@jigawatt Hi, I’m /agirlinabook and I’m sorry you’re feeling this way. I’m also a physician, but not one seeing you in person, so I apologize if any of this isn’t relevant or is generally a miss!
I’ll start by saying – your symptoms are real. There are many things that medicine cannot yet explain, and that does not make your symptoms not real even if there hasn’t been something obviously found to be wrong. It sounds like you do not have what we would diagnose as a disorder of either your HPA or your adrenal glands. Of course, our hormones fluctuate up and down over the course of the day and in response to different stimuli- and this is normal. This is what they should do! Fluctuations below the levels that would show up on our tests are therefore in the range of “normal,” though of course everyone lives in a different body and experiences things differently. Unfortunately, an entire industry has sprung up around the idea of ‘adrenal fatigue’ and ‘subclinical HPA dysfunction’ that is really not based on any sort of evidence and preys on people who are doing their best to listen to their body and trying to do what is right.
I don’t know anything about you, other than what’s in your post and other posts of yours, but if you came into my office today and told me exactly this, the top two things I would worry about (with what medical knowledge exists in the world today) would be 1) interactions between supplements 2) anxiety & insomnia.
With regard to 1)- the supplement industry is extremely horribly regulated. One does not actually know what/how much is in a lot of the supplements we can buy freely. Because of the lack of standardization, it is also almost impossible to do real research on individual supplements, and especially difficult to research how they interact with each other. But I can tell you in my time as a doctor, I have treated a LOT of people with adverse effects I can only be traced back to their supplements/vitamins/herbals- all of which they were taking because they were trying to do the right thing to protect and strengthen their body. My general advice, which is the same as most good physicians, is the cut down on this supplements. I would not take more than two. Humans really should not need ANY supplements or multivitamins if they eat a well-rounded diet (unless they have specific medical conditions, of course).
With regard to 2)- let’s talk about insomnia first, because it is common, but hard to treat, and has a huge impact on quality of life. I hear you that you’re waking up most nights- that’s incredibly bothersome, and no doubt makes every other symptom that you’re feeling worse. The body needs sleep! I do expect cortisol after working out maybe elevated, I would expect that more to interfere with your ability to fall asleep, not stay asleep. The fact that hot flashes are waking you also makes me extra suspicious about medications/supplements, and also makes me wonder about your sleep environment. The first, and most evidence based, treatment for insomnia is: sleeping in a cold, dark, quiet room (white noise machine is ok, TV is not ok), going to bed at the same time every night, having a bedtime ritual that is predictable and standardized, using your bed only for sleep, and completely avoiding electronics (& cell phones) at least an hour before bed. Let’s be real- almost no one does these things, not really, even though we say we do. But the fact is, if you manage to do all of that - FOR REAL- and to do it consistently, most people’s insomnia will be fixed. If that doesn’t work, the second step is CBT-i (cognitive behavioral therapy for insomnia). I cannot impress on you enough how well this works, though almost no one tries it. With regard to the anxiety – I’m glad you’re seeing a psychiatrist! That’s wonderful. It also sounds like you’ve made really strong progress in decreasing stressors in your life, which is no small feat, and has huge physical and psychological effects. I hear your reluctance to try an SSRI, and that’s fine, but I do want to offer the SSRI’s are not impacting total body serotonin (you mentioned serotonin not being a problem for you anymore), but rather serotonin just in the brain. Other meds that are known to help include SNRIs, TCAs. I also want to offer that being on an anti-anxiety medication like one of the above is not necessarily signing up for a lifetime of that medication- think of it more treating where you are, right now. I also would strongly suggest therapy, or CBT, in addition to seeing psychiatry – we know that mental health treatment works best when it’s a combination of different types of treatment. And anxiety is a huge, huge, huge culprit for insomnia. I’m glad you’re getting another sleep study done, which I think is a great idea- OSA can manifest as anxiety and exhaustion, and certainly wakes you up at night. I also think you should address with your doctor why you are getting up 3 to 4 times a night to pee, especially given you’ve already restricted water two hours before bed. Even if that’s just your normal, and not the sign of a bigger problem, waking up that much is no doubt further exacerbating your sleep problems.
That was long because I tried to explain my reasoning, so I apologize if it was excessive! TLDR, my take home recs are: 1. Do not be on more than two supplements at a time. Seriously. 2. Significantly limit caffeine (literally nothing with any caffeine in it after noon, including workout supplements) 3. Do the sleep hygiene stuff ALL THE WAY 4. Keep considering things that will treat your anxiety, including medicines, 5. Good luck on your sleep study, and 6. Get this nocturia situation checked out.