Disease or hormone imbalance?

I have been plagued by insomnia for years and years. I have attributed it to many things and have been diagnosed with a variety of “disease states”. Depression is associated with insomnia, check. Too much stress from the loss of loved ones to the stresses of medical school and residency, check. The perils and pitfalls of perimenopause and menopause, check. But, I have discovered a new one that gets barely a mention and is thought to be inconsequential by most physicians, and I believe it may be contributing to the legions of people suffering from insomnia in our society. This is the complex biology of blood sugar regulation.

Blood sugar and cortisol

For the last several years, I have suffered from that 2-3 AM awakening, and am unable to go back to sleep. In fact, it has actually gotten worse over the years, but is inconsistent with periods of severe insomnia, awakening with a pounding heart and a feeling of anxiety and sweating. My hormones are perfectly balanced, I eat an organic diet and I exercise, so why can’t I SLEEP?! I have asked my professors and colleagues and have gotten many theories and suggestions but nothing has worked. One night as I struggled with a sweaty attack and pounding heart, I got up to go the bathroom and decided to check my blood sugar – 75. I went back to bed (I confess after taking GABA supplement to try to get back to sleep), and the next morning, again took my blood sugar – 95. Hmmmm, why would my blood sugar go up in a fasting state? Well, this has to do with poorly functioning hypothalamic-pituitary-adrenal axis, and what we in functional medicine know as adrenal fatigue or adrenal dysfunction. This is thought to be a very common thing in our stressed, overworked, burned-out society. Cortisol, which is produced by the adrenal glands, is your stress hormone and one of its jobs is to maintain your glucose levels so that your brain, heart and muscles have a continuous supply of glucose to create energy for these vital organs. Cortisol is essential to life and your body will defer to making cortisol when stressed as evolutionarily, this can save your life. Your body does not know or care WHY you stressed. The flu, surgery, running a marathon, starvation, or a crummy, demanding job; it’s all the same to the body and it pours out cortisol for your survival.


With excess demand over the years, your adrenals falter and misfire, the signals are erratic and along with many other symptoms (fatigue, apathy, depression), your blood sugar can get too low or too high because of erratic cortisol. During the night, when you are in a fasting state, the adrenals will slowly secrete cortisol to maintain your glucose, and the peak cortisol usually occurs shortly after arising in the morning. However, if your adrenals are a little off, or your blood sugar gets too low, the adrenals can overshoot and your cortisol will increase too early (2-3 am) to make sure your blood sugar is maintained. Thus, you get symptoms of hypoglycemia, followed by a cortisol surge accompanied by an increase in epinephrine and norepinephrine resulting in sweating, a pounding heart, and an anxious alertness. I might add that falling estradiol associated with menopause is a contributing factor and can make these symptoms even worse, but that is another post.

What can you do?

Our highly processed Standard American Diet (SAD) is very high in simple carbohydrates, which is contributing to our epidemic of insomnia.

I have discovered that if I carefully follow a low glycemic diet (nothing above 60 with a glycemic load <10), I sleep much better. No more ice cream, chocolate, or even fruit especially at night. A high protein breakfast (eggs and spinach) begins the day, with each meal containing at least 20-30 grams of protein. I avoid most grains. I am not

photo courtesy of PlanetChopStick under Creative Commons

saying that whole grains are not good for you, but if you have blood sugar issues, you probably want to make grains a rare treat. Avoid fruits with high sugar content and opt for those that are more tart and loaded with fiber like raspberries. At night, I have added a protein drink from Metagenics called Perfect Protein. It has 16 grams of whey protein and only 80 calories. This has become my nighttime desert. If I watch my sugar intake and take this at bedtime, I am much more likely to get a night of blissful, uninterrupted sleep. Maybe there is something to the old adage that a glass of milk will help you sleep. With a few modifications, it seems to be working for me. Happy snoozing! ZZZZZzzzzzzz

NB: At posting time, my favorite site to check glycemic load is down – for more information, try here.

Marsha Nunley MD
Marsha Nunley MD
I am an internist, trained and experienced in Western Medicine, who believes that illness and disease are best treated by working to discover their underlying causes. Come to me for bioidentical hormones, advice on healthy aging, and whole-body medicine.