Early-morning waking - managing the morning cortisol spike

[Dragoon909]

Derealization is worse in the mornings as well...of course it is a product of anxiety/cortisol. 

 

Cortisol is needed, but ohhh what an enemy it is. 

[KingPrawn]

As far as waking early I'm.not too badly affected currently- maybe because I try to make the most of feeling half normal by staying up late. But eventually when the spike does wake me up around 7 it soon turns into sheer hell. Its now 12 and I'm still in torment - whole body energised to the point of near tremors - ruminations, guilt, intrusive thoughts, catatrophising all almost out of control. Had a fair amount of sugar yesterday 3  sugary drinks so I don't know if that's aggravating things. There's usually a slight amount of relief by around now but it's jyst snowballing today. Had alcohol for 2 nights about 4-5 days ago so maybe that's also not helped. Also can't find my next strip of fluoxetine to take my 1mg which I intended to start taking in the morning from now on which has added to the stress. Also after being regular since about the third week of WD when the zcute physical symptoms started to get better I had bad diarrhea yesterday which I hope isn't a sign thar the reinstatement hasn't worked and that it's causing physical issues.

 

Anyway back to the morning spike If it wasn't for this cortisol issue I'd say my WDs would be only half as bad. What I mean is as for the few hours after it usually dies off in the evening withdrawal is almost tolerable. But for the rest of the time this is sheer horror.

[manymoretodays]

Did you level off at some point KingPrawn? (asking 7 hours later, after your post above)

 

And knowing your case.......I would advise you to stay with the same time for dosing your reinstatement.

Later, I mean after a few weeks you could work it or move it toward the morning by an hour a day.

I just don't want to mess up seeing how this reinstatement goes now, with any other drug changes(timing included).

 

I'm hoping you leveled off, and feel better.

And yah, the alcohol......not good.

 

This all may be a week or more until we start to see some subtle improvement.  And we WILL.  Okay?

You've had a lot coming at you lately.

 

 

Edited December 29, 2022 by manymoretodays

[Tulip52]

Just a suggestion.  I’ve read that adding more potassium ( specifically the adrenal cocktail) helps with the cortisol spikes. 
 

1/4 tsp Celtic sea salt

1/4 tsp cream of tartar

4 oz orange juice

 

drink on empty stomach

[snowdog]

A question for those who are more experienced. Could these cortisol spikes (or some sort of dysautonomia related to adrenals) lead to a situation similar to an heart attack, or even a panic attack? 

 

I'm asking this cause since my last jump of medications I developed severe exercise intolerance (I had it before on and off but know the thing is insane). After a B12 shot last week things went really bad. Today I went for a hard walk for 20 minutes and after come back I developed some weird feelings like chest pressure, dizziness and my heart rate doesn't want to go down. My blood pressure spiked to 147/100. I panicked, and after some months I went to the ER. EKG and troponin ok, they wanted to gave clonazepam and I didn't accepted. I ended up taking a blood pressure medication and a beta blocker (I don't know if it was the right thing, it is a different hospital that I use to go). After three hours my heart rate was ok, but blood pressure was still kind of high (137/105). They send me home and now my BP is at the normal level. 

 

I know this event is similar to many crisis (which I refer as abstinence) I have during my taper. But it's becoming more common after exercises, so I freaked out. Last october I did the treadmill test and had the same kind of crisis, but they only said I had sinus tachycardia and, interestingly, during the test my blood pressure just went to 140/80. After I got home I spend the rest of the day feeling unwell and many hours with higher blood pressure than the test and tachycardia. 

 

Using all theses facts I was thinking about dysautonomia.  But in dysautonomia we can start this sort of crisis that last sometimes hours?

[tsranga]

7 hours ago, snowdog said:

A question for those who are more experienced. Could these cortisol spikes (or some sort of dysautonomia related to adrenals) lead to a situation similar to an heart attack, or even a panic attack? 

 

I'm asking this cause since my last jump of medications I developed severe exercise intolerance (I had it before on and off but know the thing is insane). After a B12 shot last week things went really bad. Today I went for a hard walk for 20 minutes and after come back I developed some weird feelings like chest pressure, dizziness and my heart rate doesn't want to go down. My blood pressure spiked to 147/100. I panicked, and after some months I went to the ER. EKG and troponin ok, they wanted to gave clonazepam and I didn't accepted. I ended up taking a blood pressure medication and a beta blocker (I don't know if it was the right thing, it is a different hospital that I use to go). After three hours my heart rate was ok, but blood pressure was still kind of high (137/105). They send me home and now my BP is at the normal level. 

 

I know this event is similar to many crisis (which I refer as abstinence) I have during my taper. But it's becoming more common after exercises, so I freaked out. Last october I did the treadmill test and had the same kind of crisis, but they only said I had sinus tachycardia and, interestingly, during the test my blood pressure just went to 140/80. After I got home I spend the rest of the day feeling unwell and many hours with higher blood pressure than the test and tachycardia. 

 

Using all theses facts I was thinking about dysautonomia.  But in dysautonomia we can start this sort of crisis that last sometimes hours?

Yes. I developed dysautonomia after I stopped mirtazapine cold turkey, so these are very familiar symptoms. 

 

Fortunately, they are not life threatening, and they do reduce over time. It can take years to recover.

[FeralCatman]

On 3/13/2011 at 10:27 PM, Altostrata said:

Since the cortisol increase is signaled by early morning light, you can reduce the stimulation by reducing light in your bedroom with the use of blackout shades and curtains and a sleep mask to shield your eyes. Strengthening your sleep also helps.

I bought a good sleep mask finally. It works great and once it warms up you can't even feel that it is on. This really messed me up the first couple of nights. I woke up and of course everything was black. I went to turn the light on and nothing happened. I thought that was odd and that the power went out and my generator didn't start. Then I heard my furnace kick on and realized that wasn't it. Then I started to panic and thought OMG I can't see, I'm blind!!!! 😬 I reached up to touch my eyes and then felt the mask and realized what the problem was. I had totally forgot that I was wearing it. I was so relieved but boy did I feel stupid 🤪

[Onmyway]

So I continue to wake up with terrors a few times a night (not every night). Recently I got a smartwatch that notes that my blood oxygen level goes down at certain points in time (seems to correspond to these). I am wondering if this is at all related. I never had this before withdrawal and never considered potential sleep apnea. I have no reason to have obstructive sleep apnea (weight, neck size etc.) so I wonder if I have central sleep apnea related to dysautonomia. I don't have any of the orthostatic issues related to dysautonomia though have the heart rate issues. Apparently stopping breathing increases cortisol. I am not sure the watch is accurate but the pulse ox that measures continuously during the night seems to be quite accurate during the day when compared to a regular pulse oximeter. Anyone had similar experiences?

Edited April 3, 2023 by Onmyway

[FeralCatman]

7 hours ago, Onmyway said:

So I continue to wake up with terrors a few times a night (not every night). Recently I got a smartwatch that notes that my blood oxygen level goes down at certain points in time (seems to correspond to these). I am wondering if this is at all related. I never had this before withdrawal and never considered potential sleep apnea. I have no reason to have obstructive sleep apnea (weight, neck size etc.) so I wonder if I have central sleep apnea related to dysautonomia. I don't have any of the orthostatic issues related to dysautonomia though have the heart rate issues. Apparently stopping breathing increases cortisol. I am not sure the watch is accurate but the pulse ox that measures continuously during the night seems to be quite accurate during the day when compared to a regular pulse oximeter. Anyone had similar experiences?

I have not personally experienced this drop in blood oxygen. However, here is a link which discusses the relationship between Dysautonomia and Sleep Apnea. I have had several sleep studies done and this was never found to be an issue. You may be able to get a home sleep study done where they give you the monitoring devices to wear at home to see how things look at night and this would confirm or rule out this problem.

 

https://www.sciencedirect.com/science/article/abs/pii/S1566070219300487

[Onmyway]

@FeralCatman, thank you for that article. It has led me to this book Primer of the Autonomic Nervous System and I am going to try to devour all 800+ pages of it. I should really have gone to medical school! 

 

https://www.bookmegastore.com/gb/primer-on-the-autonomic-nervous-system-4th-edition/p-137728603-290696744?language=en&ac=bookmegastoremulti

[tsranga]

10 hours ago, Onmyway said:

So I continue to wake up with terrors a few times a night (not every night). Recently I got a smartwatch that notes that my blood oxygen level goes down at certain points in time (seems to correspond to these). I am wondering if this is at all related. I never had this before withdrawal and never considered potential sleep apnea. I have no reason to have obstructive sleep apnea (weight, neck size etc.) so I wonder if I have central sleep apnea related to dysautonomia. I don't have any of the orthostatic issues related to dysautonomia though have the heart rate issues. Apparently stopping breathing increases cortisol. I am not sure the watch is accurate but the pulse ox that measures continuously during the night seems to be quite accurate during the day when compared to a regular pulse oximeter. Anyone had similar experiences?

 

I used to get these  in the first 2-3 years of withdrawal, but it has reduced considerably (2-3 times a month) in year 4, and none so far in year 5. 

 

I too suspected sleep apnea, because I also have bruxism (worn out my molars), and my Fitbit would show drops in oxygen and HR. 

In my experience,there are a lot of things that go on to contribute to this -  postural blood pressure/HR,  ambient air temperature, etc, but the biggest factor in these episodes is an exaggerated fight/flight response from the ANS.

 

Essentially your body is going into rest (parasympathetic) but your sympathetic nervous system doesn't let you sleep or wakes you up because it thinks you are in danger. 

 

I call these burp jerks, and sometimes I get the feeling of air bursting through my nose with snorts as well. 

 

Some things I have learned personally that I think reduces these events - 

 

1. Gradually ease in to rest/sleep. That includes moving from standing to sitting to lying down. This allows the BP/HR to stabilize. Use massage in your head/neck/thighs/calves, and a warm shower to help with blood circulation before you sleep.

 

2. Keep the room and body temperature consistent (don't switch on AC/heat or fans as soon as you lie down, but well before you go to sleep in the room). 

 

3. Make sure your gut isn't too empty or too full. This is the most important thing to help sleep without triggering all other symptoms.  In my case, I found that lying down triggers gut activity (burping, gas, pain, multiple BMs, peeing frequently), so I had to take frequent breaks during the day to lie down and breathe in so that it doesn't flare up at night.

 

4. Lastly, make sure your sleep routine is consistent and use music or something boring to get your brain into a safe place to avoid triggering the limbic system. This may be the most important thing for you.

 

Btw, I mostly ignore my smartwatch's HR and o2 readings knowing that it's all related to a autonomic nervous system that takes longer to adapt to changes in posture, temperature and pressure.

 

 

 

[tsranga]

BTW I am also looking at some sort of vascular compression syndrome (could be just vasodilation/vasoconstriction issues) as a possibility based on some of my preexisting (before withdrawal) and weight loss (in withdrawal).  I seem to get better and less symptomatic as I gain back my weight, and more symptomatic when I lose weight. 

 

I was at 165lb, dropped to 150lb, then went on mirtazapine, spiked to 175lb with mirtazapine, dropped to 128lb in withdrawal, and now at 155lb. I was at my  worst when my weight was at its lowest.

 

Here is a symptom checklist for vascular compression syndromes - 

 

https://scholbach.de/gefaesskompressionsphaenomene-darstellung-fuer-patientinnen-und-patienten/checkliste-gefaesskompressionssyndrome#gsc.tab=0

 

And here is the treatment (basically myofascial PT and breathing exercises) which help me quite a bit - 

 

https://scholbach.de/behandlung-von-kompressionssyndromen#gsc.tab=0

 

 

 

[Heath]

On 4/3/2023 at 9:03 AM, tsranga said:

 

I used to get these  in the first 2-3 years of withdrawal, but it has reduced considerably (2-3 times a month) in year 4, and none so far in year 5. 

 

I too suspected sleep apnea, because I also have bruxism (worn out my molars), and my Fitbit would show drops in oxygen and HR. 

In my experience,there are a lot of things that go on to contribute to this -  postural blood pressure/HR,  ambient air temperature, etc, but the biggest factor in these episodes is an exaggerated fight/flight response from the ANS.

 

Essentially your body is going into rest (parasympathetic) but your sympathetic nervous system doesn't let you sleep or wakes you up because it thinks you are in danger. 

 

I call these burp jerks, and sometimes I get the feeling of air bursting through my nose with snorts as well. 

 

Some things I have learned personally that I think reduces these events - 

 

1. Gradually ease in to rest/sleep. That includes moving from standing to sitting to lying down. This allows the BP/HR to stabilize. Use massage in your head/neck/thighs/calves, and a warm shower to help with blood circulation before you sleep.

 

2. Keep the room and body temperature consistent (don't switch on AC/heat or fans as soon as you lie down, but well before you go to sleep in the room). 

 

3. Make sure your gut isn't too empty or too full. This is the most important thing to help sleep without triggering all other symptoms.  In my case, I found that lying down triggers gut activity (burping, gas, pain, multiple BMs, peeing frequently), so I had to take frequent breaks during the day to lie down and breathe in so that it doesn't flare up at night.

 

4. Lastly, make sure your sleep routine is consistent and use music or something boring to get your brain into a safe place to avoid triggering the limbic system. This may be the most important thing for you.

 

Btw, I mostly ignore my smartwatch's HR and o2 readings knowing that it's all related to a autonomic nervous system that takes longer to adapt to changes in posture, temperature and pressure.

 

 

 

I get this waking in a panic like trying to catch my breath. Not every time. Some times it’s just startled. If it’s in the morning and If I drift back asleep it will do it again and again. Sometimes trying to sleep at night it will do this 2 times in an hour.  Sometimes not. 
Today I was relaxed some I took a nap at lunch at work and woke up to the high alert. Then I was ok for a few hours then anxiety again. 

 

thanks 
 

 

[Onmyway]

On 5/25/2023 at 3:20 AM, Heath said:

I get this waking in a panic like trying to catch my breath. Not every time. Some times it’s just startled. If it’s in the morning and If I drift back asleep it will do it again and again. Sometimes trying to sleep at night it will do this 2 times in an hour.  Sometimes not. 
Today I was relaxed some I took a nap at lunch at work and woke up to the high alert. Then I was ok for a few hours then anxiety again. 

 

thanks 
 

 

Hi @Heath,

If you're waking up trying to catch your breath it may be sleep apnea rather than/in addition to cortisol. 

 

Have you had it checked?

 

Magnesium helps with cortisol. 

 

OMW

 

 

[Heath]

Thanks @Onmyway.  I guess it could be possible. Allergies have been high lately too.
It’s mostly panic fear and sweating. It changes with stress. So I believe it is cortisol. I take about 250 mg magnesium in morning and 100 mg at night

[Comecloser80]

Has anyone recovered from early morning awakening and not being able to fall back asleep upon waking? I am not being able to sleep past 4:00am and sleep is broken with multiple awakenings at various times 2,3 am. I cannot nap during daytime. Will it get better? Nothing seems to help staying asleep longer, dark room, mag glycinate, melatonin, nothing helps.
It’s been a 7 months non stop. Is this problem permanent?

[tsranga]

Yes it will get better but it will take time - years, not months.  Just learn to accept sleep whenever you can, and accept when you cannot. Worrying about how little you are sleeping won't help.

[Comecloser80]

10 hours ago, tsranga said:

Yes it will get better but it will take time - years, not months.  Just learn to accept sleep whenever you can, and accept when you cannot. Worrying about how little you are sleeping won't help.

YEARS? Very discouraging. How long does it took you, if you don’t mind me asking? 

[tsranga]

6 hours ago, Purae said:

YEARS? Very discouraging. How long does it took you, if you don’t mind me asking? 

I'm in my 5th year and I still wakeup around 4-5am, but I can go back to sleep for a couple of hours, even though I still have GI issues, head pressure etc.. 

 

The intensity, duration and frequency will get better incrementally. It's better to look at improvements year over year than by weeks or months.

 

 

[Comecloser80]

19 minutes ago, tsranga said:

I'm in my 5th year and I still wakeup around 4-5am, but I can go back to sleep for a couple of hours, even though I still have GI issues, head pressure etc.. 

 

The intensity, duration and frequency will get better incrementally. It's better to look at improvements year over year than by weeks or months.

 

 

Wow! 5 yrs!! I hope I won’t sleep forever before then. 
Another 51 months to go. I wish you well.

[FreeMe]

It's been 2 years and 3 months for me off antidepressants. Sleep still isn't amazing, but looking back and where I was it is a lot better. I still have frequent wakes in the night but find it easier to get back to sleep - not always - but a lot more.

Things have really only started improving in the last few months. I haven't taken zopiclone or lorazepam for about six weeks. I think that has improved things. Also no alcohol, other substances, or supplements.

That all came about by accident when I had a lingering stomach bug and couldn't take anything.

I still have my depressed days and find it hard to get motivated to do much, but that also has improved compared to where I was.

All I can say is hang in there.

 

[fontana]

How can doctors know if a person has more or less of a neurotransmitter hormone like serotonin while in depression?

There is no test for this right.

 

Can someone actually have more in the brain, causing the illness or "chemical imbalance"?

 

 

[PortugueseSea]

6 minutes ago, fontana said:

Can someone actually have more in the brain, causing the illness or "chemical imbalance"?

You can only get an actual chemical imbalance by taking meds; and then you fixing by getting of meds.

 

There is no way of measuring brain serotonin, but all research points towards the chemical imbalance being a myth!

 

[PortugueseSea]

On 7/30/2023 at 10:27 AM, tsranga said:

It's better to look at improvements year over year than by weeks or months.

This is pure wisdom; I use my son's birthday to reflect upon how it has been. Even monthly is too short of a span!

 

 

[tsranga]

On 7/29/2023 at 6:48 PM, Purae said:

Wow! 5 yrs!! I hope I won’t sleep forever before then. 
Another 51 months to go. I wish you well.

Keep the faith in your body's ability to heal..  

[Mountainsky]

I have this, BAD. Monday mornings? Forget it!  It's the scariest thing. I love working, it's hard with chronic fatigue but I enjoy it and yet I still have horrible anxiety ,weird!! It's always the 2:30-3am range and from there I toss and turn looking at the time till 5am when I need to get up.

[Onmyway]

4 hours ago, Mountainsky said:

I have this, BAD. Monday mornings? Forget it!  It's the scariest thing. I love working, it's hard with chronic fatigue but I enjoy it and yet I still have horrible anxiety ,weird!! It's always the 2:30-3am range and from there I toss and turn looking at the time till 5am when I need to get up.

@Mountainsky

instead of tossing and turning, have you tried getting off the bed and doing something distracting that you would normally enjoy (even if you don't enjoy it at that time?) Turn on a TV show or read a book? It really helps me. 

 

Have you implemented the tips in the thread like blackout curtains, extended release vitamin C, low dose aspirin before bed etc.? 

[Mountainsky]

I suffer from extreme chronic fatigue so I don't want to get up and distract myself. I have room darkening curtains, yes. I just have so much anxiety, my mind races, heart pounds at times, my stomach has butterflies.The only time I'll physically get up is if I need to use the bathroom and even then it sucks because I'm so tired. Once I'm up for good and take a shower it slowly dissipates but it's still horrible.

[Mountainsky]

I would love to try the cream of tartar/juice mix that someone mentioned in another blog for fatigue but I'm on Spironolactone for acne and hirtuism, this drug is used off label for PCOS in women and other hormonal imbalnces, but is a BP lowering drug.

It has potassium in it and I need to be more mindful of my potassium intake while on it and I know the cream of tartar/juice protocol is high in it too, Ugh.

[cornchowder]

On 3/13/2011 at 9:27 PM, Altostrata said:

People generally feel this around 3:30-4:30 a.m. or closer to dawn.

 

Oofta, this was definitely one of the scarier side effects of withdrawal. Once I reinstated, I don't have this as bad, but there's still a mild version of it. Glad to know blackout curtains can help! 

[cornchowder]

Cortisol as a Biomarker of Mental Disorder Severity 

Dziurkowska, E.; Wesolowski, M. Cortisol as a Biomarker of Mental Disorder Severity. J. Clin. Med. 2021, 10, 5204. https://doi.org/10.3390/jcm10215204

 

Oh man, reading this above paper and here's a quote that seems to prove just this point --  (apologies if this has already been covered) 

Quote

When comparing the effectiveness of normalization of the HPA axis activity by TCA and SSRI therapy, it was observed that the less selective old-generation drugs cause stronger changes in cortisol secretion, which is manifested not only by a decrease in daily cortisol secretion but also by a blunted cortisol awakening response [55].

 

SSRIs are among the most commonly administered drugs for the treatment of depression. It has already been noted above [42,43,44,45] that their effect on HPA axis activity is highly dependent on the health status of the volunteer. In the case of patients with depression, citalopram has been found to decrease cortisol levels [56,57,58]

 

Citalopram has been found to decrease cortisol levels, so a withdrawal symptom may be a spike in cortisol.

 

I feel like this makes so much sense... my thunderous-heart morning, and an unbearable anxiety during the day -- a big part of it probably was because of the rapid taper no longer suppressing cortisol the same way = overall spike in cortisol in my system. 

 

Another paper referenced by the above paper, Antidepressant use and salivary cortisol in depressive and anxiety disorders has the result of SSRI users having increased cortisol levels in the evening:

Quote

Unadjusted and adjusted evening cortisol levels were significantly higher for SSRI users (d = 0.04, p = 0.02) and marginally significant for TCA users (effect size = 0.17, p = 0.05) as compared to non-users. Other AD users did not differ from non-users.

 

This may explain why I had trouble feeling sleepy in the evenings???

 

A lot of things make sense with the added context of cortisol and how it interacts with antidepressants.