Glucocorticoid replacement is permissive for rapid eye movement sleep and sleep consolidation in patients with adrenal insufficiency

J Clin Endocrinol Metab. 2000 Nov;85(11):4201-6. doi: 10.1210/jcem.85.11.6965.


There is a well described temporal relation between hormonal secretion and sleep phase, with hormones of the hypothalamic-pituitary-adrenal (HPA) axis possibly playing a role in determining entry into and duration of different sleep stages. In this study sleep features were studied in primary Addison's patients with undetectable levels of cortisol treated in a double blind, randomized, cross-over fashion with either hydrocortisone or placebo supplementation. We found that REM latency was significantly decreased in Addison's patients when receiving hydrocortisone at bedtime, whereas REM sleep time was increased. There was a trend toward an increase in the percentage of time in REM sleep and the number of REM sleep episodes. Waking time after sleep onset was increased, whereas no differences were observed between the two conditions when total sleep time or specific non-REM sleep parameters were evaluated. Our results suggest that in Addison's patients, cortisol plays a positive, permissive role in REM sleep regulation and may help to consolidate sleep. These effects may be mediated either directly by the central effects of glucocorticoids and/or indirectly through CRH and/or ACTH.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Addison Disease / drug therapy*
  • Addison Disease / physiopathology*
  • Adrenocorticotropic Hormone / blood
  • Adult
  • Circadian Rhythm
  • Cross-Over Studies
  • Delta Sleep-Inducing Peptide / blood
  • Double-Blind Method
  • Female
  • Hormone Replacement Therapy*
  • Human Growth Hormone / blood
  • Humans
  • Hydrocortisone / blood
  • Hydrocortisone / therapeutic use*
  • Male
  • Middle Aged
  • Sleep / physiology*
  • Sleep, REM / physiology*


  • Human Growth Hormone
  • Delta Sleep-Inducing Peptide
  • Adrenocorticotropic Hormone
  • Hydrocortisone