The Overflowing Cup and Your Nervous System

By: Dr. Katie Wadland, PT, DPT, Board-Certified Geriatric Clinical Specialist, Owner: Healthy Aging Physical Therapy

I went to yoga this morning, in an attempt to regulate nervous system after a week of solo parenting while my husband was out of town. Normally, I can balance all the regular demands of my life, which as a mother, caregiver, business owner, and home owner, are many. But with him away, the balance shifts. Suddenly, it’s double the drives to the pool for swim team, only one man on deck for the morning routine, and each meal and clean up falls to yours truly. By the end of the week, my metaphorical ‘nervous system cup’ was overflowing; while I meet all the needs of my business, my kids and my home on weeks like this, I frequently deprioritize my own needs, failing to get enough water, proper nutrition, exercise or rest. While I know the cycle well, it’s still hard for me to maintain a good balance when something like this tips the scales. During my much-needed yoga session this morning, I got thinking about how interesting it is that while this phenomenon, and the resulting impact on our bodies and nervous systems is so universal, the triggers and manifestations differ from person to person. The good news is that while our own experiences of stress, overwhelm and exhaustion may differ, the ‘treatment’ is relatively simple, evidenced-based, and enjoyable. The first step is understanding your nervous system:

The Overflowing Cup Metaphor

Think of your nervous system as a cup. When it’s half full, it has room to absorb life’s stressors or give more to those around you. But when your cup is full—due to stress, pain, life’s demands or a physiologic change like an illness—even a small addition of water overflows it. As I mentioned, our individual manifestations are varied, but often lead to symptoms like fatigue, brain fog, or heightened emotional responses. Dysregulation activates the body’s "fight or flight" mode, flooding it with cortisol.

Chronic elevations of cortisol have wide-ranging effects on health. Prolonged stress and high cortisol levels can lead to systemic inflammation, insulin resistance, hypertension, and impaired immune function, ultimately increasing the risk of chronic diseases such as cardiovascular disease, diabetes, and autoimmune disorders. There is no lack of evidence in this area. Research published in Frontiers in Endocrinology emphasizes the connection between chronic stress and metabolic disorders, while findings from the National Institute on Aging highlight the role of cortisol in neurodegenerative diseases, such as Alzheimer’s.

Even if you’re "managing" well and the impacts of dysregulation haven’t yet caused physiological change, a dysregulated nervous system simply feels crappy. It leaves you less efficient in your work, less present in your relationships, and unable to be the best version of yourself. When your nervous system is dysregulated, it’s harder to focus, connect, and enjoy the things that matter most. Prioritizing nervous system regulation is not just about avoiding future health issues; it’s about improving your day-to-day experience of life. It’s about creating more space in your cup so you can thrive, not just survive.

Dysregulation in Chronic Pain, Fear of Falling, and Parkinson’s Disease

Many of the patients we see in our practice experience nervous system dysregulation, often as part of a broader health condition. These patients show patterns of heightened stress response that exacerbate their primary symptoms. Whether it’s chronic pain, fear of falling, or neurological conditions like Parkinson’s disease, the effects of dysregulation can significantly worsen their quality of life. Below are some specific examples and approaches for nervous system regulation in these populations.

Chronic Pain

Patients with chronic pain often live with a nervous system in overdrive. Long-term exposure to pain can cause the brain to become hypersensitized, interpreting even minor stimuli as significant threats. This constant activation of the sympathetic nervous system amplifies pain and perpetuates a cycle of stress and physical discomfort. Gentle movement, mindfulness-based stress reduction, and diaphragmatic breathing can help calm this cycle, retraining the brain to regulate pain responses more effectively.

Fear of Falling

In older adults, the fear of falling is not just psychological—it’s a full-body response that often keeps patients trapped in a state of hypervigilance. This fear increases muscle tension, disrupts balance, and raises the risk of further falls. Patients in this state frequently withdraw from physical activity, which only worsens functional decline. Interventions such as balance training, slow-paced walking, and grounding techniques can help mitigate these responses and restore confidence.

Parkinson’s Disease

For individuals with Parkinson’s, nervous system dysregulation exacerbates motor and non-motor symptoms, including tremors, freezing, and cognitive challenges. Stress often worsens these symptoms, creating a feedback loop that further destabilizes the nervous system. In these patients, incorporating aerobic exercise, yoga, and social connection into their routines can help regulate the nervous system and improve both physical and mental outcomes.

Evidence-Based Tools for Regulating the Nervous System

Nervous system regulation is key to maintaining physical, mental, and emotional balance. The key to regulating your nervous system isn’t always about eliminating stressors—because often, we can’t. We can’t always reduce our demands, get rid of our chronic diseases, or eliminate every source of stress. Instead, it’s about building a bigger cup. When we do things that increase our capacity, the same amount of water—the same stressors—can fit without overflowing. By expanding our nervous system’s capacity (otherwise known as our resilience), we can absorb more challenges without triggering the negative effects of dysregulation. Below is a list of simple, easy-to-incorporate strategies that are backed by research. These practices can help you expand your capacity, regulate your nervous system, and create more balance in your life.

1. Breathwork

Breathwork practices such as diaphragmatic breathing, box breathing, or the 4-7-8 method stimulate the vagus nerve and activate the parasympathetic nervous system. These techniques reduce heart rate, lower blood pressure, and counteract the effects of the "fight or flight" response. Controlled breathing has been shown to significantly reduce stress by shifting the autonomic balance to favor parasympathetic activity. For some easy-to-follow videos and tips on breathwork, check out the resources on our website here.

2. Mindfulness and Meditation

Mindfulness meditation helps bring attention to the present moment and reduces stress hormones like cortisol. Techniques like the 5-4-3-2-1 grounding method are particularly effective during acute stress. Studies, including those supported by the NIH, show that mindfulness can lower inflammation, improve emotional regulation, and enhance the nervous system's ability to adapt to stress. For a step-by-step guide to the 5-4-3-2-1 method, check out our resources here.

3. Physical Activity

Exercise, particularly rhythmic and moderate-intensity activities such as yoga, walking, or swimming, helps regulate the nervous system by releasing endorphins and improving brain plasticity. It also enhances heart rate variability (HRV), a key marker of parasympathetic activation. Research from the National Institute on Aging highlights that consistent physical activity supports the body’s stress recovery mechanisms, making it a powerful tool for nervous system balance.

4. Quality Sleep

Sleep is essential for nervous system health, allowing the brain to consolidate memories, process emotions, and clear out metabolic waste. Poor sleep disrupts the balance between the sympathetic and parasympathetic systems, exacerbating stress. Adopting sleep hygiene practices—consistent bedtimes, reducing screen exposure, and creating a restful environment—improves sleep quality and nervous system regulation. For comprehensive sleep hygiene tips, you can refer to the National Institute on Aging's guide here.

5. Nature Connection

Spending time outdoors in natural settings promotes grounding and nervous system regulation. Nature exposure has been shown to reduce cortisol levels and increase parasympathetic activity. A 2020 review in Frontiers in Psychology reported that "forest bathing" or similar nature-based activities improve mood, lower blood pressure, and enhance mental clarity. How easy is that? Feeling overwhelmed? Just go outside.

6. Socialization

Strong social connections play a critical role in nervous system regulation. Meaningful interactions with trusted friends or family members activate the parasympathetic system and promote emotional resilience. Research from the National Institute on Aging indicates that loneliness and social isolation are linked to heightened sympathetic nervous system activity and increased inflammation. In contrast, social bonds lower stress markers like cortisol and improve overall well-being. Group activities such as exercise classes or support groups are particularly effective in this regard. For this reason and many more, Healthy Aging loves teaching our group fitness classes. You can see where we teach on our Group Fitness page here.

Moving Forward: Make Nervous System Regulation a Priority

While we know these strategies sound simple, in reality, it’s the consistency that makes the difference—and that’s often the hardest part. The key is to start small and meet yourself where you are. Focus on adding just one thing at a time. Whether it’s five minutes of deep breathing, a short walk outside, or a single restorative yoga pose, small, consistent steps can begin to regulate your nervous system and create more room in your cup over time. Progress doesn’t have to be perfect; it just needs to start.

References

1. Frontiers in Psychology (2018)
   Study Title: The Effects of Controlled Breathing on Stress and Autonomic Function
   Annotation: This study highlights how breathwork techniques like diaphragmatic breathing and the 4-7-8 method can activate the parasympathetic nervous system and reduce stress-related symptoms.
   Link: Frontiers in Psychology

2. National Institute on Aging
   Resource Title: Getting a Good Night's Sleep
   Annotation: A comprehensive guide to sleep hygiene, detailing practical strategies to improve sleep quality and regulate the nervous system.
   Link: National Institute on Aging

3. National Institute of Neurological Disorders and Stroke (NINDS)
   Research Title: Deep Phenotyping of Neurologic Post-Acute Sequelae of SARS-CoV-2 Infection
   Annotation: Explores the biological mechanisms of nervous system dysfunction, including the impact of autonomic dysregulation and immune response.
   Link: NINDS

4. Therapist Aid
   Resource Title: Grounding Techniques (5-4-3-2-1 Method)
   Annotation: A clear, actionable guide for using the 5-4-3-2-1 grounding method to manage acute stress and promote mindfulness.
   Link: Therapist Aid

5. National Institutes of Health (NIH)
   Resource Title: Long COVID and Autonomic Dysfunction
   Annotation: Details autonomic nervous system regulation and strategies for improving resilience against stress-related symptoms.
   Link: NIH

6. Frontiers in Endocrinology
   Study Title: Chronic Stress and Metabolic Disorders: Insights from Recent Research
   Annotation: Discusses the long-term health effects of elevated cortisol, including systemic inflammation and increased risk for chronic disease.
   Link: Frontiers in Endocrinology

STRESS!!! Three Easy Changes You Can Make Today to Decrease your Stress and Improve Your Health

Anyone out there feeling extra stressed lately? No? Just me? Great…

In reality, I think I’d be hard pressed to find someone who hasn’t been unusually stressed out this year. 2020 has been a veritable buffet of stressors - there’s been something for absolutely everybody. Job insecurity? Check. Overworked and underprotected? Check. Fear for your children? Check. Fear for your aging parents? Check. Fear of death or disability from a mysterious illness no one fully understands that is spreading like wildfire through the world? CHECK!  Loneliness, isolation or stuck in the house with your entire family for months on end? Check, check and check. For even the most stoic of individuals, 2020 has shaken us to our core, and more than likely, given each of us more than our fair share of things to worry about. 

Stress is a fact of life. In fact, some stress is actually helpful. Our bodies are designed to respond to stress in a way that keeps us safe in the presence of impending threat or danger. But while the experience of stress is natural and unavoidable, stress is meant to be experienced in the acute state: ‘Oh, is that a bear? I better prepare to run. Body: Send blood to my extremities, shut down my immune system and digestion. Get my heart pumping and let’s get some extra glucose circulating so I can move even faster.’ However, the body is not designed to react in an adaptive way to chronic stress. All the physiologic reactions to stress (increased cortisol, glucose and adrenaline release) act to shunt resources away from non-essential functions like the immune and digestive systems, to redirect the body’s resources to systems involved in response to the present physical threat. The cardiorespiratory system revs up, increasing the heart rate to pump more blood into circulation and triggers you to breathe faster to increase oxygen uptake to respond to increased energy demands. Blood (and the oxygen and glucose circulating within the blood) is sent to the extremities and large muscle groups to prepare to run or fight. While these physiologic reactions are super helpful when you’re face to face with a bear, they can be quite maladaptive and destructive to your body when they don’t shut off after the source of stress has been resolved (like in response to chronic anxiety) - or in the case of 2020, if the stressors just keep coming. 

Exposure to chronic stress results in an increased state of systemic inflammation. And again, while inflammation can be a good thing (it is how we heal from a cut or virus or other invading pathogen), chronic inflammation is associated with nothing but bad outcomes. Chronic systemic inflammation has been linked to increase risk of cardiovascular disease, metabolic syndrome, diabetes and cancer. It is associated with the development of arthritis, Alzheimer’s, IBS and a host of other bodily dysfunctions. It is one of the primary theories linked to aging in general. And also, it makes you feel like crap. Chronic inflammation increases aches and pains, disrupts your sleep and increases anxiety and depression. So, if you haven’t been feeling yourself this year, you can probably chalk it up to chronic stress, systemic inflammation and the fact that your entire life and physiologic sense of homeostasis is TOTALLY OUT OF WHACK. 

Now, (and I say this with total lack of judgement because I 100% fall into this camp) some of us think that ‘we can handle it’ or that living a busy, stressful life is simply your status quo. While this may be true, this doesn’t mean your body is handling it any different then the rest of us frazzled, stressed out hot-messes (I also fall into this camp sometimes, too. Lucky me.) Whether you’ve got your make-up on, kids out the door (or at their zooms) and to-do list half finished by 7am, or you’re simply struggling to find the motivation to pour a cup of coffee and deal with the mess you’ve left from the night before, under the surface, we are all the same. When we don’t address how we respond to stress, our body experiences inflammation. No matter what. And as I briefly explained before, inflammation causes disease and dysfunction. So what do we do about this? How do we stop the cycle?

Personally, (and I’m writing this partly to give myself a concrete stress-reduction plan) I suggest trying to reduce stress in two ways. First, I think it is critical to find ways to interrupt the stress-response cycle. This requires two steps - learning to identify when you are experiencing stress, and making the choice, then and there, to ‘change the story’. Second, it is important to minimize the state of systemic inflammation throughout your body, not only to promote improved health, but also to set yourself up to better respond to stress in the first place.

Interrupting the stress-response cycle:

The first step in interrupting the stress-response cycle is to identify that you’ve begun to feel a reaction to stress. Note that I didn’t say identify the stress. The stressor itself is immaterial, it doesn’t matter if it’s a bear or a work deadline. Your body responds in the same exact way (though in variable degrees of severity). Try to notice next time you encounter a stressor what happens in your body. Do you get tense and find your shoulders riding up to your ears? Does your heart race? Do you get a headache or experience nausea? Some people get strong somatic responses - increased heart rate, flushing, muscle tension, headaches or other bodily responses. Other people (myself included) experience more emotional responses. You may feel angry, overwhelmed, irritated or worried. Try to make a list of your specific stress responses and then try to be mindful of these throughout the day. The first step in interrupting the stress-response cycle is simply identifying when you are experiencing it. 

The second step is to change the story. In my experience, this is the most helpful thing you can do right now to reduce the effect of stress on your body. By consciously changing the way you react to the stressor, you change the way your body perceives it. This is the key to stopping the cascade of the physiological responses that lead to systemic inflammation and the physical effects of stress. I learned to use this technique when I experienced sudden onset tinnitus last year. Everytime my ears would start to ring, I’d panic. The anxiety and panic would worsen the experience of the tinnitus, and the worsening of tinnitus would increase the feelings of anxiety. See the problem here? The key to curbing my tinnitus was not getting rid of the stressor (as often, we can’t), but changing my reaction to it. When I would notice the ringing, I taught myself to stop and listen to it. I’d simply identify it for what it was, literally tell myself this is a symptom, not a crisis. This is a sound, not a bear. Then, I’d take a few minutes to listen to the ringing while taking slow deep breaths. Within a few days of practicing this behavior, the ringing didn’t trigger the panic response anymore, and eventually, the tinnitus improved. Even though I still am aware of the tinnitus at times,  it no longer initiates the stress, panic, inflammatory cycle for me, it’s just simply ‘there.’

You can adopt this two-step stress reduction plan to address any stress you encounter. Whether it’s pain, background noise, or demanding coworkers or children - when you identify the onset of the physical effects of stress, stop. Stop and identify the stress for what it is and remind yourself this is not a crisis, or a threat or an oncoming train. Then, take whatever actions best help you retrain your body to enter a state of calm, instead of a state of fight or flight.  If the deep breathing works, great. If you respond well to meditation, use that. Take a walk, go outside, read a book, write in your journal. Whatever you associate with calm, substitute that behavior for your instinctual response to the stressor. It takes practice, but your body will adapt and you can extinguish this response, despite how automatic it may initially be.

Decreasing systemic inflammation: 

Lastly, find ways to lower your systemic inflammation. According to the American College of Sports Medicine, there are four methods to decrease systemic inflammation. First is to take anti inflammatory medications. Second is to ingest antioxidant foods and supplements. Third is by caloric restriction. And the fourth is to exercise. Guess which is the most effective? Exercise. No joke. How great is that? The most effective solution to reduce inflammation is something you can do on your own, for free, right now. It doesn’t even need to be aggressive exercise! Low impact steady state cardio has been shown to reduce cortisol levels and is great for stress-reduction. More moderately intense exercise has even greater benefits on your mental and physical health. Effects start right after you exercise and last hours, and are cumulative over time. There is literally no downside to making exercise part of your regular routine. There is also substantial evidence there are benefits in following an anti-inflammatory diet (like the Medeterranean diet), getting adequate sleep and practicing habits like gratitude, yoga and other mindset-shifting activities daily. You don’t need to follow a guru or pay thousands to a health coach to get in these habits either. Just sit down, in the morning, and try to write a few things you’re grateful for. Make time to exercise. Drink plenty of water. Go to sleep on-time. 

So, am I writing about this because I am a stress-management expert? No. I’m writing this because I’m a frazzled, stressed out control-aholic trying to manage my home, my children, my career and my life in the middle of a dumpster fire of a year. I’ve turned to my vices more often than I’d like to admit, found myself grumpy, irritable, achy and run down and I know perfectly well that this is because I’ve been letting my reaction to stress run the show, instead of using these strategies to change the story. 

I hope you find this information useful and these strategies helpful. Not only do I find that these techniques help me, but these are skills I teach to my patients who struggle with pain management and anxiety related to physical dysfunction and disability. Of course, my advice does not take the place of the advice of your doctor or other clinical professional, and if you feel like your level of stress is unmanageable, please reach out to those individuals for help. And if you see me somewhere staring off into space taking nice slow breaths, now you know why:)

#justtryingtokeepmyishtogetheroverhere