@pgrovetom, where are you now with this situation?
Because it is SO similar to mine that it gave me chills when I read your post. My symptoms seem to be a bit less severe, yet at the same time the insomnia component alone has wrecked my life.
My experience:
- Bad sleep began in 2019, starting around summer while camping and increasing in severity after taking licorice root. During this time I briefly had a Fitbit which measured dips in O2 at the time of awakening. I no longer have Fitbit or O2 data, as I got the device only while having lost my Oura ring, which I’ve otherwise worn consistently since early 2019. During most of my awakenings, it does show an HR dip, then spike as the body tries to recover. — I also just ordered a pulse oximeter after reading this thread.
- When my HR dips around 3am / after 4 hours of sleep, I’m often awoken with a racing heart, rapid breathing.
- I just recently learned to describe it as a “lack of saturation” in my breath, and only this morning (at 3am of course) had the epiphany that it could be lack of blood oxygen saturation, which led me to this thread by way of researching hypoxemia.
- I typically never have the willpower/energy to get up and walk around to raise HR efficacy, however I have noticed a recurring tendency toward, ahem, masturbation, which I imagine has achieved the same thing. If you have a partner, maybe some 3am sex might be in order?
- My onset was roughly associated to 1 weak or camping during summer 2019. My current, more open-minded doctor just ordered tests for EBV, lyme, etc.
- However, my symptoms were severely exacerbated Nov 2019 when I had licorice root tea. Licorice root can cause pseudohyperaldosteronism, which I’m certain I experienced … however that’s an acute phenomenon, and here I am two years later:
- In the last three months it has gotten worse, proportional to increased physical activity. So I should clarify that I don’t only have an HR dip + awakening, but now my RHR is too high: 80-100 during the day, and 60-68 during the night, sometimes 56-58 at night. But before Nov 2019 it was at 60-75 during day and 52 at night, WITHOUT hypoxemia symptoms. — What is your day RHR like?
- I have severe lack of physical endurance. Used to be able to take long walks, now half a mile can wipe me out.
- I tropically have diarrhea during these episodes, not constipation. However, my lower gut/abdomen does typically feel very tight and stressed from these episodes.
- After these episodes my tongue is usually quite white (the muscle, not the surface) = anemia?
Here are the things I’ve tried with some success, especially within the first 1-6 hours, but the effects don’t “hold”:
- Magnesium (citrate / Calm brand helped more than Glycinate)
- Sodium (possible sodium deficiency? I heard in a podcast with Morley Robbins that he thinks serum sodium should be 141 or above, and chloride 105 or above. If this is true, I’ve been sodium deficient much of my life — which could explain exercise intolerance / low endurance. I’ve learned that some of the most common blood tests (serum sodium, serum magnesium, serum potassium) only gauge how well that particularly body system is functioning, not whether there are enough stores for the body to operate smoothly. Plus a week ago I woke up at 3am distinctly dehydrated, and a year ago I craved Pedialyte, which helped a bit at the time.
- Potassium sometimes helped, especially with physical endurance/exhaustion.
- Adrenal Cocktail: sodium + potassium + C.
- Vitamin C seemed to help sometimes
- Phosphorus. This is the most oddball, out-there supplement I’ve tried, but may have had the most success in mitigating 4-hour awakenings.
- However the ionic liquid bottle I found on Amazon helped the most, but it became cost-prohibitive since the RDA of 750mg-1g seemed to help the most. I then found Sodium-Potassium-Phosphorus powder packets by Rugby, but the effect has been less. It’s worth noting that with either version of phosphate, taking it sublingual helped more than swallowing it: I have a blood test from last autumn showing my P levels right at the threshold for being low. Unfortunately, there’s no “RBC phosphorus” test to gauge storage levels like with magnesium, potassium, and zinc. However a hair mineral test may achieve this; I had one before licorice which showed it low; I also had an OAT before licorice showing P very low.
- Note that I began researching P based on a theory of hypoparsthyroidism, as during licorice I was mega-dosing vitamin D to try to heal a different issue, and my PTH levels now come back quite low.
- Another reason I explored P is because in Aug 2019, before the insomnia/hypoxemia really took hold, I did a 7 or 10 day fast. I did not manage electrolytes well since I was rather ignorant of the consequences of fasting/keto, and only later did I learn or refeeding syndrome, which can deplete P and vitamin B1! — I briefly explored B1 last week but may need to try even higher doses.
- Lithium/B2/B9-MTHF. Still experimenting with this. My B12 levels were though the roof in January, but then I experimented with lithium and had a blood test last week, so I’m curious to see if B12 levels lowered due to increased usage by lithium, as I definitely felt lithium kicking in, and taking MTHF post-lithium led to overmethylation symptoms at way lower doses (2.5mg vs 12mg).
- Biotin. Started taking larger doses in November and it distinctly induced sleepiness and at least getting me back to sleep after waking up.
- Vitamin A. Began larger doses in January and it had a similar effect as biotin: great sleepiness. I suspect I’ve been deficient a while, especially after my vitamin D explorations. Vitamin A also resolved chronic eye tingling/prickliness … which has since returned, and is worsened by MTHF and lithium.
- Serotonin and dopamine. I was deficient in both. Serotonin has not secured sleep / prevented hypoxemia, and dopamine merely helps me fall back asleep sometimes and feel refreshed, but it might be worth exploring neurotransmitters OP, at least to improve quality of life. Even in spite the insomnia, beginning 5HTP (and somewhat lithium) has greatly improved mood abs daily living. The questionnaire at bravermantest.com can help you gauge neurotransmitters; bebrainfit.com also links to two more quizzes in their article Serotonin Deficiency; also look into the bullet points from the book Mood Cure / take the quiz on the author’s website.
- Vitamin B5. Sometimes this helped, sometimes not.
- NAC for RHR, energy, brain fog.
- Beets/arginine/citrulline for RHE and endurance.
- Sometimes a snack before bed helped, under the theory of adrenal fatigue / hypoglycemia … but again, not dependably.
- Calcium?? Either calcium helps improve my sleep/mood/RHR/stress, or it directly induces the 3am attacks. Unfortunately it might be both, so I’m unsure how to test it. The last time I took some during the day in January, it led to my worst 3am attack in ages, after which I explored cortisol/ashwaghanda, which helped a bit.
- Copper: TBD. My RBC zinc levels are at the very high end of the normal range, after high intake over the last few months, and I’m confident I have a copper deficiency, which a 2020 serum+Ceruloplasmin test confirmed but I never addressed. Waiting on new results. The hypoxemia could relate to anemia?
And here’s a special shout-out to things that at one point or another helped me sleep through the night
even with a hypoxemia awakening, rather than preventing it:
- Ashwaghanda, maybe paired with theanine. This helped big time after a severe crash, but may have worn off.
- Adrenal fatigue has been on my radar since 2019. I do sense these hypoxemia attacks correlate to low cortisol; before serotonin and ashwaghanda, my mood, energy, and brain-state was horrendous, with easy irritability and rage. Now, I’m still waking up, but my mind and mood are adequately functional, if not “great” considering the circumstances.
- Methylation/MTHF/B2.
- Serotonin.
Those are all of the things that have helped 1) sometimes lower my HR to normal and 2) get through the night. But again, not consistently or dependably. However I was not exploring hypoxemia with those tests, which I will now prioritize.
FWIW my approach to health has been 1) replenishing deficiencies and 2) balancing imbalances. Addressing deficiencies alone has been a big help. I’m also operating from the place of basic physiology. What could we be deficient in that is inducing hypoxemia? Is it only at night or also throughout the day? (I’m inclined to the latter, with that 3am HR dip just being a “weak spot”.)
Could we/I be low in nitric oxide? Supporting NO has helped my RHR in the past: arginine, citrulline, beets. I want to experiment further.
In my case, I suspect I have NO issues related to urea cycle / ammonia issues. One of my personal tests is soda, which induces fatigue and cognitive impairment / brain fog, which I think is ammonia. I’ll be doing a urine amino acid test after drinking soda to confirm. This possibly-ammonia symptom set began for me in Jan 2017 alongside molybdenum deficiency (since resolved) and would explain so much of my situation, since NAC helps brain fog and RHR sometimes, and the urea cycle uses arginine/citrulline/ornithine as much as NO production.
Oh, and the real kicker after reading your story: I track all of my supplements/symptoms/sleep quality in the app Bearable, which automatically computes correlations between these things. Earlier I was reviewing what helped sleep, and I found it so peculiar that caffeine showed up! Twice in January I meant to drink decaf but got normal coffee, and both times my mood and energy felt amazing/normal, and one time I even had caffeine too late in the day and did sleep through sleep wasn’t spectacular, I did sleep through to 6 hours without a post-4-hour awakening.
I may tentatively explore nightly caffeine… Like you OP, I don’t think this is optimal; but if you explore neurotransmitter support you may find it easier to mitigate the fallout of insomnia … until we discover what is causing acute hypoxemia… I thought my issue was chronically high RHR, however that only began with licorice, whereas hypoxemia began before and worsened after fasting + licorice. I wonder if 50mg caffeine to keep my HR really going paired with serotonin/ashwaghanda for mood support could be a winning combo unti hypoxemia is figured out.
I know my post has a couple of redundancies, some disorganization, and maybe typos, but that’s what four hours of sleep gets us.
If I get any updates from my doctor or experiments I’ll be sure to share. I currently have a NutrEval in the works and am eager to get it. Next: urine essential elements + amino acids, and more experimentation with B1 and nitric oxide.
, and even then, you may have to go injectable. I think I will back table that one for me.
