sleep and cortisol in PTSD

Understanding the 3 AM Wake-Up Call: Cortisol and Sleep in PTSD & C-PTSD

The tranquility of nighttime can often be disrupted for many people, leaving them wide awake around 3am. This phenomenon, while common, takes on a deeper significance for  people with Post-Traumatic Stress Disorder (PTSD) or Complex-PTSD (C-PTSD). The culprit often responsible for this unwelcome early morning awakening is cortisol, the “stress hormone.”

Cortisol earned its moniker as the “stress hormone” due to its pivotal role in our body’s response to stress and danger. In a typical, healthy sleep cycle, cortisol levels are at their lowest during the night, facilitating uninterrupted, restorative sleep. However, people with PTSD or C-PTSD often experience a disruption in this balance.

How cortisol affects sleep

  1. Cortisol’s Natural Rhythm: Our bodies follow a natural circadian rhythm for cortisol, with levels peaking in the early morning (around 3am) to promote alertness upon waking. As the day unfolds, cortisol levels should gradually diminish, reaching their low point at night. For people with PTSD or C-PTSD, this rhythm can go awry.
  2. Cortisol Dysregulation: Trauma can throw off the cortisol response. People with PTSD or C-PTSD frequently exhibit elevated cortisol levels, even during the night when they should be at their lowest. This persistent cortisol surge can manifest as waking up around 3am.
  3. The Fight-or-Flight Response: PTSD and C-PTSD are often characterised by a heightened “fight-or-flight” response, which involves an upsurge in cortisol production. This response can be triggered by nightmares, flashbacks, or simply the lingering effects of trauma. When cortisol surges at 3am, it becomes challenging to return to sleep.

The Overflowing Cup Analogy

Imagine your body as a cup, and cortisol as a liquid. Cortisol naturally rises in the early hours, typically around 3am, in a healthy sleep cycle. Think of this as pouring cortisol into your cup. If your cortisol levels are in balance, your cup can accommodate this influx without overflowing, allowing you to continue sleeping soundly until morning, perhaps around 6 or 7am.

However, for people with elevated cortisol levels due to PTSD or C-PTSD, their cups are already brimming with stress hormones. When cortisol surges again around 3am, their metaphorical cups overflow, waking them up and adding to their night-time distress.

Consequences of 3am Awakening in PTSD & C-PTSD

Waking up in the middle of the night due to cortisol spikes can have several negative consequences for people with PTSD or C-PTSD:

  1. Sleep Disruption: Interrupted sleep can lead to further exhaustion, exacerbating other PTSD/C-PTSD symptoms like irritability, anxiety, and difficulty concentrating.
  2. Increased Stress: The very act of waking up in the middle of the night can be distressing, leading to an increase in overall stress levels.
  3. Impaired Functioning: The lack of quality sleep can impair daytime functioning, making it difficult to maintain relationships, hold a job, or engage in daily activities.

Managing Cortisol and Improving Sleep

While cortisol’s role in sleep disruption for people with PTSD and C-PTSD is challenging, there are strategies that can help mitigate these issues:

  • Relaxation Techniques: Practices like deep breathing, meditation, and progressive muscle relaxation can help manage cortisol and reduce stress, making it easier to fall back asleep after a nighttime awakening.
  • Sleep Hygiene: Establishing a consistent sleep routine, creating a comfortable sleep environment, and avoiding extra stimulating activities before bedtime can all contribute to better sleep quality.
  • Reduce Caffeine Intake: Cut back on caffeine consumption as it can trigger the production of cortisol. Consider switching to decaffeinated options or simply reducing your caffeine intake. Be mindful of hidden caffeine sources in energy drinks and colas.
  • Make Dietary Adjustments: Balancing your hormones can be aided by reducing your intake of sugars that provide rapid energy bursts. Limit your consumption of sugars found in white bread, cakes, biscuits, candies, and pastries. Instead, opt for whole grains, starchy vegetables, fruits, and high-protein foods, which offer more sustained energy and promote overall health. Regular, balanced meals prevent nutrient deficiencies and the potential for stress-induced overeating, both of which can lead to increased cortisol levels.
  • Avoid Alcohol and Recreational Drugs: Especially during periods of stress, even small amounts of substances like alcohol and recreational drugs can interact with cortisol levels, potentially worsening your mood and amplifying stress levels.
  • Stay Hydrated: Ensure you maintain proper hydration throughout the day to prevent internal signals of stress that can trigger elevated cortisol levels.
  • Establish Consistent Sleep Patterns: While we understand that sleep and PTSD/C-PTSD often pose challenges, aiming for regular sleep patterns is crucial. Check out our website for articles on techniques to help you fall asleep quickly, the benefits of weighted blankets for sleep, and strategies to reduce nightmares, all of which may aid in achieving better sleep.
  • Moderate Your Exercise: Intensive and prolonged exercise can actually increase your body’s cortisol production. If you suspect that exercise is contributing to heightened stress levels rather than alleviating them, consider transitioning to a more moderate fitness routine.
  • Explore Relaxation Therapies: Engage in relaxation practices like journaling, meditation, and yoga to create a state of relaxation that signals to your brain that it can reduce cortisol levels. Spending time with loved ones and feeling comfortable and supported can also contribute to relaxation.
  • Embrace Joy and Laughter: Surprisingly, studies have shown that indulging in a 15-20 minute belly laugh can significantly reduce cortisol levels. So, go ahead and enjoy your favorite comedy film or engage in activities that bring you joy and laughter to help lower stress hormones.
  • Therapy: Trauma-focused therapies, such as Trauma Focused Cognitive-Behavioural Therapy for PTSD/C-PTSD and Eye Movement Desensitisation and Reprocessing (EMDR), can help reduce overall stress levels and cortisol dysregulation.
  • Medication: In some cases, doctors may prescribe medications to help regulate cortisol levels and improve sleep.

The 3am ‘wake-up call’ can be a challenging, especially for people dealing with the heightened stress response associated with PTSD and C-PTSD. Understanding the role of cortisol in this phenomenon is the first step toward finding effective strategies to manage it. 

  • Caffeine and Cortisol Production:

    • Nehlig, A. (2018). Interindividual Differences in Caffeine Metabolism and Factors Driving Caffeine Consumption. Pharmacological Reviews, 70(2), 384-411.
  • Dietary Adjustments for Hormone Balance:

    • Ludwig, D. S. (2002). The Glycemic Index: Physiological Mechanisms Relating to Obesity, Diabetes, and Cardiovascular Disease. JAMA, 287(18), 2414-2423.
    • Roberts, C. K., & Barnard, R. J. (2005). Effects of Exercise and Diet on Chronic Disease. Journal of Applied Physiology, 98(1), 3-30.
  • Alcohol, Recreational Drugs, and Stress:

    • Fox, H. C., et al. (2008). The Effects of Alcohol on the Hypothalamic-Pituitary-Adrenal Axis. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 32(3), 559-563.
    • Koob, G. F., & Le Moal, M. (1997). Drug Abuse: Hedonic Homeostatic Dysregulation. Science, 278(5335), 52-58.
  • Hydration and Stress Signals:

    • Popkin, B. M., D’Anci, K. E., & Rosenberg, I. H. (2010). Water, Hydration, and Health. Nutrition Reviews, 68(8), 439-458.
  • Sleep and PTSD:

    • Germain, A., & Nielsen, T. A. (2003). Sleep Pathophysiology in Posttraumatic Stress Disorder and Idiopathic Nightmares. Biological Psychiatry, 54(10), 1092-1098.
    • van Liempt, S., et al. (2013). Sleep in Post-Traumatic Stress Disorder: A Systematic Review of Polysomnographic Studies. Psychological Bulletin, 139(5), 1043-1065.
  • Exercise and Cortisol Regulation:

    • Hill, E. E., et al. (2008). Exercise and Circulating Cortisol Levels: The Intensity Threshold Effect. Journal of Endocrinological Investigation, 31(7), 587-591.
    • Salmon, P. (2001). Effects of Physical Exercise on Anxiety, Depression, and Sensitivity to Stress: A Unifying Theory. Clinical Psychology Review, 21(1), 33-61.
  • Relaxation Therapies:

    • Sharma, M. (2014). Yoga as an Alternative and Complementary Approach for Stress Management: A Systematic Review. Journal of Evidence-Based Complementary & Alternative Medicine, 19(1), 59-67.
    • Pennebaker, J. W., & Seagal, J. D. (1999). Forming a Story: The Health Benefits of Narrative. Journal of Clinical Psychology, 55(10), 1243-1254.
  • Laughter and Cortisol Reduction:

    • Berk, L. S., et al. (1989). Neuroendocrine and Stress Hormone Changes during Mirthful Laughter. American Journal of the Medical Sciences, 298(6), 390-396.
    • Bennett, M. P., & Lengacher, C. (2006). Humor and Laughter May Influence Health: III. Laughter and Health Outcomes. Evidence-Based Complementary and Alternative Medicine, 3(1), 61-63.

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