3am wake up/adrenaline rush/pain/sweating

[teefy]

worst symptoms occur at 3-4am . . . . . wake up abruptly and feel terrible . . . . . any suggestions on how to treat the adrenaline filled wake ups that leave me feeling so ill . . . . feels like it is hormonal yet all my tests are normal (of course).

This sounds so familiar to me. For the past few years I have had mid-sleep waking (even after standard meds), racing thoughts for a couple of hours, then just get up or back to sleep exhausted, then wake feeling worse and more tired than when I went to bed, usually drenched in sweat. Never seem to reach deep sleep, always feel horrendous on waking. Adrenaline, noradrenaline or(and) cortisol filled wake ups - probably what I have experienced too, although unlike WoolPippi I never once experienced this or insomnia (or reversed/chaotic sleep cycles, which I have) prior to the illness, and the mid-sleep waking is mostly a characteristic of my current relapse. In the first year or so it would be like I would barely sleep at all one night, feel very agitated, then would only sleep the next night because I'd be so utterly exhausted . . . I could go on . . .

Anyway recently what I've found most helpful for sleep, particularly for the mid-sleep waking, is a combination of Gabapentin 300-600 mg, taken a couple of hours before bed, and Magnesium Sulfate injections 2 ml diluted with Xylocaine or Taurine.

I'll still take a regular med like Zolpidem to initiate sleep, but the Gabapentin has alleviated the mid-sleep waking very effectively. I'm still new to this and I really hope the benefits last, so many things I've tried for sleep seem to stop working after a while.

Here's a couple of links, one to an article abstract on how Gabapentin can inhibit hormones like adrenalin, another about how it reduces glutamate release:
http://www.ncbi.nlm.nih.gov/pubmed/22417967
http://www.ncbi.nlm.nih.gov/pubmed/15355323
I'm sure there are better articles out there.

The Magnesium seems to help most in big doses like 2 ml plus. Night sweats have pretty well cleared up and overall quality of sleep has improved, which in turn has helped with the brain fog and other symptoms, although I've still had some really bad crashes since starting this.

 

[Hanna]

I have started supplementing with 100mg oral Progesterone pill which converts to 10mg Progesterone in the body which is a neurotransmitter also. Especially when it gets converted to Allopregnanolone, a calming neurotransmitter as potent as benzo's such as Valium.
I sleep through the night now. Wake up refreshed. Have not grown breasts or babies under the excess progesterone.
)

@WoolPippi
I havn't had my gene tested, but your description fits so much what I have been experimenting at nights (very bright and sharp mind on awaking around 2:30 for me). Maybe there is some MAO mutation going on. What I find interesting, is that it correlates with a depressed progestone level on saliva test. So maybe I would gain starting again a progesterone supplementation.
Have you noticed at what time do you have to take your progesterone supp in order to have the best effect?

 

[WoolPippi]

@WoolPippi
Have you noticed at what time do you have to take your progesterone supp in order to have the best effect?

No, I've only been taking this for a few weeks to say anything about timing. But I've been keeping records. I'll put them in a chart today and get back to you.

 

[Hanna]

Thank you WoolPippi!

 

[WoolPippi]

I had a look but the timing seems of less importance than other things.
I take my pill right before sleep, anywhere from 5 to 45 minutes before onset.

Things that influence my sleeping through significantly are:

• easy digestion (no vegs, no starch, no sugar, no nutmeg, lots of HCL, small portions);
• no noise (earplugs);
• relaxed day (Valerian, resting, meeting only nice people, optimistic outlook);
• supplements right before sleep (100 mg Progesterone pill, Valerian, 200 mg of Magnesium, half a pill of Lithium from Biotics and 1 pill of Pollinosan - a homeopathic aid against dust allergy)
• clean bed sheets, clean body (hoover the bed if you can't change the sheets)
• no needing to pee (no liquids after 7 at night, except bit of water for the supplements)
• Not too much methylfolate during the day
• no puking cat at night...

chart with my hours in connection to this pill is on my blog: http://marvellogic.wordpress.com/2014/01/23/sleep-progesterone-pill-works/

 

[Hanna]

Found something which doesn't apply to everyone, but for me sure! (from Dr John Lee MD)
"A frequent cause of insomnia may be food intolerance. One of my insomnia patients woke up every night about 2 a.m. feeling anxious and wide-awake. Her problem was her habit of eating chunks of cheese just prior to going to bed. Her cheese of choice happened to contain high amounts of tyrosine, a precursor for the synthesis of noradrenalin (a stimulant made by the adrenal gland). After discontinuing the bedtime cheese, she slept fine."

And this,
John Lee, MD from "What Your Doctor May NOT Tell You about Menopause" had this to say about Progesterone cream and sleep:

"Many of my patients have volunteered that the first benefit they perceived from using natural progesterone was an improved sleep pattern. After years of unsettled sleep they now look forward to retiring each night because they know they will enjoy sound sleep and awake refreshed in the morning. This is one of the reasons I tend to recommend that progesterone cream be applied at bedtime.
Research concerning progesterone's role in brain cell function is still in its infancy. It is likely that as research progresses more discoveries of progesterone's benefits will emerge."

I think I'll give a try to my transdermal progesterone once again...

 

[xks201]

BLOOD SUGAR CRASH DING DING DING - take selenium, chromium, and vanadium ... make sure you aren't hypothyroid and if on HC pop 2.5mg before bed.

 

[WoolPippi]

BLOOD SUGAR CRASH DING DING DING - take selenium, chromium, and vanadium ... make sure you aren't hypothyroid and if on HC pop 2.5mg before bed.

nope.

 

[WoolPippi]

I fixed it, I figured it out. In my case (ymmv)

it's waking up when I go from non-REMsleep to REMsleep after the first five hours of sleep. These five hours are essential and sleep-deprived bodies will make sure they compensate for these hours of sleep (they do not for the predominary REMsleep after 3AM).

Going from nonREM tot REM is a peculiar transition with all kinds of neurotransmitter things happening in the brain. Prof. Mallick is the expert on this transition.

For one thing: noradrenaline needs to rise a little in the brain, just a little, to get from nonREM to REM.
I have a MAO A mutation which hinders the break down of said neurotransmitter. Noradrenaline rises too much in my brain, making me wake up en be alert for the next hour or so.

Any external stimuli that causes noradrenaline to rise during the night will add to this phenomenon (pain, cold, blood sugar peak during the day, stress during the day, blood sugar shortage during the night, noise, snoring partner, snoring cat, heavy digestion, dust mites, ...).
Which is why I avoid all these things.

Another factor that plays in my case is an overall shortage of progesterone. This puts my body in constant stress which somehow is felt most at night. (I'm taking about the human base level of this hormone/neurotransmitter, the level men need)

Since I cannot fix the MAO A mutation I cannot avoid my bout of insomnia. But I have reduced it and have increased the quality of my sleep.
I am in recovery now -because of good sleep!- and have been steadily healing for the past 4 weeks. I'm at activity level 70% now (it was 40%)

Here's what I do:
- take 100 mcg pill of Progesterone each night, every night (even when I'm on my period which doesn't get affected)
- avoid all the noradrenalin-triggers I mentioned above and take plenty of vit D
- stopped worrying about bodily things. (this stopped the HPA-axis that was constant active in me)
- I wake up at 3AM but I don't worry. I lie around, think up some alternative story for Little Red Riding Hood or read for a bit. After about an hour I feel the alertness subsiding. I then take a morsel of hydrocortisone and some progesterone cream. I then fall into a deep, healing sleep for another two hours. This is crucial as this is the sleep that provides a surge of Growth Hormone, healing the body.

The hydrocortisone I take covers the natural rise humans have in the early morning. I lacked it and it put my body on stress.
If I take it too early, say when I just wake up at 3AM my insomnia will last 2 to 3 hours. It's vital I take it after the first hour of insomnia, when the alertness subsides.

So I still wake up. But my sleep now is good.

PS. having faulty MAO A enzymes makes you vulnerable to the "cheese effect". Cured foods will give you head ache (cheese, meat, saurkraut, wine, chocolate). The enzyme is used to break down Tyramine. Which you don't when you have MAO A mutation.
This mutation may also make you more happy than others with working MAO A. I know it does for me.

 

[heyitisjustin]

(don't start HRT without broad selfstudy on the subject. Then start low and go slow.)

I also have MAOA and have wakenings issues. I just ordered progesterone (I am male).
I plan on reading through the forums about progesterone whilst I wait.
Are there any particular things you want others to be wary about?
Progesterone could decrease serotonin from what I can tell and I am looking out for that.
I am not sure what else I need to think about.

 

[WoolPippi]

I also have MAOA and have wakenings issues. I just ordered progesterone (I am male).
I plan on reading through the forums about progesterone whilst I wait.
Are there any particular things you want others to be wary about?
Progesterone could decrease serotonin from what I can tell and I am looking out for that.
I am not sure what else I need to think about.

how are you doing?

Progesterone could decrease serotonin from what I can tell and I am looking out for that.

I'm not aware. And cannot think of a reason why this should be. Serotonin has no bearing on the adrenal cascade in which progesteron plays a rol.

Are there any particular things you want others to be wary about?

Only take bio-identical progesteron, never progestins. (read the label/ingredients)
for men/women adrenal requirement of progesteron in 10 mg per day. Oral pills will be 100 mg because convention says the liver will only allow about 10% of "the poison" to go into the blood stream. You milage may very well vary so keep an eye on blood levels and symptoms.

 

[WoolPippi]

UPDATE: I've found the physical stressor that starts my insomnia.

Then my sensitive nervous system gets triggered and keeps me awake.

I now do two things and am sleeping 6 hours every night or more:
1. avoid the physical stressor
2. calm down the nervous system 24/7

My physical stressor is the colon. My ascending colon has so many twists and turns that it will fill with food during the first hours of the night. My body gets panicked as it cannot shift the food and it wakes me up.
I now avoid having food in the colon at that time:
1. I eat a "low residue diet" = no fibres, no bulk
2. I avoid foods that feed the bacteria that produce gas (FODMAP)
3. I stop eating at 2 o'clock in the afternoon. Only drink after that (tea, bouillion, stock)
4. stand up straight for a while in the evening (talk a walk or a shower)

I calm my nervous system with:
- deep breaths all the time
- Reverse Therapy to stay out of Fight or Flight
- take the minerals I need (Zinc! Molybdenum, Selenium, Lithium. Vit D, progesteron, hydrocortison, florinef, salt.)
- little lie downs during the day
- mentally stopping myself whenever I start thinking gloomy thoughts (I start to solve a mental puzzle instead such as a design problem)

Here now are some more technicalities about colonic function:
If your bowel movements are normal then a person does not need fibres. Specialist told me.
Small intestines take about 4 to 5 hours to digest foods and give it to the colon.
Colon has many motility patterns including a big sweeping one called the Big Mass Movement. This one comes around every 1,5 hours.

In my colon this BMM tries three times to shift the stuck food when I sleep and then pulls the emergency signal, waking me up. I have no pain but I have a swollen stomach at the right underside. Where the appendix is.
I had a CT colon done and dr. says it looks good. Normal. I'm guessing lots of people have this problem
It's this stupid sensitivity that makes me wake up from it. And then the sensitive brain chemistry that makes it into 1,5 hours lasting insomnia.

I now sleep 6 hours, sometimes 7. I still wake up with uncomfort in the lower right belly but seldom in a sweat or a panic. Yes I am hungry in the afternoon and evening. But getting a good night's sleep is all worth is.
Sleeping better has allowed me to lower my hydrocortison somewhat. I'm better able to cope with stress during the day. This results in more peace and bliss at night. Which gives better sleep. I still may wake up in the night but now I can turn on my other side and enter sleep again.

I had my CT in May. Have been eating weird since June and sleeping longer than 4,5 hours now for six weeks. I've been in recovery from ME/CFS for a year now. Have lots of energy during the day the last six weeks.
MUST have lie downs during the day, MUST pace myself, MUST still give ME all my attention and come at it from all angles. Have changed my life totally from how it was when I got ill (2009). My insomnia is not the cause of ME, I've had it all my life, every night. Right up until a few weeks ago.