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[Kobisimms]

Hi it’s my first time posting and really struggling at the moment.
I wake anytime between 4 and 5am for the day (I have had really broken sleep for years), my heart is racing and a terrible anxious feeling hits me within a few minutes. This has been going on for months now and I’m exhausted
What has been your experience and symptoms of early morning cortisol surges?
I do suffer from severe health anxiety and going through the worst bout I’ve ever had at the moment which is making everything feel overwhelming. I feel like I’m going mad

[CLKD]

Firstly U R not going mad!

   In the 1990s when in hindsight I may have been going into peri, I would wake anytime after 3.00 absolutely terrified.  I would get out of bed, get dressed and have to go downstairs.  My GP prescribed Propranolol; a betablocka ; to ease the early morning surges. It really did help.

Also do check your diet, eating regularly i.e. every 3 hours, 24/7 may also help.

let us know how you get on. What R your periods up to for example?

[Kobisimms]

Thanks for your prompt reply. My periods stopped about 8 years ago, I’m 57 now. I have had periods of similar before but it seems to be starting earlier and earlier in the morning. I’m at the point where I hate going to bed as I anticipate it all happening again the next morning. I feel quite calm until I start thinking and I can actually feel the anxiety twisting my stomach into knots and I often have to go to the toilet within  a short time of waking. The anxiety normally recedes as the day goes on but that’s not happening at the moment, it’s lasting most of the day

[Tulip256]

I get this too. I find breathing exercises help (4 7 8 or box breathing) when I wake early or listening to something light (I use the archers podcast) I also find I sleep much better when I get as much natural light during the day as possible especially earlier in the day as early morning light is really important for the circadian rhythm.

[bombsh3ll]

If you haven't already addressed estrogen, progesterone and testosterone, that's where I'd start.

However assuming it isn't related to gonadal hormones, and given the chronicity it may not be, (I too have had lifelong insomnia) then I have a couple of suggestions:

One thing you can do for free at the moment is a free 10 day continuous glucose monitor from dexcom. If you go to their website they are offering a free sample.

I did one recently and discovered I was spending the second half of every night profoundly hypoglycemic. This can cause the exact symptoms you describe.

An increasing number of people in the health and wellness sphere are advocating not eating in the evening in the interest of metabolic health, and when you add that to all those taking progesterone orally at bedtime, with instructions to take on an empty stomach, that is a lot of people going to bed hungry.

Without doing a CGM, nocturnal hypoglycemia is impossible to identify, and I believe this issue is likely to be a lot more common than people realise.

Eating a slow release carbohydrate snack with cornstarch powder before bed has corrected this for me.

Two other things I use and find helpful to improve sleep and reduce chronic high cortisol are phosphatidylserine, and low dose mirtazapine off label.

[Kobisimms]

Thank you, I’m finding I’m becoming more and more anxious about these symptoms recently for some reason even though I have had bouts of similar over the years. It’s triggered a terrible bout of health anxiety for me which will of course be making the situation worse. I wake up expecting it so like a panic attack it will continue to happen. I associate bed with being frightened now and I don’t know how to get out of it. I live alone so waking up like that at that time of the morning is a very lonely and terrifying experience
I took a huge step and started taking Duloxetine after a breakdown in October where I became agoraphobic but had to stop that 8 weeks in after I experienced a 3 week period of awful Diarrhea over Christmas which I found out was a delayed side effect of this drug. I think this has left me traumatised as having health anxiety I was terrified I had something terrible. I’m scared now to try any medications for the anxiety. I have never taken HRT because of the risks even though minuscule but I so wish I had tried as I’ve had at least 8 years of hell battling the thoughts in my head

[Minnie Mouse]

Much sympathy from me....this has been my worst Meno symptom by a mile.
Waking anytime 2.30am-4.30am absolutely terrified.
HRT helped massively at the beginning when suddenly my sleep patterns fell off a cliff.
It has eased over the years, but I'm still prone (especially when in a hotel) and I've built a whole survival system.
Favourite podcasts are my saviour, calms me down & sends me back to sleep.

[CLKD]

Kobisimms - what risks in particular worry U and where did U learn about them? 

Quality of Life is important.  Eating every 3 hours was recommended by The National Association for Pre-menstrual Syndrome [NAPS ] to keep blood sugar levels even.  When getting out to go to the bathroom I had a biscuit by the bed, my puppy soon learned that when she had gone to P in the garden in the early hours, there was a treat 

I've not taken HRT other than for VA.

[Epona52]

Hi Kobisimms,
I too have had this for years, I can go for a while and sleep quite well and then like now waking up early hours feeling scared and unable to go back into a sound sleep, back in 2019 my gp started me on Bisoprolol it's a beta blocker and this really helped with the morning anxiety, I would take it upon waking, I too suffer with health anxiety but have loads of health issues, antidepressants are a no no for me they just exacerbate the anxiety, I do use hrt gel and testosterone, I do find it strange how some women really do suffer with the anxiety part of menopause and some don't, just to feel free from it would be life changing, as for some menopause really is life changing and scary as in that awful feeling you describe in your stomach, I have that too for most of the day, like you I stay up quite late as scared of going to bed knowing it's all going to happen again! I cut out all caffeine too,
You could start out with a small dose of hrt and see how you go, as CLKD says changes can be scary even when we need them, you can always stop if it's not for you, Best of luck x

[Kobisimms]

Thank you for your suggestions, another bad night woke at 1:30 after 2 hours of sleep terrified and couldn’t get back to sleep. Luckily I’m not at work today as I feel dreadful.
With HRT I’m always concerned about the BC risk, suffering from health anxiety as I do it just feels insurmountable. Currently my days are dominated by health anxiety and I’m reaching the end of my tether now. I have tried various forms of counselling over the years including CBT and EMDR but when I’m in a spiral as I am I find I can’t apply the tools. I’m hoping to start hypnotherapy next week as a last ditched attempt to sort myself out. This morning I could just sit and cry

[CLKD]

Which risk have U read about?  Time to get yourself to a GP for a discussion and a referral to a dedicated menopause Clinic.  Every thing that we do is a risk - quality of Life is important.  I had breast disease treated in the 1990s, still here >wave<.  If required I would have pushed for HRT - VA treatment has helped and I never thought twice about using it.

MayB keep a diary as well as jotting down your worries .  Try a betablocka to C if that helps, it certainly eased early morning symptoms 4 me.  I was going to suggest using HRT for 6-8 months 2 find out if symptoms become better, as with most treatments, it can be stopped. 

Feeling better is important and if HRT helps ?  I used to wake sometimes 2 C whether I had been asleep and yes, I dreaded going to bed due to impossibly bad dreams and early waking. 

[Kobisimms]

Thank you CLKD, did you suffer from
an upset tummy too in a morning. I wake myself up like you I think to check if I’ve fallen asleep and to see how my tummy feels. It’s just a never ending cycle I need to break

[Wrensong]

So sorry to know you are struggling with this at night; it's the bane of my life too & a truly dreadful situation to have to keep dealing with. 

Please don't beat yourself up for wanting to avoid HRT, though many women on here report it helps their sleep & it is definitely worth trying if you feel you can, sadly it doesn't improve sleep for everyone.  I've been on it for 9 years & frustratingly no amount of tweaking the components of my regimen has resolved the horrible sleep issues to date & now in my early 60s, they are inexplicably worse than ever.

Some really good suggestions on this thread though & I agree it's well worth learning about managing possible nocturnal hypoglycaemia.  The mentions of controlled breathing & listening to something relaxing are great advice too.  Regular meditation can also promote a more relaxed default state, improving general health & sleep, if you haven't looked into that already.

To add to the helpful mention of Mirtazapine, this can be very sedating at low dose (7.5mg), reducing histamine & cortisol levels, according to study findings.  I took it for a while & would have been happy to stay on it for life but for interaction with other essential medication.

With that in mind, just a quick mention for any hypothyroid members, Mirtazapine can bring down levels of thyroxine in the blood, unfortunately without a corresponding rise in TSH, potentially exacerbating hypothyroid symptoms without validation of this interaction if TSH testing alone is relied on to assess thyroid status.

Please don't continue to suffer alone Kobisimms, there's a wealth of collective experience & knowledge on here that could help you crack this tough nut & at very least solidarity can be a source of reassurance, helping to reduce anxiety during this often very trying stage of our lives.
W 

[Wrensong]

Another quick thought - imagine the answer is yes, but have they tested your thyroid function recently?  With diarrhoea, chronic anxiety & insomnia of the type you describe, I wonder whether your thyroid might be overactive.  If you also tend to feel the heat to an abnormal degree &/or struggle to maintain weight, those could be other signs suggestive of thyroid malfunction.  I'm sorry to raise this given your health anxiety, but I think it would be worth just checking with your GP if you're not sure whether a thyroid condition has been ruled out.
W x

[CLKD]

My gut is my weak spot. When I feel queasy it starts the anxiety surges