Anyone else have this insomnia issue?

[Furryfeet]

Sorry about the long post. Ideally I'd like to hear from anyone who has come through similar experiences to give me encouragement or anyone who just wants to share their own circumstances. (Btw I'm 45; been on Evorel 100 patches for about 8 weeks, upped to 150 3 weeks ago + cyclical utrogestan + 37.5mg venlafaxine for 5 weeks + 10mg amitriptyline started v recently)

I am continually perplexed by the way I have lost the ability to sleep and my sleep is at the same time really bad AND erratic. The thing that aggravates me most is that I've lost count of the number of times I've tried something new to help sleep and it's worked and I've thought 'Brilliant - I've cracked this' and then it's stopped working after 2 nights max.

For example I noticed for several months I was sleeping longer and more soundly on the nights my dh had ended up falling asleep downstairs on the couch, so he offered to sleep on the sofa for a week as an experiment to see how it benefited my sleep... 3 nights of great sleep for me and then it just stopped working. Same when i took taurine - first 2 nights slept like a baby but not since. First night of amitriptyline knocked me out for 8 hours and then the next night I was awake within 30 minutes and only got back to sleep again from 3-5:40am, CBD oil was similar. I've tried CBTi and hypnotherapy but they just seem like expensive chats.

I seem to sleep for little more than 3 hours a night with maybe 1-2 nights a week of a magical 7 hours, but I never know which I'll get. To make it more confusing, dh thinks I sometimes think I'm awake when I'm actually asleep. I thought about getting a smart watch to track sleep but think I'd probably just get even more obsessed with it.

The thing I find the hardest is the sense of not 'knowing myself' any more. I have been off work for a while with anxiety, low mood and insomnia after a fairly full-on stint of homeworking during the pandemic (which was when certain peri symptoms emerged). Some of my physical symptoms have gone and part of me would love to go back to work and feel part of that world again (and in fact I'll have to return soon anyway), but it's hard to tell how working will impact on my sleep and wellbeing. My managers have been pretty supportive in terms of asking me all about what might support me, but it's actually hard to know what would help when I've been feeling so weird for so long.

Whilst I know that as I age I will require less sleep, I need more than 2 hours broken sleep each night @JinglingHellsBells

I forgot that phenergan did help me...might try them again

I struggle. I often have about three hours’ sleep a night. I work full time, which is exhausting, and I can’t have HRT. I don’t drink alcohol at all and I have one cup of coffee and one cup of tea a day. I’m not sure what else I can do.

I can really relate to the something working for a couple of nights and then not. It’s v frustrating and I don’t know how I’m able to function on so little sleep. It really is mind boggling

No @Furryfeet but thank you.

@Furryfeet - I have tried a few different earplugs and I find QUIES to be the best one. You just squish them thin and insert them deep enough, they swell back and create a good sound barrier.

I can use a pair for a few weeks/ a month before I move to a new pair.

Good luck!

I agree with @JinglingHellsBells that your oestrogen is possibly too high and causing this. I would cut it back to a 100 patch and see how you are on that.
The Newson Clinic do sometimes seem to go higher on doses than most specialist clinicians would and more is not always better. The NHS works on the lowest dose that suppresses menopause symptoms and Louise Newson's training for clinical professionals stresses the need for 3 months on each dose before review to assess if the body has responded to the treatment so it seems unusual that you were advised to increase so quickly

Melatonin is thought to work better when taken daily rather than as a one off, this is because it’s a very gentle replacement hormone which can help reset your circadian/sleep rhythms. It’s not like knock-out drops.

It should be taken 20 mins to 2 hours before you want to fall asleep depending on your body’s response to it (20 mins for me). It won’t send you to sleep if you are doing something else or over thinking.

Its not like prescription sleeping tablets, it allows you to sleep not makes you sleep. It has a relatively short half life and therefore won’t still be in your body in the morning if you take it in the evening.

For insomnia we need a slow release version which I find really helps for a max of about 6 hours. The dose is usually 1-10mg depending how your body responds. My menopausal insomnia is terrible and I need 6mg slow release nightly to make a difference.

Whilst very difficult to get on the nhs it’s cheap and completely legal to import from US. Order a low dose prolonged release eg 2mg and you can then try doses of 2/4/6mg etc to find what works for you.

You can buy melatonin pretty cheaply on the internet. I get it from iHerb. The trick is to take it every night, at a set time, then do your wind down.

It's not a sleeping tablet. I suspect the first time you took it and slept well was a placebo effect.

It doesn't "lose its potency".

It wouldn't hurt you to give it a go for a couple of weeks.

i am taking this advice very seriously. It annoys me that the likes of Newson present HRT as the answer but there’s so much more to it than that. I have been thinking of getting a follow up appointment with a Newson nurse (cheaper than Dr, whose advice was fairly generic anyway) and asking for full range of hormone tests. It’s tempting to buy an online test but I wouldn’t necessarily know how to interpret it

The Newson Clinic do sometimes seem to go higher on doses than most specialist clinicians would and more is not always better. The NHS works on the lowest dose that suppresses menopause symptoms and Louise Newson's training for clinical professionals stresses the need for 3 months on each dose before review

@QueenOfHiraeth @Furryfeet

It's not that there is a difference between the NHS and Dr Newson. There is a difference between private drs.

My private consultant is more senior and experienced than Dr Newson (she's referred to him online as an expert and puts him on a bit of a pedestal) and trains other medics.

I was told to use the smallest amount to start with, to see how I responded, and to increase gradually.

I was older than the OP when I started HRT but I started on half a pump of gel, increasing to one pump, then 2. One pump worked pretty well but didn't control night sweats.

I find it hard to understand why anyone would start on a 100mcg patch which is the same as 3 -4 pumps of gel. It's usually the LAST step after trying patches from 37-50-75mcg.

Sometimes younger women who are well into peri need more (as they'd normally have more of their own than older women) BUT equally they may have higher estrogen anyway and only need a small top-up.

Honestly, OP I'd start at the beginning again and rather than searching for an insomnia solution (separately to your HRT) I'd reduce your HRT to a more normal level.

There are very few women using a 100mcg patch.

I see what you mean about melatonin being distinct from a sleeping tablet. I have avoided it because there is so much conflicting advice online on using melatonin and I think of it as yet another hormone that I don’t want to alter if I’m not sure what I’m doing - plus I only have 12 slow release left. Would you be able to pm me details of how you buy it? Thanks

x-d posts @Furryfeet Don't dismiss HRT as not being the answer.
You just need your dose sorting out!

I think Dr N provides a good service, when women can't get NHS treatment so easily, but please note that most of the team are 'only' GPs. They are not gynaecologists/ consultants, and are trained to the 'Newson Way'.

There has already been some controversy over how she has suggested reducing the dose of progesterone (when used vaginally) and the BMS produced a statement in January saying this isn't 100% advisable as the evidence re. safety is not robust enough, although it may be fine for the majority of women.

What can you do if you can’t take HRT, though?

@JinglingHellsBells I’m not dismissing HRT at all. It’s just that the landscape is so confusing (the whole ‘too much v not enough’ question). I ended up going to Newson and being on 150 because I had been to my gp and been on 1mg of elleste duet for 8 weeks and my GP said that if that hadn’t worked I must have a mood disorder not peri menopause. I will certainly look into the dosage but I also need to try to manage my sleep and mental health in the meantime and I need to think about managing my return to work, which will likely happen before I crack this puzzle

Good point @Delilahwasframed

I totally empathise OP .
My sleep is crap also, has been for years and I'm 51 now.
I take 25 mg Amitriptyline every night at 8.30pm for a 10.30pm sleep.
It works for me ( for now!).
I tried mirtazapine a couple of times: never again! Couldn't wake up, constipated,, just meh!

Before Amitriptyline, I had tried sleep gummies, cbd oil, lavender baths, chamomile tea, essential oil sprays. Basically you made name it, I've tried it, but to no avail.

Menopause really stressed me out over the years. I've needed HRT, but due to a breast cancer diagnosis a long time ago, accessing treatment has been tough ( even via a specialist) At one point, I could barely drive from anxiety and unbalanced hormones. Then I just started to worry about EVERYTHING. Money, the teens. the house, being far away from my parents, the garden.
literally everything.

What am I trying to say here? Well after my last appointment with my specialist in October, a few things etched in my mind. She said that women in particular, spend a lot of time in life, juggling many different balls and at some point the juggling doesn't work so well, balls are dropped, which impacts on sleep as we start to worry and our minds go into overdrive at night. Then we need intervention, which can come in many forms I guess.

Some women need Oestrogen and their insomnia is cured within a certain time. Some need sleeping tablets, others need a break from their jobs and responsibilities. It's a time to completely reflect on your life.

Maybe you need to reflect OP? You are on a huge whack of Oestrogen, but that's not helped your sleep. This means, low Oestrogen isn't causing your insomnia, UNLESS you are not absorbing?

Maybe getting back to the office will help?

Why were you upped to 150 within 3 weeks?
The general rule do thumb is. start low and slow with HRT.
You wouldn't usually start on a 100 patch, more a 25/50 for a least 3 months.

I hope things improve soon.
Have you had thyroid checked recently?

@Furryfeet I am trying to help you based on my own experiences but also what I've been told /learned from my consultant. It seems very likely that your dose is wrong and as a PP said too much estrogen is as bad as too little.

Your GP is clearly very ignorant on HRT and menopause.

The guidance is give it 3 months then increase the dose in the same format (tablets) and/ or swap to another route of delivery.

1 Tablet form HRT is poorly absorbed- up to half can be lost in digestion.

2 Elleste contains the progestin Norethisterone, which many women find makes moods and depression worse.

3 The next step OUGHT to have been one of these-
-change to a higher dose of tablet , like 2mgs.
-change to a different type of progestin (such as Utrogestan and an estrogen only patch)
-change to gel and Utrogestan

But instead, you have gone from a low dose to a very high dose, with nothing in between.

Can you appreciate that your sleep issues are likely to be caused by too much estrogen?

That's what you need to sort out, rather than starting using melatonin etc.

If you want the name of my consultant I am happy to share by PM.

@Runaround50 The huge dose of estrogen may be preventing sleep!

@JinglingHellsBells yes that's a huge dose of Oestrogen that OP is on and if she is absorbing a majority of the hormone, it could well be a factor regarding her poor sleep. Obviously if she isn't absorbing, then that could also come into play?

A

The one debilitating symptom is the insomnia.

I've recently cracked it I think but it's odd.

I now no longer sleep when others do. I say awake and read until 2am. Then when my eyes start to close I sleep, I'm tried but sleep only until around 7am. It's the least sleep I've ever had but I'm finding I can function on 5 hours unbroken sleep.

If I try to sleep before 2am it's a broken night awake many times.

Im tired but not shattered. I'm hoping it will regulate again and I'll be able to sleep properly. On occasion I can go back to sleep after I wake at 7 but it's rarely.

@JinglingHellsBells @Runaround50 I am stuck in the too much, unless I’m not absorbing in which case it could be too little question. Surely this points to the need for a blood test? I also wonder whether there was a typo in the Newson dr email and she was saying an increase to 150 after 3-4 months?

And @Runaround50 I totally see what you mean about the pressure on women in mid-life. The difficulty is that there have just been so many changes for me in the last year - Covid, two job changes, return to office.m, new manager, DH returned to work after furlough, youngest child started high school. However I’ve had years in the past when lots of things happened at once (2012 my daughter started primary school, then contracted life-threatening illness, DH got run over and BF diagnosed with breast cancer all in the space of 3 months) but while I was stressed and anxious it never affected sleep like this year, which makes me feel it must be hormonal

@Furryfeet If you are Peri ( still having periods) then blood tests are usually a waste of time because your own hormones are fluctuating madly in the background.

But, once you hit post menopause ( simply the complete absence of periods) in theory, your Oestrogen should be zero and your body will adapt.
If symptoms occur which are unmanageable, then HRT is one way to help alleviate them.

You would usually start low and slow as @JinglingHellsBells has said.

25/37.5/ 50/75/100 patch.
1 pump/ 2 pumps and so on.

It's not usual practice to start a woman on such a high dose.
You are flooding your body too quickly. Where do you go from there, if the 150 stops working??

By starting low and slow, you give your body the time it needs to adjust and the HRT time to work.

Lifestyle changes may be needed also.
HRT isn't the silver bullet that women sometimes think it is.
We are aging and bodies and brains change in the process.

I would go request to reduce to a 50 patch and stick with it for 3 months.
The issue is going to be, the huge drop in hormones.

@Furryfeet read back your post about all that has happened in the last year for you. A huge amount is what has happened. At the time, you coped because you had to. People depended on you and you had to cope and continue life because otherwise life grinds to a halt.

BUT, fast forward a bit of time, your brain is slowly catching up with all these events and bang.. brain can't cope and sleep is shot to pieces. Are you with me?

I could be wrong. Just my thoughts.

I sympathise op. I went through a not sleeping phase and it was brutal. I honestly thought I was going mad and wasn’t going to be able to continue working it was so bad. I am currently on a waiting list for a menopause specialist appointment (been on the list since September 2020…) For me at least the not sleeping phase faded, and I just get other meno symptoms instead mostly now. Apologies, that doesn’t help you - just wanted to offer sympathy - it’s a shit time!