Cortisol  Information

Edward Lichten, M.D.,PC
180 East Brown Street
Birmingham, MI 48009 

THE NEW BREAKTHROUGH in  Insomnia, Fatigue and Thyroid Disorders

"The problem with insomnia is that the individual suffers all day long with adrenaline (epinephrine) overload, which is related to cortisol deficiency, so he/she is unable to sleep at night" states Edward M. Lichten, M.D., clinician and researcher in Birmingham, Michigan.

HISTORY: The typical insomniac is under stress: emotional, financial, marital and physical.  Chronic stress while awake is manifested by a decrease in lean body mass, type 'A' personalities,  carbohydrate loading and skipping meals, and the inability to '"get everything and everyone taken care of."

SYMPTOMS: The degree of insomnia varies from mild: awakening and falls back to sleep; moderate, cannot fall asleep or cannot fall back to sleep; to severe, cannot sleep without over-the-counter to prescription medications. The worse of the worse individuals cannot sleep even with prescription medications.

DIAGNOSIS: The diagnosis of cortisol deficiency and neuro-chemical imbalance is made with a Neural-adrenal saliva and urine kit from Immunoscience and serum Calciferol (Vitamin D3) level from Quest Diagnostic Laboratories. See article- insomnia. The low levels of cortisol, low DHEA, increased epi- or nor-epinephrine, low serotonin and abnormal dopamine allow the physician to intervene medically-and-naturally.  The emotional and physical causes of stress must be addressed separately but balancing the adrenal hormones must be done concurrently.

PHYSIOLOGY:  The adrenal cortex releases CORTISOL (prescription CORTEF) in response to the pituitary hormone ACTH's signal. The problem is that ACTH can only be turned down by Cortisol yet it triggers increased release of adrenaline.  The absence of the Vitamin B's and C's that are necessary for the adrenal cortex to manufacture Cortisol from being produced, aggravate and accelerate the problem of adrenaline (epinephrine) overload.  The cycle continues until intervention breaks the cycle.  That break can be a 3-month hiatus (vacation or mental breakdown) or the modified Jeffries protocol that we incorporate in our office.

PREVIOUS THERAPIES: Prozac and anti-depressants, Ambien and other sleeping agents fail to address the underlying physiology of too much epinephrine and too little cortisol, DHEA, Calciferol, magnesium, zinc and gabapentin.  Small doses of Ativen, Xanax or Klonipin many be incorporated acutely,  because they individuals are 'panicked' not 'depressed.' But after the acute distress is controlled, increasing dosages of 5-HTP, magnesium and vitamin-mineral-amino acids are integral to our program of recovery.

The depression results from the seemingly incurable problem of insomnia which prevents REM sleep, IGF-1 release and tissue repair. And this depression, may be curable.  For those with low serum lithium levels, we start lithium replacement at 150mg daily and increase accordingly with therapy to 300mg twice daily.

OUR TREATMENTS: We start by adding large doses of Intravenous B's, C's and magnesium to supplement the adrenal cortex. 5-HTP is prescribed because routinely serotonin levels are low.  We use the findings of  the Neuro-adrenal test and add Cortef 5mg upon awakening.  For those falling asleep in the early afternoon, an additional 2.5 to 5mg is given at lunch. Note that 2/3 of all Cortef should be taken before 12 noon and none should be taken at dinner or bedtime. Cortef should always be taken with food.

Following the excellent recommendations and applications of Jeffries, we have found Cortef and our insomnia and depression protocols to reduce our reliance on Prozaclike anti-depressants and Ambien-like sleep medications by 80%.[EML]

WJJ Recommendations: Much higher than we recommend because of our reliance on balancing all the endocrine life-pyramid hormones.
1. Maximum Cortef dosage is 20 mg daily.
2. Maximum length of time on Cortef is 6-8 weeks.
3. May need to reduce any thyroid medication on Cortef by 1/3.

1. Insomnia
2. Panic Attacks
3. Hyperthyroidism
4. Asthma, Acne
5. Infertility: low progesterone
6. Hives, skin eruptions
7. Fibromyalgia
8. Diabetes
9. Heart palpitations

For thyroid information, see right column and thyroid articles.

William Jeffries. M.D. The Safe Use of Cortisol. University of Virginia Press. 1970



1. Meaure Calciferol (Vitamin D3) 0,25 OH to determine lack of appropriate sunlight-pineal function.
2.   Measure IGF-1 to determine if the sleep-wake cycles are disrupting tissue repair. Low levels of IGF-1, less than 160, are typical in fibromalygia and fatigue states.

1. Measure TSH, T3free, T4free, TBG, Thyroid peroxidase antibodies, Thyroid antibodies, Reverse T3, on all with fatigue, cold hands/feet, weight gain and FIBROMYALGIA.

2..  Measure cortisol and DHEA levels in saliva at 7AM, 11 AM, 4 PM and 10PM for those having problems stabilizing thyroid replacement.

3. Measure serum cortisol, pregnenolone, progesterone, and DHEA-S in the AM for those with memory problems.

4. Screen for zinc, magnesium, and selenium deficiency in hair analysis. Iodine deficiency is noted in all.

5. Replace thyroid slowly and immediately. Add cortisol  in low doses if indicated by saliva test or clinical parameters.

Sex Hormones
1. Menopause is typical in women with insomnia. Measure the FSH and LH to show hyper-secretion by the pituitary. LH triggers the hot flush and normal FSH and LH are less tha 10mIU/ml.  With addition of appropriate estradiol, the FSH and LH will drop and the insomnia and hot flushes will disappear.

2.  For men, elevated FSH and LH and low testosterone/SHBG are seen in andropause. Sleep disturbances identical to the woman's hot flush with LH spikes can be seen. Again, by replacement of the appropriate  dosage of testosterone, the symptoms of insomnia and sleep waking at 3-4 AM will often abruptly disappear.