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Insomnia Questions Keeping You up at Night?

Insomnia is the inability to fall asleep, difficulty staying asleep, waking early and unable to return to sleep or some combination of these, despite ample opportunity for adequate sleep. Approximately 30% of adults suffer from insomnia of some type, and when this is ongoing, it can lead to a myriad of additional symptoms including depression or anxiety, weight gain, hypertension, heart disease and, of course, fatigue and slowed reaction time. Due to its common nature, as well as its far-reaching consequences, this condition is one of the most asked about topics when providers call the lab to discuss cases. We’ve listed some of the more common questions and concerns here:

  • My patient can’t sleep. I expected her cortisol levels to be high, but they are so low that she is basically flat-lined. How do you explain this?

One of cortisol’s functions is to act as our internal clock. The classic diurnal pattern of cortisol is to rise early in the morning to wake us up, and then to steadily decline over the course of the day, reaching its lowest level at the hour of sleep. If those low levels are achieved early in the day, the patient might experience afternoon and evening fatigue, but that drop off at bedtime is not present, which may make falling asleep difficult. Having low cortisol levels does not equal good sleep. Reestablishing a proper diurnal cortisol pattern can result in better sleep. Additionally, because of the role that cortisol plays in regulating blood sugar, patients with chronically low cortisol levels are more susceptible to sharp drops in their blood sugar during long periods of fasting (i.e. overnight) which can often trigger an awakening response. This can occur even without the patient being aware of “hunger”.

  • I have been treating my patient’s adrenal fatigue for some time, and her cortisol levels have greatly improved. She feels better in many ways, but her insomnia is not much better. What else can I do?

Consider neurotransmitter testing. Many neurotransmitter imbalances can contribute to poor sleep. Serotonin is a precursor to melatonin, adequate levels of which are required for healthy sleep wake cycles. When serotonin levels are low or suboptimal, patients may not make adequate amounts of melatonin. GABA, the primary inhibitory neurotransmitter, is essential for promoting sleep. In fact, many prescribed sleep aids (i.e. Ambien and Lunesta) act via stimulation of GABA receptors. Conversely, elevations in the excitatory neurotransmitters (dopamine, epinephrine, norepinephrine and glutamate) can interrupt sleep.

  • What can I do to help my patient get some sleep right away?

Poor sleep makes it difficult for patients to truly heal and for symptoms to improve. Sometimes palliative care can be an important addition to a treatment plan. When patients sleep, they begin to feel better, and when they begin to feel better, they are able to be compliant with treatment recommendations aimed at producing long term changes in physiology. Oral progesterone is a good sleep aid, as it is largely metabolized on its first pass through the liver to allopregnanolone, a metabolite that stimulates GABA receptors. Additionally, GABA itself can be beneficial, or L-theanine. Melatonin is also an effective sleep aid for many

  • How does sex hormone imbalance affect sleep?

Night sweats, a common cause of sleep disturbance, can be associated with inadequate estradiol and/or progesterone levels in women and declining testosterone levels in men. Supplementing with the appropriate hormones can improve these vasomotor symptoms, resulting in a better night’s sleep.

Research points to a correlation between sufficient DHEA levels and adequate sleep. One trial points to DHEA supplementation increasing REM sleep. REM sleep, or dream sleep, is essential to our minds for processing and consolidating memories, emotions and stress, and is also vital to learning. Studies have shown that better REM sleep helps boost your mood during the day. (But remember that DHEA supplementation is only recommended for those individuals whose DHEA values test below range.)

For more information on the benefits of testing and treating hormone and neurotransmitter imbalances, including insomnia, please join us at our upcoming Core Training seminar on May 16 in Chicago. Visit labrix.com to register today.

References:

  • American Academy of Sleep Medicine. http://www.aasmnet.org/resources/factsheets/insomnia.pdf Accessibility verified 4/22/15
  • Jackowska M, Kumari M, Steptoe A. Sleep and biomarkers in the English Longitudinal Study of Ageing: associations with C-reactive protein, fibrinogen, dehydroepiandrosterone sulfate and hemoglobin. Psychoneuroendocrinology. 2013 Sep;38(9):1484-93.
  • Leproult R, Van Cauter E. Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA 2011 Jun 1;305(21):2173-4.
  • Friess E, et al. DHEA administration increases rapid eye movement sleep and EEG power in sigma frequency range. Am J Psysiol 1995;268(1 Pt 1):E107-13.

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