When Is It Time To Talk To Your Doctor About Sleep Challenges
According to Dr. Luo, it’s important to talk to your healthcare provider about sleep if you’re experiencing daytime fatigue or sleepiness, drowsiness while driving, or cognitive difficulties. Your healthcare provider will ask about your typical sleep onset and wake-up times , total sleep time on average, whether or not you work in shifts, and your quality of sleep. There’s also something called the Epworth Sleepiness Scale that can help doctors evaluate your sleep issues.
“The doctor’s initial goals are to assess for medical, neurological, or mental disorders that can affect sleep including the effects of medications or recreational drugs,” says Dr. Luo. “And to rule out any specific sleep disorders, like obstructive sleep apnea and restless leg syndrome.”
You and your healthcare provider can work together to find the best treatment for extending and improving your sleep duration whether or not issues are caused by your hormones.
Addisons Disease And Adrenal Insufficiency
Addisons disease, also called primary adrenal insufficiency, is a rare disorder. It occurs when your adrenal glands produce too little cortisol. This disease can be caused by:
- an infection
Secondary adrenal insufficiency is more common than Addisons disease. If your pituitary gland is functioning as it should, it releases ACTH, which in turn signals your adrenal glands to make cortisol when your body needs it.
But with secondary adrenal insufficiency, theres a problem with your pituitary gland. As a result, your adrenal glands dont receive the signal to make cortisol when you need it. If your adrenal glands dont get that message, they may eventually shrink.
Disrupted cortisol levels dont only impact your ability to sleep. They can also affect other aspects of your health. For instance, disrupted cortisol levels can cause:
- changes in your metabolism
Balancing your cortisol levels can take time. While youre working on it, here are some ways you can aim for a better nights rest:
Sleep Inducing Hormone: Difference In Sleep Patterns By Gender
Women tend to have shorter circadian rhythms and sleep and wake up earlier than compared to men. Research also indicated that women have better nights sleep as they sleep longer hours than men as they have less wake time.
However, women are more at risk of insomnia than men due to hormones that affect sleep like the melatonin effects. Hormonal imbalance during menopause and menstrual cycle as age affect sleep patterns and cause insomnia.;
To learn about what affects sleep and tips for better sleep keep following this space.;
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Light Control Of Pineal Melatonin Secretion
It has been suspected for some time that different photoreceptors subserve sight and melatonin production. Thus, some blind people without pupil light reflexes have light-induced suppression of melatonin secretion; their eyes serve more than a cosmetic function as they do not report insomnia. Conversely, blind patients without light-induced suppression of melatonin do have sleep disorders.
A non-rod, non-cone photoreceptor was suspected when transgenic mice lacking both rods and cones were nevertheless found to have light-responsive clocks. Furthermore, monochromatic blue light of 446477nm wavelength was found to be the strongest input for melatonin regulation in healthy subjects, suggesting that a photo pigment distinct from that of rods and cones was responsible for melatonin regulation.
It is thought that at least one other photopigment must be involved in lightdark circadian rhythm entrainment because mice without melanopsin have an attenuated but recordable bright light phase shift in circadian rhythms. Also vitamin A depletion does not degrade pupillary light responses and circadian entrainment to lightdark cycle, and not all ganglion cells that project to the suprachiasmatic nucleus contain melanopsin.
Currently, cryptochromes that function in blue light are considered likely candidates. Cryptochromes undergo a conformational change on exposure to light and are involved in light responsive induction of c-fos in the suprachiasmatic nucleus.
Circadian Rhythm And Hormones
Circadian rhythm in humans depends on the daytime and nighttime and guides our body processes accordingly. However, there are individual differences among people; such as when we prefer to get up, have a meal, be productive, etc. These differences are known as chronotypes. Regardless of your chronotype, one thing all people have in common is that they are most active during the day and sleep at night. Here are examples of how some hormones fluctuate throughout the day. Note that not all hormones are strictly linked to our circadian rhythm.
Melatonin, for example, is the lowest in the morning this is when we feel the most refreshed and energetic. It slowly increases during the day, though almost unnoticeably. Melatonin increases sharply after 8 pm and reaches its highest point at about 4 am, after which it plummets back to normal daily levels.
Cortisol, the stress hormone, is low at night. That is because our body is relaxed during sleep. If we get too stressed and our adrenal glands produce too much of stress hormones, we might be unable to fall asleep. Cortisol peaks at about 7-8 AM the time when we are supposed to wake up.
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Circadian Rhythm And Energy Homeostasis
Energy metabolism is regulated by many hormones, enzymes, and transport systems, and circadian rhythm effectively modulates their expression, secretion, and/or activation . The metabolic pathways that provide energy homeostasis are coordinated by metabolites that propose changes and proactively prepare the molecular environment as well as acute signaling systems that respond instantaneously to changes in circadian clocks .
Hormone receptors, interactions between genes, and intracellular oxidation/reduction reactions drive the regulation of energy metabolism at the cellular level. These pathways have important interactions with the biological metabolism clock. The circadian clock can affect the function of hormone receptors and some genes at the cellular level .
Nuclear hormone receptors and ligands present in metabolic tissues function as sensors that combine circadian and metabolic pathways . For example, PPARs are a link between the circadian clock and energy metabolism. PPAR localizes in adipose tissue and activates transcriptional factors that increase lipogenesis and lipid storage. PPAR from nuclear hormone receptors triggers ketogenesis and hepatic fatty acid oxidation in response to starvation. PPAR is the most prevalent nuclear cell receptor in the body and is able to correlate daily changes in body temperature with the circadian clock .
Hormones Temperature & Sleep
Hormones are big player when it comes to sleep. Whether you are a night owl, a parent with small children or someone who does shift work hormones are what help you regulate.; Womens hormones add another layer to how we sleep and its not just at menopause.; Im excited to dig into the role of body heat with regards to hormones and sleep.
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How Will A Doctor Diagnose Irregular Sleep
Your doctor will ask you about recent sleeping habits. Theyll also ask about ongoing issues with insomnia or excessive sleepiness during the day.
Your doctor may use a sleep diary and an actigraph to help diagnose irregular sleep-wake syndrome. A sleep diary involves keeping a record of how long and when you slept over a set period. An actigraph is a device that resembles a watch and tracks your sleep-wake patterns.
These tools will likely be used to track your sleep for at least 7 days. A physician will look for a minimum of three cycles of sleeping and waking within a period of 24 hours to make a diagnosis.
Cortisol And Sleep Cycles
Sleep isnt a steady state. Your body goes through various stages of sleep each night.
Non-REM sleep has 3 stages.
- Stage 1. This stage lasts a few minutes as you drift from being awake to being asleep.
- Stage 2. Your bodys systems relax further, your core temperature drops, and your brain waves are slower. You spend about 50 percent of your sleep cycle in this phase.
- Stage 3. This phase is also known as slow wave sleep. Its when your heart rate, breathing, and brainwaves are slowest.
REM sleep is the part of your sleep cycle when you have vivid dreams.
A sleep cycle lasts about 90 minutes, and during that time you move through these four stages of sleep.
Most of your deeper slow wave sleep happens in the first half of the night, while REM sleep happens more during the second half of the night.
Researchers have found that when the HPA axis is overly active, it can disrupt your sleep cycles, causing:
- fragmented sleep
- shortened overall sleep time
Those sleep disturbances can wreak further havoc on your HPA axis, distorting your bodys production of cortisol.
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The Role Of Suprachiasmatic Nucleus And Circadian Rhythms In Sleep
The way our master clock functions is primarily through light exposure. As the figure below shows, when a person is exposed to natural daylight, there is a process taking place which stimulates a series of nerve reactions.
In particular, there are certain photoreceptive ganglion cells in the retina of the eye, which consist of a specific pigment called melanopsin. A specific connection named retinohypothalamic tract reaches the anterior hypothalamus, the area in which the SCN lays. Melanopsin is light-sensitive and even detects blue light.
Interestingly enough, even blind people can detect these light-dark cues with eyes shut. These signals travel via the optic nerve to the suprachiasmatic nucleus, which then are used to reset its circadian clock on a daily basis.
Melatonin secretion and sleep regulation
Melatonin is quite significant in regulation sleep and other activities in the body.
The suprachiasmatic nucleus regulates melatonin secretion by the pineal gland responding to the environmental light-dark cycle.
Melatonin sends the message of both the time of day and the time of the year to all the body tissues.
It has been recently found that abnormalities in the circadian control of melatonin secretion are linked with sleep disorder related with aging and different degenerative and developmental disorders.
There are however other more permanent situations, when irregularities in the circadian rhythms could lead to conditions like:
How To Choose Melatonin Supplements
Melatonin is sold in the U.S. as a dietary supplement and not as a medication. This is a vital distinction because it means that melatonin products are not closely regulated by the Food and Drug Administration .
A wide range of brands with varying formulations and dosages are available over-the-counter in groceries and drugs stores, but there are important quality differences to look out for. A study that reviewed 31 melatonin supplements found major inaccuracies in dosage information; 71% of the tested products were not within 10% of their listed dosage. An incorrect dose of melatonin can have meaningful consequences including a higher risk of side effects and reduced supplement effectiveness.
Some products labeled as only containing melatonin contained impurities or other compounds, such as serotonin, that can pose health risks. Melatonin is often combined with magnesium, valerian root, or other natural sleep aids in supplements, which may further affect the accuracy of dosages and labeling.
Buyers of supplements should take care when shopping and remember that labels like natural, certified, and verified are not standardized or regulated. Although not a guarantee of safety, certification from organizations like US Pharmacopeia , ConsumerLab.com, or the NSF International Dietary Supplement program can offer confirmation that products have been tested for contaminants or mislabeling.
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How Does Circadian Rhythm Work
Circadian rhythms work by helping to make sure that the bodys processes are optimized at various points during a 24-hour period. The term circadian comes from the Latin phrase circa diem, which means around a day.
Circadian rhythms exist in all types of organisms. For example, they help flowers open and close at the right time and keep nocturnal animals from leaving their shelter during the daytime when they would be exposed to more predators.
In people, circadian rhythms coordinate mental and physical systems throughout the body. The digestive system produces proteins to match the typical timing of meals, and the endocrine system regulates hormones to suit normal energy expenditure.
The circadian rhythms throughout the body are connected to a master clock,sometimes referred to as the circadian pacemaker, located in the brain. Specifically, it is found in the suprachiasmatic nucleus , which is in a part of the brain called the hypothalamus. At different times of the day, clock genes in the SCN send signals to regulate activity throughout the body.
The SCN is highly sensitive to light, which serves as an critical external cue that influences the signals sent by the SCN to coordinate internal clocks in the body. For this reason, circadian rhythms are closely connected to day and night. While other cues, like exercise, social activity, and temperature, can affect the master clock, light is the most powerful influence on circadian rhythms.
The Pineal Gland And Melatonin
The pineal gland or epiphysis synthesizes and secretes melatonin, a structurally simple hormone that communicates information about environmental lighting to various parts of the body. Ultimately, melatonin has the ability to entrain biological rhythms and has important effects on reproductive function of many animals. The light-transducing ability of the pineal gland has led some to call the pineal the “third eye”.
Anatomy of the Pineal Gland
The pineal gland is a small organ shaped like a pine cone . It is located on the midline, attached to the posterior end of the roof of the third ventricle in the brain. The pineal varies in size among species; in humans it is roughly 1 cm in length, whereas in dogs it is only about 1 mm long. To observe the pineal, reflect the cerebral hemispheres laterally and look for a small grayish bump in front of the cerebellum. The images below shows the pineal gland of a horse in relation to the brain.
Histologically, the pineal is composed of “pinealocytes” and glial cells. In older animals, the pineal often is contains calcium deposits .
Melatonin: Synthesis, Secretion and Receptors
The precursor to melatonin is serotonin, a neurotransmitter that itself is derived from the amino acid tryptophan. Within the pineal gland, serotonin is acetylated and then methylated to yield melatonin.
Biological Effects of Melatonin
Effects on Reproductive Function
Effects on Sleep and Activity
Other Effects of Melatonin
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Sleep Disturbances And Hormonal Changes
Sleep problems can cause hormonal imbalances, and in turn, hormonal imbalances can aggravate sleep problems.
It is known that sleep deprivation, even for a short time, has noticeable consequences on our hormones. In healthy young people, it can significantly decrease testosterone in men and estrogen in women. It increases insulin and causes higher insulin resistance. A lack of human growth hormone leads to skin and immunity problems. If disturbed, many hormones change our mood so we become more prone to stress and anxiety, along with insomnia.
Ghrelin causes you to have late night meals and eat more during the day this might be a bodys way to get more energy which is lost due to not sleeping. If the thyroid doesnt work properly, adrenal glands start producing more adrenalin to compensate, but this hormone also keeps us awake.
Many sleep problems which include short sleep time or poor sleep quality go hand-in-hand with hormonal imbalances.
Circadian rhythm disorders and bad sleep schedule confuse our body and the result is bad circadian hormone management. This means our melatonin could surge at inappropriate times, making us sleepy. High cortisol and adrenalin presence at sleep time can completely ruin our sleep time plan, leaving us tired the following day.
Additional Steps To Improve Sleep
People with sleeping problems can benefit from taking steps to develop healthy sleep habits. Even if melatonin offers relief, improving their sleep routines and environment known collectively as sleep hygiene can promote durable sleep quality improvement.
Talking with a doctor about melatonin and sleeping problems can also help reveal whether a person has an underlying sleep disorder. For example, raising poor sleep issues or excessive sleepiness may uncover a problem like sleep apnea. Melatonin isnt a therapy for sleep apnea, but in this scenario, working with the doctor can lead to more appropriate and effective treatments.
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Melatonin And The Lens
Melatonin is produced within the lens in a circadian rhythm, where it acts as an antioxidant; melatonin administered to rats immediately following ultraviolet-B light was found to reduce cataract formation. In glutathione-depleted rats , melatonin also significantly reduced the incidence of cataracts and, in addition, stimulated glutathione production.
Melatonin has been shown to be an important antioxidant both at physiological and pharmacological concentrations. It is more effective than mannitol and vitamin E, and is about five times more efficient a scavenger of the hydroxyl radical than glutathione. Experimentally, melatonin has been shown to cause some restoration in vitamin C and E levels and the activity of catalase in cells exposed to oxidative stress.In vitro studies show that melatonin scavenges a common oxidantnitric oxide. It also protects against chromosomal damage caused by ionizing radiation and other oxidative stresses. Whereas most antioxidants can only function within certain subcellular compartments, its lipid and aqueous solubility allow access to virtually all parts of the cell.
Effect Of Circadian Rhythm On Energy Balance
The energy produced and stored in metabolism is used to maintain metabolic activities such as basal metabolic rate, physical activity, and thermal effect of foods .
Francis G Benedict first described the circadian changes in energy metabolism in 1915 . Furthermore, Haugen et al. found that the resting metabolic rate was 6% higher at noon than in the morning hours. One of the most important factors affecting the basal metabolic rate is the sleep pattern. Sleep and circadian rhythm are the main components of energy metabolism regulation . There are 2 phases of sleep: rapid eye movement and non-REM . The sympathetic nervous system activity and dreams increase during the REM period. Body temperature, heart rate, respiratory rate, and blood pressure increase during REM. Irregularities in the REM period increase due to the activity of the sympathetic nervous system . Because of the increases in body temperature and energy expenditure in the brain , the metabolic rate during sleep reaches its highest point in the REM phase . Therefore, deterioration of the sleep cycle due to late sleeping, jet lag, shift work, and so on can lead to a decrease in the basal metabolic rate by altering the timing of the REM phase of sleep.
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