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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by linkadge on March 4, 2009, at 18:20:15
Hi, I am waking up about 3 hours before I need to be up and unable to get back to sleep. I have major surges of adrenaline at this time and feel helpless.
I could take a sedative the night before, but am wondering if there are any other options people have found for this problem.
Any help appreciated.
Linkadge
Posted by janejane on March 4, 2009, at 19:24:28
In reply to Early morning wakenings - help, posted by linkadge on March 4, 2009, at 18:20:15
Have you tried magnesium citrate? It really helps me sleep through the night. I've always been a poor sleeper so I wish I had known about it decades ago.
Posted by desolationrower on March 4, 2009, at 20:40:12
In reply to Re: Early morning wakenings - help » linkadge, posted by janejane on March 4, 2009, at 19:24:28
are you getting enough excercise during the day?
at least a time-release melatonin.
-d/r
Posted by yxibow on March 4, 2009, at 21:42:32
In reply to Re: Early morning wakenings - help » linkadge, posted by janejane on March 4, 2009, at 19:24:28
> Have you tried magnesium citrate? It really helps me sleep through the night. I've always been a poor sleeper so I wish I had known about it decades ago.
Magnesium citrate is what comes in bottles for preparation for colon exams....
Just a comment that magnesium in amounts is necessary for the body but it is a laxative
-- Jay
Posted by yxibow on March 4, 2009, at 21:50:00
In reply to Early morning wakenings - help, posted by linkadge on March 4, 2009, at 18:20:15
> Hi, I am waking up about 3 hours before I need to be up and unable to get back to sleep. I have major surges of adrenaline at this time and feel helpless.
Do you use any significant amounts of caffeine during the day or take naps that might change the sleep cycle ?
> I could take a sedative the night before, but am wondering if there are any other options people have found for this problem.
>
> Any help appreciated.
>
> Linkadge
How much sleep in total are you getting ? Some people don't necessarily need 8 hours although its somewhere in a range.Yes, a sedative like Lunesta would probably be helpful in the short term, it wouldn't be something that you could take though at that hour because it would be still active while you're awake.
Are you taking anything else, antidepressants that might contribute ?
A small amount of propranolol might help with adrenaline surges, it sounds like you're just barely in a REM stage at that point. Any nightmares or thoughts that accompany them ?
Just some ideas
-- Jay
Posted by Sigismund on March 4, 2009, at 22:08:13
In reply to Re: Early morning wakenings - help » janejane, posted by yxibow on March 4, 2009, at 21:42:32
Avoid green tea, especially if your sleep seems light throughout the night.
Posted by Phillipa on March 5, 2009, at 1:16:29
In reply to Re: Early morning wakenings - help, posted by Sigismund on March 4, 2009, at 22:08:13
Sigi I drink two bottles of green tea a day though was relaxing? Love PJ
Posted by Phillipa on March 5, 2009, at 1:19:10
In reply to Early morning wakenings - help, posted by linkadge on March 4, 2009, at 18:20:15
Link didn't you recently start celexa? Could it be that? I know I've never slept more than four hours without waking and needing a med. Lunesta I've also taken with extra benzos . How about sonata if you wake up? Love Phillipa
Posted by Phillipa on March 5, 2009, at 1:21:19
In reply to Early morning wakenings - help, posted by linkadge on March 4, 2009, at 18:20:15
Link just remembered what about valerian? Love Phillipa
Posted by yxibow on March 5, 2009, at 1:24:19
In reply to Re: Early morning wakenings - help » Sigismund, posted by Phillipa on March 5, 2009, at 1:16:29
> Sigi I drink two bottles of green tea a day though was relaxing? Love PJ
Depends on the variety of green tea, but yes, in general they have less caffeine than black tea. They're mainly regarded these days for their alleged antioxidant properties.
It depends on how much it is steeped and whether it is a fresh steeping or a further use of the leaves, as to how much it compares to average tea, and average coffee which is even more.
It probably has about half the potential of the strongest tea on average.
-- Jay
Posted by desolationrower on March 5, 2009, at 6:17:36
In reply to Re: Early morning wakenings - help » Phillipa, posted by yxibow on March 5, 2009, at 1:24:19
perhaps you live near me and are hearing this GOY#H$@QH@#JMN JACKHAMMER.
being unemployed doesn't have too many perks, but sleeping in is supposed to be one.
arg.
-d/r
Posted by janejane on March 5, 2009, at 10:21:24
In reply to Re: Early morning wakenings - help » janejane, posted by yxibow on March 4, 2009, at 21:42:32
Since 2/3 of Americans don't get the US RDA of magnesium, I think it should be a natural top candidate for anyone seeking a sleep aid (chances are, your body could use more anyway). I have personally experienced a huge improvement in sleep quality from supplementation, so I can't help but be enthusiastic about it. I agree that magnesium citrate may be more likely than say, the glycinate form, to have a laxative effect, but taken judiciously (i.e., start with a small dose), it seems to have a slight edge for benefitting sleep (for me). A popular product called "Natural Calm" uses the citrate form as the primary ingredient, and reviewers seem to like its sleep-enhancing effects. (Never tried that one, but found the much cheaper Now Foods brand to work just fine.)
By the way, I have also tried valerian and low-dose trazadone, and found them not to do much at all. Others' experience may differ, but I though it might be helpful to mention my own. If magnesium didn't work for me, and I still had sleep issues, I think I would probably try 5-HTP in the evening, and if that didn't work, maybe straight-up melatonin.
Posted by janejane on March 5, 2009, at 10:56:51
In reply to Re: Early morning wakenings - help » yxibow, posted by janejane on March 5, 2009, at 10:21:24
I forgot to mention, Natrol makes a time release version of 5-HTP which could theoretically be more helpful than other 5-HTP products for early morning wakening. (5-HTP has a short half life so an extended release form might be helpful for keeping you asleep through the night in contrast with other products that might wear off in effectiveness before night is over.)
Posted by bleauberry on March 5, 2009, at 18:24:04
In reply to Early morning wakenings - help, posted by linkadge on March 4, 2009, at 18:20:15
HI Link. I am very familiar with what you are experiencing. I've been dealing with it for several years.
When you say it feels like adrenaline, I believe you are correct. That is exactly what it is. More specifically, cortisol. I know you probably won't opt for the cost and time to do it, but if you were to take a 24 hour saliva cortisol test, I would strongly bet you would see a spike way above the normal curve at the exact time you are feeling the adrenaline.
It is basically the pituitary confused and out of sync. Offenders that can cause that are heavy metals and hidden bacterial infections putting undue stress on the system. Longterm stress from dealing with psych issues will do it too.
I have found only two things completely effective at ending that adrenaline rush. One is Milnacipran. The other is Hydrocortisone 2.5mg. Both I believe, my own theory, work so well because they support your adrenaline during the day so that no rush-job to make up for the day's weakness happens at night during rest. In other words, the norepinephrine/adrenaline/cortisol feeback loops kick in and squash down that adrenaline spike.
For me, it actually meant about 3 days of it being worse at first. It took about that time for the feedback loops to figure out what was happening and to respond by putting the brakes on night-time rushes. But until they did respond, the boost of NE/adrenaline/cortisol by Milancipran or Cortisol intensified the symptoms maybe about 25%, and then suddenly after 3 days they were 100% gone. Completely gone.
Years ago I tried Klonopin and it also worked. But it did not offer the antidepressant, antipain, ainti-inflammatory benefits of Milnacipran or Hydrocortisone. Klono made me a lot more depressed and cognitively dull.
For herbal stuff, I found Valerian root and/or Skullcap helpful for immediate use, and Licorice Root helpful in the feedback loop 3 day onset thing. But you know all about these herbs so I know I'm telling you anything you don't already know.
Other things that help somewhat...
Minimal caffeine intake during the day.
Minimal sugar intake during the day.
Eat mostly proteins and veggies, not much fruit or carbs.
An hour before bed, a baked potato with skin (important) and a half glass of milk (the potato triggers your circulating tryptophan to convert to serotonin, the skin makes it time released, and the milk adds to it synergistically).Avoid late day exercise or exertion. That will only prime your adrenaline more. Actually, until this thing is under control, exercise and exertion should be kept to a mimimum at all times. If you overdo it in the morning, you'll burn up all that excess adrenaline, and then the body will try to recover its high levels again...right about the time you feel it during sleep. The idea is to spend your adrenaline smoothly, gradually, and equally throughout a day.
This thing can get worse, actually a lot worse than it is, so that's why I mentioned the things to prevent that from happening as well as things to totally fix it.
As a sidenote, I found antipsychotics made this thing worse. They all have alpha-2 antagonism. That just stimulates more adrenaline and basically cuts the brakes off the feedback loops. The D2 and 5HT blockade do nothing to calm that down. Remeron was probably the worst at making these symptoms more powerful over time.
I have often wondered if this is what akathisia is...too much adrenaline stimulation with the feedback loops crippled by alpha-2 antagonism coupled with D2 and 5HT blockade. You know, adrenaline stimulation along with zombyness, all mixed together in a crazy concoction. Its description as inner restlessness fits perfectly.
Hope you get some ideas here and that something might be helpful to think about.
Posted by linkadge on March 6, 2009, at 6:41:21
In reply to Re: Early morning wakenings - help » linkadge, posted by bleauberry on March 5, 2009, at 18:24:04
I am not ingesting caffiene and I am getting some exercise during the day. I have been using magnesium and with no help - my brain just does not want to shut off. Milnicipran is not an option in canada.
I lie down at about 9:00pm (because I am so scared about not sleeping) and don't fall asleep till about 1:00. After which I wake up several times and finally wake up about 4:30 after which point I can't get back to sleep.
It has been hell. Nothing makes me feel more out of control of my life than this.
I have been taking zoloft which I think may be contributing.
Since starting zoloft, my anxiety has become much worse and my sleep patterns have become all messed up.
I honestly don't know how this drug is approved for GAD.
Posted by bleauberry on March 6, 2009, at 10:01:10
In reply to Re: Thowing in the towel on zoloft, posted by linkadge on March 6, 2009, at 6:41:21
Yup, sounds like the Zoloft. How long have you been on it? Those side effects should go away within 4 to 12 weeks from starting. To give it a fair shot, you would definitely need something for sleep. Lack of sleep will hurt even the healthiest of people, not to mention all of us. I think the sleep thing has to be addressed seriously if you want to really see what Zoloft can do. Maybe that means Lunesta, a smidgen of Seroquel, 10mg Amitriptyline maybe. Yeah, I like the Amitrip idea best if you can't get Lunesta.
Posted by Phillipa on March 6, 2009, at 20:27:28
In reply to Re: Thowing in the towel on zoloft, posted by linkadge on March 6, 2009, at 6:41:21
Link so sorry how high is the dose. benzos???? Love Phillipa
Posted by Larry Hoover on March 8, 2009, at 7:12:14
In reply to Re: Early morning wakenings - help » janejane, posted by yxibow on March 4, 2009, at 21:42:32
> > Have you tried magnesium citrate? It really helps me sleep through the night. I've always been a poor sleeper so I wish I had known about it decades ago.
>
> Magnesium citrate is what comes in bottles for preparation for colon exams....
>
> Just a comment that magnesium in amounts is necessary for the body but it is a laxative
>
> -- JayJust a further comment. The amount of mag citrate I'd take for insomnia would be 300 mg. The amount of mag citrate in one of those bottles of stuff used to flush you out for a colon exam is 15,000 mg.
So, the concern is not literally with respect to magnesium citrate. It is the dose of magnesium citrate that may lead to concern. As recent data demonstrate that less than 22% of Americans even meet the RDA for magnesium, I think supplementation is a good idea, overall.
Lar
Posted by yxibow on March 8, 2009, at 23:38:06
In reply to Re: Early morning wakenings - help » yxibow, posted by Larry Hoover on March 8, 2009, at 7:12:14
> > > Have you tried magnesium citrate? It really helps me sleep through the night. I've always been a poor sleeper so I wish I had known about it decades ago.
> >
> > Magnesium citrate is what comes in bottles for preparation for colon exams....
> >
> > Just a comment that magnesium in amounts is necessary for the body but it is a laxative
> >
> > -- Jay
>
> Just a further comment. The amount of mag citrate I'd take for insomnia would be 300 mg. The amount of mag citrate in one of those bottles of stuff used to flush you out for a colon exam is 15,000 mg.
>
> So, the concern is not literally with respect to magnesium citrate. It is the dose of magnesium citrate that may lead to concern. As recent data demonstrate that less than 22% of Americans even meet the RDA for magnesium, I think supplementation is a good idea, overall.
>
> Lar15 grams ?? Sounds hard on the kidneys but its a citrate formulation. Okay, I stand corrected on that one.
Posted by Larry Hoover on March 9, 2009, at 11:20:35
In reply to Re: Early morning wakenings - help » Larry Hoover, posted by yxibow on March 8, 2009, at 23:38:06
> > > > Have you tried magnesium citrate? It really helps me sleep through the night. I've always been a poor sleeper so I wish I had known about it decades ago.
> > >
> > > Magnesium citrate is what comes in bottles for preparation for colon exams....
> > >
> > > Just a comment that magnesium in amounts is necessary for the body but it is a laxative
> > >
> > > -- Jay
> >
> > Just a further comment. The amount of mag citrate I'd take for insomnia would be 300 mg. The amount of mag citrate in one of those bottles of stuff used to flush you out for a colon exam is 15,000 mg.
> >
> > So, the concern is not literally with respect to magnesium citrate. It is the dose of magnesium citrate that may lead to concern. As recent data demonstrate that less than 22% of Americans even meet the RDA for magnesium, I think supplementation is a good idea, overall.
> >
> > Lar
>
> 15 grams ?? Sounds hard on the kidneys but its a citrate formulation. Okay, I stand corrected on that one.Well, that's what Citro-mag brand has in it (15 g/300 mL), and I'd assume others are similar. I can't remember if I used one or two bottles.
It doesn't tend to enter systemic circulation though, so I would downplay the effect on the kidneys. It's a hyperosmotic laxative. The magnesium ions draw water from the gut wall into the gut. Some electrolytes get drawn in, too, so they recommend you hydrate with e.g. gatorade to replace the fluids. The hyperosmotic effect is far quicker than the uptake effect. By far the bulk of the mag gets flushed out the anus, rather than via uptake/renal discharge. In fact, net mag balance can go negative, due to electrolyte losses into the gut.
Lar
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