This morning my brother was complaining about not being able to fall asleep last night. He had worked quite late and come home tired, but despite this he was awake for hours in bed trying to sleep. This phenomenon of being exhausted yet unable to sleep is what I call “tired and wired”. The body craves sleep but the mind won’t let you. For some people this turns into a vicious cycle of exhausted days and restless nights. So how do we stop the wind up and restore normal sleep?

It turns out the answer is stress, more specifically, the stress hormone cortisol. Cortisol follows a diurnal pattern. It spikes every morning as part of our wakening response, and then goes down gradually throughout the day. In order to get restful sleep, cortisol must stay low throughout the night.

As an interesting side note, cortisol is an anti-inflammatory hormone that dampens the immune response. Cortisol being low at night is why it is more common to get a fever at night rather than during the day when you’re sick.

This cortisol rhythm can get disrupted in two main ways. The first is in acute stress which causes a spike in all the stress hormones, including cortisol. If this happens before bed, the high cortisol may be enough to prevent sleep or keep you out of a deep sleep. Most of us have experienced waking multiple times throughout the night before a big event, checking the clock anxiously to make sure we hadn’t overslept. That’s cortisol at work.

The second way you see cortisol impact sleep is from long term or chronic stress. Any kind of long term stressor will do this, from work stress to emotional duress to intense brain work like learning a new job. At first cortisol spikes in response to stress, but in chronic stress the levels actually drop off and you end up with a cortisol flatline. 

You body loses the signal that tells it where you are in the day, and instead of waking rested you have to drag yourself out of bed and through your day. Because cortisol levels should be lower in the evening anyways, people with a cortisol flatline tend to feel the best in the evening when their cortisol levels are closest to normal. Of course this can make it harder to go to bed on time, which makes it even harder to get out of bed the next day.

The first step is to identify what type of cortisol imbalance you have. In the case of my brother, he was experiencing insomnia due to the acute stress of working late to get an urgent project done. His brain was wound up and his cortisol levels were high to keep him functioning optimally, which unfortunately prevented sleep.

I think the more common scenario is actually the second one with the chronic stress picture. This is because we often forget to take care of ourselves. American culture values the person who burns the candle at both ends and we are encouraged to skimp on sleep and over-caffeinate to make it through. 

But we were designed for rest. The seasons are such that spring through fall are active and productive, but winter is a time for rest. Every religion asks you to set aside quiet time every day to reflect and practice gratitude. Coincidence? I don’t think so.

So the first step to addressing cortisol imbalance is addressing the stress and adding some personal time into your day. Start with just 10 minutes. If you have trouble falling asleep, aim for 30 minutes of quiet time before bed to get your brain to wind down. Try some deep breathing, an epsom salt bath ( the magnesium helps with sleep), or quality time with a loved one.

The second step is to support the adrenal glands. I normally test cortisol levels throughout the day if we suspect it is an issue so I know when my patient has a cortisol imbalance and how badly out of range it is. However herbs like eleuthero and rhodiola are generally well-tolerated and help support healthy cortisol amounts without being stimulating. Licorice, ashwaghanda, and ginseng are also common adrenal support herbs but do have some contraindications to taking.

The last step is to try to improve sleep with calming or nervine herbs taken before bed. One of my favorite ways to do this is with herbal teas. Look for a blend that has valerian which is specific for decreasing sleep latency. Other wonderful support herbs include passionflower, chamomile, kava kava, and skullcap.

Don’t have stressors but still have sleep issues? Your cortisol may still be out of balance, especially if you have tried the sleep basics and still have issues.