The Connection Between Chronic Illness, Cortisol, and Sleep

How Your Chronic Illness and Poor Sleep May Be Related to Adrenal Function

Depressed woman with head in hands
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A big focus in anti-aging medical science today is understanding how the hypothalamus, pituitary gland, and adrenal glands act together in concert. All three glands together are referred to as the hypothalamic-pituitary and adrenal axis or HPA axis for short. With this focus on the HPA axis, it has become more common in the treatment of chronic illness to look for deficiencies or abnormalities in the HPA axis through personalized and specialized testing.

It is believed that by understanding how stress, sleep, and chronic illness affect the HPA axis, a personalized treatment plan can be developed. As a result, there have been multiple recent studies in these areas.

The Relationship Between PTSD, Cortisol, and Sleep

In the study and treatment of post-traumatic stress disorder (PTSD), both abnormalities in the HPA axis and sleep disturbances have been identified as common symptoms and concerns. In an effort to study whether the abnormal HPA axis function and sleep disorder in people with PTSD are related, a study published in the journal Neuropsychopharmacology in 2005 evaluated twenty male patients diagnosed with post-traumatic stress disorder.

The PTSD Study

In the study, the twenty men were compared to a control group of sixteen individuals. Both groups had their sleep patterns monitored overnight via a polysomnography. Levels of adrenal cortisol (one of the hormones associated with healthy adrenal function and homeostasis) were also measured, including a 24-hour urinary collection.

The authors noted that those study participants with PTSD had higher than normal cortisol levels in their urine when compared to the control group, which ultimately led to some interesting conclusions.

Conclusions About Cortisol and Sleep

One of the conclusions that the study authors reached was that the presence of increased urinary cortisol is, in fact, associated with decreased delta wave sleep.

In other words, having higher than normal cortisol levels affects your ability to transition into a "deep sleep." The fourth stage of sleep after delta wave sleep is called REM sleep, the stage in which dreaming occurs. Those suffering from PTSD are likely never able to achieve REM sleep, a finding that will have significant impact on the understanding or the condition and the treatment and recovery.

But the study findings go beyond just the understanding and treatment of PTSD. It is this relationship between adrenal cortisol and deep sleep that may be responsible for the sleep disturbances common in other conditions characterized by increased levels of cortisol.

The Relationship Between Chronic Illness, Cortisol, and Sleep

Much like the study of PTSD, cortisol levels, and sleep disturbances, there has been several other notable studies about the relationship between cortisol secretion and sleep in other chronic illnesses. One of the most interesting was a meta-analysis published in the journal Psychoneuroendocrinology in 2013.

The meta-analysis was a review of nineteen related articles that the study authors analyzed looking for important similarities and differences in observations and conclusions.

The Chronic Fatigue Syndrome Meta-Analysis

The investigators looked at nineteen other articles that evaluated cortisol levels in subjects with chronic fatigue syndrome (CFS). They all had one similarity: an increase in overnight cortisol production. If chronic fatigue syndrome is associated with increased urinary cortisol excretion, then what is the expected sleep pattern of someone with CFS? Based on findings like those from the PTSD study above, one would expect their sleep quality to suffer, particularly with regards to deep sleep and REM sleep. Another study of people with CFS shed light on the sleep experience.

The Chronic Fatigue Syndrome Sleep Study

The study published in Sleep Medicine Reviews journal in 2014 attempted to study the presumed sleep impairment in people with Chronic Fatigue Syndrome. What is interesting in this study's findings is that there was no significant differences in the sleep patterns on polysomnography between those with CFS and those in the control. Despite having no significant difference in sleep patterns, all study participants with CFS reported not experiencing a "restorative sleep." The subjective and experiential difference may be due to the cortisol.

What This Means for People with Chronic Illness

As a doctor of osteopathy and board-certified internist, I believe that stress and chronic illnesses like CFA and fibromyalgia are associated with not only adrenal fatigue but also alterations in the HPA axis. How do you test for this? This requires specialized testing by a trained practitioner in anti-aging medicine. Their focus of treatment is multifaceted and involves an evaluation of nutrition, your inflammatory status and risk, your sleep patterns, and your hormonal profile. I truly believe that this approach is the future of not only the treatment of chronic illness but medicine in general.

Sources

Mariman, An N., Dirk P. Vogeelaers, Els Tobback, Liesbeth N. Delesie, Ignace P. Hanoulle, and Dirk A. Pevernagie. "Sleep in the Chronic Fatigue Syndrome."Sleep Medicine Reviews17.3 (2013): 193-99.

Otte, Christian, Maryann Lenoci, Thomas Metzler, Rachel Yehuda, Charles R. Marmar, and Thomas C. Neylan. "Hypothalamic–Pituitary–Adrenal Axis Activity and Sleep in Posttraumatic Stress Disorder."Neuropsychopharmacology30.6 (2005): 1173-180.

Powell, Daniel J.h., Christina Liossi, Rona Moss-Morris, and Wolff Schlotz. "Unstimulated Cortisol Secretory Activity in Everyday Life and Its Relationship with Fatigue and Chronic Fatigue Syndrome: A Systematic Review and Subset Meta-analysis."Psychoneuroendocrinology38.11 (2013): 2405-422.

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