If You Find It Especially Hard to Get Up in the Morning

"I sleep, but it doesn't feel like sleep. The morning is the hardest."

The people who say this have something in common. They feel a little better once the afternoon comes. They barely get up in the morning and drag themselves out the door, but by evening their minds actually clear.

And in that state they stay awake late into the night. The next morning is hard again.

What Gets You Up in the Morning

The body has a device that prepares for morning.

Having bottomed out around midnight, a hormone called cortisol climbs slowly from the later half of your sleep. Two or three hours before you open your eyes it has already brought your blood sugar up, brought your blood pressure up, and held inflammation down. The body gets ready in advance to begin the day.

Then, within 30 to 40 minutes of waking, it surges once more. This is a separate thing from the gentle climb before it, and it carries its own name. Waking itself is the trigger — a short spur that opens the day.

So cortisol runs high in the morning and low at night. That rise and fall is what gives the day its rhythm.

In people who find the morning especially hard, this morning hill is low. The gap between night and day has narrowed — the curve has flattened.

Why It Flattens

One misunderstanding is worth clearing up here. The usual explanation is that "the adrenals are worn out and can't make the hormone anymore." But measure the day's total in people whose curve has flattened, and it is usually not short. It is less a matter of depletion than of distribution.

Cortisol's level is not set by the adrenal gland alone. The brain sends a signal, the adrenal answers it, and the cortisol that comes out feeds back to the brain — the whole regulating loop that makes the rise and fall takes part. On top of that sits the question of how readily the tissues take the cortisol signal in.

Some things change the shape of that loop.

• When inflammation carries on somewhere in the body for a long time
• When absorption has broken down from long-standing diarrhea or digestive trouble
• When sleep has been short for a long time
• When tension has run on for years
• After coming through a serious illness

When these persist, cortisol does not come down far enough at night, and there is that much less room for it to rise in the morning. Raise the floor and the hill looks lower.

This is not laziness. It is the mark of a body that has been holding on for a long time.

This Is the Face It Comes In

• Cannot get up in the morning. Better in the afternoon, if anything
• Not refreshed even after sleeping
• Mind clearing in the evening, so the night gets away from you
• Not holding up under stress the way you once did

The last one matters most. What you used to get through, you now cannot. It means the body's margin is gone.

What Has to Be Ruled Out Before a Name Is Given

Morning fatigue comes with a name attached: "adrenal fatigue." The trouble is that once the name is on, people stop looking behind it.

Morning fatigue is common. And mixed in among it are things a test confirms quickly.

These come as morning fatigue too	How they are ruled out
Hypothyroidism	Blood test
Anemia	Blood test
Diabetes	Blood test
Sleep apnea	Heavy snoring, breathing stopping in sleep
Depression	Interest fading, mood sinking
Actual adrenal disease	Blood test — rare, but dangerous

These are not things to spend time on while taking herbal medicine. For someone in this situation I suggest testing first. That is the order.

One Note on Licorice

Because licorice is sometimes taken over long stretches for the sake of energy, there is one thing worth saying.

Licorice works by keeping cortisol from being switched off, which prolongs its action. It can feel like a lift for a while. But at the same time it sends potassium out and holds sodium and water in. Taken in quantity over a long period, it brings swelling, raises blood pressure, and in serious cases makes the heartbeat irregular.

The effect and the burden come from the same place. It is a herb to use with an amount and a length of time decided in advance, and a herb that becomes a burden when taken long without deciding either. (Herbal medicine has side effects too — the story of licorice)

No Pushing — an Order Instead

With these patients the body does not get pushed. It is a body with no margin left to push.

Give a large meal all at once to someone who has gone hungry a long time and they get sick. Give a strong stimulus to a worn-down regulating device and the same thing happens.

So I keep to an order.

First, I look for what keeps forcing it to be drawn out. Long-standing inflammation, a problem of absorption, or sleep. Bailing water out before turning off the tap gets you nowhere.

Second, I bring absorption and metabolism back. The materials have to come in before anything can be made.

Third, I return the rhythm of the night. Cortisol has to come down far enough at night to rise in the morning. To mend the morning, you start from the night.

Fourth, only then do I add daytime activity, a little at a time. Only as much as has come back.

What You Can Start Today

Get morning light. Ten minutes after getting up is enough. The body's clock is set by light.

Cut down bright screens in the evening. Cortisol has to come down at night to rise in the morning.

Lie down before 11 p.m. If you work in the evening because your mind clears then, the body takes night for day.

Don't skip breakfast. Eat something, at least.

Exercise only as much as has come back. For a worn-down body, hard exercise is a burden rather than a stimulus. Begin with a short walk.

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Cortisol runs high in the morning and low at night. Long-standing inflammation and lack of sleep flatten that rhythm.

The difficulty is real even when testing shows nothing. But once you put a name on it first, the cause worth finding — inflammation, absorption, sleep — goes unlooked for. The cause comes before the name.

How far herbal medicine returns this rhythm has not been worked out sufficiently in people. That is as far as what is known goes.

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If you have been told that not being able to get up in the morning means a weak will, don't believe it.

It may mean the body has been holding on for a long time. If so, what it needs is not a push, but first finding what made it hold on that long.

References

• Cortisol and ACTH follow a 24-hour rhythm — lowest around midnight, rising steeply in the later half of sleep to peak in the early morning, then declining through the day — Endocrine Reviews, 2017
• The flatter the diurnal cortisol slope, the worse the health outcomes, with the association strongest for immune and inflammatory measures (80 studies, 36,823 people) — Psychoneuroendocrinology, 2017
• A systematic review finding no evidence supporting "adrenal fatigue" — 58 studies reviewed out of 3,470 screened — BMC Endocrine Disorders, 2016

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Written by Dr. Heo Ji-young (PhD in Korean Medicine Pathology, Kyung Hee University · former Research Professor of Herbology, Kyung Hee University)