Robin's Short Version
- Chronic stress can dysregulate the HPA axis and flatten the normal cortisol curve without causing structural adrenal disease.
- A drop in stress can trigger fatigue, headaches and other “let-down” symptoms—the pattern sometimes called leisure sickness.
- A five-point saliva test can reveal whether cortisol is low on waking, flat through the day or elevated at night.
- Recovery starts with real rest, followed by daily downshifting, consistent sleep, balanced blood sugar, hydration and moderate movement.
- Adaptogens and interventions such as stellate ganglion block should be matched to the individual and cannot replace addressing the stressors driving the pattern.
My body is coming off its own chronic adrenaline. Here's what that crash is scientifically, and how to land it.
I've been running on adrenaline for 11 years. Building a company. Having three kids. Living in New York City. Always on, always going.
I've also prided myself on living my medicine. I meditate 15 minutes every morning. Most weeks I get acupuncture, a massage or at least a pedicure. Something to drop me into rest-and-digest, relax-and-heal mode.
But TBH, my sleep is erratic, and I'm constantly on the run.
Now I've stepped out of the CEO role. The first couple of weeks, I kept myself super busy. But as some spaciousness has come in (which was the whole point), so have the symptoms. I'm tired during the day. I wake up with headaches. Getting up and leaving the house feels harder than it should.
I joked to a friend that I could feel the adrenal fatigue slipping in. She said it sounded like coming off Adderall.
She's right. I'm coming off my body's own Adderall: adrenaline.
I've been here once before, the month after I finished residency. For weeks I was exhausted, low, headachy, like I was fighting off the flu. And I see it in patients all the time. The ones who crash on day 3 of vacation. The ones who leave a high-stress job and feel worse, not better. The moms who suddenly feel tired all the time once the baby starts actually sleeping.
If you're tired all day, can't get up in the morning or are wired at night, that's exactly what I'd want to map with a cortisol curve. Let's figure out what's driving it →
This week: what running on adrenaline does to your body, how we test for it, and how to land the crash.
⚡ Forward this protocol
💡 Forward this protocol
Coming off a big push? Use the Soft Landing Protocol.
- Give yourself 72 hours of real rest. No catching up on email, no packed weekend plans. Sleep, walk, eat well, lie on the couch. Your body will find its new equilibrium if you give it the time.
- Then downshift daily, not weekly. 5 minutes of slow breathing, 20 minutes outside, a consistent bedtime. Every day, not just on massage day.
👉 Forward this to the friend who always gets sick on vacation.
What to know: Adrenal fatigue isn't a disease. It's a dysfunction.
❌ The old assumption: Adrenal fatigue is a myth. Either your adrenals work or they don't.
Conventional endocrinology looks for disease: Addison's, where your adrenals can't make enough cortisol, or Cushing's, where they make far too much. If you don't have either, you're told your adrenals are fine. A 2016 review called adrenal fatigue a myth.1
✅ The new reality: It's real. It's functional, not structural. Your adrenals aren't "burned out." But the system that tells them when to release cortisol, the HPA axis, can get dysregulated by chronic stress. Researchers have documented underactive cortisol output in otherwise healthy people living under chronic stress.2
In my practice, it shows up as:
- daytime fatigue
- a hard time getting up
- feeling wired in the evening
- disrupted sleep
- abdominal weight gain
❝ Your adrenals aren't broken. Your cortisol rhythm is.
📈 The shape of your cortisol curve matters. Healthy cortisol spikes in the first 30–45 minutes after you wake up.3 Then it falls steadily all day to its lowest point at night.
Chronic stress flattens that curve. Flatter curves were linked to worse health in 10 of 12 outcome categories, with the strongest link to inflammation and immune problems.4 In 4,047 adults followed for about 6 years, higher bedtime cortisol nearly doubled the risk of dying from heart disease. Morning cortisol didn't matter.5
Translation: the problem isn't usually too much cortisol in the morning. It's not coming down at night.
🎢 The crash has a name. Psychologists call it leisure sickness: you feel fine all week, then get sick the moment you stop. About 3% of adults recognize themselves in it. The top symptoms? Headache, fatigue and muscle pain. Women reported fatigue more than twice as often as men, 45% vs 21%.6
And who gets it? People with a heavy workload, a high sense of responsibility and a hard time relaxing. Sound familiar?
The headaches have data too. In people with migraine, stress itself didn't predict an attack. A drop in stress did, raising the odds 1.5–1.9x over the next 6 to 18 hours.7
That's the let-down. Your body built a counterforce to keep you going. Take away the pressure and, for a while, the counterforce has nothing to push against.
UnlockedYou're in.
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What to do: Test your curve. Land the crash. Fix the root.
1️⃣ Map your cortisol curve.
At Parsley, we test cortisol 5 times across a day with saliva: on waking, in the morning, at midday, in the evening and at bedtime. A single morning blood draw can't show you the shape.
- Low on waking, slow to rise → the "can't get up" pattern
- Flat all day → the "tired all day" pattern
- High at night → the "wired but tired" pattern
It's one piece of the puzzle. We look at it alongside thyroid, nutrients, blood sugar and sleep.
2️⃣ Go with the crash, don't fight it.
Give yourself 3 full days to truly rest. After that, keep as much rest in your week as you can. It may take months to find your new normal. That's not failure. That's your body recalibrating.
3️⃣ Downshift every day, not just on spa day.
Weekly acupuncture and massage are great. But your nervous system needs a daily signal.
- 5 minutes of cyclic sighing: two inhales through the nose, one long exhale through the mouth. It improved mood more than meditation in a month-long trial.8
- 20–30 minutes outside: the most efficient dose for lowering cortisol. Walking or sitting both count.9
- Meditation or NSDR: across randomized trials, meditation lowered cortisol most in people under stress or at risk for high cortisol.10 Yoga nidra counts.
4️⃣ Protect the basics that keep your rhythm steady.
- Consistent sleep. Just two nights of short sleep raised evening cortisol and flattened its daily drop by 21%.11
- Balanced blood sugar. When glucose dips, your body releases adrenaline before you even feel shaky.12 Protein at every meal. No running on coffee until noon.
- Hydration. People who habitually drank less than 1.5 liters a day had a bigger cortisol spike under stress than people who drank more.13
- Regular movement. More active people tend to have a steeper, healthier cortisol curve.14 Keep it moderate while you're crashing.
5️⃣ Match your adaptogens to your curve.
Adaptogens are herbs that help your stress system respond more flexibly. But they're not one-size-fits-all. Some formulas nudge cortisol up. Others bring it down. In my practice, I pick them based on your cortisol test and your symptoms.
- Tired all day, can't get going? I like HPA Adapt, a blend of rhodiola, ashwagandha, eleuthero, holy basil and maca. Rhodiola is the standout here: in people with burnout, 4 weeks improved fatigue and focus.15
- Wired at night? For a high evening cortisol pattern, I like CatecholaCalm in the evening. It pairs calming herbs (lemon balm, passionflower, valerian) with L-theanine, magnesium and B vitamins.
- Ashwagandha is in both. In a 2025 meta-analysis of 7 trials, it lowered cortisol vs placebo.16 Skip it if you're pregnant or have liver disease.
But supplements only do so much. They support the system. They don't fix what's driving it.
6️⃣ Treat the root: your fight-or-flight.
You may be hearing about stellate ganglion block, or SGB, in longevity circles. It's an injection of numbing medicine into a nerve bundle at the base of your neck that drives your fight-or-flight response. The idea: temporarily switch off the alarm so your nervous system can reset.
The best data is in PTSD. In a randomized trial of 113 service members, SGB cut symptoms about twice as much as a sham injection at 8 weeks.17 How long it lasts isn't settled. One review of 75 patients' charts saw benefits hold for 6 months, but with no comparison group.18 And while serious complications are rare, they've been reported, including bleeding in the neck.19
The most telling study? The newest trial paired SGB with trauma-focused therapy. The block helped the therapy work faster.20 It opened a window. The therapy did the work.
For severe, treatment-resistant PTSD, it can be a real tool.
For everyday burnout, I'd start somewhere else. A block quiets the alarm. It doesn't change what keeps setting it off: the pace, the sleep, the blood sugar swings, the never-off phone, the stress you haven't processed. That's the work. Daily downshifting, therapy, and a life with more room in it.
The goal: Not to never crash. To build a nervous system that can go up and come back down.
One more thing...
Tired all day, can't get up, wired at night? Let's map your cortisol curve and find out why. Book with a Parsley clinician →
Stay strong, stay curious, and breathe,
Robin
References
- BMC Endocrine Disorders, 2016
- Psychoneuroendocrinology, 2000
- Psychoneuroendocrinology, 2016
- Psychoneuroendocrinology, 2017
- Journal of Clinical Endocrinology & Metabolism, 2011
- Psychotherapy and Psychosomatics, 2002
- Neurology, 2014
- Cell Reports Medicine, 2023
- Frontiers in Psychology, 2019
- Health Psychology Review, 2021
- Journal of Clinical Endocrinology & Metabolism, 2014
- Journal of Clinical Investigation, 1987
- Journal of Applied Physiology, 2025
- Biological Psychology, 2023
- Planta Medica, 2009
- Nutrition and Health, 2025
- JAMA Psychiatry, 2020
- Clinical and Translational Neuroscience, 2025
- Regional Anesthesia & Pain Medicine, 2019
- Psychotherapy and Psychosomatics, 2025
Originally published in the Off Script newsletter. Join Robin’s readers for weekly functional medicine insights.
As always, this newsletter is for informational and educational purposes only and is not intended as medical advice. Always consult your healthcare provider before making any health decisions or changes to your treatment plan.
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