Have I ruled everything out?
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Have I ruled everything out?

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Posted by F43 on July 24, 2007 at 10:21:02:

I’ve been an avid reader of this forum for a while, and would like to seek comments from readers here. I’m grateful for the experiences so many have posted, and for the advice shared.

I suspect my insomnia is learned and related to prolonged stress and a sense of helplessness from all that’s come at me over the last four years, but I’m trying to rule out any underlying disorders or nutritional deficiencies while I practice the CBT and relaxation. I’d like to know from folks here if I’ve overlooked something. Apologies for the very long post.

Here’s the situation:
I lost both my parents four years ago (8 months apart) at a time when I was going through a difficult set of circumstances. (I'm 43). Their deaths, and the challenges I experienced following them, have set off a lovely midlife crisis. Being single, having a career in transition, not knowing what to call home or family, and seeing many friendships end, have been contributing factors to a profound sense of being lost in my life. (I recognize that these experiences are not uncommon, and know I'm in good company.)

I slept beautifully during this difficult time, but developed chronic delayed-onset insomnia 20 months ago following a sudafed withdrawal (after 3 weeks of taking it for a sinus infection). It was as if my body had learned a new trick. I began experiencing a flood of adrenaline daily, with tremors, shakes and muscle spasms, followed by full-night insomnia several times a week, off and on. I was prescribed Zopiclone (Imovane) and used it periodically, with mostly great results. Except for a few nights every week or second week, I was falling asleep just fine on my own.

Five weeks ago, following the conclusion of three stressful events within two weeks, the insomnia notched it up: I simply stopped being able to fall asleep at all. No matter how relaxed or sleepy I was, after 30 minutes in bed or so, the sleepiness wore off, and I was awake the entire night for 7 out of 10 days. I’m now in week 5 of this delightful full-night insomnia cycle. I’m sleepy and relaxed when I go to bed (usually 10:30PM), then that sleepiness wears off and I’m awake until about 7AM. I am certain that I don’t sleep unknowingly.

Zopiclone (as little as 1.25 mg) is the only thing that will knock me over the edge and put me to sleep. A psychiatrist I trust diagnosed PTSD (at least, the hypervigilence part, following prolonged stress) and urged me to take Zopiclone every night while I work on examining attitudes towards sleep. He’s not concerned about Z addiction or withdrawal; when I asked him how long I should take it for, he said, “you’ll know when to stop.”

Because I'm not entirely persuaded the problem is solely psychological, here’s what I’ve experimented with, with no effect:
1) Increased my early morning exercise, by adding 40 minutes of swimming or 10 minutes of rope skipping to 40 minutes of walking 5 times/week. I look great—but I’m not sleeping. I just returned from two weeks working on a country property and was getting 4 hours of intense outdoor activity a day. It made me sleepier, but didn’t put me out.
2) Eliminating caffeine. I drink one cup of black tea in the morning, with some dark chocolate. Elimination had made no difference (except to remove the relaxing effects of theobromine and thenylanaline), but the longest I’ve gone is 3 days without caffeine. Do I need to try longer?
3) Eliminating other vitamins & medications that could be causing the insomnia, chiefly my 1,200 mg Ester-C and my 5 mg Reactine (caused sleepiness for years). Seemed to make no difference.
4) I take 20mcg Minestrin (low-dose oral contraceptive) daily for endometriosis, so this is non-negotiable. But I’ve wondered if the estrogen might be a culprit (none of the MDs think so), so I’ve tried taking it in the morning or afternoon instead of at bedtime. Leaves me feeling awful, and doesn’t reduce the insomnia. I’ve only tried this for two days max. Should I try for longer? Also, continuous use of oral contraceptives depletes magnesium and zinc, and increases copper…so I’m wondering if there’s an imbalance there.
5) I’ve been supplementing with 50mg additional B-complex (on top of my daily 50mg), and about 400 mg elemental magnesium. Hmm, sleepiness, where are you?
6) Supplementing with 300 mg rhodiola. Very positive effect on stress, but…
7) All manner of herbs, alone and in combination, in capsule, tea and tincture: hops, valerian, skullcap, lemonbalm, lavender, catnip, chamomile, spearmint. I liken this to tossing a pub dart at the rampaging elephant terrorizing the village, instead of getting out the high-powered tranquilizer rifle and squeezing off a shot.
8) The usual pre-bedtime relaxants, in combination: a hot bath; a glass of warm milk with honey; soft music; a high-carb snack; and inhaling lavender essential oil. Relaxing, but I don’t fall asleep.

Blood work for hyperthyroid (T3 and T4 levels) has come back negative twice.
I’m wondering if it’s time to rule out:
1) An endocrine disorder besides hyperthyroidism.
2) Blood work for a B-vitamin or magnesium deficiency…though if I’m supplementing and it’s having no effect, that suggests that’s not the problem.
3) Hypoglycemia.

Or is it time to simply accept that my insomnia is a reflection of a significant life transition, and will settle down once I’m done wrestling with the fallout of these changes?

I welcome all your comments and suggestions. Janet

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