The meeting ended hours ago. So why is your body still acting like it’s in the middle of it? Here are five things that can keep your stress response switched on, and what to look at next.
Your stressful meeting ended at 2 p.m.
So why is your jaw still tight at 9:12? Why are your shoulders up near your ears, and why does your brain decide to open seventeen tabs the second you lie down?
A healthy stress response works like a wave. It rises to meet a demand, then settles back down once the demand is over. You handle the hard conversation, the deadline, or the near-miss in traffic, and an hour later your body has moved on.
The wave rises, but it doesn’t come all the way back down.
Ongoing stress can make that settling harder. That’s what people mean when they say they feel “stuck in fight or flight.”
These are the five contributors I look for most when someone tells me they can’t seem to come down.
Cortisol does two jobs during stress. It helps you respond, and then it signals your brain to ease off. That built-in feedback loop is part of how the wave comes back down. With long-term stress, that feedback can change in some people. The “ease off” message may not land as clearly, so the system stays more active than it needs to.[1] Some research suggests the body’s tissues can also become less responsive to cortisol’s calming signal over time.[2]
Long gaps between meals, eating too little, or certain glucose-lowering medications can drop your blood sugar. When that happens, your body releases adrenaline and cortisol to bring it back up.[3] The result can feel a lot like anxiety: shaky, sweaty, heart racing, irritable. One honest note: I don’t blame blood sugar unless the symptoms and the glucose data actually line up. Plenty of people feel shaky for other reasons. More on how to tell in your anxiety might be a blood sugar event.
Your immune system and your stress system talk to each other constantly.[4] An infection that won’t quite clear, an inflammatory condition, or daily pain can keep both systems activated, even when nothing stressful is happening in your life. If your labs look normal but you still feel inflamed, this post is for you.
Short sleep and frequent waking can raise stress activity the next day.[5] That 2:53 a.m. wake-up may show up at 4 p.m. as a headache and a short fuse. And because a keyed-up body sleeps lighter, it can turn into a loop: stress breaks up sleep, and broken sleep keeps stress up.
After months of vigilance, like caring for a sick parent, a layoff scare, or a hard season at home, your body can stay keyed up even after the crisis is over.[6] It learned to stay ready, and it hasn’t gotten the message that it can stand down. Worry and replaying the day can also keep the stress response going long after the actual stressor has passed.[7] That’s the seventeen open tabs at bedtime.
Tired all day but wired at bedtime is one of the most common patterns I see, but it’s not the only one. Some people launch hard in the morning and crash by 3 p.m. Others feel flat from start to finish. The Cortisol Rhythm Decoder helps you find your pattern in about five minutes: spiking, flat, running late, or stuck on at night. It also explains why a single morning blood test can’t see it, and which testing actually shows your rhythm.
Feeling keyed up isn’t always about stress. Several other things can look and feel exactly like a stress response that won’t shut off, so I screen for these, too:
| What I check | Why it can feel like stress |
|---|---|
| Thyroid issues | An overactive thyroid can cause a racing heart, anxiety, and trouble sleeping. An underactive one can cause fatigue and low mood. See the stress-thyroid pattern. |
| Anemia | Low iron or low red blood cells can cause a fast heartbeat, breathlessness, and fatigue. |
| Sleep apnea | Pauses in breathing at night jolt your body awake and trigger a stress response, often without you knowing. It’s common and often missed.[8] |
| Medication effects | Some medications can make you feel wired, jittery, or unable to sleep. More on this below. |
| Perimenopause | Shifting hormones can bring night sweats, broken sleep, and anxiety that feels new. Here’s why holiday anxiety can feel harder in perimenopause. |
| Anxiety and depression | These are real, treatable conditions, not just “stress,” and they deserve their own care. |
For men, this often shows up a little differently: irritability, poor sleep, and low drive more than racing thoughts. I cover that in why men lose energy and drive.
A breathing exercise can help your body shift gears when you’re keyed up. One simple version: breathe in through your nose, take a second small sip of air at the top, then let it out slowly through your mouth. Repeat for a few minutes.
In one study, about five minutes a day of slow, exhale-focused breathing improved mood and lowered signs of physical arousal.[9] It’s a great tool. It just isn’t the whole answer.
If you’re stuck on most days, a breathing exercise is a bandage. The full pattern deserves a closer look. That means asking:
The answers usually point to which of the five reasons is doing the most, and that’s where to start. My evening wind-down routine is a good place to begin if nights are your hardest time. And if the load feels bigger than any one thing, read why you’re so easily overwhelmed lately.
When someone tells me they can’t come down, I always look at their medication and supplement list. A few common culprits:
Please don’t stop or change a medication on your own. But it’s always worth asking your pharmacist or provider, “Could anything I take be keeping me keyed up?”
If you’d like extra support while you work on calming your evenings, these are the options I trust for supporting relaxation and restful sleep. Check with your pharmacist or provider first, especially if you take other medications.
Available through my Fullscript dispensary. Farmacy Counter may earn a commission on purchases.
It’s worth checking in with your provider if:
Get care right away for chest pain, fainting, or a racing heart that won’t settle.
A breathing exercise can help in the moment, but the full pattern deserves a closer look. On a free discovery call, we’ll walk through your symptoms, your sleep, your medications, and any labs you’ve had, and figure out which of these five is doing the most. If you haven’t yet, grab the free Cortisol Rhythm Decoder first.
Book Your Free Discovery Call →To your health and vitality, Dr. Ryan
Ongoing stress can make it harder for your stress response to settle. Changes in cortisol feedback, blood sugar dips, inflammation, broken sleep, and months of vigilance can all keep your body keyed up after the stressful moment has passed.
It’s an informal way to describe a stress response that rises but doesn’t fully come back down. It can show up as a tight jaw, tense shoulders, racing thoughts at bedtime, or trouble sleeping.
Yes. When blood sugar drops, your body releases adrenaline and cortisol to bring it back up, which can cause shakiness, sweating, a racing heart, and irritability. The symptoms and glucose data should match before blaming blood sugar.
Yes. Your immune system and stress system communicate constantly, so an infection, an inflammatory condition, or daily pain can keep the stress response activated.
They can help in the moment. Slow breathing with a long exhale can help your body shift gears. If you feel stuck most days, it’s worth looking at what’s driving it.
For educational purposes only. Not a diagnosis, and not a substitute for care from your healthcare provider or a licensed mental health professional. Do not start, stop, or change any medication or supplement without talking with your provider or pharmacist.
