Sleep issues

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Sleep/wake patterns
When suffering from adrenal issues, bedtime should be no later than
10 p.m. and wake time no later than 8 a.m. This follows the normal
diurnal pattern of cortisol. For someone who has a later bedtime,
working toward a 10 p.m. bedtime in small increments, such as ten or
fifteen minutes earlier each week, may be helpful.

Good sleep hygiene
• Subdued light at least an hour before lights out
• Avoid computers late in the evening
• Room should be completely dark with no electronic indicator lights
• Ear plugs may be helpful
• White noise, with or without earphones, may be helpful
• Seek natural light or bright light after waking in the morning

Nighttime cortisol and sleep
Trouble falling asleep is common with adrenal fatigue. Low cortisol in
the morning results in too much being produced at night. Treating high
nighttime cortisol with strong cortisol-lowering supplements such as
phosphatidylserine does not address the underlying problem of low
daytime cortisol. Ideally, high nighttime production of cortisol needs to
be pushed toward morning, not eliminated.

Safe sleep aids
• Melatonin, 0.3 to 5 mg, over the counter
• about 30 minutes before lights out
• use lowest dose that is effective
• start with small dose of 0.5 mg and titrate up
• trial a dose for three days before increasing
• too high a dose may cause grogginess or difficulty waking the
following morning
• sublingual lozenge or drops for trouble falling asleep
• time release for waking up in middle of night
• some tolerance may develop but usually levels off at 3 to 5 mg
• can be used perpetually
• Antihistamine, over the counter (such as Benadryl)
• not non-drowsy
• about 30 minutes before lights out
• not meant to be used long term
• Vitamin B12
Studies wth teenagers have indicated that in some people the
sleep/wake cycle can be corrected with 3 milligrams a day of B12. It
appears to affect the release of melatonin at night and the response
to sun in the morning and helps reset the sleep/wake cycle in four to
six weeks.

Prescription sleep aids
• Affect the HPA axis
• Can cause addiction
• Need to be weaned gradually

Insomnia with bedtime dose of hydrocortisone
• May indicate insufficient daytime dosing
• Trial increased daytime dosing
• Replace other sleep aids with melatonin, antihistamine
• Grogginess in the morning indicates time to replace the melatonin
with bedtime dose of HC

Waking during the night
• Waking in the middle of the night caused by low overnight cortisol
and/or dysfunctional insulin secretion causing a hypoglycemic state
• If cortisol is unavailable, adrenaline is produced instead
• Support adrenals to correct daytime cortisol
• High fat, high protein (no carb) snack at bedtime may help
• Repeated waking to urinate can be from low aldosterone, high
potassium or possibly from potassium supplements taken late in the

Waking early
Waking early can be from high cortisol or from adrenaline due to low
cortisol or low blood sugar.

Difficulty waking
For someone taking T3 thyroid medication, a bedtime dose will
generally help with waking easily in the morning.