Archive for the ‘cortisol’ category

Sleep and Trauma

May 20, 2010

In my office, it is not unusual to learn that a person’s sleep difficulties started with a trauma or bad experience.  For many people, the trauma they experienced was years (or decades) ago, and still affects their sleep.   These sleep difficulties can take the form of insomnia, nightmares or excessive daytime sleepiness.   Although this can be a hard topic to discuss, it is something to be aware of.

It is thought that brain chemistry can be altered, creating a hyperalert state.  People can also become very vigilant, staying on-guard even during sleep time.

As a naturopathic physician, here are some of my thoughts when working with someone who has sleep changes after a trauma:

  • Biochemically, I think about the 24 hour cortisol rhythm.  Cortisol should be high in the morning, and decrease over the day. (For more complete discussion, see my blogpost on cortisol). 
  • I also think about changes in neurotransmitter levels that may have occurred. 
  • Current safety, creating a sleep space that feels (and is) secure.
  • Stress reduction throughout the day to reduce sympathetic activation.  This can be in the form of a 2-3 minute break every 2 hours to do some deep breathing.
  • Unravel negative sleep associations with the bed, bedroom and bedtime.
  • And the use of other Cognitive-Behavioral techniques for insomnia.
  • Referral to a mental health professional to address trauma.

This blogpost just scratches the surface of this important topic.  You can learn more about sleep and trauma on The National Sleep Foundation website   They include tips for people who are suffering from temporary sleep disturbance.

Your Cortisol Rhythm and Sleep

November 23, 2009

Cortisol is an intrinsic hormone we all have. It is secreted by the adrenal glands on a regular daily basis.  There is a daily fluctuation in levels, called it’s circadian rhythm.  Cortisol should be low at night while we sleep.  It rapidly rises in the early morning, helping us have the energy to start our day.  Cortisol also can increase due to acute stress, such as an auto accident, or can be chronically elevated due to a chronic stressor.  It is thought that after long periods of chronic stress the adrenal glands get fatigued, so that cortisol is abnormally low.  Cortisol is typically elevated in depression, and low in Chronic Fatigue Syndrome (CFS).

So how does our cortisol levels affect our sleep? 

Cortisol is a wake-promoting hormone, so it can contribute to insomnia when it is high.  In my naturopathic sleep medicine practice we evaluate cortisol when the patient reports high stress levels and difficulty sleeping in the middle of the night.  Salivary cortisol levels are typically tested at four time points throughout a day – 7am, noon, 4pm and midnight.  The patients results are then compared to the normal profile. 

What will help normalize cortisol levels?

Many nutrients are needed by the adrenal glands to function well.  These include vitamins C, B6, and zinc and magnesium.  Some botanical medicines will also support adrenal function.  When the 24 hour cortisol profile is abnormal, supplements are typically recommended for 3 months, then levels are re-tested.  As always, it is equally (or more) important to address the underlying reason that the cortisol has gotten out of balance.  Behavioral approaches to decreasing stress include deep breathing, progressive muscle relaxation, good diet with avoidance of caffeine and alcohol, and good relationships.  If you suspect your cortisol levels may be affecting your ability to sleep consult with a physician for evaluation and treatment if necessary.

For more information about Naturopathic Sleep Medicine go to