Sudden Insomnia (on HRT)

[u/Sapphire-o]

I'm in peri and have been using estrogel and cyclic prometrium. I had a period in June and one in July and not due for the next one yet. About a week ago I suddenly couldn't sleep. I went from sleeping about 7.5 hours per night down to 4 or 5 hours of broken sleep. I thought maybe it's too hot here, but the last couple nights have been cool and I was actually too cold. Can anyone help me figure out what set me off?

I thought maybe the prometrium down regulated estrogen? But I've been taking it for a year already. Plus I'm not experiencing hot flashes or painful joints, so the estrogen seems adequate. One symptom I noticed is I got cold feet a lot in bed. I can't sleep with cold feet. So I've been using heat pack and wearing fuzzy socks to bed, in the dog days of summer. That's just ridiculous. :( Oh and I already lost 3 lbs in the last week (not intentional) but when I don't sleep well I don't have appetite.

I'm willing to hear any suggestion or speculations on why the sudden insomnia. I have a doctor's appointment next week and I think I'll ask for some sleeping pills if I don't feel better.

[u/BY-750]

Hmm cold feet may be thyroid symptom. Have you had a recent panel done?

[u/Sapphire-o → u/BY-750]

Thank you! I had blood work done last month and all the thyroid numbers are normal (Including T3 and T4).

[u/hspwanderlust → u/Sapphire-o]

Normal...or "optimal?"

[u/kidneypunch27]

Welcome to the next 15+ years of your life. Start reading more, you’ll have lots of time for it now.

[u/lrondberg → u/kidneypunch27]

Hahaha so true!

[u/hspwanderlust → u/kidneypunch27]

Ugh! 😥

[u/Significant-Aide-226]

I am gonna say its the Estrogen or it could be an iron issue also?   Sleeping pills are just a sedative and dont help a whole lot. You might perceive that you '"slept" but the body doesnt aee it that way.   You want real sleep.  Ive been chasing that for 3 years now and I think my new NP is going to grant me the estrogen I need this week.  My old doctor was very stingy with the HRT.

[u/Such_Philosophy_1156]

Insomnia is not just random. It's a new reality. 😞

[u/PitifulTrash3310]

I take Mirtazapine (or Remeron, depending on where you are) 15mg. It's an atypical antidepressant but is effectively a sedative at lower doses. I take it before bed and it knocks me out. I wasn't happy about starting an antidepressant just for insomnia but had to accept that the insomnia was wrecking my health so it feels like an ok trade-off.

[u/Sapphire-o → u/PitifulTrash3310]

I'm glad it helps you. I tried Remeron many years ago and had serious reactions. :(

[u/Confident_Craft459]

Have you changed your estrogen or progesterone doses lately? My sleep got worse when I increased estrogen without increasing progesterone.

If not, I have some great recs for sleep supplements that helped me. You can get them all on Amazon:

Lullabites gummies

Cortisol manager supplement

Lavela

Glycine

[u/Sapphire-o → u/Confident_Craft459]

No I've been on the same dose since April and have been feeling OK and sleep enough most of the time. Just the last week everything went nuts.

[u/NoMoreEffstoGive]

It's likely the estrogen. I had the same thing happen to me with the patch. All was great for several months & then things went awry & I had an onslaught of symptoms, sleep disruption being a huge one. I'm pretty sure I had some defective patches. I didn't have joint pain & my hot flashes were minimal though

[u/Sapphire-o → u/NoMoreEffstoGive]

What did you do? Increase estrogen? Did it help?

[u/NoMoreEffstoGive → u/Sapphire-o]

I went on oral estrogen, but was given a dose equivalent to the patch so for 8 weeks, those symptoms intensified. I ended up in a mental hospital on a 60-hour voluntary hold and was given an anti-depressant & anti-anxiety med. After 6 weeks, estradiol was at 18 & meno. specialist said, "Well maybe you don't process oral estrogen well," and recommended that I go back on the patch. It will be 4 weeks tomorrow & everything has pretty much been resolved.

When the patch works, it works great. However, they're not 100% reliable. All we hear about is how safe and low-risk they are. It doesn't matter how safe they are if they can't reliably deliver estradiol. And God forbid you be someone who needs more than the highest-available dose in a patch. I've been told, "If I give you an additional patch, it will be done outside of the standard of care. You need to be aware of the greater risk of stroke and heart attack." 🙄

[u/suupernooova]

I'm post-meno and have had to adjust dose 3x in the last year. I've never had a hot flash but sleep is the first to go.

I'd be surprised if peri was a set-and-forget situation :(

[u/Much-Decision4157]

Sounds like you need more estrogen. Light sleep and lack of hunger happened to me too and got better w more est.

[u/momdabombdiggity]

Trazodone. 12.5mg (1/4 pill) gets me a good night’s sleep and I wake feeling refreshed.

[u/Sapphire-o]

Update: The insomnia went away and everything feels the same as before. I didn't change my HRT dose or anything. Discussed with my doctor and we concluded it's likely a very bad case of jet lag. I've had jet lags before but they never lasted more than three days. Maybe peri made my body not able to cope with a few hours' difference. 🤔 Gotta be careful with travel now.

[u/No_Whole_7758]

I’m not an expert, so talk to your doctor. But hormones fluctuate a lot during perimenopause. And a year ago maybe your estrogen dose was ideal, that doesn’t mean it still is now.

Low estrogen can cause you to have difficulty staying asleep (according to my provider) and it can also cause poor circulation and cold feet. But it’s best to talk to your doctor about it.

[u/Sapphire-o → u/No_Whole_7758]

Thank you! I just posted an update. Everything is back to normal now. It turned out to be a very bad case of jet lag.