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Sleep and Stress

By Tieraona Low Dog, M.D.

Sleep is the best meditation – Dalai Lama(1)Sleeping Woman

In health – and perhaps in life generally – one-way causality is rare.

That’s why researchers are often careful to note association between phenomena, not causation.

Which brings us to sleep dysfunction and a dysregulated hypothalamic–pituitary–adrenal (HPA) axis.

As you know, the HPA axis is the body’s principal neuroendocrine system that plays a primary role in regulating many processes including digestion, immunity, mood, sex drive and sleep.

A review in Sleep Science makes it clear that HPA axis dysregulation and dysfunctional sleep patterns are often associated.(2)

As the reviewers note, “Hormones like melatonin and others from the hypothalamic–pituitary–adrenal (HPA) axis modulate the sleep–wake cycle, while its dysfunction can disrupt sleep. In turn, sleep loss influences the HPA axis, leading to hyperactivation.”

In other words, stress causes sleeplessness and sleeplessness causes stress.

Lifestyle and Plant-Based Interventions

But the situation is far from hopeless. In my clinical experience, I’ve found that this vicious cycle can be interrupted by proper sleep hygiene including limiting caffeine and alcohol intake, starting a regular exercise program (not late at night) and increasing daylight exposure, especially in the morning.

Plant-based interventions can also address both sleep and HPA axis dysregulation. My favorites include:

  • Valerian Root (Valeriana officinalis): Long associated with restful sleep, “available evidence suggests that valerian might improve sleep quality without producing side effects” according to a comprehensive review.*(3)
  • California Poppy Herb (Eschscholzia californica): A common cause of both stress and insomnia is pain. Research indicates that a “standardized extract of California poppy can be used in the management of chronic pain and as a hypnotic-mild-sedative for the management of pain-related insomnia.”*(4)
  • Ashwagandha (Withania somnifera): Even the name “somnifera” hints at its long history of use as a calming, sleep inducing herb. In animal models, supplementation with ashwagandha, “significantly improved electrophysiological parameters” associated with sleep.(5)
  • Lemon Balm (Melissa officinalis): Once referred to as “heart’s delight,” lemon balm has a long history of use as a relaxant. It is often combined with valerian. Lemon balm leaf extract has been shown to exhibit both anti- anxiety and sleep-inducing effects.*(6)

To get the benefit of all four, I recommend a synergistic blend of these herbs, as part of an integrative approach to helping patients experience restorative sleep.

Tieraona Low Dog, MD




  1. Enthroned at 4, Exiled at 23, Tibet’s Dalai Lama Visits the U.S., but Can He Go Home Again? tibets-dalai-lama-visits-the-u-s-but-can-he-go-home-again-vol-12-no-11/. Accessed March 6, 2018.
  2. Hirotsu C, Tufik S, Andersen ML. Interactions between sleep, stress, and metabolism: From physiological to pathological conditions. Sleep Science. 2015;8(3):143-152. doi:10.1016/j.slsci.2015.09.002.
  3. Bent S, Padula A, Moore D, Patterson M, Mehling W. Valerian for Sleep: A Systematic Review and Meta-Analysis. The American Journal of Medicine. 2006;119(12):1005-1012. doi:10.1016/j.amjmed.2006.02.026.
  4. Assessment report on Eschscholzia californica Cham., herba.,5067.1. Accessed March 7, 2018.
  5. Kumar A, Kalonia H. Effect of Withania somnifera on sleep-wake cycle in sleep-disturbed rats: Possible GABAergic mechanism. Indian Journal of Pharmaceutical Sciences. 2008;70(6):806. doi:10.4103/0250-474x.49130.
  6. Cases J, Ibarra A, Feuillère N, Roller M, Sukkar SG. Pilot trial of Melissa officinalis L. leaf extract in the treatment of volunteers suffering from mild-to-moderate anxiety disorders and sleep disturbances. Mediterranean Journal of Nutrition and Metabolism. 2010;4(3):211-218. doi:10.1007/s12349-010-0045-4.

*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

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