Welcome to Dr. James Wilson's Adrenal Fatigue Blog

Sleep & Adrenal Fatigue

People are becoming more aware of the ravages of stress and how it leaks into every corner of their lives. Of course, increased stress means increased sleep disturbances for many. Less sleep means they experience more stress the day after. This pattern continues in a vicious cycle, making stress and sleep loss in terms of hours and quality intimately interconnected.

If stress has somewhat depleted the adrenal glands, which is often the case, people under stress do not wake feeling rested. Cortisol, an adrenal hormone, is needed to allow that person to wake feeling refreshed and bouncing out of bed in the morning. It is also important to induce an alpha wave, a requirement for the first phase of sleep. If cortisol is low, falling asleep is difficult. Cortisol is also necessary to maintain good blood sugar levels throughout the day and night. If cortisol is low during the day people wake feeling tired and often need coffee, cola and other caffeinated beverages to get going and to keep going during the day. This over consumption of caffeine not only causes blood sugar to rapidly rise and then precipitously fall an hour and a half later, but also tends to interfere with sleep that night. The resulting lack restful sleep creates more stress the next morning and perpetuates the cycle of low cortisol and difficulty sleeping. This low adrenal function is a frequent occurrence in both sleep disturbance and inadequate response to stress. During adrenal fatigue, a condition where the adrenal glands are not able to keep up with the demands placed on them, people often have problems managing their stress and sleeping well.

There can be several reasons for sleeplessness with adrenal fatigue. If you are waking between 1:00 and 3:00 AM, your liver may be lacking the glycogen reserves needed for conversion by the adrenals to keep the blood glucose levels high enough during the night. Blood sugar is normally low during the early morning hours but, if you are experiencing adrenal fatigue, your blood glucose levels may sometimes fall so low that hypoglycemic (low blood sugar) symptoms wake you during the night. This is often the case if you have panic or anxiety attacks, nightmares, or sleep fitfully between 1:00 and 4:00 AM. To help counteract this, have one or two bites of a snack that contains protein, unrefined carbohydrate, and high quality fat before going to bed, such as half a slice of whole grain toast with peanut butter or a slice of cheese on a whole grain cracker.

Both too high and too low nighttime cortisol levels can cause sleep disturbances. To determine if this is a problem for you, simply do a saliva cortisol test at night and compare your night sample levels with your own daytime levels and with the test standards for those times. To do the night test, take a saliva sample at bedtime, another if you wake up during the night and a third when you wake up in the morning. Write the time each sample was taken on the vial and in your notebook on a separate sheet of paper. If cortisol is the culprit, your cortisol levels will be significantly higher or lower than normal for those times. If your nighttime cortisol levels are too low, you may sleep better when you exercise in the evening, before going to bed because exercise tends to raise cortisol levels. If your nighttime cortisol levels are too high, try doing one of the relaxation or meditation exercises to calm you down before going to bed. The specific yoga posture called the alternate leg-pull can be quite helpful in getting to sleep or returning to sleep. This is a basic yoga posture that almost any yoga book or video will describe but an instructor is preferable because there is some subtlety to doing this posture.

Here is a list of some additional things you can do to improve your sleep:

• Above all, go to bed before 10:30 PM and stay in bed until 9:00AM as often as possible, even if it is just on the weekends. It is amazing how restorative sleeping until 9:00 AM is for the adrenals.
• Be sure to get enough physical exercise during the day. Try varying the kinds of exercise you do, their intensity or when you exercise. Many people have told me swimming at night helps them sleep.
• Certain postures in yoga, ta'I chi and qi gong can also be helpful. Check with a teacher of these disciplines to find out which postures or exercises would specifically help you.
• Avoid coffee, caffeine containing beverages and chocolate because they act as stimulants. These can interrupt sleep patterns and increase morning lows. Even if they are consumed early in the day, they can disrupt sleep and make the next morning harder to negotiate.
• Some people are photosensitive and watching television or looking at at computer screen keeps their melatonin from rising and inducing sleep. If you are having difficulty going to sleep and usually are staring at a TV or computer screen late at night, try having an 8:00 PM limit on these visual stimuli.
• If your cortisol levels are low late at night, try exercising in the evening, as exercise raises cortisol levels and may afford you a sound night's sleep.
  
• There are particular nutritional supplements that can be beneficial. Often melatonin (0.3-1.3 mg) taken 30 minutes before bedtime helps establish normal sleep patterns. Calcium citrate (500mg) taken with 50 mg of 5-hydroxytriptophan (5HTP) at night before retiring is also relaxing and helps many people sleep throughout the night. Trace mineral tablets taken at the evening meal also help relax the body. Adrenal extracts taken ½ hour before bedtime often help those with adrenal fatigue fall asleep and remain asleep. If your adrenal fatigue is moderate or severe, try this one first.
• The hypothalamus is very important in regulating sleep. Although accurately testing hypothalamic function is complicated, a simple test you can do yourself is to try takig one to four tablets of hypothalamus extract and 10-40mg of manganese before bedtime and see if your sleep improves. Sometimes the hypothalamus tablets need to be combined with the adrenal extracts to normalize sleep.
  
• There are also several herbs commonly used to promote better sleep such as hops (whole plant), catnip (leaves), valerian (root) and licorice (root). Although not known as a sedative, the herb ashwagandha can help indirectly through its ability to normalize cortisol and sex hormones, both of which can produce sleep disturbances.

If none of these help and your life is being deleteriously affected by lack of or interrupted sleep, check your local area for the location of the nearest sleep center. Several cities around the country have these centers that specialize in helping individuals determine the cause of their sleep disturbances.

Take Short Horizontal Rests During the Day

During the day, you will probably notice that you have particular times when you feel more lethargic, cloudy headed, tired or have other symptoms of adrenal fatigue. Try to schedule your breaks so that when these occur, you can physically lie down for 15-30 minutes. Lying down is much more restorative than sitting for the person with adrenal fatigue.

Problems Interpreting Cortisol Lab Tests in Adrenal Fatigue

Complicating the problem of proper interpretation of laboratory data in adrenal fatigue is the fact that steroid hormones occur in more than one form in your body, but most lab tests measure only one. Cortisol, for example, takes on three forms in your blood: 1) unattached to any other substance (free), 2) loosely bound and, 3) tightly bound to blood proteins. The most common measurement for hormones is the amount of hormone not attached to anything, called the free circulating hormone. However, this usually represents a meager 1% of the total amount of hormone available. It does not measure the bound hormones, which act as reserves and become free hormones if needed. This reserve can be critical to proper physiological function. For example, very low circulating cortisol levels can be brought to within normal range by the administration of a synthetic cortisol. But people taking synthetic cortisol cannot withstand stress as well as people with naturally normal cortisol levels, even though blood tests for both show normal free circulating cortisol levels. One reason for this is that although free circulating cortisol levels are increased by taking the synthetic cortisol, levels remain low of tissue bound cortisol that provides reserve stores in cases of emergency (stress). Blood tests can often be deceptive because they do not typically give you the whole picture. Therefore, even though both healthy people and people taking cortisol might show normal free cortisol levels, their response to stress will probably differ considerably. The test results would give a very deceptive picture of "normal" in the case of the person receiving the drug, as it tests only the most superficial layer of cortisol availability.

In adrenal function, the extreme low on a bell curve is Addison's disease and the extreme high is Cushing's disease. The other 95% represents an enormous variation in levels of adrenal function that is usually disregarded by lab computers and overlooked by doctors because the scores in this range do not fall into either of the two extreme or "diseased" categories. By default, any scores falling within this range (95%) are considered "normal" The end result of basing laboratory test scores on statistics rather than on signs and symptoms is that many people who have mild to moderately severe adrenal fatigue are never accurately diagnosed; they look "normal" on the tests.

Stress is a factor that significantly affects adrenal hormone levels. Your cortisol level tested after a quiet, relaxing morning will be very different from your cortisol level tested when you are under stress before you arrive at the lab. To obtain a typical value, have your test on a typical morning.

Dr. Wilson’s Guidelines for Overcoming Adrenal Fatigue

Here are some general guidelines to follow and things to avoid to help you recover from adrenal fatigue. Use this list as a reference guide and adapt it to your particular situation.

• Make your lifestyle a healing one
• Do something pleasurable every day
• Be in bed before 10PM
• Sleep in until 9AM whenever possible
• Look for things that make you laugh
• Eliminate the energy robbers (things in your life that drain your energy)
• Take action on one of the "three things you can do" whenever you are not enjoying your life - first locate the energy robbers and then 1) change the situation, 2) change yourself to adapt to the situation, or 3) leave the situation. Notice at least one small, everyday thing that you are grateful for each day
• Take your dietary supplements, regularly
• Move your body and breathe deeply
• Believe in your ability to recover
• Use your mind as a powerful healing tool
• Keep a journal - jot down your experiences each day
• Eat the foods your body needs
• Learn which foods make you feel bad (keep a list of them)
• Read/Re-Read Part 3 of "Adrenal Fatigue: The 21st Century Stress Syndrome"
• If you do not have high blood pressure, try having a glass of water in the morning containing ½ to 1 teaspoon of salt stirred in until dissolved. If this makes you feel better, continue doing it. Note: On mornings when you exercise fully, you may not want as much salt. Be mindful of your cravings for salt and potassium containing foods (e.g. bananas, melon, potatoes, tomatoes, beans) during the day. These desires may serve as rough indicators of adrenal function during the day.
• When you eat fruit, have something with salt before or after the fruit and chew very well
• Combine starchy carbohydrates, protein and fats at every meal, including breakfast
• Always eat breakfast - it is very important for people experiencing adrenal fatigue
• Eat an abundance of whole foods - those foods which are eaten like nature grows them
• Eat lots of colored vegetables
• Chew your food well
• Take the power and responsibility of your health into your own hands
• Make whatever lifestyle changes you need to make to regain your health
• Laugh several times every day
• Enjoy your recovery
• Take 1,000 mg of Vitamin C complex with 200mg magnesium and pantothenic acid at approximately 2PM every day along with a small snack containing protein, complex carbohydrate and fat in order to help avoid the 3-4PM low
• Follow my Program for Adrenal Fatigue and Stress
  

Avoid These Things

• Getting overtired
• Caffeine, sugar, alcohol, and white flour products
• Coffee, even decaf
• Staying up past 11PM
• Pushing yourself
• Energy robbers
• Being harsh or negative with yourself
• Feeling sorry for yourself
• Foods you are addicted to
• Foods you suspect an allergy or sensitivity to
• Foods that make you feel worse, cloud your thinking or pull you down in any way
• Skipping breakfast
• Avoid fruit in the morning
• Never eat starchy carbohydrates (breads, pastas) by themselves
• Do not eat foods that adversely affect you in any way, no matter how good they taste or how much you crave them

Frustration and Discouragement in Adrenal Fatigue

Frustration and discouragement are experienced intimately by most people suffering from adrenal fatigue. When you start on the road to recovery and have a setback, you may become discouraged and frustrated even more easily than someone recovering from a different illness. But do not give up!  Even when things are not going like they should and you have tried everything, do not despair. Often, it is the next thing you do, or sometime it is just the amount of time needed for your program to work. If you keep trying, there is hope. If you give up and quite doing the things that make you feel better, you can be sure your chances of healing are slim to none. So, the first and last rule of the program is to never give up!

Some people start feeling better in the first week of their recovery program, especially if they dramatically improve their diet or make changes in their lifestyle that greatly reduce stress. But typically you should not expect changes before at least three weeks.

I advise patients to keep journals in which they jot down notes daily about how they are feeling, what they are able to do, and their general overall symptoms. On days when you are feeling discouraged, you can go back to the early journal entries and note that you have made progress even though it does not feel that way at the moment. As you get better, you will find that you are able to do and complete more things, your frame of mind is improving, generally, things are going more smoothly in your life, and you are better able to handle the rocky times. You will even have happy days or nearly happy days, replacing all those bleak ones that came before. Note the happy days in your journal. They will serve as landmarks and as inspiration on other days when you need encouragement.

Although regaining your health and vitality is very important and requires considerable commitment and persistence on your part, do not wrap your entire life up into getting well. This creates a compulsiveness that is not usually conducive to restoring health. It causes you to be driven by the effort to get well which then becomes just another source of stress draining your adrenals.

Eating with Adrenal Fatigue by Dr. James Wilson

If you are experiencing adrenal fatigue, you will probably notice that you do best if you combine some protein (meat, fish, eggs, dairy, nuts, seed, legumes, etc.), complex carbohydrates (whole grains, root vegetables, etc.) and a small amount of healthy fat (preferably fresh vegetable oils) at every meal and snack. Eating this way helps sustain steady energy throughout the day because your body converts protein, complex carbohydrates and fats into energy at different rates - prolonging the flow of energy fuel. It is important to remember that foods that are converted too quickly into energy (like sugary snacks or highly processed foods) will quickly let you down after the initial rush.

One of the major dietary mistakes made by people with low adrenal output is not eating soon enough after waking. If you are experiencing adrenal fatigue, it is very important to eat (protein + complex carbohydrates + healthy fat) before 10:00 am - even if you do not feel very hungry. This is vital to replenishing your waning stored blood sugar supply after the nighttime's energy needs.

An early lunch, preferably before noon, is better than a late lunch because your body quickly uses up the morning nourishment and is ready for more. Between 11 and 11:30 am is usually the best time for lunch. It also helps to eat a nutritious snack between 2 and 3 pm to sustain you through the cortisol dip that typically occurs between 3 and 4 pm.

Eating dinner between 5 and 6 pm supports adrenal function and blood sugar levels through the evening. A few bites of a high quality snack (protein + complex carbohydrates + healthy fat) before bed can help sustain blood sugar levels at night for sound sleep.

http://www.adrenalfatigue.org/diet-for-adrenal-fatigue.html

 

The Price of Stress by Dr. James Wilson

If you're like many North American adults, you may have noticed that it's harder to get up and keep going than it used to be. Caffeine is almost as essential as air to modem life. Perhaps you've even found yourself turning down fun activities because you're too tired. When stress and fatigue are the two things you can count on each day, your health is paying a price.

Persistent tiredness is so widespread it almost seems normal but, in fact, it is often the most visible sign that you have a stress disorder called adrenal fatigue. Although it wreaks havoc in the lives of millions of people, conventional medicine does not yet recognize that it is a distinct, diagnosable syndrome. As a result, an estimated 80% of North Americans suffer from Adrenal Fatigue at some time in their lives without the help they need to recover. It can last anywhere from days to most of a lifetime if nothing is done about it.

The ability to cope with physical, emotional or psychological stress depends largely on the activity of the adrenal glands. They produce and secrete hormones such as cortisol and adrenaline that regulate energy production and storage, heart rate, muscle tone, and other essential processes that enable the body to deal with stress. No matter what the source of stress is, the adrenals have to orchestrate a complex biochemical response.

In adrenal fatigue the output of adrenal hormones has been diminished by over-stimulation, usually from the cumulative effect of chronic or repeated stresses. Resultant biochemical and cellular alterations adversely affect everything from the ability to handle allergens and environmental toxins to resistance to infectious agents and autoimmune processes such as fibromyalgia. These same biochemical changes also lead to other problems such as hypoglycemia and depression. The lower adrenal function drops, the more profound is the effect on every organ and system in the body.

An illness, life crisis or stressful lifestyle can drain the adrenal resources of even the healthiest person. However there are certain things that make someone more prone to Adrenal Fatigue. A diet low in nutrients and high in sugar, refined carbohydrates and hydrogenated oils is probably the single greatest contributing factor. Substance abuse, lack of sleep and too many pressures also tend to lower adrenal function over time. All repeated infections such as bronchitis or pneumonia and all chronic diseases from arthritis to cancer place demands on the adrenals that can rapidly deplete them. In addition, a mother with low adrenals during pregnancy predisposes her child to Adrenal Fatigue.

Although it is more complex to diagnose adrenal fatigue than something like measles, the best indicators of its presence are the symptoms themselves. Anyone who regularly experiences one or more of the following may be suffering from Adrenal Fatigue:

1) trouble getting up in the morning even after going to sleep at a reasonable hour
2) tired for no reason
3) feels rundown or overwhelmed
4) can't bounce back from stress or illness
5) craves salty and sweet snacks
6) afternoon low between 2-4pm
7) feels best after 6pm

Another indication of low adrenal function can be a need for prescription corticosteroids. Pharmaceutical corticosteroids are designed to imitate the actions of cortisol and so they are used primarily when the adrenals are not providing adequate amounts of natural cortisol. Ironically these drugs further suppress adrenal function and intensify the severity of Adrenal Fatigue that occurs once they have been discontinued.