Hint: It's not coffee!
Fatigue is one of the most frequent complaints I see in clinical practice. When I ask about what time of day energy levels are lowest, the 2 most common answers I hear are: first thing in the morning and mid-afternoon.
Mid-afternoon slumps can be related to a few things including poor food choices at lunch, not eating enough early in the day, being stuck indoors in front of a screen all day, or maybe you just really don’t like your job!
Low morning energy is most frequently associated with a disrupted circadian rhythm. You can learn more about circadian rhythms in my previous post here but the basic idea is that your body functions on a natural 24 hour cycle that essentially controls your entire biology. This will have a major impact on how well you sleep and how much energy you have during the day.
When your rhythm is out of whack, your sleep will likely suffer and you’ll have difficulty getting out of bed. We can get a pretty good objective measure of this by looking at cortisol levels. Serum (blood) AM cortisol is the most common measurement but is not all that helpful. A more comprehensive approach is a 4-point salivary or urine cortisol which will provide information across the entire day. You can think of cortisol as your daytime hormone which opposes the sleep hormone melatonin.
You should start with high levels of cortisol, also known as your Cortisol Awakening Response (CAR) which is a natural "stimulant” to kickstart your day. Cortisol should decrease throughout the day and hit a low point in the evening as melatonin starts to take over. The graph below shows a fairly typical pattern that I see in patients complaining with low energy and sleep issues. Ideally you should be in the green section for all 4 measurements, though I rarely see this!
In this case the AM reading is not terrible but definitely suboptimal, similar to the noon and evening measurements. This will typically present as difficulty getting your day started and low energy throughout until nighttime hits. As you can see there is a surge of cortisol at night which is the opposite of what you want! This will lead to a “second wind” at night, difficulty winding down and poor sleep. Of course this will result in feeling unrested the following morning, difficulty getting out of bed, low energy etc.. and the vicious cycle repeats!
If this is you, don’t worry there are solutions! I find the most impactful strategy is to kickstart your circadian rhythm properly in the morning so the rest of your day can follow smoothly. In Part 2 I will walk you through the best way to fix a disrupted circadian rhythm and boost your morning energy!