Exhausted but Wired? Your Stress Response May Be Part of the Picture

By Dr. Parya Bahrampour, ND | EBL Naturopathic Clinic | Maple, Ontario

You're exhausted all day.

But the second your head hits the pillow, your brain decides it's time to think about everything you've ever needed to do.

You wake up tired.

Coffee gets you through the morning.

By mid-afternoon, you're reaching for something sweet or another caffeine hit.

You feel overwhelmed by things you used to handle easily, your sleep isn't what it used to be, and despite being completely drained, you have a hard time actually slowing down.

Sound familiar?

People often describe this as feeling "wired but tired."

And while there are many possible reasons for fatigue, sleep changes, cravings, or weight changes, chronic stress and the body's stress-response system can sometimes be part of the picture.

One of the hormones involved in that system is cortisol.

But cortisol isn't the enemy.

You actually need it.

What Does Cortisol Actually Do?

Cortisol is a hormone produced by your adrenal glands and regulated through a communication system between your brain and adrenal glands called the hypothalamic-pituitary-adrenal axis, or HPA axis.

Cortisol helps your body respond to stress, regulate metabolism, influence immune activity, and maintain normal daily rhythms.

And cortisol isn't supposed to stay at the same level all day.

It follows a circadian rhythm.

Cortisol levels are generally higher around the time you wake up, with an additional rise during the first 30 to 45 minutes after awakening called the cortisol awakening response. From there, cortisol generally declines throughout the day and reaches lower levels at night.¹

So having cortisol is not a problem.

The question is whether your stress-response system is working appropriately for what your body is dealing with.

What Happens When Stress Doesn't Stop?

Your stress response is incredibly useful when you need it.

A deadline.

A difficult conversation.

An illness.

A scary situation.

Your body responds, you deal with the challenge, and ideally, the system settles again.

But what happens when the stressor isn't over in 20 minutes?

What if it's months of poor sleep, work pressure, caregiving, financial stress, relationship stress, anxiety, illness, or simply feeling like you're always "on"?

Chronic stress can affect the HPA axis and other systems involved in sleep, appetite, metabolism, mood, and immune function.²

But here's an important distinction:

Chronic stress doesn't simply mean "high cortisol."

Research shows that chronic stress can be associated with different patterns of HPA-axis activity depending on the person, the type and duration of stress, sleep, mental health, metabolic health, and many other factors.²

That's why symptoms alone can't tell us whether your cortisol is "too high" or "too low."

Why Can You Feel Exhausted but Still Struggle to Sleep?

This is one of the most frustrating combinations.

You're tired all day, yet bedtime comes and suddenly you can't switch off.

Stress and sleep have a two-way relationship.

Stress can interfere with sleep, and poor sleep can alter the body's stress response. Research suggests that poorer sleep quality can also affect HPA-axis reactivity.³

Then the cycle starts:

You're stressed, so you don't sleep well.

You don't sleep well, so you're more tired and less resilient the next day.

Everything feels harder, which creates more stress.

And repeat.

If you've been living in that cycle for months, simply being told to "get more sleep" isn't always very helpful.

What About the "Stress Belly"?

This is another phrase we hear all the time.

Can chronic stress contribute to changes in body composition?

Potentially, yes.

But it's much more complicated than:

High cortisol = belly fat.

Chronic stress can influence appetite, food preferences, sleep, physical activity, insulin sensitivity, reward pathways in the brain, and HPA-axis activity. Cortisol metabolism within fat tissue may also play a role.⁴

Research has found relationships between stress, HPA-axis regulation, and abdominal obesity, but findings are not consistent enough to say that unexplained abdominal weight gain automatically means your cortisol is high.⁴

If your weight is changing unexpectedly, other factors such as thyroid function, insulin resistance, medications, menopause or perimenopause, sleep, nutrition, and activity also deserve consideration.

Can Stress Affect Your Hormones?

Yes, but I would be careful with the popular idea that stress simply "steals" hormones.

You may have heard of something called pregnenolone steal, the idea that your body takes hormone-building materials away from progesterone or sex hormones so it can make more cortisol.

Human physiology isn't quite that simple.

What we do know is that the stress-response system and reproductive hormone systems communicate with one another.

Significant physical or psychological stress can influence reproductive function, menstrual cycles, ovulation, libido, and other hormone-related processes.

So if your periods, PMS, libido, or other hormonal symptoms change during a prolonged stressful period, that connection may be worth exploring.

But it doesn't necessarily mean your body "ran out of progesterone because it made too much cortisol."

Can Stress Affect Digestion?

Have you ever completely lost your appetite when you're anxious?

Or suddenly needed the bathroom before something stressful?

That's the brain-gut connection in action.

Stress can affect digestive motility, gut sensitivity, eating behaviours, and communication between the nervous system and digestive tract.

For some people, stress contributes to constipation.

For others, urgency or diarrhea.

And for some, digestive symptoms such as bloating or abdominal discomfort seem to become much worse during stressful periods.

That doesn't mean every digestive symptom is caused by cortisol.

It means stress is one factor worth considering alongside diet, medications, gastrointestinal conditions, and other possible causes.

What About "Adrenal Fatigue"?

This term gets used a lot.

You might have been told that years of stress have "burned out" your adrenal glands and now they can't make enough cortisol.

Current evidence does not support adrenal fatigue as a recognized medical diagnosis.⁵

True adrenal insufficiency is a real and potentially serious medical condition, but it is different and requires appropriate medical testing.

That doesn't mean the exhaustion someone is experiencing isn't real.

It means we need to be more accurate about why they're exhausted.

Instead of assuming the adrenal glands have become tired, it makes more sense to look at the bigger picture, including sleep, stress, mental health, thyroid function, iron and B12 status, blood sugar regulation, medications, nutrition, and other medical causes of fatigue.

Do You Need Cortisol Testing?

Not everyone who feels stressed or exhausted needs a cortisol test.

And this is important because cortisol naturally changes throughout the day and responds to sleep, exercise, illness, medications, food, and psychological stress.

There are established medical uses for cortisol testing when conditions such as Cushing syndrome or adrenal insufficiency are suspected.

Salivary cortisol is also widely used in research to study circadian cortisol patterns and the cortisol awakening response.

But interpreting a multi-point salivary cortisol curve or commercial hormone panel as proof that someone's everyday fatigue is caused by "HPA-axis dysfunction" is much less established.

So testing should be chosen because it answers a specific clinical question, not simply because someone feels stressed.

Before Blaming Cortisol, Look at the Bigger Picture

If you're constantly exhausted, don't automatically assume it's your adrenal glands.

Ask:

Am I actually sleeping enough?

Do I wake feeling refreshed?

Am I snoring or could sleep apnea be a possibility?

Am I relying on caffeine just to function?

Am I eating enough protein and overall calories?

Are my meals irregular?

Have my periods become heavier?

Could I be iron deficient?

Has my menstrual cycle changed?

Could I be entering perimenopause?

Are anxiety or low mood contributing?

Could medications be affecting my energy or sleep?

Have thyroid function, blood sugar, B12, iron, and other relevant markers been considered?

Sometimes "stress symptoms" turn out to have another treatable explanation.

And sometimes several things are happening at the same time.

Three Things You Can Start With

You don't need an expensive hormone panel to start supporting your stress response.

Get outside in the morning

Morning light is an important signal for your circadian system and helps reinforce the difference between daytime and nighttime.

Try getting outside relatively soon after waking, even if it's just while drinking your morning coffee or taking a short walk.

Stop running on caffeine and empty

If breakfast is coffee and lunch happens at 3 p.m., your energy is probably going to feel unpredictable.

Aim for regular meals that include protein, fibre, healthy fats, and carbohydrates rather than relying on caffeine and quick sugar for energy.

Give your brain a transition into sleep

If you're answering emails, scrolling, working, or mentally solving tomorrow's problems until the moment you close your eyes, your brain hasn't had much opportunity to shift gears.

Dim the lights, reduce stimulating activities before bed, and create a short routine that tells your body the day is ending.

It doesn't have to be perfect.

It just has to be consistent.

When Should Fatigue Be Investigated?

Being tired after a difficult week is one thing.

Feeling exhausted for weeks or months despite trying to rest is different.

Persistent fatigue deserves proper assessment, particularly if it comes with:

• Unexplained weight loss or significant weight change

• Fainting or severe dizziness

• Persistent rapid or irregular heartbeat

• Shortness of breath

• Significant muscle weakness

• Fever or night sweats

• New neurological symptoms

• Severe depression or changes in mental health

• Very low blood pressure

• Persistent vomiting or diarrhea

• Significant changes in menstrual bleeding

And if you're sleeping enough but still waking exhausted every day, that's worth investigating too.

You Don't Need to Blame Everything on Cortisol

If you've been told to "just stress less," you already know that's easier said than done.

But you also don't need to assume every symptom means your cortisol is broken.

Feeling wired but tired can be a sign that something in the bigger picture needs attention.

Your sleep.

Your stress load.

Your nutrition.

Your thyroid.

Your iron.

Your blood sugar.

Your hormones.

Your mental health.

Or sometimes several of these at once.

The goal isn't to chase one hormone.

It's to understand why you don't feel like yourself anymore.

Ready to take a closer look at what's contributing to your fatigue and stress symptoms?

Book a consultation at EBL Naturopathic Clinic

This article is for educational purposes only and does not replace individualized medical advice or assessment.

References

[1] Fries E, Dettenborn L, Kirschbaum C. The cortisol awakening response (CAR): facts and future directions. Int J Psychophysiol. 2009 Apr;72(1):67-73. doi: 10.1016/j.ijpsycho.2008.03.014. Epub 2008 Sep 30. PMID: 18854200.

[2] Russell G, Lightman S. The human stress response. Nat Rev Endocrinol. 2019 Sep;15(9):525-534. doi: 10.1038/s41574-019-0228-0. Epub 2019 Jun 27. PMID: 31249398.

[3] Van Dalfsen JH, Markus CR. The influence of sleep on human hypothalamic-pituitary-adrenal (HPA) axis reactivity: A systematic review. Sleep Medicine Reviews. 2018;39:187-194. PMID: 29126903. doi:10.1016/j.smrv.2017.10.002.

[4] Incollingo Rodriguez AC, Epel ES, White ML, Standen EC, Seckl JR, Tomiyama AJ. Hypothalamic-pituitary-adrenal axis dysregulation and cortisol activity in obesity: A systematic review. Psychoneuroendocrinology. 2015 Dec;62:301-18. doi: 10.1016/j.psyneuen.2015.08.014. Epub 2015 Aug 21. PMID: 26356039.

[5] Cadegiani FA, Kater CE. Adrenal fatigue does not exist: a systematic review. BMC Endocr Disord. 2016 Aug 24;16(1):48. doi: 10.1186/s12902-016-0128-4. Erratum in: BMC Endocr Disord. 2016 Nov 16;16(1):63. doi: 10.1186/s12902-016-0132-8. PMID: 27557747; PMCID: PMC4997656.