Sleep- Everyone needs it, few people get enough, and others get it yet still feel tired. So, what is the deal with sleep? How come some people can sleep for hours but still wake up tired when others can get a few hours and feel great? 

Well, it all comes down to your brain! 

The hypothalamic pituitary adrenal (HPA) axis is the central stress response system in our brain and depending on how the HPA axis is functioning we may see disturbances in our sleep. 

Melatonin is a well-known hormone that plays a role in our sleep-wake cycles. Melatonin and cortisol (a steroid hormone that has a multitude of effects in the body) are mutually inhibitory and they follow a cyclical pattern. In a normal healthy person, cortisol production is elevated in the morning stimulating alertness and triggering a person to wake up. As the day goes on cortisol decreases and melatonin production is increased to promote sleep. This allows our body’s immune system to reset overnight while we rest. When this is not working properly, people will tend to fall ill after a few days of poor sleep. 

Sleep cycles are about 90 minutes long and restful sleep is a series of these 90-minute cycles. Ideally, sleep duration should be a prefect multiple of 90 minutes (i.e. 6 or 7.5 hours) to provide the most benefit. Also, sleeping between 10:30pm and 2:30am provides the most mental and physical repair. Sometimes a simple alteration in pre-bedtime habits or a shift in sleep times can help improve sleep quality. 

 There are 3 main type of sleep disturbances to be aware of…

1.    Not being able to fall asleep 

2.    Not being able to stay asleep 

3.    And not feeling restored after sleep

Some people may experience just one while others may experience a combination or even all three!

**It is important to note that with all three of these, it is important to check blood sugar and the adrenals as these are often typical culprits for sleep dysfunction. 80% of the time, correcting blood sugar issues fixes the problem and this should always be the first line of treatment**

Not Being Able to Fall Asleep

•   Think simply: High cortisol at night. Cortisol plays an important role in how the body responds to stress. When cortisol is high, melatonin production is inhibited. Therefore, high cortisol at night reduces your ability to fall asleep. 

• Stimulants such as coffee can produce a cortisol surge.

• Stress including arguments with spouses or issues with work can increase cortisol levels.

• Topical phosphatidyl serine, meditation and supplemental melatonin may help promote sleep initiation.

• Sleep preparation is triggered by low-light conditions. Blue light before bed (i.e from electronics) can disrupt the production of melatonin.

• GABA is a neurotransmitter that also plays a role in sleep. Hyperexcitability of neurons from faulty GABA metabolism can produce symptoms such as “racing mind.”

• Gluten and eggs are two foods which may cross-react with GABA and result in poor sleep initiation. Eliminating these foods from the diet can have considerable improvements on sleep and brain function. 

• Often with a GABA dysfunction there will be other symptoms related to the cerebellum such as balance issues, the development of tremors or OCD like tendencies. 

 Not Being Able to Stay Asleep

• Most likely due to blood sugar control. Throughout the night blood sugar dips and cortisol is released. Too low blood sugar will have a larger cortisol response which will inhibit melatonin and stimulate waking. Over time the brain will become more sensitive to cortisol resulting in even small spurts to cause waking. 

•  Similar as with falling asleep, not being able to stay asleep can be due to GABA dysfunction as well.

•  Acetylcholine is a neurotransmitter which regulates REM sleep functions. Acetylcholine dysfunction can result in poor sleep patterns and the inability to stay asleep throughout the night. Typically, memory and the ability to learn is also affected.

• Acetylcholine production is also tightly linked with blood sugar control. Maintaining stable blood sugar throughout the night is important to stay asleep. A healthy snack prior to bedtime can help accomplish this.

• Cholinergic enhancing supplements such as Bacopa, American Ginseng, Ginkgo biloba and ashwagandha may provide benefits for memory and learning. 

Not Feeling Restored After Sleep

• Check cortisol! High cortisol in the morning implies that cortisol rises too high too quickly throughout the night or is staying elevated consistently. This prevents the body’s immune system from resetting while we sleep. 

• Herbal adaptogens and phosphatidyl serine can help to promote regular cortisol patterns.

• Dopamine plays a role in the waking state and can affect dream recall. Dopamine also synergies with testosterone and males with low testosterone may lack restorative sleep. 

As a general reminder, most sleep issues can be traced back to blood sugar issues and the adrenal glands. It is important to fuel your body properly throughout the day to avoid large spikes and dips in blood sugar. A small snack containing protein, fat and carb such as an apple with peanut butter before bed may help to stabilize blood sugars throughout the night. Always consult your doctor before taking any supplements or medications.