Episode 8: Why Nurses Wake Up at 3AM: The Cortisol & Blood Sugar Crash No One Talks About

If you’re a nurse who keeps waking up at 2–4AM with your mind racing… this is not anxiety.

This is physiology.

In this episode of Proactive Wellness for Nurses, Jessica Veloza, NP breaks down one of the most overlooked signs of metabolic dysfunction: early morning awakenings.

You’ll learn:

• Why cortisol spikes at the wrong time in stressed, burned-out nurse bodies
 • How overnight blood sugar crashes wake you up (even if you ate “healthy”)
 • The impact of night shift and circadian disruption on your hormones
 • How nervous system dysregulation keeps your brain “on” at 3AM
 • Why this pattern blocks weight loss and keeps you inflamed and exhausted

This episode connects the dots between sleep, stress, metabolism, and weight in a way you’ve likely never been taught—even as a nurse.

Because waking up at 3AM isn’t the problem.

It’s the signal.

And once you understand it, you can finally start fixing the root cause.

🔥 If you’re ready to stop guessing and start healing your metabolism from the inside out, this is your starting point.

Intro

Promo

outro

Transcript

SPEAKER_01 0:59

Let me ask you something. Have you ever driven home from a shift and realized you don't even remember like the drive home? I'm not talking you were at the bar drinking. I'm talking you're exhausted from work and you are feeling delusional. I remember so many times pulling up in my driveway and just sitting there melting and zombifying in the car, not being able to get out, just numb. And yeah, I remember many times where I didn't remember the last 10 minutes of my drive home because I zoned out. Like I knew I left the hospital. Of course, I knew I got in my car, but the entire drive home just felt like a like a blur. Have you been there? Your brain is just empty, like your body feels heavy. And when you finally get home, you're thinking, thank God I can finally sleep. But then you crawl into bed and suddenly your brain turns just back on. And you replay your shift. You're worried, you know, did I miss something? You're worried about, oh, I told the night nurse I would collect that urinalysis before I left. And I know for a fact in the morning I'm gonna be emotionally demeaned upon because I forgot to after working 13 hours. So you're laying there trying to go to sleep and you're thinking, did I chart that medication right? Or should I have pushed harder for that one patient? Or, you know, before you know it, it's 2 a.m., 3 a.m. and and then your alarm goes off at 5, 5 45, you know. So you do what most nurses do. You grab caffeine and you drag yourself back up out of the damn bed into the hospital, and you tell yourself, this is just part of the job. But what if it isn't? What if the exhaustion nurses feel isn't just about being tired? What if it's about a nervous system that has been living in survival mode for far too long? Because the the truth is, truly, truly, the truth is that healthcare workers live inside an environment that the human body was never designed to sustain long term. And if you're struggling with sleep or brain fog, anxiety, that wired but exhausted feeling, there is a real physiological reason for it. Let's talk about some examples. One patient I will never forget. I remember one shift early in my nursing career. It was one of those days where everything felt chaotic, like from the get. Alarms going off everywhere, staff short, you know, we're short staffed, everyone's running. As soon as you walk in, like the night shift secretary's all pissed, slamming down the clipboard with the assignments. You know, the the charge nurse from the night shift looks like they just ran a fucking ultra marathon. And already everyone's running. So I remember like one of my patients started crashing. Of course, shit shift change. You know, we were doing everything we could, right? Medications, monitoring, calling for help, trying to stabilize them. I but I remember the moment vividly when like the room went quiet. You know the moment I'm talking about. Everyone kind of looks at each other and they know what just happened, right? And then it's done, and the that patient was gone, right? And the family walked in, and they're looking at me for answers. You know, I'm early, remember, I'm early in my career. It's a nightmare shift. I come in, it's chaotic. Already, it's like not even eight o'clock. Might have been into eight by now, but like I don't want to be there. And I'm standing there just like trying to hold it together for them, trying to explain to them what happened, trying to be strong for them, you know, and and and eventually I have to go to my next patient. I have to move on. I have to start fresh now, late, figure out my med paths. But what I remember is nothing else about that shift, obviously. I was in a blur, I was in a daze. I walked out of the hospital, I got into my car, but I just remember this feeling and this thought, like the world outside of here, outside of my brain, outside of my experience, keeps moving on like nothing happened. Right? But my brain, my brain was still in that room, still replaying the moment, still wondering if there was something else I could have done to save that person. And the hardest part about being a nurse is that we don't just experience these moments once, right? That experience was not unique at all. We experience these things over and over again repeatedly, and our nervous systems remember every single one of these instances. You know, I remember that day because it was one of the first deaths that I was my patient, you know, it was my patient. And we can all relate to that. And the thing is, no one else could understand. My mom's a nurse, you know, I could talk to her, but my husband, you know, my my my family, my home, they they see me come in with that mask, that gray face, bags under my eyes, just how are you today? I'm fine. It was a rough shift, you know. You don't have anything left to freaking give. Okay. Like truly, you don't have anything left to give these people. And over time, again and again and again and again, your nervous system becomes accustomed to this being your normal, right? The survival mode. So your your nervous system remembers every single one of these episodes, even if I can't recall the details of all of them myself. So let's talk about the science, right? We've touched on this in in other episodes. But cortisol and the stress system are incredibly tight bound. Tight bound. The human body has a system designed to handle stress. It's called the HPA axis. That's the hypothalamic pituitary adrenal axis, and it's essentially your body's stress command center. When your brain detects danger or urgency, the hypothalamus sends a signal to the pituitary gland. Okay, and then the pituitary gland signals the adrenal glands, and the adrenal glands re release cortisol. Cortisol mobilizes energy, it raises blood sugar, it sharpens focus, it helps you be on, ready, it prepares your body to respond to emergencies, which is exactly what nurses need during critical situations, right? But cortisol was never designed to stay elevated all day long. It was designed for short bursts of stress. I mean, our ancestors needed cortisol to escape predators, to respond to danger, you know, but once the threat was gone, the system shut back down. The problem is healthcare workers don't experience short bursts of stress, right? I don't know if all of you nurses have experienced what I'm talking about, right? I know that not everyone and their grandpappy and grandmammy will be able to relate to what I'm talking about, but I feel that most nurses do. And I'm talking to you, that burnt-out nurse that is, you know, registering what I'm saying and feeling heard and seen. You know, the problem is with this system when we're all it's hijacked by cortisol and uh stress hormone production is that we don't get a break. It's not it's not shortbursts of stress for us, right? No, I know there are good jobs, I know that there are jobs out there that do not function like this. And if that's true, then you're probably well regulated and you don't need me. You don't need this episode, you don't need this information. But unfortunately, I feel that most healthcare workers, shift workers, extremely busy people can relate to this. We have that cortisol jacked up all freaking day long, and we don't get a break. We experience constant activation, constant patient alarms, emergencies, high emotional situations, you know, it's time pressure, responsibility for human freaking lives. All day long, your brain is asking, is something about to go wrong? Is did I remember that? Did I do this? How am I gonna do all this? Look at this list, how am I gonna do all this? And then every time you turn around, the damn phone's ringing or the pagers going off or they're calling you overhead. You know, they're calling you overhead in your room. Have you ever worked in one of those hospitals where they like HCA hospitals I've worked at had trekkers on your badge, and I think Banner did too. It's cool because if you're like, where's Jodi?

SPEAKER_00 12:14

I haven't seen Jodi in 27 minutes. Where's Jodi? She's probably smoking a suckin' a dick.

SPEAKER_01 12:21

Sorry. I'm so sorry. But if you uh, I guess it's it's it's well timed to get get you to know me. This is me. I'm crass, I'm assertive, I'm passionate, and I've been through this shit. That is why I care to speak about it. That is why I care to build my entire business model around providing functional medicine-driven direct care to nurses who are experiencing this because this is my story, right? This is what I experienced and what I had to get myself out of personally to become healthy. Now, I am not saying that you have to get out of nursing to become healthy. I'm just saying, so yeah, they call you overhead so they can find Jodi in the room. Jodi's not doing anything you thought she was, or Jody's cleaning Miss Robinson's third butt fold so she doesn't get any wounds. Healthcare workers, shh, we don't get arrest from this constant activation. Oh, your body is releasing an unreasonable amount of stress hormones over and over again. Let's let's talk about another example. This is something that one of the most common things nurses tell me is that they are exhausted, but their brain won't shut off. Okay, and they may talk to the doctor and be diagnosed with anxiety, given sleeping pills and blah, blah, blah, blah. But personally, maybe that helps you. If that helps you, and some people, that's all you need. And it gets you there. It's a melatonin, it's a benadryl, it's a trazodone. If that's what you need, right? But it's a slippery slope. I'm not saying it's bad. There are definitely supplements that we can use that are natural supplements that will help uh initiate the regulation of your circadian rhythm. I'm not going to get into that right, but I remember one night in particular when I experienced this myself. I mean, I remember many nights, but there is one night when I was attempting to come up with some example stories that came to mind. So it had been a brutal shift. At this point, I was on night shift. I worked night shift, not initially as a nurse, but eventually as a nurse. It was a money. It attracted me. Money attracted me. I don't know. It almost makes me want to cry just thinking about night shift because though I love night shift people and I am a night owl person, I don't know. It was traumatizing. It was just, it was taking me that was in a very bad nervous system situation already, and I was pregnant, and I was working on getting my BS in. And now I'm gonna work night shift. I don't know. But I remember this particular brutal night shift. Multiple unstable patients, right? I think this might have been one of the nights that I was charging, I was charge nurse, but I also had a full team. Like, how can you do both of those jobs? I don't know, but it was a brutal, it was a brutal shift. Many I had patients that were unstable, family members, grieving, you know, just constant stress. And I remember by the time I got home, I could barely keep my eyes open. You know, I I helped with saying bye off to the kids and my husband to work, and wasn't able to give him any solace or them any the kids were the kids were young. But anyways, I crawled into bed and I was thinking, I'm just about to pass TF out immediately, but no, because I laid there and my freaking heart was racing. I'll never forget this, like when it got really compounded a lot from night shift specifically, because I lived in this apartment and there was an entire wall of windows, and we had wonderful blackout curtains, but the temperature when it was hot would just beam in and radiate from that side of the room. It was just you couldn't regulate it. And we had a hammock in our room, and so I thought I would get in the hammock. Maybe that would be like rock me to sleep. I'm exhausted. Of course, I'm gonna fall asleep immediately. But no, my frickin' heart was racing, my brain kept replaying the shift over and over again. You know, my bot my body felt tired, but my mind felt felt it, it was like I was still in the hospital. Okay, my body is exhausted, but my mind is still in the hospital. That moment made me realize something very important. Because the body doesn't just flip a switch and exit survival mode, okay? When your nervous system has been activated for 12 to 14 hours, it does not automatically calm down the moment you walk through your front door. Your brain is still attempting to protect you, still trying to stay alert, still scanning for danger. And that's where for many people sleep starts to get disrupted. That circadian rhythm disruption is a whole nother layer that adds multitudes of weight to this situation. We have this whole another layer to the problem, right? Shift work. The human body runs on the circadian rhythm. This is the biological clock that regulates sleep, hormones, metabolism, our energy levels. Light exposure tells the brain when it's time to wake up. It's a beautiful system. Darkness signals the brain to release melatonin and prepare for sleep. But how many shifts have you worked where you came in and it was maybe dusk or dawn or dark already, or still dark, and you you may not have great witness, you may peek out the window and see some sunshine in the middle of like patient care, but for the most part, you haven't inhaled fresh air and you have not seen natural light for 12 to 14 hours or more. You might be a 16-hour person, crazy ass. Been there, done that. So shift work disrupts these signals. Early morning light is naturally meant to come and flood our eyes and our brain and tell our brain to release cortisol. And then the evening light after, you know, a day of work is meant to stimulate that release of melatonin. And it's not working if you're doing this shift work shit. If you're working nights in particular, right, your brain is awake when it should be sleeping. If you rotate shifts, oh gosh, what a disaster. Okay. Your body never knows what schedule it needs to adapt to. So over time, this creates circadian misalignment. This is not the first time I've talked about this, but this is what's up, man. You're wired but exhausted. You you maybe you fall asleep when you get home, but it's restless, and then you just wake up at 3 a.m. It's another thing that can be really fun. So your circadian rhythm is all misaligned, right? And that means that your body's internal clock is all confused. Cortisol may spike at night instead of in the morning, and melatonin release becomes delayed. Now, I have met people that do not feel dysregulated on night shift. They have worked night shift for years or decades and it works for them, and they're down with it, and they have completely flipped their circadian rhythm, and they're not having to like live their, they they build their life around it. If that's you, cool, man. We need people to work night shift. I mean, it does have to happen. But when this gets all flip-flopped, your cortisol might just spike at times you don't want it to, right? And that melatonin release might be delayed or just totally inadequate. Energy crashes become just unpredictable for you, okay? Most nurses suddenly find themselves in a strange state where they wake up exhausted, they feel wired at night. You know, they get in, it's like on their day off. Maybe you work day shift, but then you're wired, you know, your your circadian rhythm is still jacked up because you're not seeing the light, you're not letting your nervous system rest. You're wired, you're wired at night. You know, you all rely on caffeine to function. And we nurses, what do you think we do? We're so good at this. I'm gonna give you one guess, but I'm just gonna tell you we blame ourselves. Doo-doo doo. It must be that you're not good enough, right? It must be that you are bad at time management or your critical thinking skills are just not tuned in as well as they should be. So we blame ourselves for not being able to sleep. Isn't that funny? But guess what? This is not a personal failure, it's actually physiology. So let's talk about the caffeine because I love my caffeine. Ugh caffeine is massively negatively impacting our society as a whole. I feel, and I love my caffeine. And I'm not I'm not gonna quit drinking my caffeine, but I have drastically become. Become more in control of and inadvertent in inadvertently, or like because of that, decrease the amount of caffeine that I drink. But that caffeine loop that happens. So once your sleep starts getting disrupted, that's the next part of the cycle. It's the caffeine cycle, right? And caffeine actually blocks adenosine receptors in the brain. Adenosine is the chemical that builds up during the day and signals sleep pressure. By blocking adenosine, caffeine temporarily makes you feel more awake. This is how it works. Which is incredibly helpful during a shift or 8 a.m. freaking soccer game on your one day off or whatever. Which it's incredibly helpful for that, right? But it also, guess what? It also stimulates cortisol release. So now you've added another cortisol spike into a system that's already overstimulated, which makes falling asleep later even harder. And the cycle continues. Poor sleep leads to exhaustion. Exhaustion leads to caffeine. And then caffeine leads to cortisol spikes. And cortisol spikes lead to poor sleep all over again. It's just a negative feedback loop. So, where does the nervous system fit into all this? Like, this is another critical piece we really need to talk a little bit more about. Again, there are more previous episodes that talk about this, but I can't not talk about it here. The autonomic nervous system. This system has two main branches. You know it. The sympathetic nervous system is the fight or flight or freeze, right? The parasympathetic nervous system is rest and digest. The sympathetic nervous system is designed for action. It is why the heart rate increases, your blood pressure rises, your focus, excuse me, sharpens. But the parasympathetic nervous system is designed for recovery. Slow that heart rate down, improve your digestion. The body begins repairing itself in this parasympathetic nervous system dominant situation. So sleep requires the parasympathetic system to take over. But if your brain is stuck in sympathetic activation, sleep becomes difficult, dude. Difficult. Difficult. And nurses spend a huge portion of their shifts in sympathetic mode. I like that they call it sympathetic. Like there's the system is sympathetic to us. If you have the tiger coming at you, I'm gonna give you how I feel for you, dog. I'm sympathetic to you. I'm gonna give you the stuff you need to get your get your ass in gear to try to get you away from that tiger. But nurses were in that sympathetic mode, we'll shift possibly most of your waking life. Okay. And what that means is that when nurses that are living this life finally lie down at night, the nervous system doesn't know how to switch gears. So we've really, really painted a picture of the problem. If you don't relate to this, that's wonderful. If you don't relate to this, I'm so happy for you. I'm so happy for you. And it's possible because I'm putting this caveat in there because it is possible that you do not relate to this. Now, wonderfully, I hope you have not listened to this episode. If you don't relate to this, because I don't want to waste your time. But on average, many of us nurses have experienced this. And if you're in the darkest tunnel right now, or like you just see yourself moving towards that dark tunnel, I want you to know that we can turn this boat around. Your body is not broken. Okay. This is the part that I want every nurse that relates to this that's here listening to really absorb and remember from this episode. Your body is not broken. Your nervous system is responding exactly the way it was designed to respond to stress. And the problem isn't that your body is malfunctioning. The problem is that your environment keeps activating that stress system over and over again. But the nervous system is incredibly adaptable. The same brain and hormonal release cascade, all of it, that same beautiful, intricate system that learned to stay hyper alert can also learn how to become regulated again. We can get cortisol rhythms to normalize. Circadian patterns can also stabilize. The parasympathetic nervous system can become active again. And when that happens, sleep comes back, energy comes back, natural, clear, clean, fresh energy. And mental clarity comes back. So if you're a nurse listening to this, I want you to know something. You are not weak for feeling exhausted, you are not broken for struggling with sleep. Okay. You you are definitely not alone. The work you do is emotionally intense and it's physically demanding, and it asks your nervous system to carry far more than most professions ever will. But healing is possible, okay? Your body is capable of recovering, your nervous system can become balanced again. And when that happens, you don't just survive through these shifts anymore. You start feeling like yourself again. And you know what? The world needs nurses who feel like themselves, not just nurses who are barely hanging on. So if this resonates with you, please come check out what we're offering. I will be having links to free resources in the show notes and my coaching programs and everything I have in the works. I am, you know, a registered nurse with graduated in 2012, worked most of my years in cardiology in the hospital, did some ICU, some home health, hospice. Now I've graduated as a nurse. Guess what? I've graduated as a nurse practitioner and not happy with my job. So