Ashwagandha: Finding Resilience When You Feel Wired but Tired
Updated: Sep 16
Created by Christopher Caffrey, ACNP, PMHNP, Functional Medicine-trained
June 1st, 2025 (Updated September 16th, 2026)
Key Takeaways:
Stress and sleep are ashwagandha’s best-supported uses. Human studies suggest benefits, although results vary by preparation and person.
Whole-person care comes first. Sleep habits, nutrition, medications, training demands, and underlying conditions help determine whether supplementation makes sense.
Strength and cognitive benefits are promising. Small trials show potential, but ashwagandha is not an established treatment for ADHD, dementia, or low testosterone.
Animal research offers clues, not clinical proof. Mouse studies help explain possible mechanisms but cannot establish the same benefits in humans.
Hormonal effects and safety deserve attention. Ashwagandha can affect thyroid function, interact with medications, and rarely cause liver injury. Avoid it during pregnancy and breastfeeding.
By nine o’clock, Daniel has finally stopped moving. The children are in bed, the kitchen is mostly clean, and tomorrow’s calendar is already full. He has spent the day wanting a break. Now that he has one, he cannot settle down.
He checks his phone, remembers an unfinished task, and opens his laptop. His body feels drained, but his mind seems determined to work a second shift. Lately, workouts feel harder, patience runs shorter, and the energy he used to take for granted requires another cup of coffee.
Daniel is a fictional example, but this pattern will sound familiar to many people. Eventually, someone suggests ashwagandha. The claims are appealing: less stress, better sleep, more energy, improved hormones. He wonders whether one supplement could help him feel like himself again.
There is a reasonable conversation to have here. Ashwagandha has meaningful research behind some uses, especially stress and sleep. Understanding where it belongs starts with looking at the person taking it, the demands on their body, and the opportunities they have to recover.
A Traditional Herb With Modern Research
Ashwagandha, or Withania somnifera, has a long history in Ayurvedic medicine. Its roots and leaves contain several biologically active compounds, including withanolides. Modern supplements use different parts of the plant and different extraction methods, so products bearing the same herb name are not necessarily equivalent. [1]
It is often called an adaptogen, a term used for substances thought to support adaptation to stress. That description can be useful, but it does not mean the herb senses every imbalance and corrects it automatically.
My interest in ashwagandha comes from a functional medicine question: could this tool address a meaningful contributor to someone’s symptoms, within a plan that considers their whole health? That question leaves room for botanical medicine without expecting a capsule to solve every problem associated with modern life.
Stress: The Most Useful Starting Point
In a randomized trial involving 64 adults with chronic stress, participants received either 300 mg of a concentrated root extract twice daily or placebo for 60 days. The ashwagandha group reported greater improvements in stress measures. Serum cortisol fell about 28% from baseline, compared with about 8% in the placebo group. [2]
That is an encouraging signal. It supports considering certain preparations for selected adults experiencing stress, while recognizing that a small trial cannot tell us how everyone will respond.
The cortisol finding also needs context. It does not demonstrate that the same supplement will reduce abdominal fat, prevent diabetes, or improve immunity. Those are separate outcomes requiring their own evidence. A change in a laboratory marker can help explain a treatment’s effects without proving every downstream benefit we might imagine.
For Daniel, I would be more interested in whether he can disengage from work, sleep more consistently, and function better during the day than in pursuing a lower cortisol number.
Your Stress Response Needs Context
The hypothalamic-pituitary-adrenal axis is part of the communication system linking the brain and adrenal glands. Cortisol is one of its messengers. Popular explanations often describe chronic stress as exhausting the adrenal glands, but “adrenal fatigue” is not an established medical diagnosis. Persistent exhaustion deserves evaluation for actual causes, including sleep disorders, depression, and other medical conditions. [3]
This is where a detailed history becomes valuable. When did the fatigue begin? Did it follow a medication change, illness, heavier training, or a change in menstrual patterns? Is someone allowing enough time for sleep? Are they snoring, restricting food, or relying on alcohol to unwind?
Functional medicine should make those questions more connected and more useful. It should help identify which contributors matter most and which next steps are likely to change the outcome. Testing has a role when it answers a specific clinical question.
Sleep: A Promising Benefit With Practical Limits
A 2021 systematic review combined five randomized trials involving 400 adults and found an overall improvement in sleep with ashwagandha compared with placebo. Benefits appeared more pronounced among people with insomnia and in studies using at least 600 mg daily for eight weeks or longer. However, the trials were small, used different preparations, and did not establish long-term safety. [4]
This suggests a possible role for someone whose sleep difficulty overlaps with stress. It does not make ashwagandha an immediate rescue treatment or guarantee mornings without grogginess.
Before recommending a sleep supplement, I would want to understand the problem. Difficulty falling asleep, repeated awakenings, and sleeping eight hours without feeling restored can require different approaches. Persistent insomnia may call for cognitive behavioral therapy for insomnia, while suspected sleep apnea needs evaluation. A supplement trial should not delay that work.
What a Mouse Study Can Actually Tell Us
Animal studies can provide valuable supporting evidence, especially when they show a measurable effect that increases with dose and fits other findings. They help explain possible mechanisms before those mechanisms are fully understood in people.
In a 2017 mouse study, researchers used brain-wave and muscle recordings to measure sleep. A water extract of ashwagandha leaves promoted sleep, and triethylene glycol, a component identified in the leaves, increased non-REM sleep in a dose-dependent manner. Objective measurements and the dose-response pattern make this an interesting mechanistic signal. [5]
The limits matter too: this was a small animal experiment, the researchers studied leaves and an isolated compound, and commercial root extracts may differ substantially. It does not establish the mechanism of human sleep benefits or justify taking isolated triethylene glycol. The useful conclusion is that there is biologic activity worth investigating, alongside the human sleep findings.
Strength and Recovery: An Adjunct to the Work
In an eight-week trial, 57 men with limited resistance-training experience were randomized to ashwagandha root extract, 300 mg twice daily, or placebo while following a training program. Researchers reported greater gains in strength and some muscle-size measures in the supplement group, along with changes in testosterone and a marker of muscle damage. [6]
That is promising for exercise research, but the participants were relatively inexperienced lifters. Results cannot automatically be extended to experienced athletes, women, or long-term use. The study also does not establish which biological mechanism produced the differences.
For someone whose training has stalled, I would first review the program, food intake, sleep, and recovery time. Adding another hard session to an already overloaded week may be the wrong move. Ashwagandha might be considered as an adjunct, but the basic conditions for adaptation still need attention.
Brain Fog and Focus
A small eight-week trial in 50 adults with mild cognitive impairment found improvements in memory and several measures of attention and executive function with ashwagandha compared with placebo. These findings are interesting, but they do not establish it as a treatment for ADHD or as a way to prevent dementia. [7]
“Brain fog” also needs unpacking. Someone may use the phrase to describe sleepiness, distractibility, memory lapses, or feeling mentally overwhelmed. Each description points toward different possibilities.
For Daniel, the first task would be understanding what has changed. If concentration improves while sleep and stress improve, that would be useful, but it would not tell us whether a supplement directly enhanced his brain function. In practice, we can value improvement while remaining honest about its cause.
Hormones: Specific Effects Deserve Specific Caution
Ashwagandha is frequently marketed as a hormone balancer. The evidence supports a more specific discussion. Limited studies suggest possible increases in testosterone or sperm quality in some men, but these findings do not establish improved pregnancy or live-birth rates, nor do they make ashwagandha a replacement for evaluating low testosterone. Evidence for female infertility, menopause, and diabetes remains insufficient. [1]
Claims about improving egg quality, restoring ovulation, correcting PCOS, or regulating menstrual cycles go beyond what can currently be promised. Symptoms such as reduced libido or irregular periods deserve attention to their possible causes.
Thyroid effects are especially relevant. A small randomized trial in adults with subclinical hypothyroidism found changes toward normal thyroid laboratory values during eight weeks of treatment. 8 However, case reports have also described thyrotoxicosis associated with use. Increasing thyroid activity can be harmful, particularly when thyroid disease or thyroid medication is already part of the picture. [9]
This is precisely why a biologically active herb requires personalization. The same capacity to change a hormone level can create either interest or concern depending on the person.
Choosing and Evaluating a Trial
When ashwagandha is appropriate, I prefer a clearly defined purpose and a manageable plan. Trying it for difficulty winding down is more informative than taking it indefinitely for “overall balance.”
Several cited trials used 300 mg of a particular root extract twice daily. That is a research example, not a universal dose. Root powder, root extract, and root-and-leaf preparations can differ considerably. A higher withanolide percentage does not automatically mean a better product, and milligram amounts cannot be compared without considering the formulation.
Look for transparent labeling and independent testing for identity and contaminants. Avoid starting several new products together. Otherwise, it becomes difficult to identify what helped or what caused a problem.
Choose one or two outcomes to follow, such as time spent awake at bedtime or perceived stress during the day. Reassess tolerability early and benefit over the following weeks with your clinician. If the product is ineffective or causes adverse effects, there is no reason to keep taking it simply because it has a good reputation.
Safety Belongs in the Conversation
Ashwagandha can cause drowsiness, stomach upset, diarrhea, or vomiting. Avoid it during pregnancy and breastfeeding. People with autoimmune or thyroid disorders, upcoming surgery, or hormone-sensitive prostate cancer should generally avoid it unless their treating clinician specifically advises otherwise. Review potential interactions with sedatives, seizure medicines, thyroid hormone, immunosuppressants, and blood-pressure or diabetes medications. Long-term safety is not established. [1]
Rare but clinically significant liver injury has been reported, often appearing within weeks of starting. People with advanced chronic liver disease should avoid it. Stop taking it and seek prompt medical care for yellowing skin or eyes, dark urine, or significant unexplained itching, particularly with nausea or abdominal discomfort. Third-party testing cannot eliminate an individual adverse reaction. [10]
Building Resilience Into Daily Life
If Daniel feels better a few months from now, I would want that improvement to extend beyond the supplement bottle. Can he finish the day without immediately opening his laptop? Does his schedule leave room for meals, movement, and sleep? Has he addressed symptoms that needed medical attention?
Ashwagandha may help some people create a little more room to recover. Its strongest practical appeal is as a targeted tool within a broader plan, with a clear goal and regular reassessment.
At Flexup Wellness, that means considering the connections between the mind, gut, metabolism, hormones, and lifestyle without assuming that every symptom has one cause. We can respect traditional medicine, learn from compelling animal research, and apply human evidence thoughtfully. The aim is to help you function better in the life you actually live.
This article is educational and does not replace individualized medical advice. Review supplement use with your clinician, particularly if you take medication or have an ongoing health condition.
References
National Center for Complementary and Integrative Health. Ashwagandha: Usefulness and Safety.
Chandrasekhar K, Kapoor J, Anishetty S. A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults. Indian Journal of Psychological Medicine. 2012;34(3):255–262.
Endocrine Society. Adrenal Fatigue. 2022.
Cheah KL, et al. Effect of Ashwagandha (Withania somnifera) extract on sleep: A systematic review and meta-analysis. PLOS ONE. 2021;16(9).
Kaushik MK, Kaul SC, Wadhwa R, Yanagisawa M, Urade Y. Triethylene glycol, an active component of Ashwagandha (Withania somnifera) leaves, is responsible for sleep induction. PLOS ONE. 2017;12(2). Mouse study.
Wankhede S, et al. Examining the effect of Withania somnifera supplementation on muscle strength and recovery: A randomized controlled trial. Journal of the International Society of Sports Nutrition. 2015;12:43.
Choudhary D, Bhattacharyya S, Bose S. Efficacy and safety of ashwagandha root extract in improving memory and cognitive functions. Journal of Dietary Supplements. 2017;14(6):599–612.
Sharma AK, Basu I, Singh S. Efficacy and safety of ashwagandha root extract in subclinical hypothyroid patients: A double-blind, randomized placebo-controlled trial. Journal of Alternative and Complementary Medicine. 2018;24(3):243–248.
Kamal HI, et al. Ashwagandha as a unique cause of thyrotoxicosis presenting with supraventricular tachycardia. Cureus. 2022;14(3). Case report.
National Institute of Diabetes and Digestive and Kidney Diseases. Ashwagandha. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Updated December 2024.
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