Waking in the night feeling anxious and with a jolt of fear, having a panic attack, experiencing feelings of impending doom, with a pounding heart and even feeling depressed is a common issue I see with clients and it’s a common question that I’m often asked on my blog and on Facebook.
Here is a typical question you may relate to:
I usually wake between 5-6 am and have this overwhelming feeling of dread and start thinking of all the things I have to get done. And then I can’t fall back asleep. What is this?
Or this one:
Does anyone have severe depression when waking up in the middle of the night, but never during the day or before falling asleep. It doesn’t go away until after I’m fully awake and upright in the morning.
Low serotonin?
Serotonin is known to dip later in the day and at night and we know low serotonin can cause depression and insomnia/waking in the night, so my first thought would be to assess for low serotonin and address this if it is the case. I use the questionnaire and trial method.
I always start with tryptophan, but may switch to 5-HTP if that’s not working as expected as some people do better on one versus the other. We add melatonin if the tryptophan or 5-HTP isn’t quite enough to help with the waking.
There are many possible causes of low serotonin so over the course of the next few months these will be addressed too, on a case by case basis. Some of the causes in include: a poor diet, low stomach acid, malabsorption, low zinc, low B6, low iron, low magnesium, dysbiosis and/or parasites and/or candida, the birth control pill, MTHFR defects (with this defect expressing) etc.
Low GABA?
Low GABA levels may be a factor too as this can contribute to insomnia and waking, especially when there is physical tension. New research reports GABA’s involvement in unwanted thoughts and it’s a common factor in my community and clients. Again, I use the questionnaire and trial method to find the ideal amount of GABA for each person.
High cortisol?
High cortisol in the night can also be a factor and I suspect this when someone says they wake with a jolt of fear or feels what they describe as an adrenalin rush. Saliva testing can confirm cortisol levels and Seriphos is the best product I’ve found to lower high cortisol. Addressing low blood sugar and finding the root cause of the adrenal issues are also key. General adrenal support with B vitamins and adaptogenic herbs are often needed too.
Hormone imbalances and/or PMS?
Here is another typical question you may relate to:
I’ve had the worst week regards 3am panic attacks, lurid dreams and wake up aching. It always feels like the end of the world and yet I get up and stagger out to do my morning routines and all is right with the world (apart from physical aches and pains). I have often had bouts of this. It’s a week to go until my period.
If the anxiety or panic attacks are cyclical and tied to your menstrual cycle I will still start with a trial of tryptophan which has been shown to help PMS, tension, depression and mood swings. Serotonin support also helps with fibromyalgia-type aches and pains.
A trial of GABA is often needed too and can help with alleviating the panic attacks, waking and some of the aches. Other factors like a gluten sensitivities, adrenal issues and high oxalates may also play a role in physical aches.
Lurid dreams clues me into the possibility of low vitamin B6, which is an important co-factor for making both GABA and serotonin, as well as being important for alleviating PMS symptoms and the social anxiety condition called pyroluria. The pyroluria protocol, with vitamin B6, zinc and evening primrose oil, helps both the social anxiety as well as PMS symptoms and insomnia.
Address the basics
You may be looking for the perfect supplement to help and while the amino acids come pretty close to being that, it goes without saying that you want to always address the basics. This means making sure you are eating a real whole food diet with quality animal protein and getting that animal protein at breakfast in order to balance blood sugar. The following needs to be eliminated too: caffeine, gluten and sugar. Some individuals do even better on a ketogenic diet.
Looking at sleep hygiene factors fall under the basics too: a dark, cool and quiet room, no PC or iPhone late at night, no iPhone or other EMF sources close by, sunlight exposure in the early morning etc.
And we mustn’t forget stress reduction, exercise and nature.
Address other bigger issues
Medication side-effects must always be considered. Here are a few examples:
- benzodiazepines, commonly prescribed for anxiety and insomnia, can increase anxiety and worsen insomnia as tolerance develops and during withdrawal
- beta-blockers, prescribed for high blood pressure can affect melatonin levels;
- some antidepressants ‘may worsen or cause primary sleep disorders like restless legs syndrome, sleep bruxism, REM sleep behavior disorder, nightmares, and sleep apnea, which may result from an antidepressant-induced weight gain.’
Hashimoto’s thyroiditis must also always be considered especially when there are fluctuations in mood, anxiety and sleep. These fluctuations in mood and anxiety can happen at any time of the day and not necessarily in the night.
If the insomnia and middle of the night anxiety and depression persists we continue to dig and look at dietary histamine and oxalate issues, SIBO, parasites and other digestive issues.
If we are still not seeing all the expected results then a referral for Lyme disease, mold toxicity, sleep apnea, TBI (traumatic brain injury) and heavy metals may be needed. Current or past trauma and support for PTSD must also be considered – this can be therapy-based and nutritional support.
My checklist
My checklist when I start when working with someone with issues similar to the above. This will be tweaked based on each person’s own biochemistry and where they are in terms of diet, supplements and lifestyle:
- Low serotonin? Do a tryptophan or 5-HTP trial
- Low melatonin? If tryptophan or 5-HTP trial isn’t quite enough then add melatonin
- Low GABA? Do a GABA trial
- Low blood sugar? Add quality protein at breakfast, plus glutamine
- High cortisol? Support the adrenals and use Seriphos or something else to lower the high cortisol
- PMS/sex hormone imbalances or Hashimoto’s? Address with diet, nutrients and hormone support as needed
- Low magnesium, low zinc, low B6, low iron? Assess for these deficiencies and address them
- Gut health issues like leaky gut, dysbiosis, candida, parasites, SIBO? Address these issues
- Histamine, oxalate or other dietary issues? Address these issues
- Medication side-effects? Figure out which one is an issue and work with the doctor to taper if needed and address why the medication was initially prescribed.
- If the issue persists – a referral for Lyme disease, mold, sleep apnea and/or heavy metals etc
As you can see there are many overlaps with some of the 60+ root causes of anxiety.
Here is additional information on tryptophan for low serotonin, GABA for low GABA and glutamine for low blood sugar, plus the list of supplements I use with clients.
As always, if the amino acids are new to you, review the precautions and be smart about using them. My book The Antianxiety Food Solution (Amazon affiliate link) has an entire chapter on the amino acids, plus chapters on diet, gut health, caffeine, blood sugar and more.
We’d love to hear which of the above approaches have helped with your insomnia and waking with a jolt of fear or dread or pounding heart.
I had depression during the day off and on, plus, insomnia at night. During the night I would wake up with depression too. I went on hormones and something to help my low cortisol levels. I have more energy now, my depression is gone and I sleep better. I also started taking a very high quality magnesium glycinate, helps a lot more than magnesium citrate ever did.
Jo
Jo
Thanks for sharing – so glad you found your solutions
Wonderful summary!!
I just had these symptoms happen to me while taking Doxycycline for a respiratory infection. It started the first night, and got worse each day I took the medication. I had nightmares, early morning dread, anxiety, feeling like I was going to “lose it”, depression during the day, and dimmed eyesight – it was really awful! I stopped the medication after 5 days of this, and the symptoms cleared over the next few days. There is nothing about this on the package insert, but a quick Google search showed Doxycycline to cause these symptoms in some people. It just goes to show that medications should be suspected when new symptoms appear like this, even if they’re not listed as side-effects!
Cathy
Sorry to hear and thanks for sharing. You were smart to go looking and finding the cause. It’s something we need to all get in the habit of doing. Also making that connection and being a detective: “my sleep/anxiety/dread is bad, what just changed? I was prescribed x med – could that be a factor?” It could be a medication or even a supplement like adding a B complex or omega-3s at bedtime or even adding methylfolate when you discover the MTHFR polymorphism.
This is a good site for checking side-effects https://www.drugs.com/sfx/doxycycline-side-effects.html because the inserts do not seem to list everything amy more. Asking the pharmacist is also a good idea. And online forums where real people share their results usually very helpful often.
Thank you for this article Trudy! I was looking at my latest cortisol test that my functional medicine doctor ran for me After reading this blog post. It says my daily free cortisone pattern is a little on the low side upon waking and normal/low in the morning but then at night it is high- on the border of out of range. There is a 24 hour free Cortisone number, a 24 hour free Cortisol number, and then the four numbers for the different times of the day? What is the difference between all of those? My 24 hour free cortisol is below range, but my 24 hour free cortisone is within range? And then there is the abnormal night time range…. Doesn’t that all contradict each other? Thank you!!
April
I suggest checking with the doctor who ordered the test and use this feedback in conjunction with symptoms. If someone is waking with a cortisol-like surge and fear in the night with results like this I’d consider a trial of Seriphos. I’d also look at low serotonin, low GABA, low blood sugar etc as possible factors too
Can you also take Seriphos for just overall elevated cortisol? Would It be the same protocol?would I just take one at night?
HI Trudy,
I had a urine test done, and had to mail it to Kentucky, my doctor doesn’t do these tests. When I got it back it said that my oxalates were off the charts. I asked my doctor to explain it but he said he had no idea about these tests. Is there something I can do to get my oxalates in order on my own?
Thank you, Mickey
I’m also in a constant state of fear, and am even having trouble going to my appointments now. I’ve stopped going out of the house altogether. My omega 3 and 6 levels are high, which I don’t understand, because I don’t take fish supplements or even eat fish, nor do I take evening primrose oil. That doesn’t make sense to me either. I ‘ve read your book several times, but a lot of the answers don’t seem to pertain to what I’m going through. Can you help? Thanks again
Mickey
Your doctor can do a consult with Great Plains if they are the lab who did the test (assuming it was an OAT) or whichever lab did it. I have clients slowly reduce high oxalate and then medium oxalate foods and use vitamin B6 and calcium citrate to counter the effects of dietary oxalates. The Trying Low Oxalates group on facebook is very helpful for support.
High oxalates are typically a factor in pain symptoms but can also trigger anxiety and social anxiety. ‘For the anxiety symptoms you describe I also look at low serotonin, low GABA, high cortisol, low blood sugar, gluten issues, caffeine and sugar consumption etc (all laid out in my book)
I’m not sure what to think about the high omega levels unless it’s due to good fat digestion and high consumption of grass-fed red meat and nuts/seeds
Hi Trudy! I have ADHD inattentive type and low blood pressure, but I noticed that whenever I’m under stress, the ADHD backs off. Whenever the stress is over it comes back though… I’m working out 5 times a week minimum. Tried L-Tyrosine but it didn’t help. My question is weird for this blog, but speaking of anxiety, is there any amino acid that can INCREASE the level of stress/anxiety? And also wouldn’t make my newly diagnosed Hashimoto’s symptoms worse. I mean I read about Phenylalanine. What do you think about it? If you could reply, I would appreciate it a lot! Thank you!
Katie
Too much of any of the amino acids or using once when levels are not low can increase anxiety. Collagen can also increase anxiety in some susceptible folks – more on that here https://www.everywomanover29.com/blog/collagen-gelatin-lower-serotonin-increase-anxiety-depression/
Hi Trudy, I also wake up in the middle of the night or too early in the morning stressed. I start sleeping much better and deeper in the first half of the night thanks to L-Tryptophane from Lidtke. I would like to take the Seriphos Interplexus together with the Tryptophane.
Two questions: can you use them both at the same time? And testing for high cortisol isn’t so easy and very expensive. What if I just try the Seriphos at night and see if it works, without the test? Can that do any harm?
Claire
So pleased to hear the tryptophan is helping with deeper sleep. Ideally I refer to test for high cortisol but I’d be open to doing a trial of Seriphos for a month if a client could not afford or do testing. I’d expect to see results in about a week or two.
Hi Trudy
I’ am stressed with some panic attacks. I wake three times each night.
I’ve just received my urinary neurotransmiters test results.
Only adrenaline and gaba are ok. I’ve low dopamine, serotonine and noradrelanine.
I’ve read your book, so i take following:
– 1500mg l-tyrosine at raising and 11 am.
-1000 mg l-tyrosine at 3pm
– 150mg 5-htp at 4pm and 10 pm
– 500mg Gaba at bedtime
– 1mg melatonine 30mn before bedtime
– 200mg magnesium at breakfast and lunch
– multivitamine at breakfast.
– omega3 twice at breakfast and lunch.
I’ m thinking to add 600mg of ashwaganda 3 times a day.
What do you think.
Many thanks
Paul
I use the questionnaire (and don’t reply on urinary neurotransmitter tests) and do trials of one amino at a time, starting low and increasing until we see results. That way we know what is helping. I’m afraid I can’t offer specific advice via the blog.
It’s also important to address diet, gluten, gut, caffeine etc
Anyone who wakes with a jolt in the night, particularly if accompanied by a nightmare or feeling of anxiety, should be tested for sleep apnea. You don’t have to be overweight to have this condition. Using a CPAP isn’t fun but it’s very effective and I don’t go anywhere without mine.
Diane
Absolutely! I do include sleep apnea and yes anyone can suffer with this condition. Keep in mind it’s also good to look into root causes of sleep apnea too (like thyroid conditions, low vitamin D, low GABA/high glutamate, low testosterone/cortisol ratio etc)
Hi Trudy
How much time cake to l-tryptophan To convert to 5htp and then To serotonin?
Same question for tyrosine To convert to dopamin?
Many thanks
Adil
When the amino acids are opened my clients typically feel results in 1 to 10 minutes
HI Trust
Thanks a lot for your answer.
When i take l-tyrosine, I dont feel the results. I’ve tried to take from 500mg To 1500mg three times a Day (6am, 11am and 3pm). At 6 am and 3 am, i take also vitamin B complex. Do you have and idea?
Manu thanks
Adil
When the amino acids don’t help it means you don’t need them, it’s not enough or there is a quality issue or thyroid function is low
My problem with insomnia was due to antidepressants, I had two different kinds of antidepressant at the same time, amitriptyline and Cipralex ( Escitolopram ), the first one was recommended by an urologist to treat a nerve problem in my bladder ( pulssing feeling) and Cipralex was given to me by a psychiatrist who thought that my nerve bladder problem was caused by anxiety, and I was worried at that time of my life ( perfect excuse to prescribe the drug ). He didn’t tapper the first medication and added the second one. I had every kinds of side effects described on the prescriptions and after two months I had to stop them abruptly because I thought I was going to die..( hallucinations in the night etc.. ). It is more than one year gone, and I’m not taking those medications, but they left me with insomnia, and other symptoms, twitching and numbing muscles at night, swelling in the back of my throat and nose that goes and come back, most of this things happen in the night most of the time.
I’ve tried GABA, it seems to give me numbing in my limbs, so maybe the problems is high serotonin ?? I’ve heard it can give you anxiety and insomnia if the levels are too high or two low, and those drugs were involved in serotonin receptors.
I don’t sleep but I don’t feel tired at all though sometimes I forget things. It’s like my body has extra energy but I’m not rested.
Apart from that I have to say I have the slow version of COMT gene, ( comt +/+ ) which degrades dopamine and other catecholamines very slow. I’m not sure if that affected my outcome when I took those drugs. I never struggle with fatigue in my life and I though it was due to my slow version of COMT maybe, I’m on the anxious and hyperactive side of the problem. I shouldn’t have taken those drugs..
I tried many kinds of B vitamins as well and some of them makes me worst, more active, by the other hand GaBa gave me numbing and Chelated buffered magnesium helped a bit but still doesn’t solve the problem with insomnia.
I had a complete thyroid panel done and everything seems to be ok. I don’t know what else I can do.
Check my cortisol level ??
I need to see a practitioner that understand about withdrawal effects of these pills in your brain. Everyone seems to be too busy at the moment, Could someone recommend me a practitioner available at the moment? I live in the UK. thanks
Maria
Unfortunately many psych meds can contribute to insomnia at the time of taking them and especially when they tapered abruptly. I would work with someone and look into low serotonin, high cortisol and support for the effects of these medications. Melatonin can be helpful in many instances. When something works a bit – like magnesium – I work with my clients to dig deeper and see if higher doses or other forms may help further.
I have done a few things that have changed my insomnia that resulted from menopause and shift work quite a bit. I had a test run for IgG sensitivity to foods. It is like an allergy test but it reveals foods that cause inflammation anywhere in the body. I had already given up wheat and that helped tremendously. But the test showed the worst reaction to cow dairy.
So I switched over to sheep and goat dairy for my cheeses and milk. That took a while to notice the difference but I certainly did. Then a really great thing was to have dinners very early, like 4:30 or 5:00. That gives your brain and body a chance to have really good nutrition get into your cells. While you are still fairly active at 4:30 or 5:00 your insulin works much better and open cells up and bring your blood sugar down in a healthy way. They say if your blood sugar stays high all night from insulin not working as effectively (because cortisol is lower at night than during daylight) it will disturb your sleep. So I have discovered that was my problem! I eat early now and get everything cleaned up in the kitchen and leave the food in containers in the fridge for whoever chooses to eat later. This has also helped me lose weight. I also eat low carb and that is great too. Where blue blocking amber glasses at night to get your brain to calm down too. When I gave up bread and cow dairy my life really changed. So now I hardly am waking in the middle of the night at all. I used to have that depression and worry in the middle of the night, but not now. I used to wake up in the middle of the night like that if I had gotten to sleep, but no longer. Wheat definitely should be dumped by most people.
Hope that helps
Jo
Jo
Thanks for sharing and well done for figuring out what was causing your insomnia. I agree with you on the wheat/gluten comment – huge issue for anxiety, sleep, poor focus, pain, thyroid, leaky gut and more.
My son is in an extreme, constant state of panic over covid 19 and believes he has it or will have it soon. He is on Ativan and 50 mg of Zoloft. Is it safe to start the supplements you have listed ? This happened when he was in grad school with a different health ailment and was able to overcome it with meds and counseling, which he is receiving now as well. He is 29 years old. I will be so grateful for any help and advise❤️
Loretta
I’m sorry to hear about your son’s fears and panic. In a situation like this tryptophan would be my first choice but I only use tryptophan or 5-HTP with a client with monitoring by the prescribing doctor and 6 hours away from the SSRI (like Zoloft). Keep in mind that both Ativan and Zoloft can actually contribute to some of the panic-stricken feelings.
Hi Trudy!
Do you believe a good test of amino acids should be done before adding in CBD? I have full spectrum tincture on hand high quality. No THC. I am guessing I have low serotonin and high cortisol from your questionnaire. I could not fall asleep when taking 5 htp but the past two nights when switched to 400 mg l theanine and melatonin at bed time, I have fallen Asleep easily. Should I still try tryptophan? . Holy basil tea really relaxes me also which I drink at 8:30 pm and in afternoon. Can I drink that regularly as an adaptogen? I follow the specific carbohydrate diet so I am hesitant to take Ashwagandha or the others as roots are polysaccharides
With the l theanine I sleep for 21/2 to 3 hours then wake up. I took 30 mg of CBD for the first time last night but it didn’t make me sleepy. I often wake up feeling anxious and can’t stop racing brain.
Thanks!!
Katie
Glad to hear theanine and melatonin is helping you fall asleep. I like to establish what works before adding anything new – and have clients increase what is working until no further benefits are seen.
Thanks Trudy!
What seems to work one night doesn’t work the next. Can melatonin, maybe too much make you wired? I have a 3 mg time released pull from Douglas labs I cut it in half as best I can but sometimes end up with smaller piece sometimes bigger. Can a little too much make you not sleep I can’t figure out why some nights I can’t fall asleep and some nights I can’. Thank you!
My begin when I hemorrhaged. Several years ago, they gave Moloxicam for pain. I only took for a week or so. My back killed me with pain. I hurt so bad could not sleep. I had to go to two different hospitals to figure out I was even hemorrhaging . My potassium dropped to 2. dehydrated . My hair fail out. Iron was 9. They released me and finally third trip they sent to a hematologist. He took one look at me and said any new meds. I told him . He looked my eyes and fingernails , said you’re hemmoraging. Blood and stool confirmed it.
What’s odd. I taken klonopin for years and it don’t work now. One millagram.
I did find something that helped , had gaba in it.
I m not sure what happened. I take vitamins. Melotonin and no help. I do not abuse the drug. Only at night.
Last night, I awoke 2 or 3 am in sheer panic.
Anxiety. This has never happened. I swim. Walk.
My emotions are strange as well. I no longer laugh nor cry. Could I have had a stroke.? Ischemic. They gave an X ray in the hospital. Doctor ordered me there. I took saline and potassium for 3 days.
I was bad off. Weak for a year of so afterwards.
I’m still not right.
My bp is going up.
Afterwards , after hospital I could not control bladder nor empty bowels. Thank god can now.
This happened 4 years ago. Every doctor I talk to. No answer. They just stare at me like I’m a drug seeker. I’m not. I use to sleep well.
MM
I encourage you to find a functional doctor to work with and do a full workup. And find someone to help you taper off the benzo which can cause rebound symptoms of anxiety and insomnia. Feel free to search the blog for articles on benzodiazepines.
It goes without saying that dietary factors are key too – no gluten, no sugar, no caffeine, quality animal protein, healthy fats, organic veggies/fruit and fermented foods plus eating for blood sugar balance (all explained in my book “The Antianxiety Food Solution” https://www.everywomanover29.com/blog/the-antianxiety-food-solution-by-trudy-scott/)