Are Your Hormones Affecting Your Sleep?
Insomnia or sleep disturbance is common and amongst the Chinese population of Hong Hong. A study back in 2011 indicated up to 40% of the adult population have some form of insomnia, either difficultly getting to sleep or waking up more than once per night.1 In a more recent study concluded in 2019, the prevalence of insomnia in adult subjects having difficulty maintaining sleep is as high as 49%, and when combined with early morning awakening and difficulty getting to sleep the total is 64% of the adult population.2 This high prevalence of sleeping problems has many ramifications on human health and society as a whole.
Effects Of Sleep On Your Body’s Health
Research has shown that sleep has a profound effect on many aspects of our health. So much so that the world health organization has classified night shift work as a probable carcinogen, with those working 15 or more years in rotating night shift have a modest increase in lung cancer mortality.3 But not just only lung cancer but also diabetes4, heart attacks / heart disease5,6.
On a cellular level when we sleep, our DNA is in repair and regeneration mode. When sleep is compromised this affects the DNA repair and increases the risk of a range of cancers.7 Insomnia contributes to weakened immunity, with a reduction in a type of white blood cell called NK cells (natural Killer)8. NK cells are vital in controlling infections and detecting early cancer cell development. So, we become more prone to picking up colds, flu and other common infections.
Poor Sleep also contributes to hormonal imbalances. It lowers men’s testosterone which can affect his fertility. This is directly related to insomnia driving up cortisol (the stress hormone), which has the knock-on effect of reducing testosterone production.9 Lowered testosterone also puts men at increased risk of heart disease and obesity.
On a psychological level, poor sleep contributes to poor memory function and impaired learning10, which can contribute to poor performance at school or at work, thereby adding to stress levels. There is a link to neurodegenerative disorders like dementia due to an increased level of oxidative stress over time11, and this is pronounced in women who go through particularly disruptive menopause.12.
What Can We Do To Get Better Sleep?
Firstly we have to ensure that our circadian rhythms are regular and optimal for good sleep. This means getting good exposure to sunlight during the day, especially in the morning, and allowing the sunlight into our eyes. This helps regulate the production of melatonin our key sleep hormone. Next, we need to ensure our sleep environment is set up like a sanctuary, where only relaxing activities occur in the bedroom and the environment is sufficiently dark and cool, like a cave in the wild, similar to how our ancestors used to sleep.
Then we need to work on improving our autonomic nervous system, in particular, our Heart Rate Variability (HRV). The Vagus nerve connecting our brain to our heart and gut, plays a key role in determining how stressed or relaxed we are.13,14 Improving the vagal tone is important to keeping us relaxed, this is done by practicing mindfulness meditation, cognitive behavioral therapy, guided imagery therapy, singing, and gargling. Alcohol and coffee consumption will impact vagal tone having a knock-on effect disrupting sleep.
Nutrient deficiencies play a key role in sleep regulation the main ones being vitamin B6, folate, D3, and magnesium deficiencies.15 These nutrients play a key role in the production of the neurotransmitters serotonin and melatonin, which are critical to good sleep. Vitamin D3 deficiency in particular is related to a range of sleep disorders and is one of the most common deficiencies because hardly anyone is going in the sun anymore.16
Finally, there’s the role of hormones, the circadian rhythm of cortisol and melatonin are closely related. In a normal rhythm, cortisol is high in the morning and melatonin is low, this helps to stimulate the body to wake up and feel refreshed. At night time the cortisol is low and the melatonin should be high, this should help the body feel sleepy so you’re ready for bed. For many people, cortisol is elevated in the evening (working late, use of electronic devices, socializing, etc) so they don’t feel tired, or it starts to rise too early in the morning making people wake up too early. Understanding your pattern is key to the best appropriate treatment.
Treatment to fix the cortisol / melatonin imbalance requires correction to the hormonal pathways through lifestyle, herbal and supplemental interventions, which helps correct the imbalance. Using a functional medicine approach is more effective in the long term and requires less need for medication.
Sleep & Stress Test
Having trouble falling asleep or staying asleep? By quantifying the key hormones that regulate your sleep cycle (i.e. circadian rhythm) and your stress levels, our Sleep and Stress test can identify imbalances and put you on the path to a better night’s sleep.
Written by Miles Price, Functional Medicine Practitioner & Clinical Nutritionist
Miles did his initial training at Hawthorn University with an M.Sc. Holistic Nutrition. He followed this up with a professional accreditation to practice with BANT (UK) the British Association of Applied Nutrition and Lifestyle Medicine in 2017 and subsequently obtained a Functional Medicine Diploma with Functional Medicine University in 2017. This was shortly followed by enrolling with the Institute of Functional Medicine on their practitioner program.
- Wing S Wong, Fielding R. Prevalence of Insomnia among Chinese Adults in Hong Kong: A population based study. J Sleep Res, 2011. 20; 117-126.
- Sheng Zhi Zhao, Man Ping Wan et al. Short sleep duration and Insomnia symptoms associated with lower happiness levels in Chinese adults in Hong kong. Int J Envir Res Pub Health 2019. June.
- Gu F, Han J, Laden F, et al. Total and cause-specific mortality of U.S. nurses working rotating night shifts.Am J Prev Med. 2015;48(3):241-252.
- Gan Y, Yang C, Tong X, et al. Shift work and diabetes mellitus: a meta-analysis of observational studies.Occup Environ Med. 2015;72(1):72‐78. doi:10.1136/oemed-2014-102150
- Cheng Y, Du CL, Hwang JJ, Chen IS, Chen MF, Su TC. Working hours, sleep duration and the risk of acute coronary heart disease: a case-control study of middle-aged men in Taiwan.Int J Cardiol. 2014;171(3):419‐422.
- Barger LK, Rajaratnam SMW, Cannon CP, et al. Short Sleep Duration, Obstructive Sleep Apnea, Shiftwork, and the Risk of Adverse Cardiovascular Events in Patients After an Acute Coronary Syndrome.J Am Heart Assoc. 2017;6(10)
- Cheung V, Yuen VM, Wong GTC, Choi SW. The effect of sleep deprivation and disruption on DNA damage and health of doctors. Anaesthesia. 2019 Apr;74(4):434-44 . Epub 2018 Sep 25.
- Irwin M, Mascovich A, Gillin JC, Willoughby R, Pike J, Smith TL. Partial sleep deprivation reduces natural killer cell activity in humans. Psychosom Med. 1994 Nov-Dec;56(6):493-8.
- Patel P, Shiff B, Kohn TP, Ramasamy R. Impaired sleep is associated with low testosterone in US adult males: results from the National Health and Nutrition Examination Survey. World J Urol. 2019 Jul;37(7):1449-1453.
- Rasch B, Born J. About sleep’s role in memory.Physio Rev. 2013;93(2):681-766.
- Gulec M, Ozkol H, Selvi Y, Tuluce Y, Aydin A, Besiroglu L, Ozdemir PG. Oxidative stress in patients with primary insomnia. Prog Neuropsychopharmacol Biol Psychiatry. 2012 Jun 1;37(2):247-51..
- Kolesnikova LI, Semenova NV, Solodova EI, Madaeva IM. Okislitel’nyĭ stress u zhenshchin s insomnieĭ v raznykh fazakh klimaktericheskogo perioda [Oxidative stress in women with insomnia in different stages of menopause]. Ter Arkh. 2017;89(8):50-56. Russian.
- Irwin MR, Valladares EM,MotivalaS, Thayer JF, Ehlers CL. Association between nocturnal vagal tone and sleep depth, sleep quality, and fatigue in alcohol dependence.PsychosomMed. 2006;68(1):159-166.
- Vollmer-ConnaU,GunawardaneU, Patel V, Lloyd AR,Cvejic.Vagusnerve activity, a good night’s sleep, and recovery from acute infection.Brain, Behavior, andImmunity.2013; 32:11-12.
- Peuhkuri K, Sihvola N, Korpela R. Dietary factors and fluctuating levels of melatonin.Food Nutr Res. 2012;56:10.3402/fnr.v56i0.17252.
- Gao Q, Kou T, Zhuang B, Ren Y, Dong X, Wang Q. The Association between Vitamin D Deficiency and Sleep Disorders: A Systematic Review and Meta-Analysis. Nutrients. 2018;10(10):1395.