A few years ago I had a serious emotional breakdown from severe insomnia.  

At one point it got so bad I started feeling microscopic “bugs” crawling all over my skin at night.  I’d spend an hour scanning my arms with a magnifying glass trying to find invisible insects (this is a condition called formication). Formication is the perception of bugs crawling on the skin and is caused by a number of conditions including anxiety which if you’re chronically sleep deprived — is a given. 

I thought I was going crazy. 

Most people think getting “good” sleep is simply about getting enough (6 to 8 hours). But quality matters too, that is, cycling through all five stages throughout the night. Sleep is not only restorative it’s an essential part of disease prevention. Research has found that sleep helps cleans out our daily brain garbage (beta amyloids associated with Alzheimer’s).

Without adequate zzz’s it’s nearly impossible to function at full potential the next day. We feel “weirded out,” foggy, drowsy, anxious, unfocused, cranky, quick to anger, clumsy, slow and often times depressed. And at it’s worst, sleep deprivation can be dangerous, e.g. falling asleep at the wheel.

When I started having sleep problems I obsessively poured through online articles and read numerous research studies. I spent countless hours and dollars on sleep supplements and even got tested for sleep apnea. I posted desperate questions on dozens of online forums. Nothing worked.

What I tried for my insomnia (everything) 

Google “insomnia” and you’ll see pages of articles that recommend your first line of defense should be to “practice good sleep hygiene.” 

• Keep regular bedtime hours (irregular sleep patterns disrupt your body’s natural circadian rhythm).
• Keep your bedroom cool, dark and quiet at night.
• Avoid screens an hour or more before bedtime (disrupts melatonin production).
• Quiet the mind and body with a warm bath and soothing sounds.

Please. It should be so easy. 

Okay for some it is. But for the hardcore insomniac these just don’t cut it. Of course good sleep hygiene is important and without it, will only make matters worse. 

Here’s what many experts suggest to combat insomnia. I tried every single one. 

• Cut out caffeine 
• If you can’t fall asleep go read in another room. The idea is to avoid associating your bedroom with sleep problems, thus adding to “sleep anxiety.”
• Meditate 
• Listen to calming music. Certain music is actually designed to move your brain into an alpha (calm) state.
• Avoid reading or watching scary or overstimulating books and movies right before bed. 
• Wear eye plugs and an eye mask (I still do this every night).
• Try hypnosis with a professional or self-hypnotize yourself to sleep.  Imagine slowly walking down steps while you silently count backwards. 
• Try EFT, emotional freedom technique (tapping)
• Try reflexology 
• Address peri or full menopause. Bioidentical progesterone is a  calming hormone and it may help. In some instances bioidentical estrogen may be beneficial. (Bioidentical HRT is safe when monitored by a health care practitioner). 
• Quiet your mind by replacing racing/ruminating thoughts with soothing images (the beach, waterfalls, basically your happy place).
• Take a warm shower.
• Try melatonin. 1-3 mg. Melatonin by itself makes my sleep worse.  It’s a hormone produced in the brain’s pineal gland and is only secreted at night. It’s not a sedative. Melatonin works with your body’s natural circadian rhythm (internal body clock). As we age we produce less. I’m testing it right now by adding it to my current supplements. 
• For a short period, try an anti-histamine (these made me more awake, also known as a paradoxical effect).
• Try calming herbs (Valerian, Hops, Lemon Balm, Kava Kava, etc). 
• Try sleeping pills (*for a brief period).
• Get tested for sleep apnea. According to my sleep clinic doctor I move in and out of each sleep stage “perfectly,” with no breathing disruption. 

*You probably already know but sleep meds are bad news long term.  First, they don’t address the underlying problem. Moreover they disrupt natural sleep patterns, are addictive and often have nasty side effects. My Ambien hangover was mean moody and nasty. And for some people Ambien can be dangerous (sleep-walking activities like driving, etc).

Chronic insomnia made me take a few swigs at 4am

There were times when after I tried for hours to fall back asleep I just gave up and chugged a couple vodka shots. But here’s the thing, alcohol disrupts REM (dream) sleep, which in turn makes you anxious the next day. Drinking is obviously not the answer but at 3am, 4am, 5am I’d have done virtually anything to go back to sleep, legal or otherwise. 

I remember once saying to my husband something like “I wish I had a small dose of that ‘milk’ that Michael Jackson took to sleep at night.” In the most desperate and sad way I understood why he begged his doctor to shoot him up with it. MJ’s “milk” was a powerful anesthetic drug and tragically it killed him.

After months of trying everything and spending hundreds of dollars, all I had left was to pray and sob. Night after night I sat alone on my back porch staring at the sky, begging for answers.

Every morning when my daughter got ready for school I stumbled around the kitchen, forced a smile and pretended I was okay. My husband was incredibly supportive but there was nothing he could do except listen every time I broke down. During the day I tried to nap but I was either too busy with my writing work or too wired to fall asleep (the latter is a classic sign of adrenal fatigue, “tired but wired”). 

Most of my life I never had any trouble falling asleep. Within 10 minutes of reading a book I’d zonk out. Every so often I’d wake up in the middle of the night and not fall back to sleep for a couple hours.

Of course this happens to everyone.

Racing thoughts, stress, an exciting day, hot flashes, depression, chronic pain or sometimes for no apparent reason, you’re just wide awake.

I didn’t think much about it until it started to happen more frequently and then eventually I started having trouble falling asleep.

Pretty soon bedtime became my enemy.

By 8 or 9pm I could feel my anxiety and panic creep in. This stressed me out which in turn, made it even harder to fall asleep.

Here’s the thing, insomnia creates a vicious cycle.

Poor sleep = higher cortisol (the “stress” hormone). Higher cortisol = poor sleep. And round and round the nightmare goes. 

Adrenal fatigue and insomnia

After months of research I finally figured out my sleep issues were likely caused by adrenal fatigue (AF).

“Adrenal fatigue is a collection of signs and symptoms, known as a syndrome, that results when the adrenal glands function below the necessary level,” writes Dr. James Wilson. “Most commonly associated with intense or prolonged stress, it can also arise during or after acute or chronic infections, especially respiratory infections such as influenza, bronchitis or pneumonia. As the name suggests, its paramount symptom is fatigue that is not relieved by sleep but it is not a readily identifiable entity like measles or a growth on the end of your finger.”

See: Common symptoms of adrenal fatigue

I had nearly all the symptoms.  

I should stop right here and mention that the conventional medical community doesn’t recognize AF.  

It only recognizes adrenal insufficiency in the form of Addison’s and Cushing’s disease both which are not related to AF.

I should also point out that I have a pituitary disorder called Empty Sella Syndrome that affects my Hypothalmic-Pituitary-Axis (HPA). I was diagnosed at 19 and until a few years ago was under endocrinologists’ care. HPA issues can correlate to adrenal problems. 

But here’s the thing, when I spoke to my endocrinologist about my sleep issues, she was zero help.  Why? Because my standard endocrine bloodwork was within normal limits for my pituitary condition.  Because the doc didn’t test my DHEA level which later turned out to be rock bottom (DHEA is an adrenal hormone). Because the endocrinology community thinks AF is total bunk. 

So I left my endocrinologist and went to a highly respected holistic MD., Dr. Sangeeta Pati who specializes in restorative medicine. Dr. Pati confirmed that I did indeed have AF, but that it wasn’t mild as I suspected; it was severe. 

She treated my AF by suggesting immediate lifestyle changes (naps when possible etc.). She started me on bioidentical DHEA (and other bioidentical hormones), magnesium and a daily dash of Premier pink Himalayan salt in a glass of water. I also continued to take adrenal-supportive supplements I found through Dr. James Wilson’s website and Kavinace Ultra PM for sleep (more about both below). 

If you suspect you have AF (take this online questionnare) you have two options: 

1. 1. Listen to your doctor who will inevitably tell you, “There’s no such diagnosis. The Endocrinology Society doesn’t recognize it. It’s a made-up condition that preys on the unsuspecting in order to make money.”

      OR…..

       

   2. Find a health care practitioner who understands AF and takes it seriously.

       

But here’s the thing, adrenal fatigue treatment finally got me to sleep — my primary doctor and endocrinologist did not.

Sadly many people who suffer with AF are told there’s nothing clinically wrong with them, that like most Americans they’re simply overworked, tired, burnt out and stressed.

“Get some rest, stop burning the candle at both ends,” is the often the extent of insomnia medical advice. Or the doctor writes a prescription for sleeping pills, anti-depressants and/or anti-anxiety meds. All fine short term, but these won’t get to the root of your insomnia. 

Your insomnia may in fact be due to a condition that has nothing to do with AF. Menopause. Chronic pain. REM disorder. Your primary care doctor may order tests and refer you to a specialist to rule out certain conditions. But alternatively, your symptoms may point directly to AF. 

Just don’t rule it out even if your doctors automatically do. 

It’s real. Ask Dr Wilson. Dr. Lam. Dr. Northrup.

And, please please please don’t fall for the myth that “as we age we need less sleep.” Or what your friends tell you, that “as we age we don’t sleep as well and that’s just the way it is” No. As we age we still need 6-8 hours of quality sleep.  

What I did once when I realized I had adrenal fatigue

I found a website called Integrative Psychiatry that specializes in neuro-cognitive tests and sells supplements that addresses such issues. I immediately ordered the Adrenal Stress Index test.

Almost all my results were abnormal.

For a small fee I consulted with the company’s physician’s assistant over the phone. From my results she suspected I had adrenal fatigue so she told me I needed to address a number of issues that were most likely causing my insomnia.

First, gluten sensitivity.

Food sensitivities can contribute to insomnia as a result of gut inflammation and histamine. Inflammation in the body alerts the adrenals, “warning, warning something is wrong!” and bam, cortisol increases. 

And of course — stress.

Stress of any kind (good or bad) raises cortisol. But cortisol is not the enemy. We need it. It reduces inflammation.  Cortisol levels naturally go up and down with our circadian rhythm. Cortisol is also the famous fight or flight hormone we’ve relied on in our evolution to stay alert to danger, and so, to survive. “Run a tiger is coming!”

Of course we’re no longer running from tigers.

Today our “tiger” is the challenge of day to day living. “It’s time for bed but I have a business report to finish, kids to pick up, dishes to clean, emails to answer, texts to respond to, bills to juggle, persistent pain, aging parents who need me, social media to attend to (e.g. fear of missing out)…”

When something stressful happens (say a car cuts you off) your body immediately produces adrenaline. Afterward cortisol rises. As I mentioned cortisol naturally ebbs and flows.  But if you’re chronically stressed your cortisol level may never come down. So while you should be getting drowsy around 9 or 10pm you’re wide awake staring at the ceiling. Or you fall asleep but wake up because your cortisol spikes.

Eventually your adrenal glands simply can’t keep up with the demand for cortisol and your levels begin to drop. You move from “wired but tired” (high cortisol) to so exhausted (low cortisol) you can barely get out of bed in the morning.

How you feel depends on where you are within the four phases of adrenal fatigue.  Low or high cortisol disrupts sleep. 

Important: You can’t recover from adrenal fatigue without regular quality sleep. And you can’t sleep when you have adrenal fatigue. Insomnia and adrenal fatigue are intertwined. 

The physician’s assistant with NeuroScience suggested I take three products.  Kavinace and Ultra Kavinace PM for sleep  (no longer available, see below) and Dr. Wilson’s Adrenal Rebuilder. 

Both Kavinace supplements contain phenibut (listed on the label as  4-amino-3-phenylbutyric acid).

Phenibut works with the brain’s GABA receptors. GABA and other neurotransmitters play a key role to reduce anxiety and promote sleep. Phenibut unlike straight GABA,  effectively crosses the challenge of the blood-brain-barrier.

GABA is the brain’s primary inhibitory neurotransmitter. Its main role is to calm the central nervous system by neutralizing the effects of glutamate, an excitatory neurotransmitter. 

Every night before bed I took:

• One Kavinace Ultra PM (contains *phenibut, 5 HTP  and melatonin).
• Two 100 mg capsules of Pure Encapsulations magnesium glycinate (and a few sprays on my legs of Ancient Minerals Magnesium oil)
• One Dr. Wilson’s Adrenal Rebuilder.
• Two 500mg capsules of Pure Encapsulations tryptophan

Not only did this work, but I had zero “hangover” (drowsy) effect the next day. When I woke up in the middle of the night I took one or two Kavinace and one Adrenal Rebuilder. Fifteen to 30 minutes later I was fast asleep until the next morning. 

*It’s recommended people limit phenibut use to two to three times a week and take a “vacation” (come off it for a period of time). 

FDA issues warning letter. Kavinace and Ultra Kavinace are no longer available. 

The FDA recently issued a warning letter to companies who sell supplements that contain phenibut. The warning is regarding labeling phenibut or phenibut formulation as a “dietary supplement” vs. what it actually is, a nootropic.

Last week I called NeuroScience, the company that makes Kavinace supplements. The representative told me they’re reformulating all Kavinace products for release in July 2019.

Update: 7/23/19. I spoke to a rep from the company. The Kavinace reformulation will be released within a week or so after undergoing internal quality control. It will be an emulsion (thick liquid) and will not contain phenibut. It will however, work with the GABA (calming) pathways in the brain.

The replacements will not however, contain phenibut (labeled as 4-amino-3-phenylbutyric acid). This is a major disappointment because unlike many GABA agonists, phenibut effectively crosses the challenging blood-brain-barrier. 

Alternatives to Kavinace and Kavinace Ultra PM. This is what I tested.

I seriously panicked when I found out Kavinace products were pulled from the market. So I did some research and found this article by Dr. Davidson. She recommends two supplements called Cerevive and PharmaGaba. 

I contacted Dr. Davidson and she suggested people who have severe sleep issues  “layer” (take both) supplements at the same time.  

Please bear in mind that every-body and brain and sleep challenge is unique. If something doesn’t work for me, it might work for you.

Be sure to read both positive and negative Amazon product reviews.  

So, as I mentioned except for a few years ago, I generally don’t have problems falling asleep. My issue is waking up too early or falling back to sleep (sleep maintenance due to adrenal fatigue). 

Regardless of which sleep supplement I decide to test, I always take the following before bed:

~ One capsule of prescribed bioidentical progesterone (compounded by a verified compounding pharmacist).

~ One tablet of Dr. Wilson’s Adrenal Rebuilder 

~ Two 500mg capsules of Pure Encapsulations tryptophan (Pure Encapsulations is a stellar brand).

~ Three sprays Ancient Minerals magnesium applied topically to my arms or legs (and/or 2 capsules of Pure Encapsulations magnesium glycinate).

This is what I’ve tried so far (as of 6/18/19):

X CereVive – 2 capsules. Didn’t work. I was already a bit skeptical because this product while impressive with a number of sleep-promoting ingredients, has tyrosine. Tyrosine is an amino acid involved in the production of dopamine, a neurotransmitter involved with drive and motivation (daytime behaviors). When I contacted Dr. Davidson she told me CereVive works well as a sleep-aid for many of her patients.  She suggested if I can tolerate it to gradually increase to 4 capsules before bedtime. No thank you! Maybe it’s a phenomenal daytime mood-booster but it’s not right for me as a sleep aid.

X Thorne Pharma Gaba – 1 capsule 250 mg. Didn’t work. I woke up after a few hours and even after I added two 100mg of Natural Factors chewable Pharma Gaba I couldn’t fall back to sleep.  I like that Natural Factors is chewable (works faster) and comes in 100mg which allows you to start low and add more in the middle of the night. 

X Both CereVive and Pharma Gaba. Didn’t work. This combo has a boatload of sleep-promoting ingredients.  GABA, L-theanine, 5-HTP, as well as a number of vitamins and minerals to improve the synthesis of the neurotransmitters. This goes to show you, more is necessarily better. Getting to the root cause of your insomnia is.  In case you’re interested: “What is Gaba vs l-theanine?”

X NeuroScience Alpha Gaba PM (AGPM) –  2 capsules. Pretty good. This is NeuroScience’s current replacement for Kavinace products. The first time I took it I woke up a few hours later. But, I tried this before I got back on my adrenal fatigue protocol. After I started taking Dr. Wilson’s adrenal fatigue vitamins three times a day for several days, I found that AGPM worked better.  Not as well as Kavinace Ultra PM (oh how I miss you) but pretty good.

(I recently called NeuroScience and told the (very helpful) rep that their new sleep formula Alpha Gaba PM didn’t (initially) work very well. She told me, “Most people have found it takes about 2 weeks to work.”)

AGPM is an impressive formula. It contains 400 mg of l-theanine (a pretty hefty dosage), 3 mg of melatonin, and a proprietary blend of the herbs valerian, lemon balm and 5-HTP.  5-HTP is a precursor to serotonin, a sleep/mood neurotransmitter. 

So why didn’t these sleep supplements work as well as I hoped?

1. Not enough of the active ingredient (GABA, l-theanine) is penetrating the blood-brain-barrier and/or they’re missing critical co-factors that increase bioavailability. 
2. These sleep supplements don’t directly address my underlying issue, adrenal fatigue. 

*If you have adrenal fatigue it’s essential you support your adrenal glands all day long, every day. You can’t simply take herbs or supplements that boost the neurotransmitters GABA and serotonin at night and hope to avoid a 3am cortisol spike (or nighttime hypogylcemia which will wake you up. Hypoglycemia and AF are related). 

When I started testing these new supplements first night I woke up in the middle of the night. I took more supplements and read a book for about two hours. Nothing.

The more anxious I got, the more awake I felt (cortisol!). Frustrated I just sat on my porch with my head in my hands with flashbacks of my horrible insomnia days.  I finally fell asleep after taking 1mg of Klonipin prescribed by my holistic MD to use strictly for sleep emergencies (benzodiazepine drugs such as Klonipin are highly addictive and build tolerance quickly). 

So what did work? 

✔ Addressing my adrenal fatigue. I was so disappointed the new supplements didn’t work. I sat down and thought about what was probably going on, what I’ve learned after five years of researching sleep. Adrenal fatigue.

I was already extremely anxious because my perfect Kavinace Ultra PM was pulled off the market. Then when I tried new sleep supplements and none of them worked, I got more anxious.  You know the deal by now, more anxious = higher cortisol = crappy sleep.

What I did to get back to sleep:   

1. On day one I followed Dr. Wilson’s mild adrenal fatigue recovery protocol, although I adapted it a bit: 
   ~ 1 tablet Adrenal Rebuilder. Breakfast, lunch, dinner, bedtime.
   ~ 1 tablet Dr. Wilson’s Adrenal Vitamin C. Breakfast, lunch, dinner.  
   ~ 1 tablet Dr. Wilson’s Super Adrenal Stress Formula. Breakfast, lunch.      dinner. 
   ~ 10 drops in water of Dr. Wilson’s Herbal HPA breakfast and dinner. 
2. At bedtime I took one 200mg soft gel of Sports Research L-Theanine  (I only use Suntheanine™ l-theanine). 
3. As always I took my usual biodentical progesterone, tryptophan and topical magnesium.

The results?

I went to bed at 10:30pm. I woke up at briefly at 5:30am, took one Adrenal Rebuilder, rolled over and went back to sleep until 7:30am. I couldn’t believe it, I almost cried! 

So supporting my adrenal glands throughout the day stopped the middle-of-night cortisol spike. 

✔ Gaba Complex  Worked. Recently someone responded to this post that  Gaba Complex works very well for her sleep issues. But Gaba Complex has phenibut (pulled by the FDA but still available on Amazon as of this writing). I ordered a bottle and tried it. I slept well but was drowsy the next day.  So the next time I took one capsule instead of the recommended two. I woke up in the middle of the night and took one more capsule along with one Adrenal Rebuilder. I slept okay, not fully awake, but not fast asleep either. 

When I called the company that makes Gaba Complex, Natural Creations, I asked a very informative gentleman named Bill how much phenibut Gaba Complex contains (I want to be careful). 

He told me 400mg which surprised me. I expected higher. Kavinace Ultra PM contains 625mg with zero hangover effect the next day. Bill explained that it’s not just how much GABA agonist a supplement contains, it’s also the combination of co-factors that help GABA work (penetrate the blood-brain-barrier). 

(Natural Creations, like NeuroScience, is in the process of reformulating their GABA Complex.) 

So that’s my journey. Treating adrenal fatigue to cure my insomnia. It’s a process. 

And truth be told, as someone who works out rigorously, stays up too late on the weekends and loves her wine (all of the above are taboo during adrenal fatigue treatment), some of my sleep issues are a direct result of my own behaviors, over and beyond my pituitary disorder. 

I’m still in the process of testing various sleep supplements that will keep me asleep for at least 7 hours.  But most importantly I’m back to treating my adrenal fatigue. 

Please let me know what’s working for you. 

Wishing you betters zzz’s, more restful days and great joy. 

Laura

Resources: 

Integrative Psychiatry  Provides at home testing, consultation by a nurse practitioner and products. 

ZRT Labs Offers home test kits (I strongly recommend working with a health practitioner to interpret results and design a treatment plan). 

NeuroScience NeuroScience offers proprietary blends of amino acids designed specifically to provide precursors for nervous system molecules called neurotransmitters.  7/23/19. I spoke to a rep from the company. Their Kavinace reformulation will be released within a week or so after undergoing internal quality control. It will not contain phenibut, but it will work with the GABA (calming) pathways in the brain.

Find a health practitioner who understands and treats adrenal fatigue

Supplements I mentioned:

Adrenal:

Dr. Wilson’s Adrenal Rebuilder 

Dr. Wilson’s Adrenal Vitamin C 

Dr. Wilson’s Super Adrenal Stress Formula  Dr. Wilson’s Herbal HPA

Pure Encapsulations tryptophan

Pure Encapsulations magnesium glycinate

Ancient Minerals magnesium

Premier pink Himalayan salt

Sleep:

Alpha Gaba PM 

Gaba Complex 

CereVive

Thorne Pharma Gaba

Natural Factors chewable Pharma Gaba

L-Theanine(Suntheanine™) 

Sleep Time 

Phenibut by LiftMode

More: New York Times: Insomnia Can Kill You 

                                           Getting a Good Night’s Sleep Without Drugs

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