Impact of Stress on Sleep
Sleeping difficulties pose a significant struggle to a large portion of patients. Approximately 33% to 50% of the adult population have insomnia symptoms. Though dozens of complicated factors shape sleep, many sleep-related health difficulties are linked to the hormone cortisol. If you receive a patient with sleep problems, whether they suffer from difficulty falling asleep, waking consistently in the middle of the night, or low energy levels, consider testing their cortisol levels. Monitoring and understanding cortisol can be an excellent approach for patients looking to improve their sleep quality.
Cortisol: The Stress Hormone
As the hormone primarily associated with stress, cortisol is released to provide additional energy in response to an external stressor. When cortisol engages the sympathetic nervous system, the body enters what is commonly known as the fight-or-flight response, which provides enough energy to survive a high-stress situation. To accomplish this, cortisol manages how your body uses carbohydrates, fats, and proteins to regulate blood pressure and increase blood sugar. Like all hormones, cortisol is integral to whole-body health, but an overproduction of it can have far-reaching and long-lasting consequences.
The HPA Axis
Cortisol is produced by a system of endocrine pathways known as the hypothalamic-pituitary-adrenal (HPA) axis. This system includes the hypothalamus, pituitary gland, and adrenal gland. The HPA axis and its pathway result in the secretion of cortisol. The hypothalamus releases corticotrophin releasing factor (CRF) as the body’s primary stress response. CRF signals the pituitary gland to produce Adrenocorticotrophic hormone (ACTH), which travels through the bloodstream to the adrenal gland. The adrenal gland is responsible for producing corticosteroids, one of which is cortisol. As a result, the body responds with rapid heart rate, sharpened senses, and accelerated breathing.
The activity of the HPA axis shapes many different body functions. Its production of cortisol directly influences the sleep-wake cycle.
Cortisol and Sleep
Like many hormones, cortisol has a 24-hour rhythm. When cortisol is low, melatonin levels increase. Melatonin contributes to consistent sleep patterns and a regular circadian rhythm, so maintaining cortisol’s cycle is vital to a good night’s rest. Since cortisol generates short-term energy bursts to survive high-pressure situations, healthy adults’ cortisol levels are very low during sleep. Sleep is actually initiated when HPA activity is at its lowest.
An overstimulated HPA axis can cause significant sleep issues. If a patient constantly has high-stress levels, their HPA axis is overstimulated, leading to an unbalanced cortisol rhythm with high cortisol levels when they should be low. This quickly becomes a cyclical problem, as poor sleep hygiene lowers energy levels, increases health problems, and, consequently, contributes to your patient’s overall stress. As a result, high stress can manifest as sleep disorders.
Sleep Disorders and Long-Term Impacts
Sleep disorders associated with HPA axis dysfunction include insomnia and Cushing’s syndrome.
Insomnia, the persistent inability to fall and stay asleep, causes a host of additional health problems. These include heart disease, high blood pressure, and stress-related mental health disorders, such as depression and anxiety. An overproduction of cortisol symptomizes Depression and anxiety, but even when unaccompanied by depression, chronic insomniacs show high cortisol levels. This indicates that cortisol may be a contributing factor to sleep disturbances.
Cushing’s syndrome, the chronic overproduction of cortisol, is often accompanied by poor sleep. An overuse of steroid drugs commonly causes this syndrome, but it can also occur from an overproduction from the adrenal glands through an overstimulated HPA axis. Weight gain, fatigue, and bone loss are all long-term effects of untreated Cushing’s syndrome.
Long-term stress itself has many risks, including a higher risk of cardiovascular disease, cancer, and ulcers. Sleep deprivation has been linked to mental blurriness, reduced sex drive, and obesity since prolonged high cortisol levels increase glucose. Additionally, low-quality sleep harms the immune system. Some studies have shown that a lack of sleep appears to lower white blood cell count and reduces infection-fighting antibodies.
However, there are many available options for reducing cortisol levels and increasing sleep quality.
Balancing Cortisol Levels
Diet
High levels of fat, salt, and refined sugars are associated with the overproduction of cortisol. If your patient is trying to naturally lower cortisol levels, discuss their diet. When they eat is almost as important as what they eat. Eating late at night causes a spike in blood sugar and an increase in cortisol at a time when both should be at their daily low. To promote regular cortisol rhythms, consider developing a healthy, balanced diet plan with earlier meal times.
Environmental Stressors
Excluding chronic diseases such as Cushing’s syndrome, many cortisol-related issues can be tied directly to a surplus of environmental stressors. Chronic stress can be linked to thousands of sources, from a high-demand or high-risk job to problematic home life. While you may be unable to identify, isolate, or remove environmental stressors, discussing these causes can help your patient recognize necessary lifestyle changes for better sleep over time.
Medication
Certain sleeping disorders, such as Cushing’s syndrome, are commonly treated with medication and supplements. Prescribing medication, particularly in the long term, can have serious long-term impacts on your patients’ health. Before prescription, it’s vital to completely understand your patients’ sleep difficulties and examine their cortisol production.
Hormone Testing: The First Step Towards Diagnosis
The signs of cortisol overproduction and the causes of sleep difficulties are incredibly complex. To give your patients the best care, it’s necessary to examine their cortisol at a microscopic level. Access Medical Labs offers a variety of saliva and blood panels, all backed by a team of experts. Our adrenal saliva panel measures cortisol levels throughout the day, providing an in-depth look at your patients’ biology for a better night’s sleep.
