Can Adrenal Dysfunction Cause Sleep Disorders?

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There are many potential causes for poor sleep. However, an increasingly common, but often overlooked source of sub-optimal sleep is adrenal fatigue.

Understanding the importance of the adrenals, how adrenal issues impact sleep, and how to properly identify and treat adrenal malfunction may help you return to wellness by facilitating high quality sleep.

What Are the Adrenals?

The adrenals are small walnut-sized glands that are located just above the kidneys. They are responsible for the production of over 150 hormones, many of which have impressive influence over various bodily functions.

Watch this video from Dr. Nancy Evans to learn even more about the adrenals.

Some of the most well-known adrenal hormones include adrenaline, estrogen, and DHEA. These and other adrenal hormones have a huge impact on health factors such as energy level, mood, weight, blood pressure, immune activity, nutrient usage, hormone regulation, and more. Any sort of adrenal irregularity can disrupt hormone activity resulting in system-wide dysfunction. A powerful but frequently disregarded source of adrenal dysfunction is adrenal fatigue.

What is Adrenal Fatigue?

Adrenal fatigue is a condition wherein the adrenal glands are overworked to a point where they become incapable of producing the hormones required to maintain healthy bodily function.

There are many components to adrenal fatigue with perhaps the most impactful being the release of cortisol. When we experience stress, the adrenals produce a hormone called cortisol. At the appropriate volume, cortisol stimulates our stress response which facilitates heightened focus, immune function, and physical ability. However, chronic activation of the adrenals and extended release of cortisol can quickly lead to adrenal exhaustion. As the adrenals become increasingly taxed, a wide array of health issues may begin to develop. Some indicators that the adrenals are entering a state of fatigue include:

  • Chronic or worsening physical fatigue that is not eased through sleep
  • Craving sugary or salty foods
  • Difficulty thinking clearly
  • Dizziness when standing
  • Exhaustion after minimal physical exertion
  • Inability to handle stress
  • Irritability and moodiness
  • Loss of libido
  • Muscle weakness
  • New allergies or food sensitivities
  • Recurrent infections
  • Swelling of the ankles
  • Weight loss or loss of appetite

Learn even more about adrenal fatigue here.

The Effects of Adrenal Fatigue on Sleep Quality

Adrenal hormones also influence sleep. As such, adrenal fatigue can have a notable effect on sleep quality. Even minor adrenal dysfunction can contribute to problems such as insomnia or inability to fall asleep, fitful or unrestful sleep, and disrupted inconsistent sleep. Some of the ways in which adrenal fatigue contributes to sleep issues is discussed below.

Adrenal fatigue may lead to irregular or inappropriate release of energizing hormones such as cortisol and adrenaline. This can trigger an unwanted state of hyper-vigilance and wakefulness, which can make it exceptionally difficult to fall asleep and sleep through the night. Some describe this sensation as being “wired and tired” or feeling as though the mind is racing while the body is physically exhausted.

In a healthy system, blood glucose levels are suppressed during sleep. This helps keep the body at rest. However, extremely reduced blood sugar values can trigger a stress response that interrupts sleep. Normally, the body responds to an impending deficit by employing cortisol to convert glycogen stored in the liver into glucose. This prevents excessive drops in blood glucose and subsequent waking. However, if the adrenals are exhausted, there may not be enough cortisol available to facilitate the conversion. The result of this being unrefreshing or disrupted sleep.

In addition to regulating stress and blood sugar, cortisol plays an important role in maintaining the body’s wake/sleep cycle. When we first wake in the morning, cortisol levels increase to provide the energy needed to start the day. As the day proceeds, cortisol levels slowly decline until reaching their lowest point around midnight. However, in the presence of adrenal fatigue, cortisol levels may become erratic. It is not uncommon for those with adrenal dysfunction to experience elevated levels of cortisol during the evening and have depressed values in the morning. This often leads to symptoms such insomnia, fitful or unrefreshing sleep, sluggishness in the morning, and tiredness throughout the day.  

How to Test for Adrenal Dysfunction

Many patients unknowingly suffer from adrenal dysfunction because they either disregard their symptoms or are unaware of the possibility of adrenal issues. Fortunately, with proper testing, it is possible to diagnose adrenal problems. Some of the most effective ways to identify adrenal irregularities are clinical symptoms, saliva tests, blood tests, and urine tests.

Clinical Symptoms

The Clinical symptoms are often the first sign that something isn’t right with the adrenal glands. Patients may be experiencing difficulty getting up in the morning, all-day fatigue or exhaustion, increased energy at night, frequent infections, lightheadedness and hypoglycemia, or low blood sugar. Patients may also feel that they are “burned out,” can’t handle everyday stressors, or have difficulty recovering from stressful situations. When a patient comes to our office with symptoms such as these, the doctor may suspect adrenal fatigue. Blood, saliva and urine tests can be used to confirm the diagnosis.

Saliva Tests

Saliva tests can be used to measure the levels of key adrenal hormones such as cortisol and DHEA. A saliva test is more accurate for cortisol and DHEA testing, as it measures the free and circulating amount of each of these hormones, rather than the total bound amount as measured in the blood.

While DHEA can be measured at any time during the day, cortisol levels vary throughout the day, and are highest in the early morning and lowest at night before bedtime. A diurnal (4x) saliva cortisol test measures cortisol levels at four key points during the day, at approximately 8 am, Noon, 5 pm, and before bedtime. The test results will allow your doctor to map out the curve of your cortisol levels throughout the day, relative to DHEA levels. This will give a clearer picture of your adrenal function, and will help your doctor determine which treatment protocols will help you feel better.

Serum (Blood) Tests

Serum tests can be ordered to check the levels of cortisol, DHEA-S, aldosterone and pregnenolone. DHEA and pregnenolone are precursors to other adrenal hormones, so low levels can often signal adrenal fatigue. Aldosterone helps to regulate sodium, potassium, and fluid levels in the body, and also affects blood pressure. Patients with low aldosterone levels often experience excessive thirst, frequent urination, and dizziness upon standing.

Urine Tests

Your doctor may also order a 24-hour urinary cortisol test, looking at multiple samples over a 24-hour period.

Effectively Treating Adrenal Fatigue

Adrenal fatigue is a highly individualized condition. Therefore, the first step of effective adrenal care is finding a doctor who is able to identify a patient’s unique adrenal stressors. Only then can an effective patient-specific treatment plan be created and employed. Depending on the specific needs of the patient, adrenal detractors such as chronic infections, immune disorders, or thyroid malfunction may be the initial point of focus. However, to fully resolve adrenal dysfunction, all contributing factors must be identified and resolved.

Patients can support their treatment by adopting an adrenal-supporting lifestyle that includes dietary improvements, reducing stress, and engaging in healthy exercise. Remember, the most important part of any adrenal treatment is that it is designed to meet the specific and unique needs of the patient.

Restore Sleep Quality by Supporting Your Adrenals

The adrenals play an important role in regulating numerous bodily processes including sleep. Adrenal fatigue can have a dramatic impact on sleep quality by promoting issues such as insomnia, blood sugar imbalances, and dysregulation of the wake/sleep cycle. Sadly, many people suffering from adrenal issues are not aware of their condition.

At Holtorf Medical Group, our physicians are trained to provide you with a treatment plan that is personalized to you. If you are experiencing symptoms of adrenal fatigue, give us a call at 877-508-1177 to see how we can help you!


1. Kent Holtorf, MD. “Diagnosis and Treatment of Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysfunction in Patients with Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FM).”

2. Kent Holtorf, MD. “Adrenal Fatigue Testing.”
3. Kent Holtorf, MD. “Adrenal Fatigue Treatment Options.”

About Holtorf Medical Group

The Holtorf Medical Group specializes in optimizing quality of life and being medical detectives to uncover the underlying cause of symptoms, rather than just prescribing medications to cover-up the symptoms. We are experts in natural, prescription bioidentical hormone replacement and optimization, complex endocrine dysfunction, fibromyalgia, chronic fatigue syndrome and Lyme disease.

We’ve dedicated our practice to providing you the best in evidenced-based, integrative medicine that’s not only safe and effective, but provides measurable results.