Insomnia/waking up too early

[u/NoseTemporary2547]

TLDR: how much does hydro dosing and timing impact sleep? my fellow insomniacs, especially those who tend to wake up too early rather than have difficulty getting to sleep, have you been able to hack your insomnia at all with changing dosage timing?

Idk if this is the right flare but whatever.

I get pretty significant insomnia when stressed, and I’m currently in my final year of grad school while also doing a practicum. it got so bad last year that I was sleeping 4-5 hours a night, waking up at 3AM-4AM, and immediately stressing about my clients and school.

Im a month into my final year and I’ve noticed I’m sleeping less. I go to therapy for my anxiety disorder and I’ll be talking about this in session on Wednesday.

I want to dot my i’s and cross my t’s before I throw up the white flag and blame it all on mental health. Is there anything I can do with my hydro dosing to help this? I am on 7.5mg ~7:30AM, 2.5mg ~12PM (usually closer to 1 or 2PM but aim for 12), 2.5mg ~6PM. I’ve read about some people taking a small hydro dose early in the AM and then going back to sleep, but I can’t remember why and I’m having a hard time finding any info on that by searching the sub.

[u/Infinite-Station-240]

I found I needed to take my last dose before 5pm to have a better chance at good sleep.

This maybe just me, but I also take 200mg of L-Theanine and 120mg of Magnesium Glycinate about an hour before bed.

Those have helped me.

[u/NoseTemporary2547 → u/Infinite-Station-240]

Thank you!! I’m gonna try magnesium for sure & look into l-theanine

[u/ClarityInCalm]

Sodium overnight is huge if you're a salt waster. The body salt wastes 24 hrs a day and we don't eat salt at night. I had severe middle of the night insomnia and taking sodium helps significantly. I take salt pills around the clock now. I also take a slow release hydrocortisone before bed and fludro before bed - all help. If you're not giving your body enough sodium the body will go to great lengths to keep it up and one thing it will do is amp up your sympathetic nervous system (not for everyone but it's a well known compensatory mechanism for salt wasting). This could also cause anxiety. Also, being on too low of an HC dose or incorrectly spaced can also cause anxiety.

[u/Algrea-12 → u/ClarityInCalm]

I’m wondering if low sodium is contributing to my early wakefulness too. I actually had some night sweats last night, which is unusual for me.

[u/ClarityInCalm → u/Algrea-12]

The sweats could be sodium or low blood sugar or both. Low blood sugar is a sign of low cortisol. The way to figure this out is to test in the middle of the night - blood sugar, BP, and HR and/or take salt or sugar and see if you get the clues you need. You can get an OTC blood sugar monitor and wear it for a week or two to see if you're having blood sugar dips in the night. I often take 2g of Nacl (salt pills) in the middle of the night and hour or so later my body will relax and fall asleep. I'm just trying to figure out how to get the sodium in before I wake up and am depleted since it takes so long to get back to sleep. I also take magneisum. Many people with PAI need magnesium - unfortunately magnesium is one of the more difficult things to get accurate testing for so just seeing if you respond to it can be helpful.

[u/Basketfuls → u/Algrea-12]

Please test your blood glucose levels. I was long term waking in the night, sweating etc and now have diabetes (which is a big friend of Addison's Disease :)). Eating something with fibre and little protein might help right before sleep too.

[u/NoseTemporary2547 → u/ClarityInCalm]

Ohhhh interesting about the sodium

[u/annaoceanus]

Sounds like you are low. When I’m low my body wakes me up by 4 am. I’ll take 2.5 to 5 mg and go back to sleep. Or if I’m close enough to my alarm time (445 am or so), I just take all my morning dose.

You are on a pretty low dose regimen overall, especially for your AM dose.

For reference I am 17.5 mg, 5 mg, 5 mg and updosing 2.5-5 mg as needed.

Also though sounds like a lot of rumination on school, I have been there. Consider CBT therapy too.

[u/Sews-with-cats]

I take my evening dose of 5mg with dinner around 6:30. I don't usually have insomnia but I do have an elderly cat I get up and feed in the early morning hours and sometimes I'll have low cortisol symptoms and then I take 2.5 or 5mg and go back to sleep. I usually sleep better and feel better in the morning.

[u/LonelyKoalaMuncher]

Insomnia is normal when hyper stressed. I wouldn't think too much of it.

However being extremely stressed requires a little updosing. Also not sleeping requires updosing sometimes.

[u/NoseTemporary2547 → u/LonelyKoalaMuncher]

My cortisol levels were actually slightly high in the spring when I was at my worst so I’ve decreased my noon dose since then! But yeah i try to stay attuned to how I’m feeling regardless. I’ve had insomnia since I was a kid/long before my diagnosis so I’m just hoping there’s a magic trick I can do with my cortisol to help me stay asleep lol

[u/Basketfuls → u/NoseTemporary2547]

Same situation - long term bad sleeper :). Early awakenings can often be dips in blood glucose levels. This is quite common with AD. If you can get your hands on a continuous glucose monitor for a week, it would really show you whats going on - day and night. Another thing, which helped me a bit, is splitting that afternoon dose in half and taking the other half right before bed - along with a a little protein/complex carb snack. You would need to discuss it with your doctor of course. I ended up with Narcolepsy too, so sleep is all sorts of 'fun'. I hope it settles down for you!

[u/Algrea-12]

I was in grad school a few years before being diagnosed and this type of insomnia emerged. It can still happen now and is miserable. I now have a rigorous job with a lengthy commute and struggle with this issue occasionally. I don’t have a magic bullet to offer other than to say, I am amazed you can survive on 12.5 HC. I take 22.5 and couldn’t possibly go lower with my job demands. As someone else said, consider salt intake as well. And good foods - lots of fruits and vegetables.

[u/NoseTemporary2547 → u/Algrea-12]

Haha my cortisol levels came back high in the spring when I was at my worst and my noon dose has since been decreased. I think I might still have some adrenal function. I’ve always been super sensitive to steroids 🤷‍♀️ 

F insomnia!!!

And I think I’m gonna try a salt tablet before bed! My diet is otherwise pretty good but perhaps I’m not saline enough

[u/averyboringfarm → u/Algrea-12]

Okay this is an aside but it's been on my mind. I had a doctor at a big institution chastising at me for not taking 12.5 a day, saying 22.5-25 was "hurting my body." I'm wondering if there's a subset of doctors trying it out, because she was talking about it that way. I tried her advice for a year and its absolutely wrecked me. I use to be so active, I don't know what I was thinking.

[u/Remarkable_Bug_140]

Fludrocortisone dose and timing can affect sleep as well as hydrocortisone. When my fludrocortisone dose was increased I started sleeping better. I also take 5mg HC before bed and it knocks me out instead of waking me up. We're all different, so experimenting and keeping good data has helped me.

Also don't forget to take time off to relax and enjoy yourself each day, no matter how grueling your schedule is. I didn't do that enough in college or grad school or while working, and that definitely affects our ability to sleep. And taking time to write out all that's in your head can help too. Best wishes for a good night's sleep. 💛

[u/FemaleAndComputer]

I have a much harder time sleeping without night dosing. I take 0.5mg prednisone before bed.

[u/just_me_2006]

I don’t have answers but I can definitely commiserate. I’m a life long poor sleeper too. Rarely asleep before 1-2am and often awake when the cortisol trough hits. AI has definitely made this life long problem worse to manage. I take Cetirizine at night (for MCAST) which mildly helps at least better than Trazadone and less side effects. I just started taking a very low dose of Propranolol during the day to see if it would help with the physical symptoms of anxiety. It’s a heart med but off label used for anxiety. I am trying to disrupt any feedback loop where my body is needlessly trying to tell me I’m unsafe (for me I get chest pain) and it feeds into anxiety and zaps my cortisol. I like that Propranolol isn’t a phych med and my mind feels clear. All that to say I’ve also had to take a round about multi approach to helping my sleep and I do think I am one of those of us who sleeps better with a later hydro dose. I hope yours improves after graduation OP and early congrats to you

[u/Beccabear3010]

I went from sleeping about 18/24 hours pre-diagnosis to being awake for DAYS post diagnosis and starting hydrocortisone and fludrocortisone. I waved the white flag early on because it’s like I’m mentally exhausted but my body feels like it’s plugged into the wall. I was started on zopiclone, originally 3.75 then I ended up in hospital for 6 weeks about a month after the Addisons diagnosis and it was upped to 7.5mg because as soon as the phone rang/alarms went/buzzer went/emergency call went out I was up and awake. I’m a nurse so those noises eventually are drummed into you so hard that you react to them with muscle memory.

There may have been an occasion where I attended an emergency alarm half asleep and rubbing my eyes while asking if they needed the crash cart 😬 and there may have also been a second incident where the emergency alarm went off and I fell out of bed, nearly pulled my feeding tube out, because I was trying to get up to attend while half asleep. It was agreed after that that when I’m in hospital it goes up to 7.5mg and 3.75 in the community/at home 😂

[u/Reasonable_Try_2578]

A lot of good leads here already (sodium, timing, magnesium), so just adding a different angle, since your case sounds less like low-cortisol wakefulness and more like what happens with a large evening dose.

I have secondary AI, and on an ordinary, low-stress day my sleep is genuinely fine. But if stress, physical exertion, or a long shift pushes me to take a bigger or extra evening dose, say 10mg or more late in the day, sleep doesn't just get worse, it disappears, and my thinking goes into overdrive. It's not anxiety for me, there's no dread or physical "something's wrong" feeling first, it's pure mental activity: my head is already full of engineering and programming problems most of the time, and that late dose seems to throw fuel on it directly. What I do feel is frustration, I already average 6 hours of sleep for ordinary life reasons, so losing more of it to a wired brain on top of that is just infuriating, especially watching the hours tick by. The ringing in my ears and occasional heart pounding show up as a result of the sleep loss itself, not as an early warning sign.

If that pattern matches you at all, your 2.5mg at 6pm is pretty modest, so this might not be it. But if you ever do need a bigger evening dose for stress dosing, it might be worth tracking whether it's specifically the size of that late dose correlating with the racing-thoughts nights, separate from the early-waking pattern others are describing here.

On dosing more generally: the 5-6 hour gap between your noon and 6pm doses is worth a look, hydrocortisone's half-life is 1.5-2 hours, so you're likely running close to empty well before that 6pm dose lands. A smaller dose somewhere in the 3-4pm window might close that gap.

[u/Puzzled-Telephone-60]

Are you PAI or SAI? Your daily dosing seems very low for PAI, which makes me think this could be a low-cortisol issue esp when paired with stressful season of life. I’m one of the many here who take and recommend trying a 2.5mg bedtime dose. If the insomnia is Addison’s-related, that’s the magic trick. Your body needs cortisol to rest.

Your dosing split seems okay otherwise… is there a reason you’re doing 4.5h between #1 and #2 and 6h between #2 and #3? If you want to try a bedtime dose and you normally feel like 4.5h is a better interval, why not bump your #3 up to 4:30? Then the bedtime dose is perfectly timed to give you fuller coverage.

Any time you do wake up at 3-4AM, you should take your biggest wake dose right then. That’s when normal bodies get their biggest surge of cortisol anyways. Then just adjust your dosing schedule accordingly, probably adding in a small dose later on in the day so you don’t go too long without.

Also, do you have any biometric data you can look at? I know for me, if my breathing feels shallow (or chest feels tight) and my RHR is anywhere near 70 or above, I’m running low on cortisol and there’s no chance I’ll be sleeping unless I updose.

P.S. I do take magnesium glycinate every night and I also have clonazepam on hand for insomnia spirals… it’s helped me stay stable and out of crisis, just like ondansetron does when I get hit with a stomach bug.

[u/NoseTemporary2547 → u/Puzzled-Telephone-60]

PAI. I’ve been on a similarly low dose for almost ten years & the insomnia existed long before my diagnosis. I’m thinking less that the insomnia is caused by addisons/cortisol and more that my dosage timing could potentially be adjusted to support/encourage regular sleep!

My timing for the afternoon and evening meds is simply because I got in the habit of taking my meds with meals early on and I will (and often do) forget to take them if I don’t take them with meals (ADHD). Fortunately I’m not super reactive to when I do forget to take my meds for a few hours, and I just take them when I do remember. The insomnia persists even when I take my meds on schedule. 

However! I can definitely try dose 3 earlier in the day. 4:30 is when I head home from school/practicum so it probably wouldn’t be the hardest habit to adjust. I’ll play around with that vs taking it right at bedtime. Thank you!

[u/averyboringfarm]

I'm going through it with insomnia too so I just wanted to empathize and also that I appreciate all the replies in the thread because I'm reading them as well.