I can’t meet with friends or go for a long walk, both physical exercise or mental stimulation causes my body to get sth that feels like an adrenaline rush. The problem is my body can't seem to get rid of all “adrenaline”. Even if the activity is in the morning the adrenaline will stay and keep me up all night. I'm currently not able to sleep without my meds. Even when being on my meds if I get too much stimulation or exercise I will be needing extra meds at night.
So I wish to find a way to calm down my body.
The way my body deals with caffeine would better illustrate the problem, so basically if I drink coffee in the morning I won't fall asleep that night and the following night! meaning i keep coffee “adrenaline” 2 days and cant seem to get rid of it.(just an example of course i don't drink any form of caffeine now because of that)
I don't have any problems with mood or anxiety, I'm never worried or nervous about events that stimulate my body. I've consulted several psychiatrists who don't seem to know what is going on anymore. I keep needing to up doses of sleep medications, but it doesn't address the cause, which is how easily stimulated my body gets, and it can't flush out the hormones for a long time afterwards.
Problems started 9 years ago, probably caused by lyme disease (cured) Also had EBV around that time. I also have anhedonia since then but I have lived so long with it that it doesn't bother me anymore, apart from that my mood is ok. (I tried every possible medication and technique and accepted there is no way to fix it) but I can live with it. My main problem is that I can't go outside for longer than an hour to meet with a friend unless I want to deal with a few bad nights and having to increase my sleep medication.
I want to be able to go for long walks, and meet with my friends often, live relatively normal life
So please
Can any of you help me with finding out:
How to fix the problem?
How to find a specialist that can help with it? (can be remote)
Any medical tests I could do?
Is there anyone else having this problem?
I will be grateful for any tips
Some additional info: Underactive thyroid (under control with my endocrinologist with good results) Pcos - under control of gynecologist. Because of insomnia and anhedonia I did a bunch of tests and consultations with psychiatrists, psychotherapists, and neurologists, but still no answers. I can't do sports and intense exercises, I just don't have energy. So kinda feel like chronic fatigue at times.
current medications: mirtazapine15 and chlorprothixene15 for sleep. Letrox75.
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Clonidine and gaunfacine meds move norepinephrine from the nervous system to the brain resulting in a sedating effect but feeling energetic and unable to sleep is not just adrenaline (norepinephrine). Sleep and wake are incredibly complex with many things causing alertness versus relaxed and sleepy. Thyroid issues by themselves can cause excessive alertness or sleepiness. Coffee also gets a lot of it's alerting effect from blocking adenosine, which is one of the major sleep triggers, and some from increasing serotonin. Serotonin has all alerting, energizing receptors except 1. Norepinephrine and the related dopamine have as many downregulating receptors in the nervous system as alerting despite being considered stimulants. Low levels cause similar symptoms to high levels. That's how you get disorders like ADHD. A lack of those neurotransmitters in the brain causes restlessness, reduced sleep, and feeling over energetic even when tired the same as high levels do. Stimulants actually help me sleep. I was rapidly drinking some caffeine if I found myself still awake at 4 am because it would instantly relax me. Then I got put on stimulant medication and it was more effective for sleep than 3 different sedatives at max dosage. Norepinephrine in the brain is also responsible for your ability to sit still and concentrate on something despite being thought of as the main nervous system stimulant that makes people anxious or agitated. Exercise may increase norepinephrine temporarily but usually causes an overall reduction the rest of the time you are not as active. That's one reason exercise is supposed to help sleep.
Have you had cortisol tests? Preferably a test of levels at different times of day but those tests aren't commonly used by many doctors. Levels change so rapidly during the day and night it can be hard to interpret what the results from certain points in the day mean without knowing everything you do around the time of the test. Cortisol spikes when you are hungry, thirsty, stressed by anything, or exercising and drops when relaxed and tired. It also impacts immune function and if you are suffering immune issues may remain raised when it should drop to allow sleep. The standard cortisol test is to simply collect urine for 24hrs and look at only the total excreted. This does not account for the rapid, high spikes and drops some experience at the wrong times or lingering high levels at night if overall level is not particularly high but even a basic 24hr cortisol test can help detect some adrenal gland or HPA axis problems.
The HPA axis are some of the most important glands that release many of the hormones to control changes in alertness, body temperature (thyroid signaling), some reproductive hormones, and other things that keep your body stable minute to minute and trigger the correct changes between day and night. It is common for disorders that cause vague symptoms like lyme disease and other tick borne diseases or fibromyalgia to have abnormal cortisol levels and altered adrenal gland function resulting in daytime fatigue and night time sleeplessness or days of high energy and then a crash when your body burns itself out.
Is it the exercise or is it the exercising in sunlight? I can't be exposed to early morning sunlight. It utterly fries my brain and a weekend of camping with no way to fully block light would make it impossible to sleep for days. I start to feel spaced out and numb after 1 day of too many hours of sunlight or direct morning sunlight. Since I also absolutely cannot sleep if taking any medication that increases serotonin and even ended up with anxiety and panic attacks I'd never had before it's probably the high levels of serotonin that make me feel dull, out of it, and unable to sleep. I also can't stay focused on things and life was just always "blah" when forced to get up at 7am, go outside in the sun to school, and then spend all afternoon and evening in sunlight if I wanted to do anything outdoors. I wouldn't sleep until 4-6am and then woke to do it again at 7am. By my late teens it was agreed I could go to school for only the second half of the day in order to reduce how much I missed from exhaustion and stress.
For another 20 years I tried everything but my body simply does not tolerate excess sunlight exposure and anything that increases serotonin including supplements that promote it's production without instant insomnia and everything becoming boring and never feeling truly comfortable. Laying on a hard floor was no different than laying on a quality bed until doctors quit trying to use increased serotonin to solve my sleep and other problems.
Another major relaxed/alert system is the gaba/glutamate balance. The 2 are opposing neurotransmitters so if gaba is high you are less motivated and sleepier. If glutamate is high you are more active and for some people anxious. While lots of meds raise gaba there isn't really much that helps lower glutamate and people generally resort to researching non-prescription supplements when they suspect or want to test if altering glutamate helps their symptoms.
Reproductive hormones also play a role in sleep/wake cycles. Especially in women. When you start to be active in the morning progesterone drops and estrogen rises. In the evening the opposite occurs. Those with high estrogen or androgens, which includes testosterone, may fail to even feel sleepy when they should be tired, and high enough levels can cause ADHD like symptoms of hyperactivity and problems concentrating.
A true adrenaline high is different from high serotonin, glutamate, or alerting hormones. I failed to be fully unaware during a molar extraction but was sedated enough I did not realize I shouldn't feel anything until pain became so severe I passed out. I woke up with a rapid heart rate, breathing, some difficulty thinking, and unable to do anything about my reaction despite logically knowing I was fine and not being that emotionally upset. My body was just doing something on it's own separate from what I knew and felt. With high serotonin or alerting hormones I might feel more energetic but I am either emotionally dull or overly emotional. Norepinephrine usually causes a sharper spike and drop while other causes of alertness may remain fairly consistent and milder for potentially many days and nights.
The newer orexin antagonist meds cause a widespread reduction in alerting substances.
Metabolic issues and nutrient deficiencies should be evaluated if exercise has negative effects.
Thank you for your reply! there is a lot of useful information in what you said
It's so unusual that you can sleep better after coffee, its complete opposite for me and I always suspected some ADD in me. I will ask my doctor about those adrenaline meds you mentioned, it might be sth. worth trying because it is even prescribed for ADHD.
Dopamine and Norepinephrine were the most addressed cause by me so far, that's why I tested variety of drugs with my psychiatrist (mostly for dopamine because of anhedonia) But they would do nothing for sleep or make it worse. So I have no idea what else I could do with those neurotransmitters. I mean there is likely something wrong but psychiatrist is out of ideas for now.
My cortisol levels were always too high but doctors used to say it's not a big deal, or it's because of an anti conception pill. I'm not taking those at the moment so I could do another test, but is there a point to do so if doctors don't seem to care enough to do anything about it? I mean they were saying how there is no way that I have for example cushings because I'm too skinny to have it... I'm not sure how to make endocrinologists treat me seriously...
I'm sure it's exercise, no matter if it's indoors or outdoors, well it can also be mental exercise like focusing on a board game, it will still cause insomnia.
Luckly i don't have any reaction to sun. But i'm shocked it can happen, I was always taught that a good amount of sun is needed for healthy sleep, but this shows how we are all different And same advice wont apply to everyone.
Lowering glutamate seemed interesting but from what I see I tried most of supplements/meds and either didn't see results (nac, lithium, magnesium) or had intense side effects (agmatine, lamotrigine) So that's probably not it.
Do you mean that your reaction to the tooth procedure was an adrenaline rush?
Will probably try orexin antagonists as they will be sold in my country since this year I think, but from the reviews I saw which were pretty bad i don't expect much... but maybe… u never know.
You are potentially dealing with a variety of very complex issues that require unique solutions for each individual.
People almost always have the wrong expectations from orexin antagonists since they got grouped with the sedative class and are prescribed as sleep aids. They generally cause no sedating feeling. Most can continue to function completely normal and stay awake after taking them without really noticing. People also suck at judging how well they slept. Deeper sleep can result in feeling more tired in the morning because it takes longer for "sleep inertia" to wear off so people report being more tired plus not getting that sudden sense of fatigue that makes them go to bed sooner. Light sleep is easier to wake up and feel alert but you get tired again sooner. Many don't realize the correlation. Orexin is a general signalling substance for other alerting substances like cortisol, serotonin, etc... Lack of orexin was found in narcolepsy and the attempt to find a way to increase it led to finding meds that block it instead. Narcoleptics can feel normal alertness and still suddenly fall asleep.
It took me months of stopping belsomra to compare and eventually looking at the stages of sleep on and off it to realize how beneficial it was. My rem sleep increased from 5-10mins to 40-80mins and I felt better rested from 6hrs of sleep than I had using sedatives to "sleep" for 12hrs. Nearly all the sedative sleep was light sleep (stage1-2). I find over several weeks of use dayvigo starts to alter my sleep schedule to be earlier. They are subtle meds that take time to realize their effect instead of the instant, obvious impact most sedative sleep aids give.
Cortisol production has to be well beyond what can cause sleep disturbances to result in cushings. Day to night changes in levels are also important and not usually tested for. Many substances only maintain daytime alertness and nighttime sleep properly if they rise and fall a significant amount at the right time. Many fail to realize that what happens in the morning impacts how you sleep at night and sometimes daytime alerting substances can improve sleep by creating a greater drop later that triggers sleep.
There are no meds specifically approved to deal with minor raised cortisol or failure to lower at night compared to daytime levels. That's why most doctors can do nothing if you don't have cushings disorder or another obvious cause of extremely high cortisol. An integrative health/functional medicine doctor recommended phosphytidyleserine. PS was shown in studies to lower cortisol but those studies extracted it from cow brains. After mad cow disease this is not possible and it is debated if the new plant derived PS works the same. In the US there is a prescription supplement approved for ADHD treatment that is a combination of PS and omega 3 fatty acids.
I found PS had a dramatic effect for about 5 nights, a minor effect for 2 weeks, and then did nothing. I tried rotating products and from others comments I found it is inconsistent what brand works. Some respond better to cheaper brands that others say don't work at all and some respond better to more expensive brands that are created slightly differently. I never found any that consistently worked for me.
The complexity and individual reactions when the immune system is involved is why most doctors don't know a lot about it and aren't typically taught much about secondary problems like sleep impact or ways to counter it. It will vary by person. Feeling sick and tired when you catch an illness is not because of the pathogen harming your body. It's your own body causing the symptoms as part of the immune reaction. Histamines are both alerting and can cause foggy thinking and lack of motivation during the day. Cortisol can help counter the problem but then it has it's own alerting effects so steroids to treat immune reactions may help you sleep and be active during the day or cause less sleep and greater daytime fatigue. When things go wrong with the immune response you can end up with lots of vague symptoms that may contradict each other and most doctors have no idea how to treat.
Some people find increasing cortisol during the day helpful for sleep later and I attempted that despite having some really crazy cortisol spikes at various times. My total 24hr level was within normal though. Licorice extract if not DGL will raise cortisol and enough glucosteroids used most often as inhalants for sinus or airway inflammation will begin to raise systemic levels. I also had surprising benefits and improved sleep when given some prednisone but when I tried to tell my doctor she just complained about making an appointment merely to tell her that. Many years later a psychiatrist/neurologist asked why someone didn't give me a low dose of prednisone longer to see what happened and I could only shrug and tell him they seemed concerned about the negative effects. Sadly attempts to use supplements that raise cortisol had daytime but not sleep benefits.
ADHD is very unique neurology that really alters approaches to sleep and almost always causes secondary complications that frequently includes mild immune system and hormone imbalances. This is only recently being fully recognized and is not well understood. It also often throws off circadian rhythm causing delayed sleep phase syndrome or many find they can't sleep longer than 5hrs at a time. Very generally speaking ADHD results from not enough dopamine and norepinphrine being transported to certain parts of the brain. This can be a result of low levels throughout the body or can result in not enough moving to the brain. Stimulants do not work well when transport into the brain is overly impaired. It raises levels systemically but what is in the central nervous system does something entirely different than what makes it into the brain. When there is a transport problem an increase in those neurotransmitters can have excessive alerting, energizing, anxiety producing, and longer lasting effects than they normally would.
Clonidine and some other non-stimulants potentially help with that by improving dopamine and norepinephrine transport throughout the brain instead of only raising the total amount in the body. Less in the nervous system causes a calming effect while more in the brain improves cognitive function including reducing ADHD symptoms. Clondine has frequently been combined with stimulant ADHD medication to enhance the effect and reduce the negatives or I take clonidine at night and adderall during the day.
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New here - matazapine not working 
Hi Sleep Matters, looking for advice.
Need a different sleep aide
