Are you experiencing high levels of stress? Do you lay in bed at night with your mind doing circles stressing about all the things you need to get done? Do you frequently wake up during the night? Are you waking unrefreshed? Many of us have experienced loss of sleep because of stress, however the relationship between stress and sleep may be more intertwined than you think.
Stress and sleep have a closely connected relationship and when both systems that control these processes are functioning appropriately they create a balance between adequate levels of alertness to get us through the day as well as allowing us to have a restful sleep. Naturopathic medicine aims to restore or rebalance these systems where necessary and considers the complexity of each individual’s case and the factors contributing to the disrupted functioning of these systems.
First, lets take a look at the systems that control both sleep (the circadian clock) and stress (the hypothalamic-pituitary-adrenal axis) independently, before we discuss how these systems impact on each other.
The circadian clock/rhythm
Our circadian clock system consists of our brain and virtually all organs and tissues, which work together to regulate the secretion of both pituitary hormones and melatonin (our sleep hormone). The circadian clock is important for vital body functions through its role in controlling our sleep, food intake and body temperature (1). The input of light and darkness within our eyes influences the functioning of our circadian clock and in particular, the secretion of melatonin. Melatonin is released in response to darkness and brings on the feeling of sleepiness that we experience. When our circadian clock is functioning appropriately, melatonin levels peak in the evening and are at their lowest during the morning (1).
The hypothalamic-pituitary-adrenal (HPA axis)
Cortisol (our stress hormone) levels naturally fluctuate throughout the day, reaching their highest point in the early morning, allowing us to be alert throughout the day and their lowest level in the late evening, allowing for rest (1). When we are stressed, a network of glands called the HPA axis, secrete various hormones in response to this stress in which interconnect or ‘communicate’ with each other. When you are stressed the pituitary gland stimulates the secretion of adrenocorticotropic hormone (ACTH), which is released into the circulation and stimulates the production and secretion of cortisol from the adrenal glands. The presence of cortisol within the blood acts a message to the hypothalamus within the brain to reset the HPA axis and restore balance of these hormones. Cortisol is a glucocorticoid; these are steroid hormones that influence the functioning of virtually all organs and tissues of the body and are necessary for the maintenance of many body functions including balancing the nervous system, cardiovascular system, metabolism and immune/inflammatory reactions (1).
Relationship between circadian rhythm and the HPA axis
The circadian clock and the HPA axis communicate with each other and dysregulation of either system may lead to the development of a number of conditions (1). Under acute stress, these systems function in releasing the appropriate levels of cortisol and return levels back to normal within a short period of time. However, irregular sleep/wake cycles, jetlag, or shift work can lead to a constant disruption of circadian processes very much resembling the effects of chronic stress exposure (2). Such disruptions can lead to elevated cortisol secretion at night and decreased secretions during the morning along with decreased secretions of melatonin occurring at night (3). A persistently activated HPA axis results in affected sleep quality, insomnia, immune dysfunction, elevated blood glucose, hyperinsulinaemia, insulin and leptin resistance and obesity (2).
Nutritional/diet and lifestyle treatment
For patients who have a disrupted circadian rhythm and therefore activated HPA axis the following strategies could be implemented:
- Increase day time exposure to the sunshine and avoid bright lights during the night. This is because to darkness and daylight help control natural circadian rhythm and the natural production of the hormone melatonin (4).
- Increase physical activity and social activity to help regulate the sleep-wake-cycle (4).
- Increase consumption of tryptophan containing foods such as bananas, kiwi, turkey, seafood, eggs and seeds due to them being precursors for serotonin and melatonin production (5).
- Magnesium, vitamin B6, vitamin C, folic acid, calcium and zinc are also required to convert tryptophan à serotonin à melatonin (6). Therefore supplementation of these nutrients could also be considered.
- B vitamin complex supplementation is indicated to help address underlying factors. B vitamins act as cofactors for neurotransmitters and B5 and B6 are specifically important for adrenal gland functioning therefore will help with reducing HPA axis activation/dominance (7).
To discuss this topic in more detail, please contact our naturopath, Karly, at firstname.lastname@example.org or to make an appointment click here. Please note, Karly recommends bringing any recent blood tests with you to your appointment.
(1) Nader, N., Chrousos, G. P., & Kino, T. (2010). Interactions of the circadian CLOCK system and the HPA axis. Trends in Endocrinology & Metabolism, 21(5), 277-286.
(2) Kolbe, I., Dumbell, R., & Oster, H. (2015). Circadian Clocks and the Interaction between Stress Axis and Adipose Function. International journal of endocrinology, 2015.
(3) Dagan, Y., & Borodkin, K. (2005). Behavioral and psychiatric consequences of sleep-wake schedule disorders. Dialogues in clinical neuroscience, 7(4), 357.
(4) Zee, P. C., & Vitiello, M. V. (2009). Circadian rhythm sleep disorder: Irregular sleep wake rhythm. Sleep medicine clinics, 4(2), 213-218.
(5) Kotsirilos, Vitetta, Sali. (2011). A guide to evidence-based integrative and complementary medicine. Elsevier: Churchill Livingstone.
(6) Braun, M. & Cohen, L. (2015). Herbs and Natural Supplements: An evidence-based guide. (3rd ed.). Elsevier: Australia
(7) McCarty, M. F. (2000). High-dose pyridoxine as an ‘anti-stress’ strategy. Medical Hypotheses, 54(5), 803-807.