Difficulty dropping off to sleep

Hello all,

I have searched because I'm certain this question has been asked before but didn't get far.

The last week or so I've been having difficulty getting to sleep, despite being tired and very ready to sleep when I go to bed I'm still laying there for hours waiting to drop off. This is utterly alien to me!

3 weeks ago I had a dose increase from 125mcg to 150mcg. I've had the same brand for almost a year.

Results on 125mcg were:

TSH 2.09 (0.27 - 4.2)

FT4 20.5 (12-22) 85%

FT3 4.6 (3.1 - 6.8) 36%

Is this sleep issue possibly a symptom of over medication? I'm wondering if my T4 is too high now? Purely speculative until I have bloods done but not sleeping feels worse than sleeping too much.

[DippyDame]

Some thoughts....

Apart from poor sleep do you have any other symptoms?

You are listening to your body which is good!

Yes, 150mcg is too much!

Also, your FT4 on 125mcg is on the high side

Because your T4 to T3 conversion is poor

Indicated by high FT4 with low FT3

I doubt your GP has recognised this!

He probably thinks increasing your Levo will raise your FT3....not so much with poor conversion

Also vit D, vit B12, folate and ferritin must be optimal for good thyroid function/ conversion

Have they been tested?

If optimal nutrients don't help then...

You may benefit from the addition of a little T3.

Suggest you discuss with GP

Meantime perhaps try an organic lavender pillow spray it may help you get to sleep. I find it useful.

Sorry, rather brief, just off to my own lavender pillow!!

Good luck

DD

[Hidden in reply to DippyDame]

Hello DD,

Thank you for replying. I don't think I have any other symptoms; nothing obvious anyway - my heart rate has started increasing according to my watch but that is just as likely to be from adequate dosing because it's only gone up a bit (average RHR 56 to 63).

I supplement and vits were all tested in July:

Ferritin 205 (13 - 150) (post transfusion)

Vitamin D 135 (75 -175)

Active B12 103 (37.5 - 188)

Folate couldn't be tested but was 41.4 (13 - 150) in April.

Private consultant wanted to see if lowering my TSH to 1 was beneficial to me before introducing T3 or NDT.

We've had a stressful week so I guess it could be stress but I have never had issues sleeping, stressed or not so something is off kilter. 🤔

[DippyDame in reply to Hidden]

Your low FT3 needs attention

It should be approaching 75% through the ref range....not 36%

For good health T3, the active hormone, is required by almost every cell in the body in a constant and adequate supply.

Nutrients seem OK so I'd be looking at poor conversion

Have you though of having the Dio2 genetic test?

thyroiduk.org/deiodinase-2-...

If positive, especially homozygous, it may persuade an endo to trial T3

Poor sleep clearly doesn't help either!

[Hidden in reply to DippyDame]

Private endo is happy to prescribe T3 but wanted to try and get TSH below 1 first. Next appointment is in September so not too long to wait now.

In the meantime, I was just trying to decipher if this semi-insomnia is medication-driven because I can tolerate it if it's just for a few more weeks. If it's not I need to find solutions!!

[greygoose]

More likely to be due to your FT3 being too low, than your FT4 to high. It's T3 that causes symptoms, not T4.

[Hidden in reply to greygoose]

Agreed! But taking more T4 wouldn't lower my T3, would it? So I wondered if the problem was that my T4 has gone over range and my system doesn't like it?

I really have no idea; I'm just stabbing in the dark for ideas really.

[greygoose in reply to Hidden]

??? You don't want to lower your T3. You want to raise it. And I didn't suggest your increase your dose. And your FT4 hasn't gone over-range, it's only 85% through the range. Was this response intended for someone else? lol

[Hidden in reply to greygoose]

😂 no, but I obviously didn't express myself well.

On 125mcg T4 was 85% and T3 36%

I'm now taking 150mcg so I wondered if perhaps my T4 had been pushed over range.

Low T3 causes symptoms and this is a new symptom but I am now on a higher dose of T4 and that wouldn't have lowered my T3 presumably?

So logic would suggest it could be related to a 'too high' level of FT4 rather than a 'too low' level of FT3!

Does that make more sense?

[greygoose in reply to Hidden]

Well, it could possibly have lowered your FT3, yes. What happens is, when the FT4 gets high in range, or over-range, the T4 starts converting to more rT3 than T3. So, not only does your FT3 not rise much, but could actually drop a little.

T4 is pretty much inactive until converted to T3, and a lot of people have very over-range FT4 without it causing symptoms, so I wouldn't suspect the FT4 of being the culprit. Be careful of logic. It isn't always logical.

[Hedgeree]

Hi plant_lady,

I'm sorry I can't offer any advice regarding your medication levels but I also know what it's like to not be able to get to sleep even when very tired.

Wondering if you've ever considered trying a weighted blanket/duvet? They're filled with little glass beads and so put gentle pressure over your body. You can get them in different weights.

I have problems with panic attacks and often have them during sleep so I really didn't think a weighted blanket would do anything for me and possibly make my anxiety worse, mainly as I don't cope well with feeling trapped. But the first time I used one I actually got to sleep very quickly, it was a revelation for me and I hadn't slept like that for many years. ☺

Unfortunately it's too warm to use it at the moment but I'm looking forward to doing so in the cooler months. I bought mine on-line (Home Bargains) and just got a cheaper lightweight one as I didn't think it would work for me, but obviously you can get more expensive and heavier ones.

Probably not suitable if you happen to have any pets that chew or dig as you wouldn't want them swallowing any of the tiny beads.

But I can recommend them.

Best wishes.

[Hidden in reply to Hedgeree]

I have considered them and have never been able to justify the money. If this not-sleeping thing carries on I will definitely invest. It's awful.

[Canu]

If you had no sleep issues before the increase, then it seems like a clear sign that you're overmedicated now, but, just in case, have you had your cortisol levels tested (24-hour saliva cortisol test).

[Hidden in reply to Canu]

I haven't because of the extra cost and because generally, I don't think I have issues with cortisol... well... not significant ones anyway BUT I have been quite stressed the last week so it is probably linked somehow.

[Canu in reply to Hidden]

If it is stress related there are many things that can help, like taking magnesium powder at bedtime, meditating, going for a short walk before bedtime, having tea with calming herbs, etc. Also make sure you take vitamin C, as it can get depleted during times of stress.

[Hidden in reply to Canu]

Started vit c this week! I do take magnesium but in the morning because I take my levo at bedtime.

I might have to start reading boring work texts in bed!

[Canu in reply to Hidden]

Stress can also be a sign overmedication.

[Hidden in reply to Canu]

It definitely feels like something is going on because stress used to make me sleep more. Not less.

[Canu in reply to Hidden]

It may be you would be better off taking 125 mcg on most days and 150 mcg on maybe two days of the week.How did you feel before the dose increase?

[Hidden in reply to Canu]

Crappy! Endo is trying to lower my TSH before introducing T3 so hopefully he will drop me back to 125 a day at my next appointment.

I do feel like I have more energy now I'm just tired from lack of sleep before I just felt like my whole body was made of stone and I couldn't make it do what I needed/wanted.

[Canu in reply to Hidden]

It sounds like you did need the dose increase then, but perhaps not the full extra 25 mcg. Though you may feel better once it settles. At least you have an endo who considers using T3, which is great! Best of luck with it all!

[helvella Administrator Thyroid UK]

I've posted this before:

It is often suggested that bed-time dosing results in slightly better absorption. It also seems slightly closer to the pattern healthy people have.

I have always taken my levothyroxine at bed-time.

For that reason, I cannot compare with taking in the morning.

Before diagnosis, my sleep was badly disturbed. Typically, I would fall asleep fairly easily. Then wake up after something like half an hour to two hours. Once woken I'd be unable to get back to sleep - often till dawn, or at all.

Once I started on levothyroxine, my sleep slowly improved. By the time I was taking an adequate dose, bad nights were unusual - just an occasional night where I might wake up for a while. Now, after years, I sleep very easily and deeply and rarely wake at all. If I do, I get back to sleep quickly.

[Hidden in reply to helvella]

Thanks, Helvella - I do take my levo at night. Have done since almost the very beginning because I decided I couldn't live the rest of my life without a cup of tea in the morning. 😂

hopefully, the non-sleep is just a passing phase...