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.

Tips to Sleep Better 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 foods containing tryptophan 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 and lead to chronic tiredness. 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 own special characteristics. It’s common to use multiple sleep aids when dealing with chronic tiredness and insomnia, but some trial and error is needed to arrive at the right combination for you.

Read Part 2 Now!

© Copyright 2014 Michael Lam, M.D. All Rights Reserved.

Dr. Lam’s Key Questions

You may want to find out what is the underlying issues that cause you to have the vivid dream.

Seriphos may help balance or lower cortisol for some that have high cortisol level with AFS. Some people, however, can have paradoxical reactions, with the opposite outcome.

Chronic Tiredness is a common symptom of Adrenal Fatigue
5 -
There is a wealth of information on this website regarding adrenal fatigue. I have always wondered why I would wake up in the middle of night and could not go back to sleep. I have fought this for years. Now I know this is called sleep maintenance insomia.


  • Toni says:

    Wow, a lot of things can effect our sleep.

  • Sherri says:

    I have suffered from insomnia for years, and after reading this my symptoms are similar that it may be Adrenal Fatigue.. definitely going to browse for some more articles alike.

  • Maleno says:

    Is there a connection between getting more sleep, then usual, and waking up with fatigue?
    On average I sleep about 6 hours a night, solid, and wake up well rested. If I sleep in more then 7 hours I will wake up tired and brainfogged. Is there any connection?

  • Lilli says:

    I can fall and stay asleep. But even after 6-8 hours of sleep, I still have trouble waking up…I still feel so groggy in the mornings. What’s going on?

    • Dr.Lam says:

      Some people with AFS tend to sleep a lot. There are many reasons and only a detailed history will tell us the story behind it, but you should check with your doctor as well.


  • Jason says:

    I have a lot of trouble falling asleep, especially if I have carbs too late (past 5pm). Why can’t I tolerate any form of carbohydrate at night? If I have any kind of complex carb, even sweet potato, I feel like I have a bit of a caffeine rush, and it’ll take me ~4 hours to fall asleep.

    • Dr.Lam says:

      Carb intolerance points to metabolic issues. We find this in some AFS sufferers.


  • Joyce says:

    I have trouble fallings asleep unless the TV is on. Is this actually making it harder for me to get into a deep REM cycle?

  • Aaron says:

    I have trouble falling a sleep and staying a sleep. When I relax and start to fall a sleep I twitch or fell as if falling and jerk awake, then I have to start all over trying to sleep, when I do fall a sleep with a sleeping pill I wake up every 2-3 hrs. What will help?

  • Kristiana says:

    I’ve had trouble with sleep…but applying some of these tips have actually helped me sleep better! Thank you!

  • Rachel Mandel says:

    I have been identified with having adrenal fatigue syndrome. This can happen every 6 months. I could fall asleep and my physical body wakes me up within minutes. this can continue until my body gives up and falls asleep. i also get up very often in middle of the night. what do you suggest

  • john says:

    Dr. Lam, I have had adrenal fatigue in an advanced stage for the last 5 years. My symptoms started with sudden sleep issues in 1997 and got worse over the ensuing years. I have recovered significantly from Adrenal fatigue. I feel almost normal many days. However, I do not sleep well yet. I cannot sleep more than 6 hours and a half and I feel sleepy the next day during the morning many days. Based on your experience, is it possible to sleep well once one has recovered completely from Adrenal Fatigue? Sleep is the missing thing in my recovery along with intolerance to supplements.

    • Dr.Lam says:

      When your sleep is not able to be optimized, it signals that your healing from AFS is incomplete, and there are blockage to your achieveing total recovery. Intolerance to supplemnet goes along with that picture. no surprise. good news is that it can be resolved.

      Dr Lam

  • August says:

    What about being wired and tired at night only? Would that be considered insomnia? I seem to do well in the day time but when I go to rest my head, thoughts race out of control. Insignificant thoughts, I might add.

    • Dr.Lam says:

      Wired and tired is a seperate issue and reflect underlying nervous system problem. Everyone is different in terms of the cause. I need more detail and you can resubmit your question through the Ask The Doctor section of my website with more history and I will give you more detailed assessment.

      Dr Lam

  • Trisha says:

    For the past couple weeks, I cannot fall asleep for at least 1 – 2 hours after lying down at night. i work two jobs and need to rise at 6:30 am each day, and now am absolutely exhausted and sleep deprived at this point. I have trouble functioning at work now, and each night I go home with a plan of getting a good night sleep, and lie down but as soon as I do, sleep evades me despite feeling more tired than I ever have in my life. I’ve never experienced this. Help!

  • ultrakevuel says:

    Hello, Dr. Lam. Do you advise clients to refrain from videogames? Thank you

  • Vanessa says:

    I get decent sleep every night..about 8 hours and yet I still feel tired every morning when I wake up! What’s going on? Do you think exercise would help?

  • Seth says:

    I don’t know if I have insomnia because I’m often woken up by heartburn. I’d like to get it under control but am worried heartburn medication will make my AFS worse. Is there anything natural I can do to rule it out as the cause of my lack of sleep? Like sleep pose or supplements?

    • Dr.Lam says:

      You can get a sleep study and see if there are other issues such as obstruction.

      Dr Lam

    • Katie Peters says:

      Go to a nutritionalist. The one my husband just started going to successfully got rid of his friend’s decades-of-heartburn by prescribing a Keto-style diet and EXTRA acid. Turns out that low acid causes the stomach valve to not close properly and heartburn is the result. Acid-reducing medications are hurting Americans by the thousands.

  • Justin says:

    I seem to be in beta wave dominant person and as I go to down to sleep much of the time as I start to drift off my brain pushes me back into beta like a hyper vigilant state. Then when finally achieve sleep sometimes wake in 2 hours and have hard time going back to sleep. What are some things I should do. Lige Stress situations create an insomnia monstwr for weeks with me until gets resolved but Even when results not best deep or long sleeper. I can remember as a boy playing a game with friends to see who could stay up longest I normally won and then nobody was up to savor the victory.

  • Mark says:

    I wake up often very stiff and sore and my doc suggested muscle relaxers. Are they safe with AFS?

  • Willemina says:

    Hi, I find it difficult to fall asleep if I have been out for the day and talking a lot. My head and mind is buzzing and find it difficult to unwind even though I do relaxing things like suduko , read a relaxing book hours before bed time. If there is added stress I have spasm in my back simular to restles leg syndrome.This keep me from sleep too. I take 3 valium a week but refuse to take more as I don’t wont to become addicted to them. Please advise me. I am on a pension and not in a position to spend much. I would highly appreciate your help. Thank you for the helpful news letters. Willemina

  • Meridith says:

    Ever since I was a young child I have felt wide awake at night and tired and groggy through the early half of the day, regardless of how much sleep I got. Is this normal?

    • Dr.Lam says:

      That is not “normal”, but a lot of people have different sleep patterns and you should check with your doctor on that.

      Dr Lam

  • Dave says:

    Hi Dr Lam

    I find that when I’m about to fall into deep sleep, suddenly my back feels this shivering cold and wakes me back up. This happens only to my back, but the rest of my body seems normal. If i put more blankets on, it stops this effect, but the rest of my body starts heating up and i start sweating. So i just cover my back area with more blankets. However it is really annoying when this happens.

    Do you know if this is a adrenal fatigue symptom? and is there anything i can do to fix this. I am recovering from stage 3 adrenal fatigue and its been roughly 8 months since i started taking supplements.

  • Melissa says:

    I have been on a healing protocol for 6 years now. I had improved and was doing pretty well until last year. I started feeling more tired again and super dry skin and my tremor got worse. The only thing that we could think of that would be causing this was my doctor decided that it was time to reduce my hydrocortisone from 15 mg to 10mg (slowly over several weeks.) So, he had me go back to the original dose. It has been about a year now and I haven’t really returned to where I was before and I am waking with adrenaline rushes many times a night. I am also peri-menopausal. So could that be the cause of the change? I do A LOT to help with sleep, but this new thing is out of control. I am weak and too tired to do much at all in the day.

    • Dr.Lam says:

      What you experienced, if indeed due to steriods, is quite common. Overtime, people can develop tolerance, so return to orignial dose dose not mean return to baseline. It indicates deeper unresolved issue that has not be fully attended to. Peri-menopausal can be contributing factor, but generally not major. Nothing you tell me is unusual. We have many on our telephone coaching program with similar history.

      DR Lam

  • Brooke says:

    Hiya Dr. Lam. I can say that since I’ve started having a snack before bed, it’s easier to fall asleep. Now I’m having trouble staying asleep though. A snack at night isn’t helping. Can you help? Thanks so much, I love your site!

    • Dr.Lam says:

      Snack before bed modulate the metabolism. If it does not work, your metabolism may have been adjusted, or some other factors are going on. We need a detailed history . the clues are there if we look deep enough. This is can process that can be done by phone but not by email as has to be interactive, like detective work to sort out the body’s clues.

      Dr Lam

  • Holly Bennett says:

    Could quercetin or stinging nettle be potentially stimulating, keeping me up at night, if I have adrenal fatigue (low output–stage 3ish)? I have been taking them to help with sinus trouble.

  • Samantha says:

    Will taking melatonin before sleep not deplete cortisol even further, giving one blood sugar crashes?
    I got prescribed melatonin but worried about taking it.

    • Dr.Lam says:

      That is possible but rare. if your cortisol is already low, melatonin may not help. Remember that melatonin is not a dose dependent compound. some people do well in high dose, while others do well in low dose. It does not behave like a medication. In high dose, melatonin is an excellent anti-oxidant also.

      Dr Lam

  • 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?

    • Dr.Lam says:

      supplements such as melatonin, GABA, HTP, etc.

      Dr Lam

      • Marie Halligan says:

        Hi Dr.Lam,
        those supplements you have mentioned are all either not allowed,prescription only and then many G.Ps don’t believe in natural remedies so won’t prescribe them, or on special licence meaning that only one or two companies can import them and thus charge a small fortune e.g. 70Euros for 60 capsules of 5HTP,here in the Republic of Ireland. If the Customs and Irish Medicines Board catch you trying to import them,they confiscate them, which has happened to me and warn you if they catch you again you’ll get a huge fine and a record because it’s a criminal offence; I think there could even be a custodial sentence.
        In the light of this, what can you suggest for people living in the R.o.I? I have had sleep onset insomnia since I was a young child, then I was a nurse working shifts for 19 years, then I had a baby and he woke me up or kept me awake every night of his life until he was 11 years old! I have been having signs and symptoms of Adrenal Fatigue since the early 1990s but no diagnosis, as most Doctors in the UK and Ireland don’t believe it exists. I was picking up just before Christmas but then caught the very virulent URTI that was going round and have been knocked right back.My son also has difficulties getting to sleep and waking up in the morning. We are on Social Welfare and money is a huge problem- the problem being, we never have enough and I now have absolutely no life at all so I can pay all my bills and feed us, so obviously I can’t avoid stress . We live in rural Ireland and there are no facilities near us. The Health Service in Ireland is a mess,especially Mental Health! have been off the cigarettes for 5 months now. Have you any advice or suggestions for me that I can actually use please? Thank you.

  • 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?

    • Dr.Lam says:

      It could be hormonal, especially thyroid can be a issue. There could be other reasons as well, so its best to get your doctor to check it out. Click Adrenal Fatigue & Sleep for more information. .
      Dr Lam

  • 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 ?