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You are here because you have tried everything else. The natural stuff hasn’t worked for you. Maybe you’re taking medications or self-medicating just to get a few hours of shut-eye. Or maybe even those aren’t working for you anymore. Don’t worry, there’s still hope. For my patients with insomnia, I recommend the following:
1. Check your oxygen supply
Oxygen is the number one most critical fuel source that we have and it’s not only crucial for your sleep, it’s crucial for your life. You can go weeks without food, a couple days without water, but literally only minutes without oxygen. If anything is diminishing the oxygen supply to your brain during the day or night, it will interrupt your sleep.
Here are a few ways to tell if you’re not getting enough oxygen to your brain:
- You’re tired and pale
- You have trouble concentrating
- Your heart rate is fast (above 90 beats per minute at rest) and you feel it pounding
- You need to take deep breaths, or you sigh a lot
- You snore loudly at night
- Your feet and/or hands are cold and sometimes look blue
- Your feet and/or ankles are swollen and when you touch them the indentation stays even after you take your fingers away (pitting edema)
If you answered YES to any of the above, please call your doctor right away. These are serious issues that need to be addressed immediately. Very often there are functional things that can be done to improve your oxygenation, but the life-threatening variables need to be ruled out first and foremost.
2. Check your blood sugar levels
If your blood sugar is unstable, it could wreak havoc on your ability to sleep, as your brain needs a constant supply of fuel to function properly. Blood sugar swings can make your brain feel like it is starving and throw off your entire system. Dysregulated blood sugar can make it hard for you to get to sleep and/or stay asleep throughout the night.
If you crave carbs or sweets, have low energy during the day, have a hard time sleeping and/or have trouble losing weight, these are all warning signs that your blood sugar is not balanced. Blood sugar testing is simple and routine, and regulating blood sugar is one of the keys to health and wellness, including healthy, restorative sleep. Three important tests to have done are: fasting glucose, hemoglobin A1c and fasting insulin.
3. Test your hormones
A complete hormone panel is important to do when you suffer from insomnia.
I look at adrenal gland hormones, especially cortisol, and especially before bedtime, if sleep is an issue. Stress can cause spikes in cortisol levels; cortisol levels that are too high at bedtime or that increase during the night can keep you from sleeping, and not sleeping can put stress on the adrenal glands and lead to a very vicious cycle. Testing allows us to develop a plan to unwind the cycle and help normalize the stressed system.
Melatonin is an important hormone for sleep and normal circadian rhythms. It should be higher at nighttime and lower in the morning when it’s time to wake up.
If your sex hormones (estrogen, progesterone and testosterone) are out of balance, this can also greatly affect your ability to get to sleep and stay asleep. Your temperature regulation centers may also be affected by these hormone shifting and you could be too hot or too cold during the night.
Thyroid hormones that are too low OR too high can affect sleep and sleep quality. Thoroughly testing your thyroid function is important for helping you figure out why you aren’t sleeping well.
4. You could have an imbalance between the excitatory and inhibitory neurotransmitters in your brain
Neurotransmitters are chemical messengers that communicate information throughout your brain and body. In general, we have excitatory neurotransmitters that are important for wakefulness, learning and thinking. Inhibitory neurotransmitters are important to help us wind down, feel calm and to help us sleep (some neurotransmitters have both excitatory and inhibitory functions, depending on where their receptors are located).
To grossly oversimplify the function of neurotransmitters, think of the accelerator and brakes on a car. The accelerator is like the excitatory neurotransmitters. They get you moving and going. The inhibitory neurotransmitters are like the brakes. They slow you down and let you stop (sleep).
If you have too much excitatory and not enough inhibitory neurotransmitters, or if the areas of the brain that release these chemical messengers are overworking or underworking, you can experience insomnia (these imbalances may be seen along side other brain-based issues such as anxiety, depression, and trouble focusing, to name a few).
This is where functional neurology comes in, and a doctor who is certified in this field can detect these imbalances and develop a plan to help you. Specific brain-based exercises and natural neurotransmitter precursors can help balance your accelerator and braking system–your inhibitory neurotransmitters and the areas of the brain that produce them.
Sleep is important, and our bodies and brains will simply break down if we don’t have enough of it. Today in the functional medicine fieldswe have more tools than ever to help you experience restorative sleep naturally. Contact Dr. Engelbart today to schedule a consultation to determine the best plan of action for you!
The adrenal glands are small glands that sit above your kidneys, but don’t let their size fool you. They are a very important part of your body, especially when it comes to energy production and managing stress. They also work hand-in-hand with:
- Your pancreas for blood sugar regulation;
- Your thyroid for metabolism;
- Your other hormones such as progesterone, estrogen and testosterone; and
- Important brain chemicals called neurotransmitters.
If you’ve been under a lot of stress or experiencing imbalances in any of the above systems, your adrenal glands could need some TLC.
Five Warning Signs:
If you are having trouble dragging your body out of bed in the morning, suffering a mid-afternoon slump, relying on caffeine to get you through the day, or falling onto the couch in a heap after you get home from work, you are experiencing fatigue. Better do something about this now, while you can at least still drag yourself out of bed and before this fatigue becomes more chronic and severe.
Your adrenal glands produce cortisol, and normally they should be able to produce a healthy dose for you first thing in the morning, as part of a normal circadian rhythm. This high dose in the AM helps you get out of bed and take on the day.
It’s no surprise then, that the fatigue caused by adrenal gland dysfunction is especially noticeable first thing in the morning. You may also notice a significant slump in the mid-afternoon, and generally low energy throughout the day. You may also notice that after you have a busy, high-demand day, or miss a night of sleep, that you can barely function the following day.
As fatigue gets worse, you rely more and more on your thyroid gland to help you out to produce more energy. Soon this gland can get overworked as well. Thyroid dysfunction and adrenal gland fatigue are almost always seen together.
2. Trouble getting to sleep or staying asleep
It seems counterintuitive because (as mentioned in warning sign #1), you’re sapped of energy and tired most of the day. But when you finally get the chance to crawl into bed, you may find that you cannot wind down, or that you don’t get restorative sleep.
If you are like many of my patients, you feel like you are finally getting your deepest sleep right about the time your alarm clock is set to go off. After hitting snooze repetitively, it’s time to start the day and do it all over again.
Normally, cortisol levels should fall gradually throughout the day, and be nice and low at bedtime. If your cortisol level elevates in the evening, or if it spikes during the night, you won’t be able to sleep.
And here’s the Catch-22: lack of sleep puts additional stress on your system, putting even more of a burden on your adrenal glands.
3. Craving carbs and salt
When you are under stress and tired, your brain knows you need fuel so that it, and you, can function. And the fuel it craves is easy-to-digest simple carbohydrates that it can quickly use for energy.
Most patients describe to me that they don’t want anything in the morning except a cup of coffee and maybe a piece of toast or cereal. But then they have cravings and hunger throughout the day. A lack of appetite in the morning is a cardinal sign of blood sugar imbalance, and very commonly seen accompanying adrenal gland fatigue.
The cravings for salt and sugar are a compensation mechanism. Your body knows that eating will boost your cortisol levels to give you some much-needed energy and make you feel a little less dead.
The problem is that this creates a vicious cycle. The more simple carbs you eat, the more of the same you crave. Your blood sugar spikes and then plummets, and the easy, yummy pick-me-up needs to happen more and more frequently. This causes blood sugar dysregulation and insulin resistance. Excess weight comes on and won’t come off, and energy becomes non-existent without a caffeine or carb boost.
Adrenal fatigue and blood sugar imbalances like reactive hypoglycemia (low blood sugar), insulin resistance, and pre-diabetes go hand in hand.
The adrenal glands also help regulate sodium, potassium, magnesium and chloride levels in the blood through a hormone called aldosterone. If your adrenal glands are fatigued, you might not be producing enough aldosterone and will crave salt. Craving salt is a sign of mineral imbalance, and is a tell-tale sign of adrenal gland fatigue.
4. Inability to handle stress
Are you feeling like everyone and everything seems to be on your very last nerve these days? Are you baffled at how short your trigger is, and the way your body spirals into fight-or-flight mode at the drop of a hat?
Maybe one of your kids spills his oatmeal right before you’re headed out the door, or someone at work makes a joke that you don’t think is particularly appropriate. Your logical brain knows it’s probably not that big of a deal, but your body reacts automatically and immediately, sending you into full-fledged fight-or-flight mode. Your heart races, your body and hands tremble a little, your face gets flushed, and you feel like you are about to jump out of your skin. You know it’s an overreaction, but you don’t know how to stop it.
This trigger-effect usually happens when you have experienced a significant stress in the past, and your body has not been able to get back to the normal set point you once had. You are stuck in high-stress survival-mode and your nervous system is now wired to release excitatory neurotransmitters that signal a surge of cortisol to come crashing out when only a little would do the trick. This trigger-happy state is not a good or healthy place to live, for you OR your family members, friends, or co-workers. In addition, this systemic overreaction can plummet you further into the adrenal-fatigue downward spiral.
5. Decreased sex drive (libido)
When you are under constant stress, sex becomes very low on the list of priorities. This is because your system is prioritizing other functions it deems more necessary for your survival, and is in the full-time business of making cortisol whenever and however it can.
When your system runs out of raw materials to make cortisol, it starts to steal other hormone raw materials to make more cortisol. The result is that your sex hormones diminish and become imbalanced, and sex just doesn’t sound so good anymore.
If you have your hormones tested, the results may show low or imbalanced hormone levels. If you try to supply more estrogen, progesterone of testosterone hormone to your body (synthetic, natural, or bioidentical), your body will likely take these hormones, break them down and try to make cortisol out of them. This result is certainly not a long-term solution or cure, and can leave you feeling worse than ever.
Your hormone levels should be tested along with your cortisol levels so your doctor can determine if cortisol is running the show. Getting to the true cause of the problem will likely involve some type of adrenal gland support.
What Should You Do?
The key is to have the appropriate testing done. Test your adrenal glands along with your other related systems (blood sugar, hormones, neurotransmitters, for example). Nothing in your body works in a vacuum. You and your doctor need the complete picture of what your body and brain need to re-balance.
Lab testing can help determine what’s out of balance, and then Dr.Engelbart can customize a sound dietary, lifestyle, and supplement plan to help turn it around. A simple saliva test can show what cortisol is doing throughout the day, and this can be compared to how your blood sugar, other hormones and neurotransmitters (especially norepinephrine, and epinephrine) are functioning.
NOW is the time to address your adrenal fatigue and start on the road to recovery. Schedule a consult with Dr. Engelbart today.
Cortisol has a bad reputation. Dubbed “the stress hormone,” it’s tagged as the causative factor for belly fat and stress-related disorders. And it’s true that excess cortisol over long periods of time can cause breakdown of bone and muscle, and it can lead to fatigue, weakness, and emotional problems. But that’s not the end of the story.
Cortisol plays a vital role during times of stress, and is important for proper immune system function. It has powerful anti-inflammatory effects — think of cortisone shots and prednisone prescriptions — and is involved in every aspect of metabolism of our macronutrients (protein, fat, and carbohydrates). In adrenal gland fatigue or insufficiency, LACK of cortisol has been linked to extreme fatigue, allergies, arthritis, weight gain, and low brain function.
Cortisol levels should follow a normal circadian rhythm, with a peak level in early morning, followed by a gradual decline to reach the lowest level by midnight. When cortisol follows this rhythm as designed, we have energy in the morning and can fall asleep easily at night. If it does not follow this rhythm (for example, if it spikes at night time, or does not reach a peak in the morning,) our entire wake-sleep cycle is affected.
So how do you know if your health problem is cortisol-related? And how do you know if it’s too low, too high, or out-of-rhythm? The answer is simple: TEST IT.
Cortisol testing involves a simple saliva sample. We usually ask our patients to do four throughout the day to track their circadian rhythm. We also measure DHEA, which is another adrenal hormone that is very important in staving off early aging, and in balancing the effects of cortisol. If sleep is an issue, we can add melatonin testing to the testing panel. Melatonin is one of the most powerful antioxidants known to man, and has been used to help with other disorders such as migraine headaches.
This is one of the simplest lab tests you could ever do, and the information you get back could be life-changing. Here are a few key reasons to CONSIDER TESTING YOUR CORTISOL LEVELS:
- Inability to handle stress
- Insomnia (inability to get to sleep or stay asleep)
- Adrenal gland dysfunction
- Thyroid dysfunction
- Inability to lose weight or gain weight
- Osteopenia or osteoporosis
- Low muscle tone
- Joint dysfunction
- Frequent infections
- Brain fog
- Memory loss
- Frequent headaches
- Low mood, mood swings, or irritability
- Prednisone or cortisone use, current or past
If your symptoms match any of the above, it’s time to take action. Contact Dr. Engelbart today to enquire about testing your cortisol levels.
4 Warning Signs You Shouldn’t Ignore
Hormones are involved in almost every function of the body, from reproduction to metabolism to digestion to hair growth. Women’s hormonal systems are more complex than men’s, and it takes a skillful eye to determine what is out of balance and the best course of action to establish synergy and homeostasis in the body.
Too often doctors have used an overly simplistic approach to try to address women’s hormones, and have used harmful, synthetic substances to take the place of our natural hormones. A better approach is to first find out what’s out of balance and WHY, and then customize a plan to help restore balance in the most natural way possible.
Below are 4 warning signs that your hormones are out of whack, as well as recommended tests to help you and your doctor figure out how to get you back in synch.
- Your Energy and Motivation Are On the Floor.
An imbalance in virtually any one of your hormones can lead to fatigue and loss of motivation. The most common one we think of is low thyroid hormone. However, high thyroid or autoimmune thyroiditis (Hashimoto’s Disease) can lead to debilitating fatigue as well.
Low OR high cortisol levels can cause fatigue and sleeplessness, and surges in insulin or insulin resistance can lead to fatigue after meals, waking at odd hours of the night, and can affect fuel delivery to the brain which can lead to brain fog.
Progesterone is another hormone that can cause fatigue if it is out of balance with estrogen. Estrogen dips can cause tiredness as well, and testosterone that is too low, even in women, can leave you feeling like a weakened shell of yourself.
It’s important to have all these hormones tested, test blood sugar levels and check for anemia to find out where the fatigue is truly coming from. In addition, it can be helpful to look at the neurotransmitters dopamine, norepinephrine and epinephrine, as these are all intimately involved in motivation, energy and metabolism.
- Your Moods Have You On A Roller Coaster Ride…and You Want To Get Off.
If you find that you are not handling stress well, happy one minute but crying the next, feel like a different (worse) version of yourself, and like everything and everyone is on your last nerve, these are all warning signs that your hormones are out of whack.
This could be due to adrenal gland fatigue, where your cortisol levels are simply not able to keep up with the continuous stress you have been under. Cortisol levels become erratic and you find you can’t handle the stresses of every day life like you used to.
Or it could be due to your sex hormones being out of balance. This is usually most noticeable before your period (yes, PMS is a real medical condition). In some women this can be severe, and is known as PMDD: premenstrual dysphoric disorder. With PMDD the mood swings before your menstrual cycle can be severe and debilitating. Symptoms can include anxiety, depression and physical pain such as joint and muscle pain as well.
Irregular cycles are another warning sign that your mood swings are hormone-related, as is heavy bleeding during your menstrual cycle.
Women may also start to notice mood swings when they reach perimenopause, a time in our lives when our sex hormones are decreasing, and more stress is put on the adrenal glands to pick up the slack.
All of the sex hormones should be tested, along with adrenal hormones Cortisol and DHEA. In addition, it can be helpful to look at the neurotransmitters Serotonin and Dopamine, as they are both involved in mood stability.
- You can’t lose the weight.
You’ve tried all the diets, you’re being consistent with your workouts, but the weight is Still. Not. Coming. Off. This is a warning sign that your hormones could be out of balance.
When this is happening it’s very important to do a FULL thyroid panel. This means having not only your TSH checked, but also free T4, free T3 and other aspects of a full thyroid panel. I also strongly recommend testing thyroid antibodies, as autoimmune thyroiditis (where your immune system attacks your own thyroid) is the number one cause of thyroid problems in the United States. Effectively treating this condition is vastly different than treating a thyroid that is simply underworking.
Checking adrenal gland hormones cortisol and DHEA is important as well. The best way to do this is with a saliva test. The adrenal glands and thyroid gland work hand-in-hand with one another (which is why the symptoms of dysfunction in either one look very similar). Usually when one is faltering, the other is in trouble too.
I also recommend looking at blood sugar levels and insulin, liver and kidney function, inflammation levels, and other aspects of the immune system that can cause weight to hang on.
- Sex is the last thing on your mind.
There are many reasons that women can experience a drop in sex drive and desire, but hormone imbalance has to be at the top of the list of things to consider. After all, doctors estimate that up to 70% of our libido is hormonally mediated.
Low testosterone, and/or an imbalance between the estrogens and testosterone in a woman’s body can put your libido on the floor. Progesterone levels that are either too low or too high can also be a culprit.
One commonly overlooked hormone connection to look at is how the adrenal glands interplay with the sex hormones. It makes sense that when we are chronically stressed, sex is literally the last thing on our minds. Our bodies are saving energy and resources for what it considers life-saving functions, and sexual desire and activity many times just don’t make the cut. Testing the adrenal hormones in addition to sex hormones is an important step to take to get your healthy sexual desire back.
Side effects of medications is another common contributor to low libido. So you have to ask: if your medication is causing this effect, what else is it doing to your brain, body and hormones? It doesn’t hurt to have a conversation with your doctor about other options or alternatives.
If you answered YES to any one of these four warning signs, you should have your hormones tested. Contact Dr. Engelbart today to schedule a consultation to discuss exactly what testing would be right for you. It’s time to get your hormones back in line. It’s time to experience Your Top Life TM.