Anyone who has experienced a major stress—death of someone close to you, financial struggles, divorce, etc.—is likely familiar with a pattern of sleeplessness called “early morning awakenings,” or awakening at 3 a.m. or other early morning hour that makes falling back asleep difficult or impossible. It is a defining characteristic of stress that leaves you foggy, irritable, and unproductive the following day, as well as adding to insulin resistance and inflammation, the fundamental processes that add to your risk for weight gain in the abdomen, high blood pressure, high blood sugars, and risk for numerous other common chronic health conditions. Stress has its own health implications and early morning awakenings make the situation even worse. There’s even preliminary evidence that acute sleep deprivation increases blood levels of the tau protein that accumulates in the brains of people with Alzheimer’s disease. In short, sleep disruption, including early morning awakenings triggered by inappropriate cortisol surges, is an important health issue.

If you were to obtain a saliva or blood sample at the moment of awakening, you would likely see that your cortisol level is inappropriately high for that time of night when it should be low. Instead, it is showing a large surge of the sort that should occur at something like 7 a.m., part of the normal arousal process. The magnitude of surge provoking your awakening can also be higher than normal. So both circadian timing and the magnitude of cortisol rise can be inappropriate.

Conventional physicians do not even recognize the disruption of cortisol release as a legitimate issue, choosing instead to prescribe pharmaceuticals that essentially force you to sleep through the cortisol rise, but never address the disrupted timing nor the excessive surge. Functional and integrative healthcare practitioners have proposed a number of solutions over the years, solutions that have included supplemental melatonin, phosphatidylserine, “adaptogens” such as ashwaghanda, exercise, meditation, and a hodgepodge of others. In my experience, such efforts rarely work and the sufferer somehow muddles his or her way through by resorting to sleep crutches such as the antihistamine, diphenhydramine (Benadryl) or pharmaceuticals, or just dealing with it as it tapers back to normal over several years.

But, as with so many other aspects of health, it is becoming clear that the gastrointestinal (GI) microbiome plays a role. Interestingly, it appears to be a two-way pathway: sleep influences the composition of the GI microbiome; the GI microbiome influences patterns of sleep. For many of us making L. reuteri yogurt, for example, using my method of prolonged fermentation and prebiotic fiber supplementation, enjoy deep, profound sleep. I have suffered with insomnia, including periods of repeated early awakenings, for many decades. With L. reuteri consumption, I sleep deeply and nearly alway straight through the night with rare awakenings. Not everyone experiences with effect with L. reuteri, so it poses many questions to understand why there is variation in the response.

Here’s an interesting recent study looking at the effects of the CP2305 strain of Lactobacillus gasseri  and its effects on stress-induced rises in salivary cortisol. In this study, there was a significant blunting of cortisol, modest after 6 weeks of consumption, more significant after 12 weeks of consumption:

Nishida 2017

They used heat-killed microbes, 10 billion per day. (They likely used heat-killed microbes in anticipation of commercializing the dead microbes as a pharmaceutical, since it is difficult to patent-protect live microbes. Killing the microbes, however, disables a crucial aspect of L. gasseri’s behavior: it’s ability, when alive, to colonize the small intestine and produce bacteriocins that reduce populations of fecal microbes, or species of Proteobacteria, and thereby blood levels of endotoxemia that could be expected to further improve health, including sleep.) If we believe these observations, it suggests that this microbe is able to suppress excessive stress-induced surges in cortisol. It does not help us understand, however, how to correct the inappropriate circadian timing of a surge. (Salivary samples were collected between 4 and 5 pm, not during the typical morning peak. Effects on the morning peak would have been interesting to see.)

In our real-world experience, of course, we do not use heat-killed microbes. Instead, we use prolonged fermentation as “yogurt” with either the BNR-17 or SBT2055 strains to obtain somewhere around 300 billion CFUs per 1/2-cup serving. Anecdotally, this has worked wonderfully in a handful of people who were suffering with stress-induced early morning awakenings. Should you give this strategy a try, please share your experience with us. As with the L. reuteri and other microbes we’ve been fermenting this way, we are learning about effects that have not yet been reported or fully characterized by the scientists studying such microbes.