[z8080]

Hi everyone, 40 y.o. male here.

I normally fall asleep easily, and although my sleep is quite fragmented, what I’ve really been struggling with for the past 6 years is a much more specific sleep disorder, that I might call an “early morning syndrome” (will refer to it as EMS). Namely, 1-2h before it’s time to wake up, I become increasingly restless, turning frequently from side to side. In this “muddy/foggy brain” state, I’m half-awake and almost hallucinating about having to wake up – but being unable to.

I eventually wake up after a very tiring couple of hours of this struggle. This means I often oversleep my 7.5h target by that much, and will have spent 9-10h in bed, only to feel more tired than when I went to bed.

What’s even worse, that weariness will follow me throughout the day, peaking during several fatigue attacks in a day. The first one starts minutes after I leave bed, when I often succumb to an intense feeling of tiredness the entire body. I typically lie down and stretch&yawn compulsively for ~15min (rarely fall asleep), before I can function again. This repeats up to 5-7 times per day.

Nowadays, about 9 out of 10 mornings I have EMS. On the 1 morning I wake up without EMS, I’ve no fatigue and can focus well that day. Also, this proportion fluctuates throughout the year: I have some good months, followed by bad months. My impression is the problem might be worse in the cold months.

Because of the fragmented nature of my sleep, I will often see it’s e.g. 6am but will feel almost fully rested. If I call it a night and wake up at that point, I avoid the EMS and the subsequent daytime fatigue. If I decide to sleep till alarm time to get a “full” rest, in most cases this will backfire and evolve into the dawn syndrome described.

I’ve tried the trick of getting at least the first good part of the night in, and waking before EMS kicks in, but it’s hard to nail the right moment to set the alarm, and often I’ll be too tired to be able to wake up after only 6h.

Two other symptoms are correlated with (or, plausibly, are effects of) EMS. First, after an EMS waking, I will typically have tinnitus for most of the day. Indeed, the first time in my life I became aware of tinnitus was 6 months after the onset of the EMS itself.

Second, during the “bad months”, the skin on the back of my hands becomes extremely dry, and will crack and bleed in parts. No dermatological cause for this has been found, and the correlation with the sleep-quality fluctuations are among the most obvious I’ve noticed in my log-keeping.

Etiology: I come to this forum after having checked every diagnosis suggested to me by multiple specialists. The following have been ruled out after investigation: sleep apnea, epilepsy/narcolepsy, ear-nose-throat, thyroid. A sleep-lab recording suggested a possible mild REM-sleep-disorder, but this wasn’t replicated later on. My blood tests lately always show high cholesterol (~215) and LDL (~135). Magnesium, Iron and Transferrin fine.

Many of those unconfirmed diagnostics ended with the medic suggesting it’s “just psychosomatic”, which of course offers little hope for treatment. I do have an anxious personality, with occasional depressive tendencies, so I admit this is plausible, and I should perhaps give CBT a more solid try. But (i) surely this should affect sleep throughout, and not just its final stage; and (ii) the good-months/bad-months pattern of fluctuations in the EMS doesn’t seem to follow my stress/happiness levels at all!

Anti-depressive medication I tried (Circadin, Trittico, Mirtazapin) didn’t help. Also not (entirely) effective were: avoiding PC/phone screens shortly before bed (between work and others I spend ~10-12 PC hours a day), breathing/relaxation techniques, meditation, other sleep hygiene tips, bio/neurofeedback, avoiding alcohol in the evenings, and going to bed earlier (typically: 11-12pm). I still suspect doing all of those things “right” helps, but often this is difficult, and certainly no one of them explains EMS single-handedly. Right now I have no known combination of precautions I can take to reproducibly avoid EMS.

The only remaining checks recommended (though admittedly unlikely) concern the adrenal glands, 24h blood-sugar measurement, evening cortisol levels, which I will do soon.

I apologise for the length of this thread, but I felt if anyone is to reply, I’d better put in all the relevant information. I’d be extremely grateful for any experiences from people who maybe have the same syndrome, and who could perhaps suggest possible causes/diagnoses, either somatic or “just psychosomatic”.

Many thanks in advance!

[z8080]

This is a diagram showing the pattern of sleep fragmentation described, getting progressively worse towards morning: https://imgur.com/a/sjPJKEX

[hiker]

Hi z8080, I am not a medical professional so I cannot speak to your various diagnoses and treatments all that well, other than to say that “just psychosomatic” is similar to what I have heard, from what I refer to as “medical engineers.” Traditional medical school training provides a solid scientific background but fails to include the role of the mind.

It is easy to resent phrases like “it’s all in your head” when coming from a clueless medical engineer. Some physicians do get it—that emotions and physical manifestations are connected. You might want to check out unlearnyourpain.com with Howard Schubiner, M.D.

And most definitely CBT. Dr. Schubiner gets into it, and on this website Martin offers a full course. Plus videos and e-mails explaining it. I get the impression that you might be analyzing yourself into a corner, much like this retired lawyer has done about insomnia and lots of other stuff. “It’s all in your head” may prove to be accurate, though not in the ignorant, patronizing tone you may have heard in the past.

Take care.

[Martin Reed]

We typically see more sleep fragmentation later in the night — because the body prioritizes deep sleep, we usually get the deepest sleep in the first couple of hours of the night and then cycle through progressively lighter stages of sleep as the night progresses. So, your sketch doesn’t look particularly unusual.

In my experience, I often see people who are getting a good amount of sleep but still complaining about light and fragmented sleep allotting too much time for sleep. The extended sleep opportunity can lead to lighter and more fragmented sleep toward the end of the sleep period and this can, in turn, lead to a sense of heightened grogginess and fatigue.

I’m not a doctor, so I can’t give you specific advice, but it might be worth considering whether allotting a specific amount of time for sleep that is more closely aligned with your 7.5 hour sleep “target” (perhaps by setting an alarm and always getting out of bed by the same time each day) might be helpful.

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