Cortisol: when it helps us and when it may be a sign we need to slow down

Our body often knows we're stressed before we're able to admit it to ourselves.

Maybe this sounds familiar. You open your eyes in the morning and you're already thinking about everything you need to get done. During the day you run on coffee, obligations and a mental to-do list. By evening you're exhausted, yet you still can't fall asleep. Your mind keeps working, your body is tense, and when you finally do fall asleep, the sleep isn't as refreshing as you need it to be. And then you read somewhere: "It's all down to high cortisol."

In recent years, cortisol has become almost a synonym for stress. It comes up in connection with weight gain, insomnia, anxiety, fatigue and so-called burnout. But it's important to say that cortisol is not the enemy. Quite the opposite. It is a hormone that is essential to how we function, and without it we wouldn't be able to adapt appropriately to pressure.

So the problem isn't cortisol itself. What matters is how, when and to what extent it is released in our body, and whether the stress response is able to settle down again after the strain is over. And this is exactly where the workings of the body meet our psychological experience.

Cortisol is not the "bad stress hormone"

Cortisol is a steroid hormone produced in the adrenal cortex. It has many important roles: it is involved in regulating metabolism, blood pressure and immune processes, and it helps the body cope with situations we perceive as demanding.

Its level naturally changes over the course of the day. Under normal circumstances it tends to be higher in the morning, when it helps us wake up and activate the body, and then gradually falls during the day. So it is not a hormone that is supposed to stay at the same level all day.

Cortisol is part of our adaptation system. When we find ourselves in a situation that calls for heightened attention – whether it's a physical threat, a difficult situation at work, a conflict or some other strain – the body gets ready to handle it. More energy becomes available, attention focuses on the problem and the body mobilises. That is very useful.

Imagine someone who has to deliver an important performance at work, sit an exam or react quickly to an unexpected situation. An appropriate activation of the stress system can help them perform. The problem arises when the body stays in threat mode for too long, or keeps returning to it without enough room for recovery.

How the stress response works: the hypothalamus, pituitary gland and adrenal glands

One of the main systems involved in regulating the stress response is the so-called HPA axis – the hypothalamus, the pituitary gland and the adrenal glands.

To put it simply, we can think of it as a kind of communication chain.

The hypothalamus picks up information about a stressor and sends a signal via the hormone CRH. This acts on the pituitary gland, which in turn releases ACTH. ACTH travels through the bloodstream to the adrenal glands and stimulates them to produce cortisol. Cortisol then acts in many parts of the body and helps prepare it to deal with the strain.

Once the danger or strain has passed, the system should gradually calm down. At the same time, cortisol helps regulate further activity of this axis through feedback mechanisms.

It is a very finely tuned system. And it is precisely its ability to switch on and then switch off again that is important for healthy functioning.

With long-term stress, however, regulating the stress response can become more complicated. Research on chronic stress shows links between long-term strain and changes in how the HPA axis functions, but it can't simply be said that every chronically stressed person has constantly "high cortisol".

When is cortisol useful and when can it start to do harm?

Let's imagine stress as an alarm. If it goes off when we need to react, it's useful. If it goes quiet again once the situation has been dealt with, the body gets room to regenerate.

The difficulty comes when the alarm sounds too often, or when a person lives for a long time in conditions where they can't relax.

This might be long-term pressure at work, a conflict-ridden relationship, caring for a loved one, financial insecurity, a long-term illness or lack of sleep, but also inner pressure we create ourselves – for example the need to be productive all the time, to handle everything and never make mistakes.

From a psychological point of view, it's interesting that stress doesn't always have to be tied to one big event. Sometimes the body is worn down by lots of small, recurring strains. "I'll just sort this out first." "I can't rest now." "I have to manage this." "Once I finish this, I'll finally catch my breath."

But the next obligation often arrives before we've had a chance to catch our breath.

What symptoms might we notice?

Today, high cortisol is talked about in connection with a huge range of symptoms. But caution is important here: insomnia, fatigue, irritability or weight gain are not, on their own, proof of raised cortisol levels.

They can have many causes – from lifestyle and psychological stress to various physical illnesses. The body may be signalling that it needs to slow down. With long-term stress we may experience sleep problems, increased tension, fatigue, changes in appetite or digestive problems. Some people also notice changes in their weight. Fat storage around the abdomen is mentioned especially often. Waist circumference alone, however, is not a simple measure of cortisol. Body weight is influenced by many factors – diet, physical activity, sleep, genetics, age, medication, hormonal factors and overall lifestyle.

With a genuine long-term excess of cortisol, for example in Cushing's syndrome, more characteristic physical signs can appear, such as more pronounced central weight gain, muscle weakness, high blood pressure, easy bruising or skin changes. This, however, is a medical condition that requires professional examination.

The mind may be more irritable

Under long-term strain we may notice that we have a shorter fuse. Things that wouldn't normally throw us suddenly make us angry. We may be oversensitive to criticism, find it harder to concentrate, feel overwhelmed, or feel that we can't think as clearly as before.

In my practice, people often describe this state in these words: "It feels like my head is running at a hundred percent, and yet I can't think straight."

Here too, though, this is not a simple cortisol test. Similar signs can accompany chronic stress, anxiety, depressive feelings, exhaustion, lack of sleep or many other conditions.

What can keep the stress system under strain?

Work, relationships and the feeling that we always have to keep functioning

One of the most common sources of long-term stress is an environment we can't simply "walk away" from. If someone is under pressure at work every day, the conflict in their relationship continues when they get home, and in the evening they are still dealing with obligations, their nervous system has minimal opportunity for real recovery.

It's very important to distinguish between stress and activation and chronic stress without sufficient recovery.

Not every demanding day is a problem. Our body is equipped to handle strain. The problem is a long-term imbalance between what we demand of ourselves and how much time, safety, sleep and recovery we allow ourselves.

Sleep and a disrupted daily rhythm

Sleep is one of the most important factors connected with regulating the stress system. Research points to links between lack of sleep or sleep disorders and changes in cortisol regulation. And we often end up in a vicious circle.

Stress makes our sleep worse. Lack of sleep reduces our ability to cope with stress. During the day we're tired, so we reach for coffee. In the evening we're tired but also overloaded, so we can't switch off. And the next day the whole cycle repeats.

How is cortisol measured, and when should you see a doctor?

Cortisol can be tested in blood, saliva or urine. When a condition involving excess cortisol is suspected, though, it isn't simply a matter of having your "cortisol measured" and finding out from one number whether you're stressed.

Cortisol has a natural daily rhythm, and the result also depends on when and how the sample was taken.

When Cushing's syndrome is suspected, professional guidelines list, for example, 24-hour urinary free cortisol, late-night salivary cortisol or the dexamethasone suppression test. A random one-off blood cortisol measurement is not a recommended way of screening for Cushing's syndrome. That's why I wouldn't recommend diagnosing yourself on the basis of a single lab result. It's a good idea to see a doctor especially if the symptoms are pronounced, long-lasting or getting worse, or if several characteristic physical changes appear. The doctor can then assess whether an endocrinology examination is needed or whether to look for another cause of the problems.

How to support healthy cortisol regulation naturally

If a person doesn't have a hormonal disorder, the goal is not to "knock cortisol down to a minimum". We need it. The goal is rather to support the body's ability to respond appropriately to strain and then recover from it.

Sleep as the foundation

If I had to choose one habit worth addressing first, it would be sleep. Not because there is some magic number of hours that suits everyone, but because regular and sufficient sleep lays the foundation for the functioning of the nervous, hormonal and immune systems.

A regular wake-up time helps, as does enough darkness while you sleep, limiting screens before bed and creating an evening routine that signals to the body that the day is ending.

And this is very important too: sleep is not a reward for getting everything done. It is a biological need.

Movement, yes – but not as another obligation

Movement is very important for health and stress regulation. At the same time, it isn't true that the more intensely we exercise, the more we "lower cortisol".

Acute intense physical exertion can temporarily raise cortisol – this is a normal part of the physiological response to strain. Regular physical activity, however, can improve the stress system's ability to respond and recover.

For someone who is exhausted and has been under pressure for a long time, another extreme workout may therefore not be the best solution. Sometimes brisk walking, swimming, cycling, easy running, yoga, or simply regular movement that the person can do without turning it into yet another test of their performance is far more suitable.

Breathing and calming the nervous system

When we're stressed, the body mobilises. The heart beats faster, muscles tense and attention narrows to what we consider important. One way to support calming down is conscious work with the breath. It doesn't have to be a complicated technique.

We can sit down for a moment, relax our shoulders and pay attention to slow breathing. Making the exhale longer than the inhale helps in particular, if this feels comfortable. But the point isn't to "breathe perfectly". The point is to give the body a moment in which it doesn't have to deal with anything. A short walk, time in nature, relaxation, meditation or a moment without your phone can help in the same way. Not as another task on the list, but as genuine space for recovery.

Diet, caffeine and alcohol

Lifestyle is also connected with how the stress axis and cortisol function. Research points to links between cortisol and sleep, physical activity, nutrition and alcohol consumption.

With caffeine, what matters most is its individual effect. If someone drinks a lot of coffee and at the same time suffers from anxiety, heart palpitations or insomnia, it may be useful to watch whether their difficulties are related to caffeine.

Alcohol may bring a short-term sense of relaxation, but it isn't a suitable tool for regulating stress and can also have a negative effect on sleep and the functioning of the stress axis.

And as with everything else, I wouldn't look for a single anti-stress food when it comes to diet either. Overall regularity and balance matter more.

What about low cortisol?

When we talk about cortisol, it's important not to forget that the problem doesn't have to be only an excess. Producing too little cortisol can be related to insufficient adrenal function or to other hormonal disorders. It can show up as fatigue, weakness, low blood pressure, dizziness or other symptoms, and it belongs in a doctor's hands. That's why the goal is definitely not to get cortisol "as low as possible".

When an adrenal disorder is suspected, test results are interpreted in a broader medical context and further tests are used as needed.

This is perhaps one of the most important points of the whole topic: health is not a state in which we have minimal cortisol. Health is our body's ability to regulate the stress response in proportion to the situation.

When might a psychological problem be behind our "high cortisol"?

This brings us to an area that is very close to my heart as a psychologist. Sometimes a person comes in convinced: "I have high cortisol, I need to lower it." But when we look at their everyday life, we find that they sleep five hours, work under constant pressure, deal with conflicts at home, catch up on work at the weekend and can't stop thinking in the evening. In such a case, a much more important question than "How do I lower my cortisol?" may be:

"What in my life is giving my body a reason to stay on constant alert?"

Psychotherapy can be useful precisely where chronic stress is connected with our patterns of functioning. We might look, for example, at perfectionism, the need for control, an inability to set boundaries, taking on responsibility for others, fear of failure or staying for a long time in a situation that drains us.

Because sometimes it isn't enough to teach a person to relax.

If they return every day to an environment where they are under long-term pressure, relaxation may be just a short break between two periods of strain.

In therapy, then, we also look for answers to the questions of what the source of stress is, what we can influence and what we can't, where we need to set boundaries and what we actually expect of ourselves. At the same time, psychotherapy does not replace a medical examination when a hormonal disorder is suspected. But the two can complement each other very well.

In closing: let's not try to "defeat cortisol"

Cortisol is not our enemy. It is part of an intelligent system that helps us respond to demanding situations. We need it – to get out of bed in the morning, to concentrate, to cope with strain and to mobilise energy when needed. The problem arises when the strain is long-term and the body doesn't get enough opportunities to return to calm. So instead of constantly monitoring the "level of the stress hormone", I would try starting with something much simpler. Let's ask ourselves:

• How am I sleeping?
• How often during the day do I have a moment when I don't have to deal with anything?
• Do I have room in my life for movement and recovery?
• What has been draining me for a long time?
• Can I say no?
• Am I in a job or a relationship where I feel safe?
• And can I allow myself to rest without feeling guilty?

It's this last question that sometimes turns out to be surprisingly important.

Because if a person first needs to finish everything, satisfy everyone and handle everything before they allow themselves to rest, they may be waiting for that rest for a very long time.

Taking care of your stress system therefore doesn't have to start with an expensive supplement, measuring every hormone or looking for the next "hack". It often starts much more simply – with regular sleep, adequate movement, food that gives us energy, a moment of quiet and the ability to stop.

And if we find that we haven't been able to slow down on our own for a long time, that we're irritable, overwhelmed, sleeping badly, or feel that we're simply always running "at full stretch", it's worth looking beyond our hormones.

Maybe it's time to look at our life as well. Because sometimes the body doesn't need us to control it even more. It needs us to start listening to what it has been trying to tell us for a while.

If you feel that long-term stress, exhaustion, anxiety, sleep problems or a difficult life situation are starting to affect your everyday life, a psychological consultation can be a space where you can safely pause, name what's going on and look for concrete steps that can gradually change the situation. You can also book a consultation with a specialist through the ksebe.sk platform.