Human beings typically sleep for about one-third of their lifetime—unless insomnia is present (13). Insomnia is characterized by difficulty falling asleep, waking up too early, or feeling unrested after sleeping for at least three nights per week for at least three months (1). The consequences of insomnia go beyond just feeling groggy, as it is closely linked to conditions like depression, heart disease, and diabetes (2-4). Cracking the code to insomnia is well worth the effort! 

If you’re reading this, you’re likely aware of how lack of sleep negatively impacts your daily life—from self-care and family responsibilities to work or school. You might have already tried cognitive-behavioral therapy, sleep aids, or other sleep hygiene tips, but perhaps nothing has worked…yet. 

If you haven’t tried focusing on sleep hygiene or are unfamiliar with it, now is the time to revisit step one and tackle the basics. Click here after reading this blog to learn how to implement sleep hygiene techniques and improve your sleep! 

Primary insomnia occurs independently, while secondary insomnia is often a result of another medical or psychological issue. Although both types share symptoms, treatment will vary based on your specific circumstances (5). Many factors contribute to insomnia, including hormone imbalances, lifestyle, stress, medical conditions, and even gut health. Let’s dive into these root causes so you can discuss them further with your healthcare provider. 

Cortisol Hormone Imbalance 

Cortisol is a steroid hormone made from cholesterol, a substance naturally found in the body (7). Higher cholesterol levels could potentially contribute to higher cortisol levels as well (10). Produced in the adrenal glands, cortisol follows a 24-hour rhythm, with levels peaking about two hours after waking in the morning and gradually decreasing throughout the day. Receptors for cortisol are found in nearly all tissues, meaning it can impact various organ systems (7). In the right amounts, cortisol is beneficial: it regulates the body’s stress response, metabolism, sleep-wake cycle, inflammation, blood pressure, and blood sugar (6). 

But how could cortisol contribute to insomnia? Here are some key factors to consider. Cortisol is a “fight or flight” hormone, triggering the release of glucose (sugar) from your liver to provide quick energy for stress responses. This mechanism supports the body during stress, but when cortisol remains elevated over prolonged periods, it can disrupt the body’s normal functions. Cortisol also helps regulate how your body uses fats, proteins, and carbohydrates for energy. At night, an imbalance of cortisol can shift your sleep-wake cycle, making it harder to fall asleep. 

This disruption can lead to dysregulation of the system that controls cortisol production, creating a vicious cycle. Dysregulated cortisol levels can make insomnia worse, creating a “snowball” effect where poor sleep and hormonal imbalance feed into each other. 

Regulating Your Cortisol Levels 

Exercise promotes quality rest and relaxation in several ways. For instance, it helps lower cortisol and adrenaline levels while increasing endorphins—the brain’s natural mood lifters. Activities like walking, running, or yoga can balance cortisol levels by reducing excess stress responses, improving sleep, and enhancing mood. Regular exercise also helps regulate metabolism, allowing the body to better manage stress and hormonal balance, both of which are crucial for overall health and well-being. 

Ashwagandha, an ancient medicinal herb, is highly regarded for its powerful effects on reducing stress and improving sleep. Taking oral ashwagandha supplements can significantly enhance sleep quality by lowering cortisol levels, promoting relaxation, and reducing anxiety. This makes it easier for individuals to transition into sleep. Ashwagandha’s ability to help balance hormones is particularly beneficial for those experiencing sleep disturbances due to stress or hormonal imbalances. Consistent use of ashwagandha, as part of a holistic approach to sleep health, may lead to more restful sleep experiences. 

If you’re looking to boost focus and manage stress, taking ashwagandha in the morning could be beneficial. If you’re aiming to improve sleep quality and reduce nighttime anxiety, consider taking it in the afternoon or early evening (11). 

While ashwagandha can be extremely helpful for many, there are some conditions where it may be harmful, such as during pregnancy, when experiencing hypoglycemia, or if you have an autoimmune disorder like rheumatoid arthritis or multiple sclerosis. Supplements may also interact with certain medications, so it’s important to consult with your healthcare provider before starting or stopping any supplements. 

How to Ask for Cortisol Testing 

Cortisol levels fluctuate throughout the day, so you may need more than one type of test to get a complete picture of your cortisol levels. The most common types of tests include: 

• Blood Test: Typically conducted in the morning when cortisol levels are at their peak. A blood draw from a vein is used to measure cortisol concentration. 

• Saliva Test: Often done at home, this test requires multiple samples taken throughout the day to track cortisol secretion patterns across a 24-hour period. 

• Urine Test: A 24-hour urine collection measures the total amount of cortisol excreted in your urine throughout the day, providing a broader view of cortisol production. 

Depending on the test, you may have blood drawn at a lab, or you could collect urine or saliva samples at home. 

The Gut Microbiome: Its Role in Sleep and Overall Health 

The gut microbiome refers to the microorganisms that inhabit the gastrointestinal tract—from the mouth to the anus (12). In a healthy gut, there is a delicate balance between different varieties of microorganisms, with approximately 1,000 types, including bacteria, fungi, parasites, and viruses, present in the adult intestinal tract (12). Some beneficial bacteria, called aerobic bacteria, require oxygen to survive, while others, known as anaerobic, do not. An unhealthy gut microbiome, characterized by a low ratio of good bacteria to other microorganisms, is linked to sleep disturbances, dysregulation of the circadian rhythm, affective disorders, and metabolic diseases (12). 

When harmful bacteria promote inflammation, it can lead to a condition called “leaky gut.” Leaky gut occurs when the one-cell-thick lining of your intestines becomes damaged, allowing larger particles such as toxins, bacteria, and undigested food to pass through the intestinal wall and enter your bloodstream (14). This overgrowth of harmful bacteria can be triggered by factors such as trans fats, high salt intake, disrupted sleep, circadian rhythm disturbances, exposure to toxins and air pollution, as well as tobacco and alcohol. The resulting inflammation can negatively affect cortisol levels and how insulin promotes glucose uptake into various tissues, including fat, liver, muscles, and pancreas (12). These disturbances can further disrupt your sleep-wake cycle, creating a vicious cycle that worsens sleep issues. 

This is where probiotics come into play. Probiotics contain live microorganisms that help maintain or improve the balance of “good” bacteria in the body. Consuming probiotics can reduce inflammation and restore microbiome balance, which in turn can improve sleep quality (12-13). You can find probiotics in foods such as kefir, tempeh, pickles, sauerkraut, kimchi, yogurt, and kombucha. While it’s beneficial to obtain nutrients from food, if you’re not consuming enough of these probiotic-rich foods, consider taking probiotic supplements. When choosing a probiotic, look for one with high potency—at least 10-20 million colony-forming units (CFUs)—and a broad spectrum of beneficial strains. 

Improving gut health through probiotics can strengthen the lining of the gastrointestinal tract and support neurotransmitter production. Neurotransmitters, such as serotonin, tryptophan, gamma-aminobutyric acid (GABA), and melatonin, are essential for brain function and sleep regulation. In fact, up to 90% of neurotransmitters are produced by bacteria in the gut (12). These chemical messengers play a key role in maintaining overall well-being, including sleep. 

For example, serotonin helps with sleep in two ways. First, when it’s released while you’re awake, it aids in producing substances in the brain that promote sleepiness. Second, during sleep, serotonin helps turn off certain neurons in the brain that are responsible for transmitting signals, allowing the body to relax and enter sleep (8). Similarly, GABA reduces the nervous system’s ability to transmit signals, producing a calming effect that can alleviate stress and improve sleep (9). However, excessive sugar consumption can lead to an overproduction of serotonin, which may initially create a temporary “high” but ultimately result in a crash, leading to poor sleep. 

Personalizing Your Path to Better Sleep and Health 

As we wrap up, it’s important to remember that there’s no universal solution for improving sleep and overall health. Cultivating a healthy microbiome and lowering cortisol levels can have a meaningful impact. While these strategies may not address every sleep challenge you encounter, they can certainly enhance certain aspects of your well-being. 

After all, the path to better health is unique for everyone. Taking proactive steps to nurture a balanced microbiome and reduce stress is a fantastic way to begin. Here’s to better sleep and a healthier, more vibrant you! 

Sending Health Your Way!

The Tula Clinical Team

Austin MS, RDN, CSR, LDN, CD
Aubree RN, BSN