Why So Much Worse After Stressand Little Sleep?

[villen]

Hi

Haven`t been here for a little while..Iam able to work part time now, but it really varies from day to day how I feel. I never feel good, but some days are better than others. My work as a nurse demands a lot of walking (which I guess is good for my symptoms, at least in the long run) but like today, when I m totally worn out of little sleep, and maybe a little too much coffee, I just feel awful at work.. I could barely make it up the stairs back home...my whole body feels so weak (like I ahve been drinking yesterday or something) and my heart races and pounds. I feel dizzy when I stand, get short of breath, and my heart pounds even stronger. I take a little more betablocker, but it doesnt seem to help. NOw its like my heart literally pounds of my chest, just from picking somethung up from the floor, or just moving and changing positions a little. Is this my ANS on high alert? (im dealing with anxiety as well) or has it to do with the bloodflow and/or blood pressure flucations? Why does it feels much worse when under/after stress? I guess I am curios on what the mecanism behind this is....I mean, I have low blood pressure when I have slept better and are not as stressed...but then the symptoms are not as bad.....so I cant see a correlation between low bloodpressure and my symptoms. Hope some of you can answer this. Sory for asking so many questions...Its hard, cause it feels like I cant relax, yet its hard to stand...hate it! Thank God I have better days too. I live for the good days:)

Anyone have some good sleep advice? I am using zopiclone some nights, but am afraid that I hve become addicted to them and I also feel much more symptoms the next day after taking them....I now that I should quit caffeine, and other "sleephygiene"...but does anyone have had sleep problems earlier (due to their pots) and have been able to sleep good again?

Take care:)

Villen

[firewatcher]

Norepinephrine is a "wake-up" neurotransmitter. The longer you are awake, the more goes into your system. Sleep resets that brain chemistry and allows your brain/nerves to recover from all that firing. The less sleep you get, the less "down time" your central nervous system gets, so it is easier to get overstimulated=worse POTS symptoms. Take the sleep med every other night so that it has time to get out of your system and you don't get dependent. I take a beta-blocker every morning which eliminates your natural melatonin production, so then I take supplemental melatonin at night (1.5mg and it causes lower BP and HR, so be careful getting up if you are normally hypotensive.) I sleep much better now than I ever have before.

[Ernie]

Hi,

Hyperadrenergic POTS is a disorder of reacting in a life of death situation. So if you are stressed this increases your symptoms.

I take Serax for sleep.

[janiedelite]

Norepinephrine is a "wake-up" neurotransmitter. The longer you are awake, the more goes into your system. Sleep resets that brain chemistry and allows your brain/nerves to recover from all that firing. The less sleep you get, the less "down time" your central nervous system gets, so it is easier to get overstimulated=worse POTS symptoms.

I agree that it seems the more I push myself, the more I pay for it later. I might feel horrible right away, or maybe a whole day later I get this overwhelming fatigue, burning sensation, palpitations/tachy, more pooling, etc. The only thing that relieves these worsening symptoms for me is rest. So frustrating because sometimes it takes so little to set off this negative cascade. Janie

[flop]

I have intermittent problems with sleeping. When I was working I was so tired that I would fall asleep too easily (like whilst trying to eat a meal) and within seconds of my head hitting the pillow I was asleep.

Since I stopped working I have been able to sleep more / better but it means that I don't have that instant lights-out sleep. My doctor tells me that if you fall asleep in less than 10 minutes after putting the light out that you are over-tired, apparently it is normal to lie quietly for 10-15 mins before going to sleep. The problem can be how to have just a while lie quietly and not hours and hours still awake.

I try to follow a sleep preparation pattern. I'll clean my teeth etc, then get a bottle of water for overnight drinking(!), then I do 3 mins of Tai Chi breathing (slow deep abdominal breaths) usually sitting on the side of the bed. Then I get into bed and slightly dim my bedside light. I like to read but I make sure it is something non-stimulating (Children's stories like "Winnie The Pooh" work well). My current favourite is to play children's audiobooks on my MP3 player. I'm listening to Stephen Fry read Harry Potter at the moment (only works as I know the stories well so they are not exciting).

My best present was a "body clock" bedside light / alarm clock. It wakes you up in the morning by gradually getting brighter and you can set it to gradually get dark at bedtime. I put the storybook to play and set the light to dim over 15 mins - the next night I always realise that I fell asleep half-way through the chapter and have to find the last bit I can remember hearing!

Some people advocate a warm bath (careful with POTS) or warm milky drink, personally I didn't find that they helped me. The audio books have been the most help I think (better to get some speakers rather than use headphones though as you wouldn't want to get tangled in any cables).

Sleep well,

Flop

[delphicdragon]

I know personally that if I don't get my 8-9 hours of sleep a night, I am going to be in for a very shaky, awful day. Everything is worse if I don't get enough sleep. Feels like I just bathed in adrenaline, I'm irritable, nauseous, physically shaking, can't tolerate cool temperatures, etc.

I think our bodies have to reset at night, and if we don't give them a chance to do it, things get horrible. The few times I've stayed up all night (friend in hospital) it took me almost a week to recover, even though I did get some sleep after being up 27 hours. We just have to be really careful with our sleep schedule, if possible.

Sara

[ramakentesh]

In all forms of POTS there is sympathetically mediated anxiety caused by an overly excessive sympathetic nervous system response to standing.

The longer you stand the more stimulated your nervous system becomes. Often as last result your system will also shoot off epinephrine/adrenaline to try and maintain blood flow to the brain.

The jury is still out on whether the sympathetic nervous system overacticity is a cause or consequence of POTS - Doctor Blair believes that some patients have 'hyperadrenegic' POTS - where there is faulty reuptake of Norepinephrine causing an excessively overactive sympathetic nervous system response to standing.

Other doctors arent so sure that this is true, and attribute all forms of POTS to either peripheral neuropathy or local circulatory disorders.

[ramakentesh]

Hyperadrenergic POTS is a disorder of reacting in a life of death situation. So if you are stressed this increases your symptoms.

yeah I guess that is what you could say.

Either there is impaired reuptake of the stress hormones epinephrine and norepinephrine (which is also a synaptic messenger), there are excessive levels of these in your blood due to POTS and stress just recipitates even larger amounts or there is hypersensativity to these two due to patchy regional peripheral autoimmune denervation (the theory being that a reduction in the nerves results in overactivity of the remaining ones to compensate).

In the study recently published from the Baker institute 5 patients were found to have no Norepinephrine Transporter proteins in a vein biopsy. They concluded that while excessive NE levels could account for most of the symptoms of POTS, it didnt account for the impaired baroreflex or blood pooling.

[Guest tearose]

I too have hyperadrenergic POTS. My best recommendation regarding your use of caffeine and I too use it medicinally, is to consider very seriously, the possibility that you have become "tolerant" of the caffeine.

This is extremely serious in us, that is, from my personal experience and research into caffeine tolerance and toxicity. Do not worry, you can have caffeine again, but you must periodically come off it totally for a period.

In a summary, here are the facts:

Caffeine mimics and therefore blocks the production of an important chemical in our body called adenosine. Adenosine is needed to produce the chemicals needed to sleep. If we have blocked enough adenosine for a long enough period of time, our bodies have learned to stop producing as much as we really need. This will make sleeping less productive and restorative. Also, caffeine has a byproduct chemical, epinepherine of all things, which can mask any allergic reactions you may otherwise experience when not on the caffeine.

When I came off caffeine nearly a year ago, my heart rate went through the roof the first week: 196 &202 and was off the charts for a remaining month while my body relearned how to produce adenosine. I was a mess!

I am still studying about the precursor drug needed to help produce adenosine which is inosine and have been taking supplements of this. I have slept better recently than I had in months! I suggest you look into some of these approaches and discuss the possibility of caffeine tolerance with you physician. I need caffeine in small, irregular doses to keep my blood pressure up. If I am on it regularly, it becomes useless.

best regards,

tearose

PS: there are too many links to post, just do a search on caffeine toxicity.

[summer]

Wow! Congratulations on getting back to nursing part-time. I am a nurse as well but have been unable to work for almost 2 years now. I certainly experience what you are talking about - increasing symptoms with poor sleep or stress. This is one of the reasons I find it hard to imagine being able to return to nursing. Are you doing shift work? Even working part-time, this really messes up sleep. Also, nursing can be very stressful.

One of my concerns is that if I would try to return to my previous job, the demands, both physically and cognitively, would make my health worse again. I am finally making some gradual slow improvement but I really feel that I would be unable to return to the same type of nursing I was doing before. I also have concerns about my brain fog at work. I struggle a lot with this and have concerns about giving meds, etc. I am looking at my options now, and hope to find a way to use my skills without putting my own health or the safety of others at risk.

I can certainly imagine your exhaution. I would love to hear more about your return to work. Do you have any modifications to your work which have helped? My days vary as well and on my best days, I imagine returning to nursing and miss it very much. On my worse days, I know I could not do it, and try to think of options and ways I could still use my skills - I worked very hard to get them.

I also have poor sleep and have used medications to help. I actually find I feel so much better if I use them. My symptoms are worse when I do not.