Do you have IBS? Have you ever been had your gut health investigated? If you are under significant emotional stress or the stress to your body and brain (from not sleeping) your gut won’t be working as well, if it doesnt get to heal at night. My endoscopy scopes were clear in gastroenterology but I had so many digestive symptoms. I could not sleep. I could not digest my days food. I have a long history with slow digestion and fullness and a gut infection called SIBO. If you are not sleeping well at night your gut cannot do its daily cleanup or heal despite all the dietary modifications in the world. If your body is slowly digesting all night then you may not be sleeping either. The gut brain axis means the brain and gut are communicating all the time and if one is stressed the other will be stressed also. So getting your gut health investigated is KEY to seeing is it the root cause of insomnia? If your not sleeping you may have anxiety which also worsens your digestion because of the gut brain axis. If your not sleeping your master pitutiary gland cant recharge so your hormones will be all over the place. If you are not sleeping longterm you may have an early menopause because of the stress insomnia causes on the body and brain. I was a walking zombie from 5 years of insomnia since I delivered my last child. Because the family doctors wouldnt give me proper medication and were gaslighting me into thinking it was my fault and i could control it..It cost me 25K AND 6 PROFESSIONALS to find my answer. It was a long and harrowing journey. I felt unheard for years.
Perimenopause was the root cause of my insomnia. My bloods showed very low testosterone when I was 38 and I had all the symptoms of low testosterone prior to starting HRT. Once you are over 40 your adrenals make most of the oestrogen as your ovaries are slowing down and the hormones that control sleep and anxiety aren’t being made properly anymore! Getting my hormones rebalanced with HRT has been the solution but it took 18 months on HRT for my body to have sufficient hormones to sleep through the night effortlessly. 200mg of utrogestan progesterone with 125 oestrogen patch and testosterone cream. At the start the oestrogen made my sleep MUCH worse. So i had to stay on 3 medications to sleep until my body regulated the levels.
Oestrogen is very stimulating and wakefullness can occur with it. I always remember being awake some days of my cycle. This side effect settled down in time for me. The medications i took for sleep and anxiety are called amytriptaline, it is indicated for insomnia and quetiapine, that is not licensed for insomnia but is excellant for sedation and used off label by doctors with psychiatry experience. I needed 50mg amytriptaline, 75mg quetiapine and zimovane 3.75mg to sleep 7 hours. Zimovane is a sleeping tablet useful for sleep initiation but not for sleeping through the night! Zopiclone can cause pain and numbness in hands and forearms over time if taken longterm. It needs to be weaned over time as can cause rebound insomnia if you stop it cold turkey. I have a lovely refreshing natural night’s sleep and I don’t feel tired or hungover the next day because the HRT gives me energy daytime and the meds keep me asleep at night. I have no side effects other than dry mouth. You could ask your doctor to start 10, 25mg or 50mg of amytriptaline, go up in the dose if its helping, or if not try just 12.5mg or 25mg quetiapine and if that works somewhat maybe increase to 100mg if required.
Quetiapine is used for bipolar disorder at the higher doses but doctors that are good at prescribing in mental health find it excellent for sleep and anxiety at the lower doses. I don’t have bipolar disorder! This medication suits me so well and it takes away all my insomnia and the anxiety due to hormone loss from perimenopause. When im lying there wondering why I dont sleep!! let me tell you how anxious you can become. I feel like the best version of myself on it. Initially i needed Quetiapine 175mg to stay asleep all night when initiated the HRT because the HRT was so stimulating. Prior to the HRT I only needed 75mg to sleep all night. Now 18 months into taking HRT i am sleeping on 50mg quetiapine and i may be able to come off it over time once i build up sufficient hormone levels.
Amitriptaline is the other one it is used for sleep and aches and pains (also due to early hormone loss) at the low doses 50 to 100mg. It is used for IBS at a low dose of 25mg to 40mg, for migraines at 75mg, for depression and anxiety at doses beyond 100mg. I cannot tolerate a dose higher than 50mg as it elevates my heart rate at 75mg. An ECG is required a few weeks after initiating as it can cause elevated BP and heart rate. Many family GPs will be familiar with prescribing amitriptaline and may initiate it for you for insomnia. Generally one needs to titrate up to a few doses to get effect. For me 50mg is all i could tolerate but with quetiapine and the sleeping tablet i got 7 hours straight sleep every night and until the HRT kicked in it kept me functioning.
Mirtazipine is also used for sleep and poor appetite but it can cause weight gain. I have no personal experience using it but i did work with many doctors over 5 years in psychiatry who swore by it for insomnia and anxiety.
Remember the gut bacteria produce hormones , if your gut is damaged and you have a poorly functioning microbiome you may not be sleeping because of this. It only takes 3 days for the cells of the gut to heal so it is never too late to start reducing your stress, figuring out the foods that are aggravating your gut and allowing your gut to heal if this is an issue for you. Remember your gut cant heal if your not sleeping! It took me 2 years to heal my gut once I got diagnosed with SIBO and started sleeping. Ive gotten a personalised probiotic made for my gut and I’m feeling so good since I started it. I am currently on my gut health and hormonal health journey to wellness. It will take time but for now I am happy to take the meds and take the HRT for sleep as it will take time for my microbiome to regrow. Most people just want their quality of life back. Starting sleep medication can buy you time and give you energy to investigate the root causes of why you are not sleeping.
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Have a gut day!