How Hormones Can Disrupt Your Sleep (And How To Fix It): Part Four of the Science of Sleep

As we know, there are many different factors that can influence your quality of sleep. From simple things like your sleeping environment to certain signals and messengers in your body, there are many ways that sleep quality can be affected. 

In addition to these messengers, or neurotransmitters, there are certain hormones that regulate sleep. And because of their importance in the body, detection of these hormonal imbalances, usually on blood work, is crucial. Especially in those that struggle with their sleep. 

In my last blog, we reviewed the different neurotransmitters in the body that regulate sleep, and we discussed some ways to treat abnormal levels of these neurotransmitters. There are many more treatment options for high levels of neurotransmitters that also offer additional benefits.

So if you’ve tried what seems like endless therapies and lifestyle changes to improve your sleep without any luck, don’t worry. Many difficulties with sleep involve many different parts of the brain and body. So your treatment may involve targeting more than one pathway, neurotransmitter, or hormone at a time. Or maybe even treating an underlying medical condition.

But first, let’s review two of the most important hormones involved with sleep: cortisol and progesterone. 

Hormones That Affect Sleep

Cortisol

Cortisol is a stress hormone that’s produced and released by the adrenal glands. It has several functions, with one being the promotion of wakefulness. Like other hormones and neurotransmitters in the body, excess amounts of cortisol for prolonged periods of time can be harmful to the body. 

Not only can chronically elevated cortisol levels contribute to illnesses like high blood pressure, diabetes, and obesity, but it can also make it harder to fall asleep at night.¹

Even though excess amounts of cortisol can be harmful to the body, high levels of cortisol are needed in the morning to allow us to wake up and stay awake throughout the day. Throughout the day, cortisol levels gradually decrease, which helps us be able to fall asleep later in the day. The trend in cortisol levels throughout the day is shown in the diagram below. 

However, some people’s cortisol levels don’t decrease throughout the day, which can result in difficulties falling asleep. Here are some supplements that I recommend that work by decreasing cortisol levels in the body: 

  1. Cortisol manager: This supplement contains phosphatidylserine, which is an amino acid that’s been found to block cortisol receptors.³ This means that even though cortisol levels are high in the body, they aren’t able to attach themselves to receptors that communicate with the brain, which then makes it easier to fall asleep. Phosphatidylserine may also improve cognitive functioning and memory.⁴  You can find cortisol manager here.

  2. Magnolia officinalis: This is also known as magnolia bark, which has been found to reduce cortisol levels. In addition to improving sleep, it’s also been found to improve stress and overall mood.⁵

People with chronically high levels of cortisol may experience symptoms like:⁶

  • Weight gain, primarily in the face and stomach

  • Stretch marks on the stomach

  • Muscle weakness

  • High blood sugar

  • High blood pressure

  • Increased hair growth

  • Decreased bone density (osteoporosis)

If you’re worried that your cortisol levels may be elevated, I offer a blood test that can check this. And if your cortisol levels are high, don’t worry. There are plenty of supplements, medications, and other therapies that can be taken to improve your cortisol levels and your sleep. 

Progesterone

Progesterone is a hormone that’s best known for its purpose in menstrual cycles and pregnancy in women. However, research has discovered that it has so many other functions in both men and women. 

One main function of progesterone is sleep regulation. When we have low levels of progesterone, we can have a difficult time falling asleep and staying asleep.⁷ Women who have gone or are going through menopause may notice that they have a harder time falling asleep, and this is largely due in part to the drop in progesterone that happens during this time. 

If you have low progesterone levels and have difficulties with sleep, the best way to improve it is by taking progesterone or a precursor to progesterone.⁸  Here are medications I recommend for low progesterone:

  1. Progesterone: Depending on the patient, this can be dosed either in oral form or in a patch that’s placed on the skin. In men, the dose is 5-10mg orally or through the skin. In women, the dose is 10-300mg orally taken before bed.  

  2. Prometrium: This is a brand-name version of progesterone that’s made in peanut oil. Unfortunately, many of my patients cannot tolerate this because of the fillers that are used in it. However, there are options for compounded progesterone that don’t contain allergens, chemicals, and preservatives. 

If you take progesterone, I recommend that you take it before bedtime as it can have a calming and even sedative effect in some people.⁹

Additionally, some of my patients with low progesterone have seen greater improvements in their sleep when they add a precursor to progesterone. Pregnenolone and DHEA are both precursors to progesterone, which means that when the body processes them, they turn into progesterone for the body to use. I recommend the following doses:

  • Pregnenolone: 10-100mg daily 

  • DHEA: 5-15 mg daily

Next, we’re going to dive a little deeper into the different treatments for abnormal levels of neurotransmitters and exactly how they can work to improve your sleep. And if you need a refresher of the different neurotransmitters and how they affect sleep, check out my last blog: Natural Sleep Aids And Medications To Help Improve Your Sleep.

Sleep Pathways in The Body

Catechol-O-methyltransferase Pathway

One of the main pathways in the body that’s responsible for the regulation and metabolism of neurotransmitters such as dopamine, epinephrine, and norepinephrine is the Catechol-O-methyltransferase (COMT) pathway.¹⁰ Many patients with poor sleep due to high levels of epinephrine and norepinephrine have issues with this pathway. 

Cardiotone is a supplement that contains the herb rauwolfia, which stops the production of epinephrine and norepinephrine. By decreasing the levels of these neurotransmitters, patients can see improvements in their sleep. You can find it here. 

In addition to the COMT pathway, there is another key pathway in the brain that’s involved in sleep regulation: the Gamma-Aminobutyric Acid pathway.

The Gamma-Aminobutyric Acid Pathway

Gamma-Aminobutyric Acid (GABA) is an amino acid that inhibits the release of several of the above neurotransmitters, specifically norepinephrine and histamine.¹¹ GABA does this by binding to specific GABA receptors in the brain and spinal cord to tell them to stop releasing certain neurotransmitters.

As we know, neurotransmitters greatly influence the sleep we get. So supporting the health and functioning of the GABA pathway is imperative for healthy sleep. The way to do this is by increasing the amount of GABA available to bind to receptors in the brain, which will ultimately decrease certain neurotransmitters and improve sleep.¹²

There are several supplements that my patients have found that work well to support the GABA pathway in their bodies: 

  • GABA + L-Theanine: This supplement combines GABA and L-Theanine, which is another amino acid that supports healthy sleep. You can find it here. 

  • 200 mg of Zen: This is another supplement that contains both GABA and L-Theanine. You can find it here. 

  • Kavinace Ultra PM: This supplement contains GABA, melatonin, and 5-HTP. It’s been shown that when GABA is combined with 5-HTP, the supplement that supports serotonin production, total sleeping time is increased even more.¹³ You can find it here. 

An imbalance in certain neurotransmitters and hormones isn’t the only thing that can disrupt sleep; certain medical conditions can as well. 

Underlying Medical Conditions That Can Affect Sleep Quality

Some of my patients have poor sleep quality not because of hormone or neurotransmitter imbalances, but instead because of certain underlying medical conditions like dysautonomia and postural orthostatic tachycardia syndrome (POTS).  

Both of these conditions can cause tachycardia, which is an elevated heart rate of over 100 beats per minute. When the heart rate is this high, affected patients can feel their heart racing. And if this occurs at nighttime, it can prevent patients from getting sound sleep. These patients may not even remember waking up or not sleeping well because they never become conscious enough at night during sleep. 

For patients with either dysautonomia or POTS who have elevated heart rates and poor sleep quality, medications that slow the heart rate down can actually improve sleep. One of these medications is called propranolol, which belongs to a medication class called beta blockers. This is taken in a dose of 5 to 10 mg before bed. 

Prazosin is an alpha blocker medication that has been studied in patients with poor sleep related to PTSD. Patients with PTSD often have nightmares that prevent them from getting enough deep sleep. Prazosin helps to improve sleep by decreasing nightmares related to PTSD.¹⁴ Sometimes, this medication is exactly what some of my patients need to improve their sleep. The recommended starting dose of prazosin is 0.1mg, and then it can be titrated up. 

One of my favorite physicians, Dr. Alan Pocinki MD, has a presentation on poor sleep quality in those with Ehlers-Danlos Syndrome (EDS). Many people with EDS have POTS, which can cause poor sleep. You can find the video here.

Additional Natural Supplements to Help With Sleep

L-Theanine

L-Theanine is an amino acid that’s found in green tea (Camellia sinensis), and it’s been found to have calming effects on brain activity, which can help with sleep.¹⁵

Many supplements on the market have combined L-Theanine with other compounds, such as GABA, to create ideal supplements to support sleep health. I mentioned several of them that contain GABA above, but another one I would recommend is Pro-Som. 

Pro-Som contains L-Theanine, magnesium, and magnolia bark, which have all been shown to support healthy sleep. There are two versions of Pro-Som, one contains melatonin and one doesn’t. You can find the one without melatonin here and the one with melatonin here. 

Melatonin

Melatonin is both a hormone and an antioxidant, and it’s known for its ability to regulate our sleep-wake cycles. Our body produces melatonin on its own, and the highest levels of it are later in the day. Melatonin makes us feel tired and ready to fall asleep.¹⁶

While our body does produce it, some people find that taking a melatonin supplement helps them sleep even better. As mentioned above, melatonin is often combined with other supplements like GABA and 5-HTP to help with sleep even more. 

Are Hormones Affecting Your Sleep?

If you struggle with falling or staying asleep and nothing you’ve tried has seemed to help, it may be due to imbalances in your neurotransmitters or hormones. It could even be due to an underlying medical condition. And while there are so many ways to treat these imbalances and medical conditions, finding the root cause of your sleep disorder is the first step.

That’s why I offer the hormonal testing and evaluations that I do. Because once we’re able to identify the main reason for your sleeping difficulties, you can get started on the treatment you need. 

With the right treatment, your body can start to heal. And you can truly experience a good night’s rest.