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?