Tips for managing hyperarousal insomnia and early waking at night

[Appleski]

I have been struggling with insomnia for the past year or so. I am perimenopausal and I am on HRT (Estrogen Patches, Utrogestan and Testosterone) The insomnia started a few years after I went on HRT. After trying various changes to my HRT, different supplements and medications I believe that my insomnia isn't hormonal or caused by anything specific other than hyperarousal that occurs if I wake up in the night.

I can fall asleep fine but if I wake up at 3 or 4 am that is it. I have been watching the sleep coach on youtube and after watching a few videos I actually started sleeping well but I'm having a set back. The past week I've been waking at 3 or 4 and that is me awake from then on. I can feel that I am in a state of hyperarousal i.e. essentially feeling upset and afraid of being awake at night. This pushes my nervous system into fight of flight mode and makes it nigh on impossible to sleep. If I am able to stay calm I might be awake for 20 minute or half an hour but I fall back asleep. I am sure those who have struggled with sleep will understand.

Unfortunately I don't think supplements or melatonin really work for this kind of insomnia and even many sleep meds struggle to control it. I try breathing exercises but they just seem to wind me up even more.

Does anyone have any tips on how to get over this kind of hyperarousal insomnia?

Magnesium is excellent for this. What makes you think it doesn't work?

I've been using magnesium and it doesn't really do anything. I did try magnesium glycinate and that was actually what initially cause the issue as it caused a paradoxical response or at least it seemed to and I barely slept for the 6 weeks I was taking it. My GP told me to stop. I have also used magnesium malate and magnesium taurate but it doesn't really make any difference to my sleep.

I didn't know there was a fancy name for it but that's been me since my mid 40s, I'm 68 now.

Try L-theanine alongside your magnesium. It’s transformed my sleep

I suffer from this when I am stressed. It’s horrible. I haven’t found an answer but listening to white noise, having herbal tea , or a herbal sleep potion have helped sometimes. Taking enough exercise during the day and avoiding stimulating tv programmes before bed also help.

Oh I get this. I sleep for a couple of
hours then im awake until morning (usually fall asleep 40mins before alarm). I’m fairly convinced for me it’s hormonal but it is getting worse. It used to be the week before my period and now it’s 2-2.5 weeks regardless of cycle. I wish I had an answer. I can’t take melatonin and can’t really take sleeping pills because I need to be alert enough for my kids.

I’ve no helpful answers but you’re not alone at 3am!

That was happening to me a lot which my gp took as a sign to increase the oestrogen dose which largely sorted it. I still get about 3 nights a cycle where it happens. She is a menopause specialist and very hot on the current research so it might be worth revisiting your dosages with your gp?

I found a meditation technique helpful for the first night, but it gets much stronger on successive nights. I have found a weighted blanket on those nights (I don’t use it the rest of the time because I don’t want to habituate and lose the impact) helped a lot.

Recently I’ve started to run much hotter at night, so the weighted blanket isn’t tolerable anymore. I just get up now and make a cup of tea. If I try and sleep I keep jolting awake, flooded with adrenaline, heart pumping. But I’m not actually anxious once I’m actually up. Occasionally I will tackle something that might be the current focus of the panic, other times I just fold laundry.

If it’s on a weekend, I can usually get a nice second sleep 7am-10 but otherwise I’m just a bit sleep deprived for a few days. Haven’t figured out a better solution yet.

Ahhh. Tara Brach’s talks. Free if you google them. Love the woman (well. She seems really nice, could be indoctrinating me for all I know) but I cannot stay awake for a whole talk!

And yes…. I thought it was all a bit woo too, but they have helped me get back to sleep in a way nothing else can!

Thanks for the advice. I think the sleep coach advice is to not try to treat the insomnia i.e. not to do special teas or techniques because that just ends up feeding the anxiety around sleep or in my case getting back to sleep the idea is that your brain has decided being awake at night or for some people trying to fall asleep is a threat and so it activates the nervous system.

My estrogen was increased to 100mcg, It apparently can't go higher unless I see a specialist with a 2 year waiting list!

I did try it and reishi Mushrooms, Taurine, phosphatidylserine, ashwagandha and so on and none of it worked.

The Sleep With Me podcast sorts me out if I wake and my mind is racing. I have it on super quietly and it just does enough to distract from my thoughts without engaging.
I do breathing exercises and muscle tension awareness and relaxation at the same time.
Insomnia sucks.

What is your ferritin level?

Low levels can cause anxiety and heart palpitations and restless legs amongst other things so it might be worth checking to see if it's optimal.

I find doing any relaxation or breathwork just winds me up all the more!

I've had a course of iron tablets and its fine now, still I don't sleep!

I have this. I cannot do or listen to anything that is any way related to relaxing or sleeping - as it just winds me up more! I listen and re listen to radio programmes that I’ve heard a thousand times before - my favourite is the whole series of Cabin Pressure…. It’s just enough to make me smile and distract me but not enough that I need to actively listen. It’s like a comfort blanket. Sometimes I drift right off, sometimes in and out - but the tension goes and I’m relaxed at least. It’s my radio equivalent of Friends - and I’ve listened to it all 100’s of times. Somehow, the familiarity just eases the anxiety and adrenaline.

I'm glad you've had a course but what is the actual level? The NHS levels are desperately low and says anything between 5 and 15 is fine but it needs to be at least 70 for healthy hair growth and 100 for optimal health. If your levels are above 40 then I agree it's probably not that.

Bill Nighy’s podcast sends me to sleep every time.

OP we could be twins. I have been up since 3 pm yesterday but only slept from noon to 3 pm because I was up for 24 hours the night before that.

This insomnia is a special kind of hell.

Just waiting for my family to awaken and try to pull an "all nighter" to try to realign for a couple of days. It will work or I'll pass out and fail.

First coffee of the day. Hope you have a good one.

I’m on progesterone. 100mg quick release helps me go to sleep. 100’mg extended release helps me stay there. It’s been a godsend.

I go to bed at 9pm every night so that when I wake up at 4 am it's not quite as bad.

Always been a light sleeper since having kids.

Solidarity OP. I wish I knew the answer.

Have you tried different types of oestrogen?. I couldn’t go any higher on the gel or patch, but when I switched to the spray I was able to slightly drop my dosage because my absorption was better. There’s also an oral form.

Progesterone tablet before bed and oestrogel HRT sorted my insomnia.

i still wake early most nights but now i go straight back to sleep.

The HRT patches did shit all for me.

i can’t take magnesium due to heart and kidney problems and melatonin didn’t work either

I can feel that I am in a state of hyperarousal i.e. essentially feeling upset and afraid of being awake at night. This pushes my nervous system into fight of flight mode and makes it nigh on impossible to sleep. If I am able to stay calm I might be awake for 20 minute or half an hour but I fall back asleep. I am sure those who have struggled with sleep will understand.

This is classic in people with insomnia - what do you do to address your fight/flight response? You need two things - lower it generally through lifestyle adjustments (no caffeine, no alcohol, healthy food, exercise, calm pastimes, meditation) and interrupt it at 3am when you wake, potentially through focused breathing or sleep meditation.

You may always need to do some preventative actions if you are prone to insomnia.

I’m 47 and I get this. I take two 8 in 1 magnesium supplements and two ashwaganda and also an L complex of total aminos. Audio book before bed, total black out bedroom. I get 3-5 good night sleeps on this regime and do better when I’m in the progesterone state of hrt. Maybe 4-6 good sleeps a week. I’ll attach photos of what I take. My DH thought it was quackery but when I threatened to kick him out of the bedroom due to his Restless legs and struggling to sleep, he started on magnesium and now he’s the one who dishes out the vitamins every night at 8.30 😂. He’s also night himself a magnesium joint spray and says that helps to.