Adrenal Fatigue, also known as adrenal insufficiency or adrenal dysfunction is a broad and heated topic.  There are many theories and opinions concerning adrenal fatigue, which makes it a controversial issue in healthcare community today.   

The majority of the conventional medical community does not recognize Adrenal Fatigue as a real diagnosis. However, some experts say everybody has adrenal fatigue to some extent.  Others say nobody has it. As I said, there is a lot of varying perspectives about the adrenal glands.

For this post, I am not going to argue whether adrenal fatigue exists or not.  From my 14 years of experience, I know it does. Over the last decade, I have observed three common types of adrenal fatigue.  

I call these types, The Vampire, The Ghost and The Zombie.  There are more types/categories of adrenal fatigue, but these three are the most common I consistently see and treat.  You might find that you can relate to one of the three types.

Quick Info on Cortisol:

Many people are familiar with cortisol as the stress hormone. Cortisol is released from the adrenal cortex and is a glucocorticoid due to its effect on blood sugar. You can’t live without cortisol; it is essential to maintaining life.

When cortisol is disrupted or being secreted dysfunctionally, it can cause many symptoms.  There is a lot of information about high cortisol or low cortisol, but the critical distinction is the daily levels of cortisol secreted are out of sync.   

The adrenal glands secrete cortisol in a diurnal fashion, which helps to establish our typically circadian rhythm. Meaning it is supposed to be high in the morning, so we wake up bright eyed and bushy tailed.  Then cortisol lowers toward later afternoon and dives at night so that we can get a good night’s sleep.

Normal Cortisol Levels:

• High in morning
• Moderate afternoon
• Low night

Types of Adrenal Fatigue:

There are many “types” of adrenal fatigue or adrenal insufficiency.  People with high cortisol, people with low cortisol and everyone in between.  I am sure many of you have read about the various types and subtypes of adrenal fatigue.  From my own experience treating patients, I am going to break it down into three simple profiles. These are the three common profiles I have seen in practice: The Vampire, The Ghost, and The Zombie.

The Vampire: (up all night, sleep all day)

• High cortisol at night
• Low cortisol in morning and afternoon

Vampires love to stay up at night.  Soon after 8 pm, their senses come alive and report they are more productive at night. They interact with others, work on the computer and even get household activities done at night.  This is also a time they report being hungry. Not for your blood, but worse. It’s a craving for junk food because they feel so much better at night, they tend to stay up late. Vampires report they couldn’t fall asleep early if they tried. However, this comes at a price, because they are always extremely tired the following morning.   

Vampires are exhausted in the morning and would love to sleep in as late as possible. Unfortunately, life starts early. Vampires reluctantly get moving in the morning and depend on lots of coffee or caffeine to function.

Vampires start to become moderately functional around noon. They optimistically think they are going to bed early and get a good night’s sleep.  No surprise, it’s groundhog’s day! Different night, same cycle.

Vampire Daily Cycle: 

• The alarm goes off, they press snooze multiple times
• Finally, drag themselves out of bed in the morning
• Need coffee to function
• Start feeling good after 8:00 pm.
• Cravings for salt or sugar (CARBS!!!)
• Sleep after midnight (usually much later)
  

A classic Vampire case is a patient of mine “Brandy.”  She is 37 years old and a SAHM (stay at home mom). She has a 7-year-old daughter and a 5-year-old son.  Her alarm clock goes off at 6:45 am and again at 7:15 am, and she barely makes it out of bed by 8:00 am.

Her husband gets mad at her because she can never get the kids to school on time, which has been a creating a strain on their relationship as well.  She drags herself through the day with the best intentions of going to bed and waking up early.

By the time 9 pm comes around, she feels like a “normal person.” She gets all her emails and housework done.  Then she watches Netflix/Amazon/Hulu while munching on chips and chocolate. Brandy reports this is the only time of the day that she has an appetite.  She tries to talk to her husband, but he is already asleep. 

Brandy says when she tries to lie down at 10:30 pm she cannot fall asleep and feels wide awake. Wisely she does not take sleeping pills because they are habit forming and have too many side effects.  Besides, she doesn’t want to be in a coma in case her kids need her in the middle of the night.

Brandy usually falls asleep between 1-2am and sleeps the entire night till the alarm at 6:15 am. No matter what she cannot get out of bed and kids are always late to school.

Vampire Characteristics:

• Set multiple alarms
• Place alarms around the room
• Sleep through all alarms
• Have family members literally shake them to wake them up
• Do not remember the family members shaking them
• Get up, turn off the alarm and don’t remember doing this

It is hard being a Vampire.  Life starts early, and they often end up getting left behind. And no, moving to Washington state is not going to get Vampires to enjoy the day.  This is not Twilight.

The Ghost: (early to rise, early to bed – sort of)

• High cortisol in the morning
• Low cortisol in the afternoon
• Cortisol spikes in during the night

Unlike Vampires, Ghosts have no problem going to sleep.  They fall asleep easy. In fact, they often fall asleep too early in the evening.  Many ghosts report they sleep hard for about 3 hours. Then they wake up like it is morning, but it is only 2 am!

Ghosts come in two varieties.

• Ghost A wakes up in the middle of the night for one or more hours.
• Ghost B wakes up many times throughout the night.

Ghosts complain that they cannot stay asleep.  You will find Ghosts haunting the house in the middle of the night.  They will be roaming back and forth from bed to couch. 

They are staring at their phones or watching TV during the night.  However, unlike Vampires, Ghosts usually wake up easily in the morning. They might be slightly fatigued from the small series of naps they had the night before, but once they get moving in the morning, they are good to go.  

Like clockwork at 1:30 to 3:00 pm they disappear.  A wave of exhaustion sweeps over them in the early afternoon and they “ghost” everyone.  These are the people that make sure to get all the essential duties done before noon. They are also the people who build secret sleeping nooks in their desk (like George from Seinfeld).   

If you are looking for them, they might be hanging by the coffee pot. Ghosts also have huge cravings to munch on carbs in the afternoon.  You can lure them out by placing m&ms or cookies on your desk.

A classic Ghost is my patient “Casey.”  She is a 44-year-old accounts receivable manager for a health insurance company.  She has great flexibility in her job and can work from home.

Her job is to deal with insurance claims and the occasional phone meeting with her group. Casey has made her job work with her Ghost-life, but it doesn’t leave much of a social life for her.  As a Ghost, Casey falls asleep early, usually around 8:30 pm and she will wake up at 11 pm for a few minutes and then at 12:30 am and again at 2 am for a few minutes.  

Then at 3:00 am, she is wide awake. At this point, she has a choice.  Either lie in bed until 6:30 am or just get up at 3:00 am. Most often Casey wakes up at 3:00 am and works from home until noon.  She then eats lunch and gets immediately sleepy.

She cat-naps for a while but then is unproductive until it is time to get dinner started and her husband comes home.  Then early evening comes, and she is dozing off before the sun has set.

The Zombie: (tired all the time)
Zombies may not have an appetite for brains, but they certainly wonder where they placed their own.  Zombies are exhausted mentally and physically ALL THE TIME.

They can sleep for hours.  They complain of brain fog and trouble with short-term memory. Their blood pressure is low. They often complain that they get lightheaded and are easily out of breath.  There is no time of the day they do not feel tired. Because life goes on, Zombies stumble and struggle through the day trying the best they can.  

“Mary” is my classic recovering Zombie.  Mary is 32 years old and married to her high school sweetheart Joel.  He is so supportive, and Mary tears up when talking about Joel because he was there for her during her stressful teen years. Still today, Joel helps because she is always so tired.  

Mary is exhausted all day and night.  She cannot do a lot of physical activity because she doesn’t have the stamina for it.  Mary is forgetful and feels like she misplaced her brain. Joel is a gem. He does all the shopping, helps with the household chores, meals and takes the kids to school and practices.  

Mary feels guilty all the time.  She has been to many doctors and given multiple medications and vague diagnoses.  She was even told, “it’s all in your head.”

Mary’s cortisol is low all the time, both day and night.  Once we were able to get her cortisol higher in the morning and day, she felt so much better.  She was able to participate in family activities and running her own Etsy business. She and Joel enjoy their daily evening walks after dinner.

I could write on and on about: How did my cortisol levels become so out of sync? How can I find out what my cortisol levels are? How can I correct my cortisol levels? If I am a vampire, which type is my romantic match?

There is a lot of discussion about adrenal fatigue in general, but there is not a lot of talk about the different variations, so hopefully, this shed some light on the three common profiles of adrenal fatigue I have seen in my practice.  Soon to come, I will be delving more into all these topics. BTW: Vampires match well with other vampires.  Ghosts + Vampires = not a good match. And nobody wants to date a Zombie.

Feel free to leave a comment below to let me know which type you are. Maybe you can identify a different type I didn’t mention. If you have any quesitons send us an email at [email protected].