Chronic Tiredness and Insomnia in Adrenal Fatigue

By: Michael Lam, MD, MPH; Dorine Lam, RDN, MS, MPH

Chronic Tiredness is a common symptom of Adrenal FatigueA common cause of insomnia is the malfunction of the Hypothalamus-Pituitary-Adrenal (HPA) axis. Adrenal glands are an integral part of this axis. Insomnia leading to chronic tiredness is therefore a classic sign of Adrenal Fatigue.

The main complaints for insomnia include: difficulty falling asleep (sleep onset insomnia), disturbed sleep, being easily woken up at night, difficulty falling back to sleep (sleep maintenance insomnia), feelings of not being rested, leading to chronic tiredness in the morning, starting slower in the morning, and feeling fatigued during the day.

Sleep Onset Insomnia (SOI)

Difficulty falling asleep is called sleep onset insomnia (SOI). It is important that cortisol is at its highest level in the morning and at its lowest level at night for normal sleep to occur, along with waking up refreshed and energized. When the cortisol balance is off, sleep patterns can be affected. High cortisol levels are typical of people suffering from Adrenal Fatigue, especially in the early stages. This happens when the adrenals are on over-drive, putting out excessive cortisol throughout the day in order to deal with the constant stress. Some of the excess cortisol even carries into the night and this will affect the ability to fall asleep, leading to SOI. At the same time, stress triggers the adrenal medulla, which then produces excessive amounts of adrenaline (a hormone responsible for the fight or flight response). A high adrenaline level can independently disturb sleep patterns as the body is on full alert. This state is commonly called being wired. High cortisol and high adrenaline can occur simultaneously and this is common for those who suffer from Adrenal Fatigue.

General tips to help you fall asleep easier and avoid chronic tiredness:

  • Sleep in a completely cool, quiet, and dark room. This will enhance melatonin production, an important sleep-regulating hormone. Try to draw and close all the shades and curtains. Even a small amount of light can reduce melatonin output from our brains.
  • Going to bed at the same time is important for people who suffer from Chronic TirednessGo to bed and get up at about the same time every day, even on the weekends. Sticking to a schedule helps reinforce your body’s sleep-wake cycle and can help you fall asleep more easily at night. Do the same things each night to tell your body it’s time to wind down. This may include taking a warm bath or shower, reading a book, or listening to soothing music. Relaxing activities done with lowered lights can help ease the transition between wakefulness and sleepiness.
  • Remove all electrical appliances, such as night-lights and alarms and put them at least 10 feet away from the bed to reduce EMF emissions, which can alter sleep patterns.
  • Do not do strenuous aerobics exercise or power yoga after dinner to avoid overstimulation of the sympathetic nervous system (SNS), which is frequently on overdrive in people who already suffer from Adrenal Fatigue.
  • Turn off your computer, TV, loud music, excitatory video games, and other devices that may trigger an adrenaline rush after 6 p.m. Try reading books in a quiet environment during the evening. If you do have to watch TV, refrain from channel surfing and violence oriented shows.
  • Avoid adrenal stimulators. It is very important to avoid certain foods and chemicals in order to avoid excessive stress on the adrenal glands. Sugary foods, caffeine and decaffeinated drinks of all kinds are to be avoided. Nicotine, alcohol, allergic foods (histamine is an adrenal stimulant), green tea, and chocolates are common offenders. Herbs and glandular products, unless approved by your health care professional, should also be avoided. Avoid partially hydrogenated fats such as deep fried foods and shortenings as they inhibit steroid hormone synthesis. Also avoid artificial sweeteners, which block the conversion of phenylalanine to tyrosine, needed to synthesize catecholamines in the adrenal medulla. Herbal tea, such as chamomile, is permitted.
  • Do gentle Adrenal Restorative Exercise, Adrenal Stretching, and Adrenal Rebuilding exercises in the late afternoon to transition the body at the end of a workday to evening. Do not do them in the evening. Low aerobics like long, slow walks should be done in the morning or late in the afternoon. Taking a short walk after dinner is an exception provided the body does not feel drained immediately afterward.
  • Always go to sleep before 10 p.m. at the latest. If you are tired, go to sleep earlier. Do the Adrenal Breathing Exercises just before bedtime and not at any other time in the evening. This will help with the transition to sleep. You should do this as part of your relaxing bedtime routine.
  • A small snack of protein and fat (a handful of nuts or cottage cheese) before sleep is good. A light snack before bed can help promote sleep. When you pair tryptophan-containing foods with carbohydrates, this will help to calm the brain down and allows the body to sleep better.
  • Try not to worry at bed time with Chronic TirednessIf you don’t fall asleep, get up and do something else like Adrenal Restorative Exercises or Adrenal Breathing Exercises. Go back to bed when you’re tired. Don’t agonize over falling asleep. The stress will only prevent sleep. It is common for many people with Adrenal Fatigue to feel wired and tired at the same time. If your mind is running and cannot stop, use the energy to think positive thoughts. Set aside worries and any negative thoughts, get into the habit of positive thinking at bedtime, and occupy your mind with images of relaxing places or happy events.
  • A good bed is subjective and different for each person. Make sure you have a bed that is comfortable and offers orthopedic support. If you share your bed, make sure there’s enough room for two. Children and pets are often disruptive, so you may need to set limits on how often they can sleep in your bed with you.
  • Take a natural sleep aid as directed by your health care professional. There are many available, each with its special characteristics. It’s common to use multiple sleep aids, but some trial and error is needed to arrive at the right combination for you.
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© Copyright 2014 Michael Lam, M.D. All Rights Reserved.

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  • Jackson says:

    Is it common with thyroid issues to have trouble falling asleep some nights and staying asleep others?

  • Priscilla says:

    Dr. Lam- what if you just stopped taking medication ( Klonopin) that was in your system for 11 years? I just tapered off my 1.5 a day dose and I’m six weeks off.. While on the medication I started developing tolerance and it has been said to affect your adrenal system. I started getting low BP while on the meds as well as cog fog, and many of the other symptoms you have listed. I also have endometriosis which I’ve had since I was 20, I’m 35 now. I have dark circles and they started many years ago as well.. Is it possible that this is a result of taking this pill for so many years or, this was the reason I needed to get on the pill and, was misdiagnosed so many years ago? What can I do going forward. Thanks Priscilla

  • Lauren says:

    I have been treating adrenal fatigue for 5 years. Initially I had sleep maintenance insmonia, which resolved a few months into treatment. Around 3.5 yrs, I became pregnant and developed occassional sleep onset insomnia. Once the baby was born and I went back to work, I the sleep onset insomnia became severe (2-3 nights per week I get between 1-5 hours of sleep). My baby is now 1 year old and the problem continues. I am treating both adrenals and thyroid with supplements and taking several natural sleep aids with limited success. Is there anything else you can recommend? I am contemplating physiologic replacement dose of cortef.

  • jennie says:

    Fortunately I sleep quite well, in fact I get to sleep much quicker these days than I did a few months ago. My cortisol levels are all highs and it’s the morning one that is the absolute worst causing me severe anxiety/ nausea/depression which has now led to me being agoraphobic and I live alone and have little support around me. I have to take beta blockers and tranquilisers to help me through most of the day when I feel so ill until my symptoms start to subside late afternoon. I have felt that bad I have also been suicidal. I don’t know how I get through each day. I have Hashi’s as well which doesn’t help. I am learning to read my body and do bits and bobs around the house and garden and then rest I take Holy Basil for my highs but not sure they are working. Please can you help Dr Lam with anything else I can try to lower the highs please

  • Jenny says:

    I find that no matter how much sleep I get each night – whether it be 2 hours or 12 – I am absolutely exhausted upon waking, and it takes me over an hour to come out of the foggy, almost unable to function feeling. Is this related to insomnia?

  • Abraham says:

    What is considered a natural sleep aid?

  • Oliver says:

    I find myself having difficulty falling asleep. I can’t seem to get cool enough to get comfortable. Is this a hormone imbalance?

  • Stephanie says:

    Have always had difficulties w/SOI. Great tips for falling asleep! will definitely be giving them a try.

  • Rebecca says:

    Some of these won’t be easy but I’m determined to correct this issue. One step at a time I guess

  • Dawn Locke says:

    I have had adrenal fatigue on and off for 20 years mainly caused by yeast allergy.
    I keep waking bolt upright with adrenaline surges that are really scary.
    Any tips on preventing this. It can happen every hour. I’m exhausted.
    Iv just started taking magnesium and vitamin c.
    Any suggestions.
    Thank You

    • Dr.Lam says:

      Adrenaline response is often indicated of end stage AFS when the body is on overdrive and put on alert. Resolve the root problme is key, and often times it will include managmnent of yeast, stress etc. Magnesium and Vit C can be helpful for some but also can make you worse if you have a sensitive body and is fragile. Do be careful

      Dr Lam

  • Jenna says:

    What if a person has sleep maintenance insomnia, and often wakes in the middle of the night and finds it difficult to impossible to get back to sleep. Would you still recommend a 10 pm bedtime to whenever you wake up (even if that’s 3 or 4 am), above sleep restriction where you commonly go to bed much later? Thanks

    • Dr.Lam says:

      There is no straight answer because everyone is different. Understanding one’s biologcial rhythm is important, and find out the source of the insomnia, whether it be metabolic, hormonal, or neurotransmitter sources, is critical. A detailed history usually will tell the story. Its not about going to sleep at a certain time which works well for healthy people but not in people with AFS.

      Dr Lam

  • Trance McDivle says:

    Do you recommend a sleep aid for adjusting the time you fall asleep ? I never seem to be able to fall asleep till after midnight. I consider myself healthy, could i use a sleep aid to help me fall asleep earlier in the evening ?