The adrenal-sleep connection

Many people with CFIDS and/or Lyme Disease have sleep problems. Often they search for ways to help sedate themselves to sleep better, or ways to restore proper melatonin production, or address imbalances. There is another possible explanation that fits CFIDS and Lyme becasue of the adrenal exhaustion common in these conditions. People with depleted adrenals often can not sleep well because adrenals support sleep. They often can finally sleep once they start on cortisol replacement. In fact this has been a popular discussion on an adrenal list I belong to - how many of the people can sleep finally after years of sleep difficulties, once they get the proper adrenal support. And salt IS an adrenal support. It is almost as good as cortisol. I have been on both cortisol and salt/c and have experienced that it is the same type of benefit, the adrenal support helps the sleep (in my case and in others also). Probably also the salt is improving the digestive dysbiosis which means less toxins to detox during the night. But if this is the primary benefit, it will probably wax and wane as you herx. So how do you know if your adrenals are shot? Is there a test? Or is it obvious if you are living in chronic fatigue and pain that they're gonners. And what about cortisol replacement? Is that safe? Here is what I have learned about these questions.

The primary symptom of exhausted adrenals for me is that energy ‘runs out’ early in the day (say, around 12-2 PM), I feel horrible when I get an ordinary virus – like I might die, and any stress at all saps so much energy that I must lay down. Also, sleep problems and chronic kidney-area pain or lower back pain whenever I lay down and relax. There are others but I would say these are primary. The problem is that when adrenals are exhausted they have actually lost some of their capacity, and therefore a person with exhausted adrenals is living with a condition that is basically a sub-clinical form of Addison’s Disease. I believe that a LOT of late stage Lymies have this and do not realize that it is an actual injury to the adrenals that should be addressed separately.

Also, one of the most telling symptoms is to lose all body hair from the lower legs, and eventually the upper legs as well. This is a strong indicator of adrenal exhaustion, but it reverses when the adrenals heal. BTW, my adrenals are slowly healing on salt/c, but I still have to treat them, and I must support them well during bad herx cycles.

There are several tests, the most useful is the Adrenal Stress Index (ASI), which is a very simple saliva test you take at home and send to the lab. You take several samples over a 24-hour period. This shows the levels of many adrenal hormones, and compares them to normal. A typical person with adrenal exhaustion has levels about half of normal, although sometimes there are reverse levels also (one time of day the cortisol is too high, another time of day it is too low), which show general regulation problems from chronic infection load. Most doctors who are ‘into’ natural medicine know about this test. A good place to get the ASI test based on a phone consultation is http://www.chronicfatigue.org/ – they have reasonable rates and are a non-profit treatment center for adrenal-related issues.

Cortisol is a hormone that is involved in adrenaline production, it is a safe supplement to take, but if a person takes too much the body may become dependent. However, there was controversy over this drug early on because its over-use caused problems. Then a Dr. Jeffries proved a number of years ago that a level not exceeding half the biological dose is safe and will not alter the body’s metabolism in any negative way. Taking too much is a problem because when we have high adrenal levels the immune system is depressed. There was a lot of misinformation about this about 20-30 years ago, and that still persists in the minds of many medical practitioners.

Some recent research has proven that about half of the people with chronic fatigue syndrome have adrenal glands that are half the size they should be based on body mass. I don’t think the reason is clear yet, either atrophy or genetics, but it was a surprise to learn this. Some people just seem to have low adrenal capacity. And as adrenals are taxed heavily with chronic infections, this is a big issue.

There are other ways to boost the adrenals, such as licorice root and salt. Because I have chronically exhausted adrenals and probably have lost some adrenal function (For now anyway) I must take adrenal support every day. On days when I go off salt (I try to take a day off now and then to rest the kidneys), I must take cortisol (Cortef) or a lot of licorice. The typical healthy adrenal gland makes 40mg of cortisol per day. I usually take 5-10mg of cortisol on days off salt, or days with high stress. So probably my daily adrenal production is lower than it should be by at least that amount. Many people take 20mg daily, and for some this has completely reversed their health problem (usually chronic fatigue type issues).

Historically, licorice was the natural treatment for Addison’s, because it acts as a re-uptake inhibitor for adrenaline. Some people treat only with licorice and adrenal extracts. I use very small amounts of licorice only because large quantities of licorice increase estrogen and lower testosterone levels. But in small quantities it does not seem to be a problem.

There are many other herbs that can be helpful in treating adrenal exhaustion. If you are serious about this topic I would recommend getting the book ‘Adrenal Fatigue’ by James Wilson (he is unique, he is an ND and DC with a PhD in nutrition). There are dozens of books on the subject but this one seems to be one of the most highly regarded, and his program does help many people, without using cortisol.