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4 Am Sleep Disturbance


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I am going on almost 7 moths of being woke up at 4 am every single night. I have tried to figure out the why so I can get it to stop. Sometimes its every hour but most nights its right around 4am. I wake with a racing heart/ beating funny, gurggling guts and shocking nerve pain in my feet. It usually lasts 20-30 minutes and then I am freezing cold and can go back to sleep. Unfortunately I wake up at 5 am to go to work. If I could get past this it would grealty improve my quality of life. What I have learned is cortisol levels are at the lowest at this time. What is also interesting is everyday at 4pm my heart would skip a beat. It did this for 3 months straight but has since quit most of the time. I am not sure what is going on but think my sympathetic nervous system is overactive for some reason. Anyone else experience this?

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It sounds like it some "misfiring" in the transition to wakefulness. My transition problems seam to come after I wake up. I feel fine initially. For a moment. Then the fun begins.

Cortisol levels are the highest in the morning. I imagine it varies with your sleep schedule instead of being set at a particular time. For many 4am may be a low point. Maybe not for you.

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Thanks for the replies! I have been trying to find an answer to help this for what seems like a really long time. I guess it happens pretty regularly at 4 am because I go to bed at the same time every day. I stayed up late night and it waited until 6 am. This made me realize that it most likely always happens when I have been to sleep for 5.5 hours. My work is forcing me to do shift work started sunday night. It will be really interesting how the change will affect me. Definitely not looking forward to it.

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Yes - to prevent this, talk to your physician about taking a bedtime/nighttime dose of phenobarbital

I will look into this. Xanax works very well for me but I have the kind of personality that tends to get addicted to things easily and am scared of the addiction so I limit it to one use a week so I only get one full night of sleep a week. From a quick preview it looks like this drug isn't as addictive as xanax?

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It sounds like it some "misfiring" in the transition to wakefulness. My transition problems seam to come after I wake up. I feel fine initially. For a moment. Then the fun begins.

Cortisol levels are the highest in the morning. I imagine it varies with your sleep schedule instead of being set at a particular time. For many 4am may be a low point. Maybe not for you.

This is how I wake most days. I am dreaming and all of a sudden I am wide awake and I think, why am i awake.then a minute will pass and the fun begins. Have you found any help for it?

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It sounds like it some "misfiring" in the transition to wakefulness. My transition problems seam to come after I wake up. I feel fine initially. For a moment. Then the fun begins.

Cortisol levels are the highest in the morning. I imagine it varies with your sleep schedule instead of being set at a particular time. For many 4am may be a low point. Maybe not for you.

This is how I wake most days. I am dreaming and all of a sudden I am wide awake and I think, why am i awake.then a minute will pass and the fun begins. Have you found any help for it?

No help yet. I thought that Clonidine was helping, and maybe it was. This stuff is so up and down. I have a hard time being certain. It may be time to up the dose.

I have speculated that it was a neuro endocrine issue. I wake up feeling fine and normal, and within a couple minutes I feel very uncomfortable. Very over stimulated. The chest pains kick in etc. If I get up and move around too much, I can get flooded and my HR has went as high as 220. 170 is more likely. It isn't just the HR though. It is a number of things.

If I wait it out, until I settle, I am much better off.

The irony is that I can go to the other extreme. I do not get this flood of sorts, and feel suppressed. My BP will be low, and my HR subdued. Even walking around it will not get over 95. Then it as if a switch goes off, and I have a huge amount of trouble breathing. I know something real is happening, or not. I can watch my O2 go from 97-98 to 89-90. I never have this happen when I wake up and get overstimulated. It is one or the other. Mostly the former.

I wonder about taking anything for the one issue, when I can go the other way. I am nervous about taking anything that would reduce my drive to breathe.

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I would see a dr and ask about getting a sleep study. There are drugs you can take for staying asleep. You can also read about sleep hygiene - non-medical things you can do to stay asleep. Also, it helps me to drink a big cup of broth at night followed by water. Boosts my BP and helps with nighttime and morning symptoms.

Edited by yogini
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This is just a thought because I have experienced this occasionally and mine has been due to certain regular medications I take wearing off. If you take certain meds regularly they could be wearing off at that time of morning and maybe shifting your med schedule could help. I dont know what meds you take but we all react differently to them and some dont last as long as the label says they should for some of us. Again, this is just my personal experience so thought I would share it. I hope you find the cause.

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Wow I had no idea that anyone else had experienced this! When I was first symptomatic, I had this every night and it drove me crazy. However, I no longer have this because I take a bedtime beta blocker called propranolol. Before this, I had a heart rate of 160 sleeping at close to 4 am (according to telemetry in the hospital)

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thanks for the help. currently on no meds but will try the beta blocker and will ask about getting a sleep study. most my symptoms are worse during my sleep since I can control them during the day with water and salt

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It is actually a common sleep issue (even among non-POTS people) to wake up every night at a certain time. Some people have trouble falling asleep, others have trouble staying asleep. There are many different causes.

When I switched to taking beta blockers at night it helped with my sleep. Betas tend to make you drowsy and the effects wear off over time.

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I was reading (watching) something not long ago and it dealt with our fluctuations in HR etc. during sleep. It attributed these things to fluctuating levels of adrenalin etc.

Pain management, beta blockers, and clonidine were mentioned as treatment options to improve the sleep of patients with these problems.

I do not fit in this crowd. My sleep problems are with the transition both ways. My sleep transition problems can be either hyper or hypo. Once I have fallen asleep (less occasional apnea episodes), I seam to do fine. The biggest issues after I fall asleep is a reduced breathing drive (more than it should be), and my HR has gotten very slow. Not long ago, I had the opposite problem. Maybe next month it will be different.

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  • 2 weeks later...

When I first started having seizures, they always started at around 3:30am (nocturnal, but my dh knew). Once they were under control with Keppra, I would still sometimes wake up with a start, buildup, flash if heat, then all over body shaking, at around the same time. There's definitely something about that time. My doc added lyrica at the time, but then had me take a teeny (I halved it) Xanax during those spells. They would resolve after 15 min, maybe from the Xanax.

I used to erroneously take my nighttime cortef too late in the evening, and when I stopped taking it, I stopped having those nighttime episodes. So maybe either too much brain activation, or maybe it was in withdrawal by that time? Idk

BUT something interesting to try-my dh got me a fitbit, which also tracks nocturnal/sleep activity. It's reeeely interesting to see how the first part if my nights, I'm out solid but that, around 3:30am, I start moving/waking that last pretty much the rest if the night. Needless to say, it's calculation of my total sleep is low, around 4-5hrs/night. :( I'm still researching to see what this means and what normal people look like :)

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Interesting. I have been on Propanolol for almost 2 weeks and so far it hasn't done much for the 4am awaking. I feel lucky if I make it to 4 am. Last night I woke at 1 am and any sleep after that didn't really count.

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I am having an awful time sleeping at night and just had a sleep study done, no results yet. They can tell you if heart rates go to high and this wakes you up, PLMD/RLS which is common with POTS etc. but there are limits. My understanding is 25% of pots patients have insomnia but this has been terrible for me.

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An antidepressant can help regulate this if you are willing to try that. I have mixed feelings about antidepressants but Paxil helped get my sleep regulated after I came down with POTS. I had been waking up at 2 a.m. every night for months. I would be on fire if I was lying down and cold if I stood up. Went down on the Paxil in Feb...hit major stressors March through now and the sleep is disrupted again so am going up a bit. I have mixed feelings about Paxil because I have learned it's one of the hardest to go off of.

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Considering antidepressant, I read that SSRI's were helpful in POTS in general. I have tried just about everything else as sleep aids.

Will discuss sleep test results. They take a while to get back. When he was hooking the wires up while I sat in a chair the tech commented something must be wrong cause your showing a 99-100 HR. I said no that's not surprising. Wondering if they will give any info. in results on my HR during the night. I have tested it bedside and even tried a sportswatch while asleep. I do not think the HR itself is waking me.

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I got a HR monitor wrist watch. On saturday I had to wake up early and had gone to bed late so I didn't get much sleep. I was so tired at 3:30 in the afternoon I thought I would take a nap, big mistake. I noticed before I fell asleep my resting HR was 61. When I woke up after 15- 20 minutes my HR was 85. I fell horrible for about 5 hours after, kept going completely white faced and almost passing out. Didn't matter how much water I drank as it wasn't helping. I just had to wait it out. I sure would like to know why sleeping screws with my autonomic nerves and why my HR rises when asleep.

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Ya my doctor wanted to try taking the propranolol at night as well to see if it helps. I really think that its also related to not being able to stay hydrated as I have been guzzling a bottle of water when I wake up and I am able to go back to sleep easier.

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