Beta Blockers ~ Propranolol/Atenolol ~ 4:00 A.M Wake Up ~ Anxiety

Just getting this on the board...though it should probably go under alternative therapies?

I have debilitating nausea - before, during and after alprazolam taper. I finished alprazolam taper on 10/10/19.  I’m currently tapering clonazepam.  Anxiety, heart racing, nausea, and looping thoughts begin EVERY morning at 4:00 a.m.  It’s been this way for months on end!! I feel like every ounce of cortisol in my body is sloshing through my brain and then being dumped into my body all at once. 

I’m wondering if I took a dose at bedtime if it would negate some of the intensity of the early morning symptoms?

Can you share your experience with either of the beta blockers in the subject line?  I was on atenolol many moons ago for PVCs (skipped heart beats) but don’t recall side effects or any other symptoms. I wasn’t on benzos at the time either.

I’ve researched online and it may be helpful easing the adrenaline surges during benzo withdrawal.  I’m more than likely in tolerance with clonazepam.  I’ve been on clonazepam for almost a year (failed crossover from alprazolam).  Idiot psychiatrist unable to compute drug equivalency. 

Thanks for your help!

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No input from buddies? 

Anyway, my doc prescribed 20mg propranolol at bedtime.  I took it last night.  I woke up at 3:30 a.m. but didn’t feel very anxious and after a bit, I was able to fall back to sleep for awhile.  I still have nausea/stomach pain.  Maybe that will improve if anxiety level drops off a bit.

I’m hoping with continued use, I’ll get into a more regular sleeping pattern. 

💜

Order a cortisol spit test with at least 4 data points. Yes, cortisol should kick on at that time. If low can come from multiple reasons. It may or may not be low other times. You can take supplements which help raise cortisol if necessary. Follow the symptoms and keep a notebook with some objective data like take your BP, pulse,BS at 4 AM.  Something is happening metabolically for it to consistently occur at same time.

Consider this: If blood sugar drops overnight, you will have a huge adrenal burst at this time. Borrow a glucometer and check before bed and in the AM. You may be dropping too low. There's a weird phenomenon where if BS drops at night, it will over compensate by AM and appear normal to a little high. Taking a protein and complex carbohydrate smack before bed may help.

If thyroid hormone is too low, especially T3, then cortisol can't kick on. Mentioned it on numerous posts to test need TSH, T3 and T4 values.

Consider finding a naturopath or other practitioner who will look at hormones, body clock, etc.

Good luck

@[ho...]

I had a full thyroid panel last month.  TSH normal, T3, T4, Free T4 normal.  I was diagnosed with hypothyroidism/Hashimoto’s more than two years ago.  Thyroglobulin Antibodies dropped from 1000+ to 658...still high but I stopped eating gluten and it’s lower. TPA dropped from 29 to 15....again, still high but gluten free.  I’ll try the protein and/or complex carb at bedtime.  I’ll try anything at this point!  You’re a wealth of information!  Thank you.

I'm Hashimotos hypothyroid as well and withdrawal played havoc with blood sugars.  Suspicious of your "OK 90-100" on waking then precipitous drops to 70s /80s  at 2 hours post food. I think you're having a rebound hypoglycemia. Look up Somolgyi effect.

Here's my experience which is similar:  The AM 90-100 is a false high that is actually a reaction to a drop during sleep. What? Why?  Because when you put food in, the body sucks it up so quickly you get a 70-80 afterwards. (Plus big weight loss) Your 2 hour post meal should be under 125, but really shouldn't drop that much.  Check it again at another 45 minutes to an hour. You're probably staying too low.  I did this.  In fact, it sometimes stayed in the 70s for hours after food and I had to deal with all the hypoglycemia stuff. Continually put food in to compensate.  Stuck my fingers infinite times because when this was happening, I could literally go from 135 to 70 in as little as 30 minutes. This adrenal burst would kick off the withdrawal. It is interrelated to the thyroid which is tied into insulin levels, etc.

*Helpful for emergency- I keep honey at the bedside. Things feel funny, take a hit. Also do ORS- oral rehydration solution (NOT gatorade, etc.) May have to order at pharmacy. This worked better than a sugary soda to get things up and keep them level.

Also did the random weird "OMG my BS is so high" thing. Not to be dismissive of your concern, but in my case it was a fluke. It was very random as I suspect if you check yours, you'll find the same.  Since your labs are OK, including A1CHgb it shouldn't be diabetes.  It was my thyroid affecting other things.  Remember T3 actually works on same brain receptors as SSRIs. When the body is stressed, T3 plummets in the tissue, but TSH can remain unchanged. Why? Pituitary not affected by toxins or tissue T3 drops from physical stressors.  T3-T4 levels can be >600 times greater in the pituitary than the body, so who knows what evil is going on.

Go to website tireddthyroid.com She has an eBook that one section talks about this paradoxical event.

Are your T3/T4 free/total in at least the 50% range? Ideal is about 75%. You can be "normal" and still Lowest ranges. I had to order it online, but got some T3 too. My endocrinologist has my labs perfect w 50mcg T4 and 12.5 T3 during my second withdrawal.  I had been in hospital for surgery then threw up for days so dropped 7 pounds. (Normally 120lbs.)  Surprisingly lowering my T4 as you did to 25mcg didn't stop the weight loss, just screwed up my labs. My T3 sucked no matter what the T4 dose until we added the med T3. The conversion of T4 to T3 quit.

Here's what is helping me right now-  I do pea protein powder in fresh apple/carrot juice at least once a day. I alternate with bone broth/complete amino acid powder in a banana /coconut milk shake. If you can only do a sip every 30 minutes, get on it. I've put on 4lbs in about 10 days.  Got it on iHerb.com. My weight was heading for the skids before this as so nauseated/vomiting couldn't tolerate real food.

I'm right there with you on this whole bizarre dance. Both darn times got into this from some hospital med following a surgery. If you need more info on what helped me, let me know.

Thanks @hothot! Lots of information to digest.  I’m not sure I can add things to my diet right now.  I’m so nauseated I can barely get/keep down what I do.  I stopped taking propranolol.  It wasn’t helping the startled early morning wake up/anxiety and I believe it was adding to my nausea.  Contrary to published reports, I think it actually was increasing my BS rather than lower as it can do.  It also interfered with falling and staying asleep.  It’s just not worth it. 

I’m going to stay with my current thyroid med. I don’t want to mess with it again.  I stopped taking levothyroxine over the winter to see if it was contributing to nausea.  It wasn’t... but did jump my TSH to almost 10.  It was at 1.8 and after the “experiment”.  I’m back to 3.3. It’s not optimal, but it’s a lot better than 10. T3, T4 are over 60%.

My weight, for the most part, is stable.  I can’t gain weight but I’m not losing right now.

What’s your medical background?  You’re very knowledgeable and I appreciate all of your advice and tips.

I’m just so sick of being sick. I hope getting to a lower dose of benzo the nausea will subside.  If not for the constant nausea, I could handle this taper so much better.

Thanks again for the info.

💜

Have healthcare background many years, but not helpful sometimes with this.  Never was taught anything about wd in school/job so had to learn on the fly and do our own research.

Not trying to overwhelm you with data, but have been down a similar path and know how frustrating it can be. Thyroid issues throw a special kink in the works. This info is from two times round the block. Even now learning. Sharing so that you might get some relief.

Propanolol only helped me with tremors. Used it as needed only. I could take it with higher BP and only 5-10mg dose. Not great with nausea.

OTC Dramamine helped the nausea the most. It's an antihistamine. I started at 50mg once a day.  Progressed to 50mg every 8 hours. You can use higher doses, check the recommendations. Wasn't perfect but greatly reduced it. Tried Zofrain and it wasn't very helpful. The gut has both histamine receptors and serotonin receptors. That's why it's called the second brain.

The thing about the shakes is when I took in a very small amount, I was able to keep it down easier than solid foods. I had irritated my stomach lining horribly from vomiting. They also very gently help the liver detox. May be later.  Your call. Glad weight stable.

Understand not changing the thyroid dose especially if you've gone through the TSH of 10. I did similarly and mine was >8. You think, "Ive got enough to deal with. " I'll offer that the high/low blood sugar swings greatly improved with the thyroid dose changes. Thyroid levels (too low or too high) can make you have nausea/vomiting even without wd (scientific studies are few but do support this.) Individualized dosing. Additionally the Hashimotos gets stressed with wd because our livers don't eliminate metabolites from drugs well.  A lot of conversion of T4 to T3 happens in the liver. Glad you're at 60% T3 T4- positive sign.  I'm lucky, my doctor was willing to see me weekly when she made any changes to keep a tighter control.  The rule of it takes at least 2 weeks to see lab changes with T4,TSH flies out the window with the withdrawal.

I use non-flush niacin and buffered vitamin C as well for symptoms. Can take lots of NF niacin to help calm down the nervous system. Might give some relief. Based on work of Dr. Abram Hoffer- see YT videos.

Leaving it with you. Pray your nausea improves.

@[ho...]

Thanks again!  I did take 50mg of meclizine today.  Dramamine is dimenhydrinate which I’ve never tried.  Maybe it would be more helpful than meclizine?  I’ll try a low dose first...then if no adverse effects, I’ll try a higher dose. Meclizine didn’t really help much other than added drowsiness to my already sleep deprived brain.  I sent a message to my doc to try Vistaril (hydroxyzine).  It may help with sleep, has some antiemetic properties and limited anxiety help. I know is just an antihistamine but I’m desperate.  I think mirtazapine pooped out on me but I’m still taking it because I don’t need another taper right now.  I’m definitely not taking propranolol anymore. 

Zofran is useless for me too.  Prochlorperazine, promethazine, metoclopramide (horrible)...not effective.

I’ve been close to vomiting but haven’t.  Hoping to keep that streak alive!

I’ll try the NF niacin.  Will it cause more nausea though?  I hope it’s truly NF as I already have sweating and heat waves especially with the early morning wake up.  20 years post menopausal so it’s not that.  Maybe TSH swings?  I don’t know.

Again, you’re a wealth of information!  Grateful to have your advice.

SG

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