insomnia, please tell me what else I can try

[lovelygirl17]

I've been struggling with sleep for more than I decade. First few years it was the kids that kept me awake every night. Eventually they started to sleep through the night and I couldn't wait. Just to discover that I didn't have the ability to sleep any more. This was about 5 years ago. I was riddled with anxiety and the worst of my demons came out at night. I never have trouble falling asleep, I'm knackered every night. But I started to wake 2am most nights no matter what, feeling anxious and wired and ready to start the day. Sometimes I managed to go back to sleep around 5 am, sometime I didn't. I used to blame my stressful job but I'm not sure anymore. I was prescribed antidepressants for my anxiety. Citalopram made me so sleepy, unfortunately mostly during the day that I struggled even more at work. I switched to Flouxetine (it has helped in the past) but this time it just didn't do anything anymore. Over the years I tried, magnesium, melatonin, new pillow, new duvet, weighted blanket, vitamin B, mindfulness, yoga, regular reflexology, acupuncture ,not looking at screens, having a regular bedtime, getting some exercise and some gave some relief but always short term only. For the last two years things have deteriorated, I'm hot and sweaty at night then I'm freezing cold and wide awake of course, I was still anxious and made me miserable during the day. The kids started to suffer, my husband and my work too. Most days I feel I'm unable to function. I went to GP suggesting it might be perimenopause. It has taken me several appointment over the course of two years to get hrt prescribed. My sleep was deteriorating fast at this time, 2 days before I started the patches, I was awake from midnight, banging my head on the wall and wanting to die. Then I put my first oestrogen patch on and I had the two most wonderful nights of the decade. I was so happy! From day 3 the situation however deteriorated and when I put the conti patch on, it went awful, I wasn't anxious anymore but deeply depressed. Still woke up after an hour sleep each night, sobbing my heart out and this didn't stop in the morning, it carried on during the day. I couldn't sleep or nap during the day either but on rare occasions, like once every 10 days I would get an ok day to keep me going, the rest is awful. Trying to get into touch with GP but it's almost impossible. Despite telling them that I lost my willingness to live, I haven't managed to speak to anyone for the last 3 weeks. Last night I was so bad that I decided to walk to a&e in the middle of the night, I was wide awake all night and couldn't stop crying. They gave me sleeping pills (Zopiclone 3.75) to break the cycle. They said I had to be careful because they were very potent. Now, I hate to say but I've taken one and it had no effect. Went to bed at 10:30pm, fell asleep, woke at midnight and sitting up ever since, wide awake. I'm going insane. So anybody, has any suggestions or just sympathy then please share. It's affecting everybody in my family now, I feel that I'm only upsetting them and there is zero happiness left.

@lovelygirl17 Maybe you can give a bit more info about the HRT you use? I just feel there is a lot more that might be done to help if you can get the type and dose right.

You mentioned patches- but what dose of estrogen?
You mentioned you feel bad on the combined patch (for half the month.)

So there are various options.

Change the patch to gel- this means you can adjust the dose yourself and keep upping it (to 4 pumps per day) to get the dose that works.

Change the type of progestin from the one in the patch, to micronised progesterone (capsule that is oral). One side effect is it is a sedative and many women find they sleep better on it.

I truly believe you need to get your HRT sorted to something better.

If it's still impossible to speak to a GP, can you afford to see a private menopause specialist? Most are still offering video appts (which they started during the lockdowns) so your location won't be an issue.

If you can afford around £250 for this, I'd go for it.

Let me know if I can offer any more ideas.

I have had life long insomnia, tried all of the sleeping tablets etc. A couple of years ago a new GP prescribed me Trazadone which is not usually used for sleep but it works like a dream. You take them 30-40 mins before bed, they don't knock you out but completely relax your body and I haven't had a bad night since.

What dose do you take @Gigia

I started on 150mg and now I take 200mg which I have been on for over a year

I found antihistamines quite good, and a gentle electric fan on through the night. No sugar in the evening (fruit, rice, bread included) and try to eat dinner early.

After menopause was diagnosed and I was able to start HRT my doctor gave me Zopiclone to sleep (I think it's Ambien in the U.S.) which helps me fall asleep and stay asleep for 3-4 hours which is SO much better than before.

I've had insomnia since I was 15, I'm now 45 and I feel your pain as I'm peri menopausal too.

I've recently been trying progesterone but little difference.

I take panadol night tablets (these have an antihistamine in them) or 10 mg of melatonin. Mixed results but they can help a bit.

I do everything else right: exercise, meditate, no phone or screen for hours before bedtime...it's a tough situation.

Have you tried melatonin?

Woohoo, thank you all for your replies and sympathy, although I wish I was strong enough not to need the latter :( Sorry for tmi but I'm pleased to say that I got my period yesterday and I feel much better. Apart from that I had half of Evorel 50 patch on (this is what I got prescribed) and taken the second Zopiclone 3.75 tablet. I spent 8 hours in bed (10-6) waking only at 2am but not anxious, distressed or needing to cry, turned the other way and went back to sleep. Kept waking pretty much every hour after that but managed to get back to sleep every time. Now, before I conclude that it's all sorted, I have to mention that the exact same thing happened last month (bar Zopiclone), back then I actually had two nights of sleep after my period arrived, and they were even better, deeper (uninterrupted) than yesterday. Then it deteriorated rapidly and you all saw the end result in my first post. I've taken on board all your suggestions, ideas and I have a call with my GP later today. I'll keep you updated.

600mg n acetyl cysteine before bed solved my insomnia which id had for four months. It might not work for you but it helps switch from glutamate to gaba production in the brain which is needed for sleep.

Saw the title of your thread and was going to suggest Piriton which works for me on the days before my period when I can't sleep a wink, but your insomnia sounds so much more extreme! If Zopiclone doesn't touch it, I doubt an over-the-counter Piriton will! You have all my sympathies, it's utterly miserable. Really hope you find something that works for you.

UPDATE, GP referred me to gynaecologist regarding hrt. Also asked me to stop the patches and use Estriol cream daily (I have been using the cream for a couple of years and it helped my symptoms when I was using it daily for a short time, once I switched to twice a week it stopped having any effect). He said it should not do any harm to use it until I can see a specialist but we don't really know how long that's going to be. Regarding the sleep, nobody knows, doesn't help that I had an appointment on the day when I had my best sleep. Last night I had my 3rd Zopiclone and was wide awake after 4 hours sleep. Not as bad as last week but my brain feels numb. @BrightonMama I have tried Nytol before and it didn't do anything, not sure if it's the same but I think they may be similar. I feel so broken. I've counselling tomorrow, wish me luck.

@jellymaker I think you do have a point, this is winding me up, it has got to me very badly now. Having been sleep deprived for so long I started to have real performance issues. I've been struggling at work for a long time, I have also been struggling socially, and recently because it's all deteriorating, my home life started to get affected too, it's after all my family that picks up the pieces.

@Spookytooth I actually have a very similar problem. 8pm is always crucial for me, I get very sleepy and if I sit down to watch telly I really struggle to stay awake (family members tend to wake me if I dose though...). I have been thinking, messed up circadian rhythm? Or just messed up in general...

Long time sufferer here too.

I tried the sleep restriction mentioned in a PP and it did actually help a bit. Don’t go to bed too early, stick to the same time every night.

You can also take up to 7mg Zopiclone (2 x 3.5) so you could try that to break the cycle. Amitriptaline is supposed to be safer snd not supposed to be addictive but it is - my mum has been stuck on it for 30 years.

I also agree that maybe oestrogel and progesterone tablets might work better. I was on HRT and didn’t notice much of a difference in sleep but then I was going through a ‘good patch’ when I started so I don’t know.

I’m not sure whether the gynae is going to be much use on insomnia, but worth a try I guess. I find that GPs lose interest after a while as they just don’t know how to solve it.

Other things I do:

Get up and eat a banana
Stay totally detached from it emotionally (hard I know!)
Play alphabet games in my head (think of a country beginning with every letter etc, then a fruit or vegetable) Sounds dumb but it stops me thinking about bigger stuff I have going on in my life.

I also wonder whether you have adrenal fatigue - the 8pm slump is classic. Try to eat regularly through the day and look it up - I’m sure there’ll be more advice online.

Amitryptiline isn’t addictive.

I’ve been on and off it about 6 times. No addiction issues at all.

@lovelygirl17 Couple of points

Why are you only using a 25mcgs patch ( half a 50 mcgs)

why has your GP asked you to stop?

Do you have some complicated issues that require a meno specialist and why can't your GP just prescribe HRT?

And Ovestin- you can use as much as you need to get results and can use it long term ( women in their 90s use it.)

Just to piont out that a 25mcgs patch is a TINY dose ( the lowest available) so it's unlikely to be doing much for you.

As others have said, and me, maybe switch to estrogen gel and then you can manage the dose yourself, by increasing in small amounts until you feel some improvement.

You would also need a progesterone - Utrogestan- to take 12 days per cycle and this has the welcome side effects of being a sedative.

Your GP can give you both of these- it's not complicated and many women use this type.

@JinglingHellsBells I'm not sure why my GP cannot prescribe the above, I asked specifically for Utrogestan as I had such a bad reaction to the patches and so many people recommended it but he wasn't really engaging with my "demands". Either he is not convinced that it is hrt what I need or he just doesn't know much about it. I asked for it myself because I'm desperate to get some sleep and reduce my anxiety and forever tiredness (I have all the perimenopause symptoms apart from irregular periods, + I'm from an early menopausal family and have been running on above average FSH for a long time if that's relevant). When I first tried the Ovestin cream, I felt so much better for a few weeks so I thought there was the answer but I'm not sure anymore. Same happened when I first put the Evorel sequi patch on, for 3 nights I had my best sleep for a decade, then anxiety's taken over everything again. I tried medication for anxiety too. 15 years ago Flouxetine has changed my life, was on it only for a few months but made a huge difference and I was fine for for years. 4 years ago, when I got fed up with anxiety keeping me awake I asked for it again but it didn't make any difference anymore. I tried Citalopram too at the same time but that had zero effect. It seems like I only get one shot with any remedy, eventually my anxiety overrides it :(

Hi - OP that is a minute amount of estrogen. I'm under Louise Newson and am now up to 5 pumps of estrogel under her supervision (which is more than 100mg patch). She says if you're younger you can need more or that some people don't absorb that well transdermally so need more - my bloods confirm this. So, after an atrocious three months of insomnia of many night of zero sleep (where I tried IT ALL) on 2 pumps - 5 pumps and I'm sleeping 7-8 hours with 1-2 wake ups. My GP has no idea at all so I stumped up the money to be taken seriously. It's transformed my sleep and it happened within 2 days of upping my dose.

Mirtazepine has been a game changer for me. I was really struggling with sleep and would wake several times a night. I still wake early but do get a few solid hours, which makes all the difference.

I feel your pain. Insomnia is possibly the worst symptom for me.

I have similar experience with the patches. Great for the first week and then get increasingly less sleep till I was back at the start of the month. I think the progesterone didn’t agree with me.

I switched to oestrogel and utrogeston and it’s the best I’ve felt for years. I get 1/2 disturbed nights in a month, around my period but other than that I’m asleep before midnight and don’t wake will 6am.

Your GP seems to be particularly unhelpful. Why half a patch? Why refer you, and delay the process rather than prescribe what you want? Is there another one in the practice you can see?

@comfortablyfrumpy

Mirtazepine has been a game changer for me. I was really struggling with sleep and would wake several times a night. I still wake early but do get a few solid hours, which makes all the difference.

I also did a course of this before HRT and it was amazing. First time I had to set an alarm in years and years. I stopped taking it and switched to HRT because the underlying issue is lack of hormones.

@Freshprincess not wanting to derail thread, but were you peri, menopausal or post menopausal? I am post (I think) and have gone through it without HRT. I'm now wondering if that was a mistake and if it's too late?

Peri I was 47ish, still fairly regular. I only started taking FRT at 50 as the GP wasn’t keen to subscribe.
You can start HRT anytime and some women never come off it.

@Freshprincess

Peri I was 47ish, still fairly regular. I only started taking FRT at 50 as the GP wasn’t keen to subscribe. You can start HRT anytime and some women never come off it.

Thank you.

OP sorry for a slight derail! As I said, Mirtazapine has been great for me but I'm now wondering from what I've seen here, whether I should actually be asking about HRT...

I hope you find an answer that works for you.