- 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.
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 http://www.naturalsleepmedicine.net.