Insomnia - night anxiety palpitations

[daleuk]

HELP! early awakening & anxiety... so my insomnia is initial sleep onset is fine, I wake after approx 3.5hrs sleep, when I wake my heart feels like it is beating hard (not so much fast) and its that wakes me, relaxation techniques hardly help and I struggle to return to sleep. I have had sleep issues for 3yrs. I know if I sleep >5.5hrs I can feel good. I have realised that some emotional time probably triggered my insomnia, then the insomnia-anxiety circle commenced. I believe that I must have some underlying anxiety that awakens me at night, by day I think I am not particularly depressed or anxious (except with sleep health, but I can do my best to control that once I have a set path to follow). At the start of the yr, I tried Sleep Restriction therapy for 6 weeks, weekly average I got my sleep duration from 3.5 to 5hrs, albeit was very up and down. It was tough I got tinnitus and started to get some chest aching. I am confident that my body and heart are physically fine (all tests confirm too), so this is all learned mental protection response but destructive. I then had to stop and relax everything. I have been on 1mg melatonin which gives me 5hrs sleep, enough to feel semi ok. I can see that I made some gains and im ready to give it another go, and I see that I must give it much more time probably 3 months+ before I would be happy with the sleep I achieve. So I have two options I can foresee:

1) attempt CBTi / Sleep Restriction again for a longer duration, maybe introduce some relaxing herbs to keep calm by day, and I mean legal ones. In the future I am due to do the CBT for anxiety, and possibly I can pay for weekly therapy sessions.

OR

2) take 15mg mirtazapine for 2-3mths, im sure ill sleep like a baby, with the hope that this breaks the anxious habit of awakening, then 1-2mths slow withdrawal whilst putting into place strict set sleep hours. I also have option of Celexa, but I think this may add to sleep difficulties. + anxiety cbt + therapy.

I can see positives and negatives of both, the medicine route could be a role of the dice if sleep well when on them, but everything returns when I stop, plus I get other unwanted side effects, could give me new problems. The CBT for Insomnia / Sleep restriction route could work to exacerbate this night time anxiety, I did see some slow but steady gain, overtime the night anxiety may calm as sleep increases and I see the light! Opinions please?

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I had to Google CBTi. I have to say that I'm not a huge proponent of anything that removes and/or limits sleep. It's been scientifically proven that the body needs at least 7-8 hours as this is when the glial cells in our brain detox and clean up neurons. We store memories, we remove the emotion as to learn from the situation. This all during normal sleep. If we cut this short, we pay the price. I don't know your particular situation and having anxiety in the middle of the night. Have you considered having a sleep study done or have had one done? They show that a lot of anxiety and depression can be linked to sleep apnea. If the CBTi has been working for you....you feel better, anxiety has decreased, and so on...maybe it's worth continuing. Does a doctor assist you through CBTi?

I might ask other medications. I use hydroxyzine (HCl or Pamoate) which helps with sleep (and anxiety). It's an antihistamine so it's non-addictive but it does eventually develop tolerance. Doesn't exactly knock you out like Benadryl....less groggy...only side effect I hate is a dry mouth. There are others like it out there. You might also see if you can increase the melatonin dose from 1 mg to 2-3 mg. As for the Celexa, you're absolutely right, it will hinder sleep. Most SSRIs/SNRIs (coming from personal experience and knowing the side effects) all have insomnia or sleep issues attached to them. REM sleep suffers from their usage and that leads us to feel like crap...no matter 6, 7, or 8 hours. If the mirtazapine works, I would go for it if nothing else works. Maybe you could cut the dose in half or use less as to not be as dependent upon it. There are really many ways this could go, so I'll definitely just leave my thoughts as opinion only.

I would absolutely see a sleep specialist for the best possible treatment if at all possible. I doubt I was much help, but I hope I was able to toss in some productive thoughts. Best of luck and I hope you begin to feel better once you settle on a solution and plan!