breaking the cycle of strange insomnia?

July 22, 2023 8:00 PM

I took Lexapro 5mg for a few days last month, which I think triggered a few days of terrible insomnia. Even though I've been off Lexapro for a month, the terrible insomnia is back. I need to work during the day, and first-line meds aren't working. What do I do to break the cycle?

I've never had insomnia before (I'm in my late 20s), I tend to err on the side of oversleeping.

Started taking Lexapro for PMDD. The side effects for my third day on Lexapro 5mg were quite bad - sleeping 3 hours and repeatedly waking up with what felt like a racing heart. (This was strange because I had previously taken Lexapro with no side effects.) I tapered off Lexapro within 3 days and started taking 7-10 mg melatonin nightly and the insomnia seemed to go away. My heartbeat was more noticeable during the day for some time. I also reduced my caffeine consumption from 1 black tea a day to 1 green tea.

Recently (a month later), I started waking up a few minutes before my alarm, then the last 2 nights, I've had terrible insomnia. Even though I take 7-10 mg melatonin nightly, I sleep for 2-3 hours, then I wake up and can't fall asleep again. My chronic back pain is worse. No specific incident during daytime life triggered the insomnia; it just randomly started again. The symptoms have improved; no specific thing seems to trigger the wake-up, and my heartbeat is not as noticeable, but still seems to be racing slightly, and preventing me from sleeping. I stopped taking caffeine entirely 5 days ago (really just tapering down from 1 black/green tea a day - not much) and I thought it would help, but insomnia is still happening. I used to have spiraling thoughts in bed, but it's been much calmer this time, I just lie there calmly not being able to sleep for 5-6 hours...

Did the low dose of Lexapro somehow trigger some latent anxiety/insomnia (which again, I've never had before) and now I'm stuck with it in my daily life even though it should technically be out of my bloodstream by now??

Wakeups are happening even through max dose of 10mg melatonin. Benadryl makes me tired but doesn't make me fall asleep anymore. I may try hyroxyzine HCL but isn't that basically just Benadryl? Also, I have buspar but that doesn't take effect for weeks, I heard.

I have a GP appointment on Tues and really need to break the cycle, are there specific meds I can take that would help? Was thinking of asking for modafinil (to function during the day) + Xanax/benzo (to sleep at night) until this is over with.

Psychosomatic background... I got mugged a few weeks ago and the doctors think the insomnia is caused by that but I disagree, I don't feel that affected by the mugging (at least consciously) and don't have nightmares or flashbacks about it. My life is higher-stress than it was before, but I feel like I'm managing it. Could this be caused by my menstrual cycle? Or by caffeine withdrawal? Could Lexapro somehow still be in my system? (I now feel suspicious of SSRIs since Lexapro seemed to be the immediate trigger for the insomnia, but would be open to SSRIs as a solution.) I exercise somewhat regularly already (20min cardio every other day). I practice enough mindfulness that I don't think I'm necessarily "anxious about anxiety," I accept that my life is higher-stress and may trigger more anxiety; I'm just trying to systematically debug what's happening, and figure out short-term coping mechanisms, since I think sleep deprivation just categorically makes things worse.

posted by glass origami robot to Health & Fitness (14 answers total)

Response by poster: Amending to add: would also love to have concrete recs for mindfulness meditation (/ other non-med things) if that has worked for you in significantly reducing insomnia.
posted by glass origami robot at 8:06 PM on July 22, 2023

I’m sorry you’re sleeping poorly. It’s the worst. I have the same issue with melatonin; falling asleep easily but then waking up later.

Here is a suggestion for a meditation app that has been sending me into sleep more easily. Insight Timer (I use the free version), specifically the meditations by Jennifer Piercy. She is very calming and I often fall asleep before the recording is done. These could be used in the middle of the night too. Hoping you start sleeping better soon!
posted by sucre at 10:02 PM on July 22, 2023

So sorry you're dealing with this.

I had a very similar issue when starting on Bupropion (I also stop-started a few times, and I think it made it all 100% worse). I was averaging 2-3 hours a night, and after a week or so of it my body was falling apart. My doctor gave me a small amount of zopiclone and ativan, and while that helped me get a few nights of sleep, it was that black-out drugged sleep that leaves you feeling hungover the next day. In my view, I think it's often a terrible idea to keep layering pharmaceuticals in an attempt to address side effects... it's just too much of a "wheels within wheels" problem. Especially with sleep issues.

I had success getting over my season of insomnia by going into a sort of low-power mode for my body, basically to try to force my body to cool it with the cortisol. For me this meant not doing any workouts beyond walking and yoga, eating whatever I felt my body wanted, and drinking tons of water and low-caffeine green tea. I would also allow myself to half-ass my chores as needed until my body was more rested.

Additionally, I wouldn't go to my bed for any other reason than sleep, and if I woke up in the middle of the night I'd get up and move somewhere else. This worked especially well for breaking the "laying in bed ruminating about random crap" cycle. Eventually I was able to have a nap in the early evening, then that slowly turned into me going to bed early and sleeping a normal amount of hours. I am a solid "black out for 7 hours" sleeper now, which I honestly never was earlier in life.

My biggest takeaway from it all was:
- Bed is for sleep only, but your body needs to learn this. All waking activities, including thinking and fidgeting, can happen outside of bed.
- If you get sleepy at any point after work, follow that feeling and nap or get into PJs. Any extra rest you can give your brain will help, don't force yourself to push through until your usual bedtime.

Edit to add: If you like meditation techniques, try the military sleep training method. I have a friend who could fall asleep while rotating in a rock tumbler, and he swears it works.
posted by Pemberly at 10:45 PM on July 22, 2023 [2 favorites]

So if I understand you correctly you got mugged and shortly after experienced insomnia/waking up with a racing heart. You were taking Lexapro at the time and you suspect that, despite Lexapro never having this effect on you before, it was the reason for your insomnia then and again now after not taking it for a month. Yes?

I’m sure other people can help with suggestions about medications but to me your description of a mugging not affecting you is a bit worrying. A mugging *should* affect you, hopefully not with nightmares or flashbacks but definitely making you evaluate your overall safety and raising the specter of having to make changes in your life. Unless getting mugged happens a lot and you’re just used to it, the fact that you’re not unsettled by it sticks out as possibly some processing you still have to do.

I may be off in the weeds but that’s what really sticks out to me.
posted by Tell Me No Lies at 11:03 PM on July 22, 2023 [8 favorites]

I was going to say that I am not sure that your analysis that this is a lexipro issue is necessarily correct,but Tell Me No Lies said it differently and much better than I could.
posted by JohnnyGunn at 11:14 PM on July 22, 2023

Oh friend. This sounds is stressful.

I want to agree with other folks that there’s a reason you started on the Lexapro, and this is likely what’s causing the problems.

I’m super worried about you taking such a high dose of melatonin. Melatonin supplements aren’t regulated, and many people experience what you do: waking up a few hours later. And the research is really inconclusive. It can also cause anxiety.

I’d really encourage you to get off the melatonin. I think it might be causing your problems. At least read up on it and dosage and possible side effects.
posted by bluedaisy at 1:19 AM on July 23, 2023

I started added a 400mg magnesium glycinate supplement an hour before bed and my insomnia is gone. I also take 10 MG of melatonin but without the magnesium it's doesn't seem to keep me asleep anymore.
posted by ananci at 3:54 AM on July 23, 2023

So you have a cyclical mood disorder and you are having cyclical insomnia? I think the culprit might be the cycle, plus the trauma, not the treatment.

Please stop taking unregulated hormones (if your supplement even contains any actual melatonin, which it might not, it could just be random garbage). Actual melatonin is okay for maybe two days for jet lag (at a dosage of three MICROgrams not milligrams), it is not a sleep aid even though it is marketed (and sold at wildly inflated dosages) as one.

You may need to consider regulated hormones, though.

I have been really happy with the hydroxizine I was prescribed with my Lexapro because I was maxed-out anxious it would give me insomnia (it took me a while to get over this fear, I now take it at bedtime and sleep great and don't have to deal with the drowsies it gives me if I take it in the day). Sometimes if I'm having trouble winding down I add half a doxylamine succinate (OTC, drugstore brand is cheapest). I take a Mag-Zinc-D3 after dinner (it has a bit of a laxative effect on me so I need time before bed for all that to happen) to help relax.
posted by Lyn Never at 6:35 AM on July 23, 2023 [4 favorites]

IIRC (and I'm not a sleep doctor, though I have been through bouts of insomnia and got some really useful answers here when I asked about it) having insomnia of the "falling asleep easily but waking up frequently" is a hallmark of anxiety and stress.

You clearly have many reasons to be stressed, even if you're not experiencing it in the way you feel like you should be. I'm similar to you -- I used to claim that I just don't get anxious, but I've learned over the years that I do, in fact, experience anxiety, it's just expressed physically (stomach upset, disordered sleep) rather than mentally. Your body is functioning with a higher level of cortisol than usual, this is going to have an impact on you in some way.

Agreed with the above advice to stop taking melatonin, it's not supposed to be used long term. Higher doses are actually much less effective as well.

My advice is to change as little as possible when it comes to your sleep routine. Paradoxically, changing things and turning the bedroom into a source of stress ("I've done everything right, so why can't I sleep???") will make your insomnia worse. Think about it -- you've always been able to sleep before, so you don't actually need to change anything there.

What helped me the most during my periods of insomnia was realising that even if I was just lying in bed with my eyes closed, or quietly reading in a low light room, I was still doing something beneficial for my body by resting it. I stopped beating myself up for not sleeping "properly", and that actually made it easier to accept what my body was doing. When I was trying to force myself to sleep, it made it worse.

Here are some other small things that helped me:

• I kept a fuzzy blanket near my feet and when I needed to zone out I would rub my toes against it and concentrate on that feeling, I found it more helpful than counting breaths (which just made me more stressed).
• During sleepless moments in the middle of the night I would visualise myself taking a nap, remembering good naps I've had or imagining myself in a classroom or at work just taking a quick nap at my desk, and would just tell myself "I'm taking a nap now, it doesn't matter how long I sleep for" and that would actually make it easier to let go of the stress about sleeping.
• Hydration, hydration, hydration. On days when I drink the right amounts of water, I sleep much better.

posted by fight or flight at 7:42 AM on July 23, 2023 [2 favorites]

Melatonin doesn't seem to be doing anything for you, and my doctor said that lower doses are actually MORE effective than higher. So stop melatonin or dramatically reduce the dosage.

Look up "sleep hygiene." The strategies it suggests are not helpful for everyone, but should be your first steps before moving on to more meds.

I love modafinil, but in my country it's hard to get doctors to prescribe it for daily use and even harder to get insurance coverage for it. And it would likely exacerbate the sleep issues. For now, do everything you can to reduce your responsibilities in order to get through your days with inadequate sleep. Try sleep hygiene practices and meds your doctor suggests (if any) for a couple months first.
posted by metasarah at 9:54 AM on July 23, 2023

During sleepless moments in the middle of the night I would visualise myself taking a nap, remembering good naps I've had or imagining myself in a classroom or at work just taking a quick nap at my desk, and would just tell myself "I'm taking a nap now, it doesn't matter how long I sleep for" and that would actually make it easier to let go of the stress about sleeping

Similarly, when my mind is up and wanting to rabbit around, I try to think up THE most amazing place to sleep. Budget and access are no issue, physics is fungible, safety is assured. If you want to set up a bed in your favorite museum or perched on a rowboat, or maybe just settle in to one of those $10K/night train sleeper cars, go for it in rich detail: what are the pillows like, what's on the nightstand, what does it sound like? Don't forget to enthuse about how very very comfortable you are, how perfect the temperature, how perfectly your neck is supported.
posted by Lyn Never at 12:06 PM on July 23, 2023 [1 favorite]

I agree with fight or flight—I‘d be reluctant to start changing lots of stuff! You’ve slept well in the past, and the ship is likely to right itself given a bit more time. I had a rough patch of sleep a few years ago and then started trying a bunch of stuff to “fix” it, but by doing so I just put pressure on myself and got really anxious about my inability to sleep despite all the “remedies” I was trying, thus making the problem a lot worse. It might be worth reading about cognitive behavioral therapy for insomnia, which helped me a lot. Things like “sleep restriction” (basically going to bed later than usual so you’re really sleepy) and getting out of bed if you’re still awake after 20 minutes or so can be helpful. I also sometimes find location changes helpful when I can’t sleep—if I go to the guest bedroom, or a couch, or whatever and turn on a relaxing podcast, I often fall asleep quickly!
posted by bijoubijou at 1:58 PM on July 23, 2023 [1 favorite]

I have found Yoga Nidra a really useful tool for rest. If you try it, and end up falling asleep, then that’s great. But even if you stay awake through the whole thing, my experience is that you feel better after doing it anyways.
posted by tinymegalo at 3:17 PM on July 23, 2023 [1 favorite]

You're taking too much melatonin. Sleep specialists recommend very low amounts, like 0.5 to 1mg at night. Our brains make melatonin, and when taking a supplement, we are trying to nudge it to produce its own. When you take high dosages, you pretty much override your brain and it's no good.

The modafinil-xanax combo is probably going to get a no from your doctor. In my experience (psychiatrist) Xanax is the most addictive benzo, and you will need higher doses for the same response pretty quickly. And then getting off of it is going to cause insomnia (and a host of other unpleasant w/d symptoms). I would be much more suspicious of Xanax than an SSRI.

I also don't think it's the lexapro--sounds like you took it only 3 days. It is no longer in your system, nor did it have any time to do much of anything.

I think TellMeNoLies is on to something, and I would pursue that. Good luck!
posted by namemeansgazelle at 3:33 PM on July 23, 2023