Hi all, 33yr Male, for 3 years I've had issues with waking around 3am. Sleep onset is just fine. I wake after around 4 hours sleep, and wake with a fast heartbeat and sometimes this is accompanied by sweating. This then tends to keep me awake for the rest of the night, I'm unable to return to sleep. It feels like it's progressively gotten worse over time. The the sleep problem iv been trying to tackle the cognitive/behavioural aspect with CBTi, primarily sleep restriction therapy, but the awakenings continue after restricting sleep for 3 months. I am of healthy weight, I try to exercise, I yoga/meditate, not too stressful life, the waking even continued during 6 months holiday! My diet is healthy, no caffine, no alcohol, no sugar. Iv always been an active person. Maybe I haven't identified an underlying root cause? Or maybe it is anxiety and I have trouble knowing what that feels like, I feel normal other than awakenings, I've had various blood tests, thyroid, iron deficiency, b12, and all came back OK. The Dr prescribed some anti-anxiety medication, but I'm not sure if it is anxiety? Am I overlooking something? (Desperately seeking help)
Waking at 3am rapid heartbeat: Hi all, 33yr Male... - Thyroid UK
Waking at 3am rapid heartbeat
Google the ‘Adrenal Cocktail’. You are not alone in this and it worked for me.
Medics rarely run FULL Thyroid testing
You need to know exactly what has been tested and the actual results. Frequently only TSH and FT4 are tested
First thing is, do you have any actual blood test results? if not will need to get hold of copies. You are legally entitled to printed copies of your blood test results and ranges.
UK GP practices are supposed to offer online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.
In reality many GP surgeries do not have blood test results online yet
Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also extremely important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially if Thyroid antibodies are raised
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)
Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins
thyroiduk.org.uk/tuk/testin...
Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random
If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).
About 90% of all hypothyroidism in Uk is due to Hashimoto's.
Low vitamins are especially common with Hashimoto's. Food intolerances are very common too, especially gluten. So it's important to get BOTH TPO and TG thyroid antibodies tested at least once .
Add results and ranges if you have them
Or come back with new post once you get results
Slowdragan, thank you so much for your through reply. I really appreciate it. I'm actually at A&E now out to desperation.. I did have the standard thyroid function test done (the following results are from 14th December 2018:
TSH 0.92 (0.3-5.0)
Free T4 9.4 (7.9-16.0), but I had not followed your helpful advice. I'll try to ask for all those things you suggested.
Normal range:
B12 was 308ng/L (120-900).
Serum Folate 6.8ug/L >2.5.
They had done liver function test, FBC, plasma glucose. Cholesterol was on higher end, but I figured that might be to do with the long term lack of sleep:
Cholesterol 5.6 mmol/L
HDL cholesterol 1.10 mmol/L
Total cholesterol:HDL ratio 5.1
(Target for secondary CHD prevention is total cholesterol of <5, HDL >1 and LDL <3.0mmol/L .)
Eosinophils 2.11 10/L 0.0-0.4, however on a subsequent test the eosinophils had reduced to 0.20 (10th January 2019)
Everything else was normal range.
They had NOT measured Ferritin, Vitamin D, FT3 plus both TPO and TG thyroid antibodies.
I have tried a snack just before bed/when waking, I believe it is not low blood sugar.
I developed lactose intolerance over the 3yrs of sleep issues, gluten I think I'm fine with, but I have a test form to do shortly, but I expect negative result. I have a prescription for Mirtazapine and Citalopram, but didn't take either, I didn't consider myself as with anxiety or depression, and so didn't want a drug to cover up other issues or give me more. Also I don't like the idea of artificial sleep that Mirtazapine could give, I believe it makes you drowsy, if I wake with that I won't feel good.
Good news I'm at the hospital, at the nurse agreed to get all the tests run for me, all those you described above, should have some further results they have an onsite lab, it's NHS.
High Cholesterol is common when hypothyroid
nhs.uk/conditions/statins/c...
Your FT4 is very low.
You need TSH, FT4 and FT3 tested together, ideally as early as possible in morning and fasting
Both TPO and TG thyroid antibodies tested too for autoimmune thyroid disease (Hashimoto's)
thyroiduk.org.uk/tuk/about_...
B12 under 500 can be too low and especially as folate is also low.
Ideally GP would run full testing for Pernicious Anaemia before starting any supplements, but they are unlikely to think these results are low enough
More in depth private testing - My B12+
Supplementing a good quality daily vitamin B complex, one with folate in not folic acid may be beneficial.
chriskresser.com/folate-vs-...
B vitamins best taken in the morning after breakfast
Recommended brands on here are Igennus Super B complex. (Often only need one tablet per day, not two). Or Jarrow B-right
If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before any blood tests, as biotin can falsely affect test results
endo.confex.com/endo/2016en...
endocrinenews.endocrine.org...
Lactose intolerance very common with Hashimoto's
Ask for ultrasound scan of thyroid, especially if antibodies are high or vitaminD and ferritin are low
If you do have Hashimoto's Gluten intolerance can be hidden issue you don't need any gut symptoms
Low blood sugar maybe? Have you tried a bit of fruit juice or small snack? That might get you back to sleep. Could be anything though..thyroid, adrenals....
Yes tried toast with peanut butter, what would you get tested for adrenals?
A 24 hrs saliva cortisol test will show you what is happening at 4 or 6 points through the day, depending on which test you have (it will need to be a private test, it isn't carried out on the NHS). You need to have the test that measures DHEA too, not all do.
Hi I recommend reading up on adrenal and cortisol levels. I think waking at 3am indicates low blood sugar. I find a low carb Keto diet has helped me with this issue. I also do meditations to help me relax and even if not fully asleep the rest helps. It may also be other hormones - sorry don’t know age and gender but high oestrogen also has similar symptoms. It’s so awful when you can’t sleep so hope you get it sorted.
Meant to add this link about importance of vitamin D and B vitamins for sleep
The waking at 3am may be explained in this way: The brain is highly active at night, transforming short-term memory into long-term memory and carrying out repair and regeneration, and it depends on a steady supply of energy to do these tasks. During night time sleep, the body is in a fasting state and in order to not deprive the brain of the food it needs for energy, the body compensates by gradually raising cortisol. Cortisol stimulates the body to release or create glucose to supply the brain with energy during the night-long fast.
Chronic low blood sugar, can interfere with this process, making it difficult to manufacture the right amount of cortisol at the right times of the day or night. So not only does blood sugar drop too low during the night, but the adrenal glands don’t produce enough cortisol to keep the brain fueled. In response, the body sounds the emergency alarm by releasing "fight-or-flight" hormones. These stress hormones raise blood sugar back to a safer level but also raise stress, hence the waking up at 3 a.m. and not being able to fall back asleep.
Hey Maisie! That sounds like me... But how to go about correcting this? Would a keto diet help or snacking before bed? I believe my issue, may now be multiple, a combination of anxiety with something like what you have described.
Hi daleuk You could certainly try a pre-bed snack, as it's a quick easy fix if that's the issue; and/or you could do the 24 hr saliva test I mentioned higher up, which will tell you what your cortisols levels are like together with your DHEA level and ratio, at key times in the day. If it identifies your levels being skewed in either direction you can then address that. Re. the keto diet, I'm allergic to the principle of any diet regime, especially one that has a noun in front of it lol, so not the person to ask. 
Have you considered indigestion as a possible cause?
I suffered from what you describe (thought I was dying a couple of times!) but it turned out to be GERD (Gastrointestinal Reflux Disease) - high stomach acid irritating my vagus nerve (the large nerve running behind the heart).
Warching what I eat (which you clearly do) and taking Ranitidine when needed has cured the problem.
In my experience GERD is exacerbated by anxiety and vice versa so if ever I get it at night (99% of the time) now I get out of bed, sit upright and read until it settles down - there’s often trapped wind too so the upright posture helps to shift that.
I rarely sleep more than five hours or less, but was recommended to eat a few whey cheese curds before bed. I am sleeping like a log and not awakening for the first time in my advanced age. Not sure why it works, but it does. I get curds marinated in garlic and perhaps that is helping since garlic is so healthy. I used to awake like I had been through WWIII but that no longer exists either. You can find in container in the gourmet cheese section should you try it. I got it from a doctors site for what to eat before sleep as I was having trouble being hungry once I went to bed. Now that is gone as well.
Also recommend an exercise to do every morning from the Polyvagal nerve literature where you lace your fingers together, place under your skull while still in bed. Look up to ceiling, while not moving head facing up to ceiling, eyes look to the right and wait until you yawn, sigh or swallow. then look center to ceiling again and do same looking to the left, head still stationary. Then get up and to about your day.
This opens up the vagus nerves to help with healing. Do every day, if you wish and enjoy the involunatry way your body responds, possibly for the first time. Sometimes looking left is a little slower. No never mind if it does not always work and do not force the response just enjoy and let the body catch on if you do every day.
Do not go back to sleep as you have now opened up you Sympathetic Nervous System to get you up and going. If you get stressed during the day take a deep breath and doubling your exhale to open up your parasympathetic system to calm you down. Do this three times only. Really focus on the exhale SLOWLY deep into your belly. I have to almost double over to exhale correctly. It does not come secong nature as many of us are shallow breathers.
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