CFS Associated with Low Morning Adrenal Cortisol, But High Evening Levels

Published: September 28, 2012

This study suggests that cortisol levels are too low during the day and too high at bed time. This can cause both exhaustion and insomnia.

This study shows that in people with chronic fatigue syndrome, cortisol levels are too low during the day and too high at bed time. This can cause both exhaustion during the day, when people need higher cortisol levels to deal with life stresses, and insomnia at night when cortisol levels need to be low so that you can sleep. An upcoming issue of our newsletter will discuss natural remedies that lower cortisol levels at night time, so you can sleep.

Alterations in Diurnal Salivary Cortisol Rhythm in a Population-Based Sample of Cases With Chronic Fatigue Syndrome

Urs M. Nater, PhD, Laura Solomon Youngblood, MPH, James F. Jones, MD, Elizabeth R. Unger, MD, PhD, Andrew H. Miller, MD, William C. Reeves, MD, MSc and Christine Heim, PhD

From the Chronic Viral Diseases Branch, Coordinating Center for Infectious Diseases, Centers for Disease Control & Prevention (U.M.N., L.S.Y., J.F.J., E.R.U., W.C.R.), and Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine (U.M.N., A.H.M., C.H.), Atlanta, Georgia.

Address correspondence and reprint requests to William C. Reeves, MD, Centers for Disease Control and Prevention, Mail Stop A-15, Atlanta, GA 30333. E-mail:


To examine diurnal salivary cortisol rhythms and plasma IL-6 concentrations in persons with chronic fatigue syndrome (CFS), persons not fulfilling a diagnosis of CFS (we term them cases with insufficient symptoms or fatigue, ISF) and nonfatigued controls (NF). Previous studies of CFS patients have implicated the hypothalamic-pituitary-adrenal axis and the immune system in the pathophysiology of CFS, although results have been equivocal.


Twenty-eight people with CFS, 35 persons with ISF, and 39 NF identified from the general population of Wichita, Kansas, were admitted to a research ward for 2 days. Saliva was collected immediately on awakening (6:30 AM), at 08:00 AM, 12 noon, 4:00 PM, 8:00 PM and at bedtime (10:00 PM) and plasma was obtained at 7:30 AM. Salivary cortisol concentrations were assessed using radioimmunoassay, and plasma IL-6 was measured using sandwich enzyme-linked immunosorbent assay.


People with CFS demonstrated lower salivary cortisol concentrations in the morning and higher salivary cortisol concentrations in the evening compared with both ISF and NF groups indicating a flattening of the diurnal cortisol profile. Mean plasma IL-6 concentrations were highest in CFS compared with the other groups, although these differences were no longer significant after controlling for BMI. Attenuated decline of salivary cortisol concentrations across the day and IL-6 concentration were associated with fatigue symptoms in CFS.


These results suggest an altered diurnal cortisol rhythm and IL-6 concentrations in CFS cases identified from a population-based sample.


Psychosomatic Medicine 70:298-305 (2008)

Jacob Teitelbaum, MD

is one of the world's leading integrative medical authorities on fibromyalgia and chronic fatigue. He is the lead author of eight research studies on their effective treatments, and has published numerous health & wellness books, including the bestseller on fibromyalgia From Fatigued to Fantastic! and The Fatigue and Fibromyalgia Solution. His newest book (June 10, 2024) is You Can Heal From Long COVID. Dr. Teitelbaum is one of the most frequently quoted fibromyalgia experts in the world and appears often as a guest on news and talk shows nationwide including Good Morning America, The Dr. Oz Show, Oprah & Friends, CNN, and Fox News Health.

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