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    (2010-01-20 10:22:22, Hit : 1960, Vote : 0)
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   Insomnia and Blood Sugar Imbalances
Insomnia and Blood Sugar Imbalances

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By Datis Kharrazian, DC, MS, CCN

Many people have a hard time sleeping, especially in today’s active society. Medications to address insomnia carry heavy side effects and are not tolerated well by most people. In addition, medications do not address the underlying causes of insomnia.

In many cases, insomnia is directly related to blood sugar imbalances, in particular to adrenal function. Clinically, patients with adrenal hypofunction typically will be able to fall asleep, but cannot stay asleep. With adrenal hyperfunction, patients often are unable to fall asleep. Therefore, both adrenal hypo- and hyperfunctions have an impact on insomnia. These patients need to learn how to stabilize their blood sugar levels during the day and take some non-stimulatory support for their adrenal glands, as will be discussed later in this article.

Adrenal hormone levels can be measured by using an adrenal salivary index (ASI). The ASI consists of having the patient collect several samples of saliva during the day; those samples are sent to a lab for assessment. The lab will then map out the circadian levels of cortisol and confirm hypo- or hyperfunction. This test is very accurate and the cost is reasonable.1,2 However, even with symptoms of insomnia, subjective indicators often are sufficient to apply conservative nutritional and lifestyle therapy.

Adrenal Hypofunction

Let us discuss adrenal hypofunction first. This pattern usually occurs in individuals who frequently miss meals and consume lots of simple sugars and caffeine throughout the day. They typically complain of irritability (when meals are missed) and low energy, and crave caffeine to keep them going. The end result is chronic stress to the adrenal glands with a loss of function to maintain blood sugar levels, especially when they are asleep.

The body depends upon a constant supply of glucose to keep the body functioning properly. When the body is asleep, it requires a constant supply of glucose from stored glucose in the form of glycogen, which is kept in supply in the liver and the muscle. On average, the body loses 60 percent of its glycogen levels after an overnight fast from sleeping. A healthy person has plenty of cortisol to stabilize their blood sugar levels during the night.3,4 However, if a person has blood sugar problems, they are not able to tolerate an overnight fast and their body will go into a stress response when blood sugar levels drop. This will cause the adrenal glands to secrete epinephrine and norepinephrine to try to mobilize glucose.5-8 The release of these stimulatory hormones will cause the person to wake up during the night.

Adrenal Hyperfunction

Now let’s discuss patients who cannot fall asleep. These people typically have elevated cortisol, especially at night.9 Cortisol, a hormone that is released by the adrenal cortex, helps stabilize blood sugar levels during the day. Cortisol is released during the day in between meals, when blood sugar levels need to be maintained. When blood sugar levels drop, the body releases cortisol to maintain blood sugar levels.10,11 It does this by releasing glucose from stored glycogen levels. The normal circadian release of cortisol is high in the morning, with levels that drop as the day goes on. An abnormal circadian release of cortisol is when the levels stay high all day. When the levels are high at night instead of normally low, a person will not be able to fall asleep, due to the excitatory effect cortisol exerts on the nervous system.12

The only reason for a physiologically abnormal circadian of cortisol is the body being placed in an alarm or stress reaction. An alarm pattern will place extra demands on the body that the adrenals will have to compensate for. If a person is having severe episodes of emotional or mental stress, for example, the body needs extra glucose to meet the metabolic activity caused by this type of stress; to compensate, the body releases cortisol to increase systemic glucose levels and produce more ATP for the extra demands.

Many other physiological patterns can cause elevations in cortisol, such as food sensitivities, which can activate the gut-associated lymphoid tissue and place the body in an alarm pattern. Also, pathogenic organisms, including parasites and other inoculations, can elevate levels. The bottom line is that any type of stress – mental, physical or physiological – can lead to elevated levels of cortisol; often, it is a combination of factors that contributes to the dysfunctional pattern.

Steps to Address Insomnia

There are three steps required to fix these patterns. The first step is to support the patient’s adrenal glands with nutritional supplements. The second step is to help them stabilize their blood sugar levels during the day. The third step is to have them perform relaxation techniques to manage their stress response.

Step 1

Let’s discuss the first step, which is related to taking nutritional supplements. One of the most effective supports for this pattern is adrenal adaptagens. Adaptagens are plant compounds that have a normalizing impact on the hypothalamus-pituitary-adrenal feedback loop. When used with patterns that have elevated ACTH and cortisol, adaptagens decrease their output. When used with patients who have adrenal hypofunction, adaptagens tend to improve the response to secrete ACTH and cortisol. The most important adaptagens for the adrenals include Panax ginseng, Siberian ginseng, ashwagandha, rhodiolia, Boerhaavia diffusa, pantethine, and holy basil leaf extract.13-23

These patients also require nutritional support to stabilize their blood sugar. This support should be in the form of B vitamins, chromium, vanadium, inositol, L-carnitine, alphalipoic acid, magnesium, and niacinimide to improve the blood sugar balance and support adrenal function.24-30

Step 2

The second and most important step is for the patient to learn to stabilize their blood sugar levels during the day. The patient should never skip breakfast and should eat a breakfast that is protein dominant. For example, the worst breakfast they can eat is a bowl of cereal with toast and juice. This type of breakfast has a very high level of sugar and will cause severe stress to the adrenal glands, especially after the body has been in a state of fasting from time spent sleeping. An ideal breakfast is a high-quality protein shake or some type of meat. The patient also should avoid adrenal stimulants such as candy, soda, fruit juice, coffee and allergic foods. Instruct the patient to eat every two to three hours, consuming low-glycemic foods such as nuts, seeds, hard-boiled eggs or vegetables. Frequent meals with low-glycemic foods take the load off the adrenals and allow them to recover.31 This, in addition to appropriate nutritional supplements, can have a profound regenerating impact on these dysfunctional patterns.

Step 3

The final step is related to performing simple exercises to reduce the stress response. It should be noted that stress will always impact blood sugar levels, and blood sugar imbalance will always decrease a person’s ability to deal with stress. Too many times, insomnia is blamed solely on excessive stress. Stress may be the trigger, but if the adrenal glands are supported during the stress response, the patient may not suffer from the physiological side effects such as insomnia. Let’s discuss two simple exercises that should not take more than five minutes per day to perform, but will have profound impacts on physiology.

The first exercise involves positive mental imaging. This exercise requires the person to think about the stressful events of the day. They are required to place themselves back in the moment while utilizing as many senses as possible. Once the stressful event has been established, they re-create the scenario while adding humorous and cartoon-like features to the people in the scene. For example, if they had a negative experience of being scolded by their boss, they picture their boss with a big clown nose and goofy ears until the scenario becomes humorous in their minds. They are required to go through all the stressful images of that day, incorporating positive imagery into each one of those scenes.

The second exercise is a muscle contraction/relaxation-type of activity. The exercise starts by having the person lie on their back in a quiet area and close their eyes. The technique requires that they contract a group of muscles for two seconds. They start with their facial muscles and go up and down their body with different muscle groups, such as their quadriceps, hamstrings, calves, toes, abdominals, pectorals, triceps, fingers, etc. They do these exercises until they have gone through each muscle two or three times. When finished with the exercise, they lie on their back and take long, deep breaths as long as desired.

In conclusion, insomnia is typically caused by some type of stress response. This stress response will have an adverse impact on the adrenal glands and blood sugar stabilization. This will cause a vicious cycle that needs to be corrected by identifying and minimizing the stress, and taking appropriate nutritional supplements, such as blood-sugar stabilizing products and adaptagens. Not only will correcting this pattern improve sleep patterns, but it also will improve the patient’s physiology. Once the appropriate support and lifestyle changes are implemented, the patient will also notice elevated and stable moods, improvement in energy levels, and enhanced feelings of vitality and general wellness.32

References

1.J. Bolufer. Salivary corticosteroids in the study of adrenal function. Clinica Chimica Acta 1989;183:217-226.
2.B. Kahn, et al. Salivary cortisol: a practical method for evaluation of adrenal function. Biological Psychiatry 1988;23:335-349.
3.Davis SN, Tate D. Effects of morning hypoglycemia on neuroendocrine and metabolic responses to subsequent afternoon hypoglycemia in normal man. J Clin Endocrinol Metab 2001 May; 86(5): 2043-50.
4.Davis SN, et al. Effects of differing antecedent hypoglycemia on subsequent counter regulation in normal humans. Diabetes 1997 Aug;46(8):1328-35.
5.Matyka, Crowen, et al. Conterregulation during spontaneous nocturnal hypoglycemia in prepubertal children with type I diabetes. Diabetes Care 1999 Jul;22(7):114-50.
6.Bendston, et al. Nocturnal versus diurnal hormonal counter regulation to hypoglycemia in type I diabetic patients. Acta Endocrinol 1993 Feb;128(2):109-15.
7.Garrel, et al. Decreased hypoglycemia effect of insulin at night in insulin-dependent diabetes mellitus and healthy subjects. J Clin Endocrinol Metab 1992 Jul;75(1):106-9.
8.Burge, et al. Effect of short-term glucose control on glycemic thresholds for epinephrine and hypoglycemic symptoms. J Clin Endocrinol Metab 2001 Nov;86(11):5471-8.
9.Scott, Scandart. Nocturnal cortisol release during hypoglycemia in diabetes. Diabetes Care 1981 Sept-Oct; 4(5):514-8.
10.McGregor, et al. Elevated endogenous cortisol reduces autonomic neuroendocrine and symptom response to subsequent hypoglycemia. Am J Physiol Endocrinol Metab 2002 Apr;282(4):E770-7.
11.Davis, et al. Role of cortisol in pathogenesis of deficient counter regulation after antecedent hypoglycemia in normal humans. J Clin Invest 1996 Aug 1;98(3):680-91.
12.Davis SN, Shavers C, et al. Prevention of an increase in plasma cortisol during hypoglycemia preserves subsequent count regulatory responses. J Clin Invest 1997 Jul 15;100(2):429-38.
13.Avakia EV, Evonuk E. Effects of Pannax ginseng extract on tissue glycogen and adrenal cholesterol depletion during prolonged exercise. Planta Medica 1979;36:43-48.
14.Fulder SJ. Ginseng and the hypothalamic-pituitary control of stress. Am J Chinese Med 1981;9(2):112-118.
15.Filaretov AA, et al. Effects of adaptagens on the activity of the pituitary-adrenocortical system in rats. Biull Eksp Biol Med 1986;101:573-574.
16.Wichtl MW. Herbal Drugs and Phytopharmaceuticals. Ed. N.M. Bisset. Stuttgart: Medpharm Scientific Publishers.
17.Wagner H, et al. Plant adaptagens. Phytomedicine 1994;1:63-76.
18.Kapoor LDL. Handbook of Ayurvedic Medicinal Plants. CRC Press: NY, 1990 (337-338).
19.Wagner H, et al. Plant adaptagens. Phytomedicine 1994;1:63-76.
20.Mungantiwar AA, Nair AM, Shinde UA, Saraf MN. Effect of stress on plasma and adrenal cortisol levels and immune responsiveness in rats: modulation by alkaloidal fraction of Boerhaavia difuasa. Fitoterapia 1997;6:498-500.
21.Kosaka C, Okdio M, Keneyuki, et al. Action of panathine on the adrenal cortex of hypophysectomized rats. Horumon to Rinsho 1973;21:517-525.
22.Onuki M, Hoshino H. Effects of panathine on the adrenocortical function. Experimental results using rabbits. Horumon To Rinsho 1970;18:601-605.
23.Onuki M, Suzawa A. Effect of panathine on the function of the adrenal cortex. Clinical experience using pantethine in cases under steroid hormone treatment. Horumon To Rhinsho 1970;18:937-940.
24.Anderson RA, Polansky MM, Bryden NA, Canary JJ. Supplemental-chromium effects on glucose, insulin, glucagon, and urinary chromium losses in subjects consuming controlled low-chromium diets. Am J Clin Nutr 1991:54:909-916.
25.Cohen N, Halberstam M, Shlimovih P, et al. Oral vanadyl sulfate improves hepatic and peripheral insulin insensitivity in patients with non-insulin dependent diabetes mellitus. J Clin Invest 1995;95:2501-2509.
26.Shang H, Osada K, Maebashi M, et al. A high biotin diet improves the impaired glucose tolerance of long-term spontaneously hyperglycemic rats with non-insulin dependent diabetes mellitus. J Nutr Sci Vitamin 1996;42:517-526.
27.Jacob S, Henriksen EJ, Schiemann AL, et al. Enhancement of glucose disposal in patients with Type 2 diabetes by alpha-lipoic acid. Arzneim-Rosch Drug Res 1995;45(2):872-874.
28.Paolisso G, Sgambato S, Pizza G, et al. Improved insulin response and action by chronic magnesium administration in aged NIDDM subjects. Diabetes Care 1989:12;265-269.
29.Maebashi M, Makino Y, Furukawa Y, et al. Therapeutic evaluation of the effect of biotin on hyperglycemia in patients with non-insulin dependent diabetes mellitus. J Clin Biochem Nutr 1993;14:211-218.
30.Mingrone G, Greco AV, Capristo E, et al. L-carnitine improves glucose disposal in type 2 diabetic patients. J Am Coll Nutr 1999;18:77-82.
31.Winger, et al. Protein content of the evening meal and nocturnal plasma glucose regulation in type-I diabetic subjects. Diabetes Care 1993 Dec;16 Suppl 3:71-89.
32.Fruehwals-Schultes B, et al. Adaptation of cognitive function to hypoglycemia in healthy men. Diabetes Care 2000 Aug;23(8):1059-66.



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