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The relationship between the hormone cortisol and sleep

Updated: Sep 2, 2023

Cortisol, often labeled the "stress hormone," is produced by the adrenal glands through the hypothalamic-pituitary-adrenal (HPA) axis when we encounter stress. Its widespread presence, thanks to cortisol receptors in many body cells, makes it an influential chemical messenger, modulating a multitude of functions based on our environment and internal states.


Its both our friend and foe and plays several pivotal roles in our physiology. For instance, by promoting the release of glucose from the liver, it ensures stable blood sugar levels, supporting the increased heart rate and blood pressure typical of stress responses.


When the stress response is triggered - our body switches to the fight/flight/freeze/fawn mode, the energy demand escalates, necessitating enhanced respiration and muscle readiness to prepare our body to rapidly respond. Cortisol elevates our sensory awareness, making us more alert. At the same time, it wisely economises energy by temporarily pausing systems like digestion and reproduction, which aren't immediately vital. Its importance in preserving our overall health and well-being cannot be overstated.

Cortisol's diurnal rhythm is a telling reflection of our well-being. While its levels naturally ebb at midnight and surge in the early morning, assisting our wakefulness, disruptions to this rhythm can provide clues about underlying stressors or mental health issues.

Cortisol and Sleep

Ideally, our cortisol dips during sleep and spikes upon waking. However, persistent aka chronic stress, indicative of an overactive HPA axis, can play havoc with this balance, leading to sleep disturbances like insomnia or fragmented sleep. Such disruptions can trap individuals in a harmful loop: poor sleep heightens stress, which in turn agitates the HPA axis, further misaligning cortisol production.

From a psychotherapeutic perspective, sleep disturbances and cortisol imbalances can be both a symptom and a cause. For instance, chronic insomnia might be a manifestation of underlying anxiety or trauma, which then exacerbates stress, leading to erratic cortisol levels. Furthermore, disorders like obstructive sleep apnea not only interrupt restorative sleep but can cause fluctuations in cortisol, adding another layer of strain to the HPA axis, further heightening stress and anxiety.

Recognising these intertwined relationships, in therapy we don't only address the sleep disruptions and physiological implications but also delve into underlying emotional or psychological stressors. There is often a good reason for the stress response to be on high so understanding more about this, gives us the opportunity to start to reduce in. In the work we are always aiming to create a feedback loop of healing, where resolving one issue aids the natural resolution of others.

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