AI Awareness: Why Waking Up Is So Hard To Do

April is Adrenal Insufficiency Awareness month. 

This is the first in a series of posts to share how my life is affected by Addison's Disease.

Why do we wake up each morning? 

Don't worry, I'm not try to start some kind of existentialist debate on the meaning of life. I'm talking about the physical reasons. I used to assume it was because our bodies had enough sleep (or the alarm went off). Since being diagnosed with Addison's Disease, I've learned that one major reason our bodies wake up in the morning is the production of cortisol. 

In a person with a healthy circadian rhythm, cortisol is lowest in the evening, helping your body relax and signaling your brain that it is time to sleep. As you rest, your adrenal glands get to work producing cortisol and other life sustaining hormones. Around 5am or 6am, most people's cortisol level is at its highest. This triggers your brain to begin to wake up and start the day. 

But for people with Addison's, our bodies produce very little, if any cortisol. We have to take cortisol pills, called steroids, to replace what our body should make. So after going to bed at night, our cortisol levels continue to fall. When a healthy person's cortisol levels would be at their highest, ours are at the lowest - since we've been sleeping and therefore not taking any steroids.

Our brains don't get that cortisol wake-up call. If anything, as our cortisol levels drop, our fatigue gets worse and worse. When I wake up, I generally feel completely and utterly exhausted. I know I need to give my body cortisol to get going. 

Here's where it gets tricky. 

I also have Hashimoto's Disease, which affects the thyroid. The medication I take for this must be taken when I first wake up and cannot be mixed with any other medications. I am not supposed to take my steroid for one hour after taking my thyroid medication. My doctor recommended I take my thyroid medication at 7am and my steroid at 8am, which sounds great in theory. 

In practice, it is very challenging for me. I'll use this morning as an example. 

I have been very tired this week as I am transitioning to a lower dose of steroids, so when that 7am alarm went off, it took just about everything I had to wake up enough to take my thyroid medication. I was so exhausted, and obviously very low on cortisol, so I just rolled over and went back to sleep. When the 8am alarm went off to take my steroid, I must have woken up enough to turn off my alarm, but I don't remember doing it. 

Next thing I knew, it was almost 10am! 

And I felt awful. By that time, my body had gone more than 24 hours without a dose of steroids. All my "warning: cortisol level reaching dangerous limits" signs were there: sharp pains in my abdomen, feeling like I was going to vomit, shaking, feeling freezing cold while sweating profusely, heart racing, and this rash that appears across my neck and chest. 

I took my steroid medication right away and laid back down to wait for it to kick in. It takes about 45 minutes for the cortisol to be absorbed by my body and to start to feel the benefits. This morning, it took about 2 hours to feel like I could stand up without vomiting. I still haven't been able to eat anything for fear of throwing up (which is a "Go Straight to Hospital, Do Not Pass Go" card for Addisnians). Somehow, I feel completely nauseous and super hungry at the same time. 

When I finally got to work, someone commented that I must feel great since I "got to sleep in all morning". 

Ha

Ha

Ha

Thankfully, most mornings I am able to wake myself up enough to take my medication on time and avoid many of these symptoms. But this is what happens if I ever sleep through my alarm or for whatever reason, take my steroid dose late. My Medical ID bracelet says "Steroid Dependent" and that could not be more true. My body is totally and completely reliant on steroids and if I don't take them in the morning, I will literally be in the ER by evening. 

So the next time you wake up without an alarm, feeling full of energy and ready to start the day, remember why you woke up and be grateful for your healthy adrenal glands and all the work they do while you sleep. 

Love,

an Addison alien

who is going to go ahead and stress dose today (and if you don't know what that means, it's a post for another day)