion well.  GABA also cannot cross the blood-brain barrier. The best way to increase GABA is to take a precursor to GABA, called 4-amino-3-phenyl butyric acid.  This GABA precursor, 4-amino-3-phenyl butyric acid is easily digested and crosses the blood-brain barrier. It will convert to GABA, hence help you stay asleep.  I like Kavinace by Neuroscience to help people with adrenal fatigue stay asleep. It is a combination of taurine and 4-amino-3-phenyl butyric acid HCL in a capsule.  Raising GABA is more helpful for people that have trouble staying asleep (ghouls and poltergeists). This is not as helpful for vampires, because they have difficulty falling rather than staying asleep.

Addendum as of April 2019:

As of April 2019, Kavinace is no longer available.  Here the link to the article I wrote explaining why Kavinace is no longer available and alternatives: What is a Good Alternative to Kavinace.

Now that PharmaGABA is available, this is fantastic way to raise your levels of GABA.  PharmaGABA is actually well absorbed through digestion where GABA capsules itself are not.  With patients to help then stay asleep though the night I have a couple of options:

Take PharmaGABA tablets before bed.  You can take the chewable form of PharmaGABA which is absorbed more quickly than capsules.  Chew up PharmaGABA tablets before bed and place 1-2 tablets on your bedside table.  So that if you wake up in the middle of the night, you can chew up the tablets.  The tablets absorb so much more quickly than capsules that in the middle of the night, it could help you fall asleep quickly.

Take PharmaGaba as a capsule.  In many cases taking PharmaGABA as a capsule before bed can help you stay asleep all night.  In the case of waking in the night, you can do as stated above.  Chew up one to two chewable, quick absorbing tablets in the middle of the night.

Balance your neurohormones, serotonin, GABA and dopamine.  People think of the neurohormones serotonin, GABA and dopamine as helping with mood and happiness.  Yes, this is correct, balancing the neurohormones can tremendously help the mood.  But did you know, by balancing the neurohormones, can also help with your sleep?  I like to use a product by Ortho Molecular Products with my patients called Cerevive.  It has the 5HTP precursor to serotonin, L-Dopa standarized to 10% and a little bit of GABA in it.  Taking this in the evening can help with staying asleep through the night.  I have noticed with my patients that it works, but it take a couple of weeks to notice the effects.  And the amount of PharmaGABA in it in low.  So in some cases, I will layer more PharmaGABA with it to help with sleep. 

5. Melatonin: Melatonin is a great way to help you fall asleep.  Melatonin works for about 3 hours. Melatonin is not helpful for people that have trouble staying asleep.  Melatonin can be a great tool for vampires that cannot fall asleep at night. Melatonin is a natural over the counter supplement.  I like the instant release versions of melatonin as opposed to sustained release. Sustained release often has the side effect of morning grogginess in many people. But melatonin is not for everyone as some people have reactions to taking it.  Some complain that they feel overly tired, “hungover” the next morning and others remark of having intense dreams. If you cannot tolerate the supplement, you can drink tart cherry juice before bed. Cherry juice (tart) is a great source of melatonin, but make sure to chose the unsweetened option so it does not have a negative impact on your blood sugar. 

6. Eat healthy carbs at dinnertime:  Having healthy carbohydrates such as fruit and starches at night will help to raise serotonin.  Serotonin will convert to melatonin at night to help you fall and stay asleep. This is also a good alternative to people that cannot tolerate melatonin as a supplement.  As mentioned above, cherries are a source of natural melatonin. Having cherries or a small glass of tart cherry juice can give you healthy carbs, balance blood sugar and provide melatonin.  Some people find that having a healthy starchy carbohydrate such as sweet potato at dinner helps sleep over the cherry juice. The carbs in food-form seem to raise their serotonin better and balance the blood sugar for the entire night.      

7. No caffeine:  Caffeine elevates cortisol.  Drinking any caffeinated beverage will raise your cortisol level.  And if you have it later in the afternoon, it can disrupt your cortisol levels at night, causing disrupted sleep.  That is because the half-life of caffeine is 5-6 hours. So if you had 200mg of caffeine at 3 pm, five hours later there is 100mg in your system.  And five hours after that there is 50mg still left in your body. So at 2 am, there is still caffeine in your system.

8. Reduce alcohol:  Alcohol, regardless of wine, beer, hard liquor will disrupt your blood sugar.  Alcohol can cause your blood sugar to drop in the middle of the night. Even carb-free liquor such as vodka will put a burden on your liver.  It may not cause a blood sugar spike but will cause the liver to increase insulin. When insulin is elevated then blood sugar will drop. When your blood sugar drops in the middle of the night, your adrenal glands will secrete cortisol.  The cortisol will signal your liver to produce glucose by way of gluconeogenesis. When that cortisol rises, you will wake up in the middle of the night. What I have observed in my practice, is alcohol is very sensitive to women and their sleep.  Many women report that after having a couple of glasses of wine with dinner, they always have trouble staying asleep. Because alcohol is a depressant, it can help you fall asleep. But it will not help you stay asleep.

9. No sleeping pills:  Sleeping pills, prescription and over the counter only have about a 3-5 hour lifespan.  They will help you fall asleep but will not help you stay asleep. Sleeping pills are habit forming and do not allow for healthy, restful sleep.  That is because they will only allow you to enter stage 2 and REM sleep. We have five stages of sleep:

• Stage one: conscious but drifting off
• Stage two: sleep
• Stage 3 and 4: Helpful for beneficial sleep.  
• Stage 3 and 4 are vital because they help stimulate the immune system and cellular turnover/restoration.
• Stage 5: This is REM sleep, it is important for our brains and restoration.  

However, stage 3 and stage 4 are also important because of its effect on the immune system and its process in restoration.

Sleeping pills provide fake-sleep.  You are sleeping but not able to get in the beneficial 3 and 4 stages of sleep. Like I mentioned, sleeping pills are addictive.  And long-term use of OTC sleeping pills that have diphenhydramine can cause memory issues and dementia in older individuals. Not mention, sleeping pills can make it very difficult to wake up in the middle of the night, if there is an emergency.    
 
10. Turn off light devices:  Any light tricks the body into thinking it’s daytime.  If it is daytime, the cortisol secretion is elevated. By having light devices, makes your body think it is daytime, hence excess levels of cortisol.  Even if you tried to sleep, you would not be able to, because your body thinks it is daytime and the cortisol is elevated. This includes your iPhone, computer, house lights, television.  You can turn down the brightness of these devices, but it still is light and can still be stimulating. There are filters you can attach to your electronic devices to reduce the light stimulation.  But it is a good idea to turn off those devices at least two hours before sleeping. On a side note about the tv shows, if they are intense and dramatic, that can raise adrenaline and cortisol. So yes, watching The Walking Dead or Handmaid’s Tale or even the news can really keep you from falling asleep.    

11. Stress: Yes, we all know we need to reduce our life stressors.  Whether that is a possibility or not, depends on the person and their situation.  I understand we all have stress we can or sometimes cannot control. This blog is not meant to be about personal development or psychology.  But do your best with the stressors we have control over. Therapists are a great resource to work with. Removing toxic people, making boundaries, starting a light exercise plan, meditation, healthy diet.  Whatever works for you to reduce stress. I had one patient, “Grace” that not only couldn’t sleep, she felt terrible all the time. Grace was overweight, had constant muscle pain, fatigue and was anxious most of the time.  

All the supplements, dietary changes, medications, nothing helped much. Grace was a stressed out, busy public defender. She hated her job. While I am grateful to our country to have the right to defense and innocent until proven guilty.  Grace’s position as a public defender did not resonate with her, and the pressures of her job were overwhelming. Six months after our last appointment, she came into my office glowing.

Grace had quit her job and took a position at a non-profit as a lawyer helping with victim rights.  She loved it, and while she took a pay cut to her salary, she was happy. Many of her symptoms went away. She slept well, her energy was better, and she lost the extra weight without even trying and even started dating. As before, Grace’s libido was at zero. Grace’s obstacle to cure was her job.  If you are not feeling well, step back and see if there is an “obstacle to cure” in your life. And if you can remove it, fantastic. If you cannot, use the tips above to better deal with it.

Sleep is incredibly important to our physical and mental health.  And there is nothing more frustrating than having trouble falling or staying asleep.  These 11 tips can help you improve sleep with adrenal fatigue. From reading above you can see cortisol can be a real obstacle to sleep.  

We created a dietary program to balance cortisol, insulin, and glucose to help with belly fat, sleep, and energy. It is called the Keto-Carb-Cycling Program (KCCP), and it is free.  If you have any questions or your own story, please feel free to leave a comment below or you can send an email to [email protected].