Sleep Hormones

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Progesterone, Melatonin, Cortisol, Compounding

Sleep that knits up the ravell’d sleeve of care,

The death of each day’s life, sore labour’s bath,

Balm of hurt minds, great nature’s second course,

Chief nourisher in life’s feast,–

William Shakespeare, Macbeth

It goes without saying that we need sleep.  Along with the basic pillars of life – water, food, oxygen – sleep is a must.  We spend 1/3 of our lives asleep and its quality is an indicator for overall wellness. During sleep, your mind and body are at rest, but physiological activities are abound.  Your brain uses sleep hours to consolidate learned information, your muscles use this time to repair, and your body releases hormones needed to regulate growth and appetite. Hormones like ghrelin and leptin that help control hunger and satiation. In addition, the balance of the hormones melatonin, cortisol, and even progesterone, are involved in achieving a recuperative sleep.

Melatonin

Melatonin is a hormone made in the brain, in an area known as the pineal gland. Melatonin regulates your circadian rhythm or your “internal clock” that triggers your bodies sleep and wake cycles.  Your body creates melatonin as a response to light.  In the late evening, natural levels rise, peak during the night, and taper off in the morning to allow for wakefulness.  As we age, natural melatonin levels decrease. Melatonin supplementation can be a taken as an oral or sublingual tablet as well as sublingual sprays to restore natural levels in the body.

Cortisol

Cortisol is produced in the adrenal cortex of the adrenal glands located directly above your kidneys.  The release of cortisol is integral in maintaining homeostasis throughout the body. The normal daily rhythm of proper cortisol production has a waveform that peaks in the early morning hours, promoting wakefulness, and slowly drops throughout the day, tapering off  at around midnight. This healthy wave pattern helps you be at your most active in the morning and gradually wind-down as the day turns into night. When cortisol levels are off balance your sleep may be light and with frequent waking episodes. Restoring a healthful cortisol balance can be a challenge, as cortisol levels are particularly affected by a ubiquitous foe: stress. Making an effort to reduce stress via diet, exercise, meditation/prayer, etc., can help restore cortisol balance. The use of adaptogenic “stress adapting” herbs (e.g.,  ashwaganda, licorice root, eleuthero root, rhodiola rosea root) can also be helpful in managing the symptoms of stress including sleep disturbances.

Progesterone

From puberty to menopause, the majority of the progesterone produced in a women’s body is made in the ovaries. Small amounts are produced in the adrenal glands of both men and women throughout one’s life; even smaller quantities are produced in nervous tissue, especially in the brain, and in adipose (fat) tissue. For menopausal women, estrogen’s effect on sleep is obvious; if you are having hot flashes and night sweats, then you are probably not sleeping!  However, progesterone and specifically progesterone supplementation, when appropriate, is a useful tool in sleep consolidation as women age. Exogenous progesterone has a sophisticated effect on sleep acting as a natural sleep regulator and not a hypnotic drug.  When administered orally, progesterone undergoes metabolism or is “broken down” in the liver. Metabolites, or children of the parent progesterone drug, such as tetrahydroprogesterone and tetrohydrodesoxycorticosterone are recognized by GABA receptors in the brain.  These same receptors, receive the signals of sleep aids like barbiturates and benzodiazepines (e.g., Xanax). Therefore, oral progesterone supplementation can improve the quality of sleep by producing sleep that has a faster onset and with fewer interruptions. Of note, not all forms of exogenous progesterone produce the same effect on sleep. Studies show that this sleep effect is seen with micronized progesterone (considered natural or bio-identical) and not with medroxyprogesterone or norgestrel, which are not metabolized into other active compounds.

Research into sleep and sleep quality flood medical literature.  It has become abundantly clear to the medical community that sleep is a critical link to a healthful society.  Currently, sleep research is focused on medical challenges such as diabetes control, dementia prevention, inflammation, etc. It is obvious that regulating sleep and stress levels are paramount to our health.  In our overworked, overscheduled, over-electrified, over-fed society, it is difficult to optimize and prioritize sleep. Using natural approaches to promote sleep including: daily exercise, eating a balanced diet, avoiding nicotine, and alcohol in the late afternoon or evening, and creating a sleep routing (evening bath/shower, darkened and cool room, wearing lose sleepwear made of natural fibers like cotton, meditation/prayer, removing electronics from the bedroom) can help. Balancing hormone levels throughout the day and night can also be a natural way to help you get the most out of your daytime and sleep hours.

Sweet dreams…

 

References:

1. Claustrat B, Leston J.  Melatonin: Physiological effects in humans. Neurochirurgie 2015;61:77-84.

2. Guilliams TG, Edwards L. Chronic Stress and the HPA Axis. The Standard 2010;9(2).

3. de Zambotti M, Willoughby AR, Sassoon SA, et al. Menstrual Cycle-Related Variation in Physiological Sleep in Women in the Early Menopausal Transition. J Clin Endocrinol Metab 2015:jc20151844. [Epub ahead of print]

4. Caufriez A, Leproult R, L’Hermite-Balériaux M, et al. Progesterone prevents sleep disturbances and modulates GH, TSH, and melatonin secretion in postmenopausal women. J Clin Endocrinol Metab 2011:E614-23.

5. Regestein Q. Menopausal progesterone replacement and sleep quality. Menopause 2001;8:3-4.


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