Managing Sleep Patterns and Autonomic Nervous System Disorders

Q: Managing Sleep Patterns and Autonomic Nervous System Disorders

We recommend that you： 1. <br>Discuss the above situation further with your attending physician, focusing on symptom management or determining if further examinations are necessary. <br>2. <br>Consider seeking treatment from other medical institutions as well. <br>Thank you, and

Adjustment of daily routine / Autonomic nervous system disorder

Hello Dr.
Hsueh, I would like to ask you some questions regarding my daily routine and autonomic nervous system dysregulation.
I am a 33-year-old female with systemic lupus erythematosus.
I was originally taking five 5 mg doses of corticosteroids (Prednisone) but have reduced it to four pills over the past two weeks.
My other regular medications include half a 50 mg dose of Azathioprine, one 200 mg dose of Bupropion, and one 5 mg dose of Domperidone.
Additionally, I take one 20 mg dose of Pantoprazole, one 10 mg dose of Propranolol twice daily (for migraine treatment), and iron supplements.
Currently, I am experiencing elevated blood pressure, occasional migraines, and gastrointestinal discomfort or diarrhea when I have trouble sleeping.
Two weeks ago, I underwent an endoscopy, which revealed gastroesophageal reflux and bile reflux.
The gastroenterologist indicated that the bile reflux might be related to autonomic nervous system issues.
I usually do simple stretching/yoga in the morning and meditate, and I elevate my legs before bed.
However, I have had difficulty falling asleep since childhood, often sleeping only 4-5 hours during my studies.
In college, as a design major, I frequently stayed up late to finish projects and would catch up on sleep afterward.
Although I once maintained a schedule of going to bed at 9 PM and waking at 5 AM due to work, I reverted to late-night habits shortly after leaving that job.
I generally do not have trouble lying in bed awake, but sometimes I feel alert or mentally active even when I am tired.
For instance, after a tiring day, I might still feel energetic the next day and not go to sleep immediately.
I also tend to delay going to bed due to reading articles on my computer or phone, and I occasionally get caught up in planning my schedule (a habit I have maintained).
My freelance work allows for sufficient sleep even if I go to bed late, but my schedule does not align with societal norms, which can be inconvenient.
If I need to wake up early, it adds stress, especially with my lupus and concerns about a weakened immune system.
Recently, my menstrual cycle has also been prolonged, and I have persistent HPV-related inflammation that has not resolved, leading to increased susceptibility to infections or bleeding due to low immunity.
Therefore, I feel the need to adjust my routine.
(I do not consume caffeine, but I occasionally eat cake or similar foods in the evening.) I would like to ask the doctor: 1) Because I wake up late, I sometimes take three doses of my corticosteroid medication after 3 PM and then two more around 5 PM.
Could this lead to difficulty sleeping at night? 2) Is it possible that my difficulty in calming my mind at night is due to heightened sympathetic nervous system activity, or is it simply a result of long-standing lifestyle habits that have disrupted my circadian rhythm? 3) I would also like to know if migraines are related to the autonomic nervous system.
I find that if I sleep only 5-7 hours for two or three days (I usually need about 9 hours to feel rested, and sometimes I can sleep 10-12 hours without setting an alarm), I am very prone to migraine attacks.
4) Do you think my situation indicates autonomic nervous system dysregulation? 5) If I want to adjust my sleep schedule/habits, what recommendations do you have? Thank you! Ann

Ann, 30~39 year old female. Ask Date: 2022/10/13

Dr. Xue Gengming reply Psychiatry

We recommend that you: 1.
Discuss the above situation further with your attending physician, focusing on symptom management or determining if further examinations are necessary.
2.
Consider seeking treatment from other medical institutions as well.
Thank you, and wish you good health!

Reply Date: 2022/10/13

More Info

Dear Ann,
Thank you for your detailed inquiry regarding your sleep patterns and autonomic nervous system (ANS) issues. Your situation is indeed complex, especially considering your medical history with lupus and the medications you are currently taking. Let’s address your questions one by one.

1. Medication Timing and Sleep: Taking corticosteroids like your current medication can indeed influence your sleep patterns. Corticosteroids can have stimulating effects, particularly if taken later in the day. If you are taking your medication around 3 AM, it may contribute to difficulties falling asleep or staying asleep. Ideally, corticosteroids should be taken in the morning to align with the body's natural cortisol rhythm, which peaks in the early morning. I recommend discussing with your physician the possibility of adjusting the timing of your medication to see if it improves your sleep quality.

2. Difficulty Achieving Mental Calmness: Your challenge in calming your mind at night could be attributed to a heightened sympathetic nervous system response, which is often associated with stress and anxiety. Long-standing habits, such as late-night screen time and planning, can also disrupt your ability to unwind. It may be beneficial to establish a calming bedtime routine that includes activities such as reading (a physical book rather than a screen), gentle stretching, or mindfulness meditation to help signal to your body that it’s time to wind down.

3. Migraine and Autonomic Nervous System: There is a well-documented relationship between migraines and the autonomic nervous system. Stress, sleep deprivation, and changes in sleep patterns can trigger migraines in susceptible individuals. Given that you experience migraines more frequently with reduced sleep, it’s crucial to prioritize consistent sleep patterns. Additionally, maintaining hydration and a balanced diet can help mitigate migraine triggers.

4. Autonomic Nervous System Dysfunction: Based on your description, it is possible that you are experiencing some level of autonomic nervous system dysfunction. Symptoms such as difficulty sleeping, gastrointestinal issues, and headaches can be indicative of dysregulation. It may be worthwhile to consult with a specialist in autonomic disorders or a neurologist who can provide a more comprehensive evaluation.

5. Adjusting Sleep Habits: To improve your sleep hygiene, consider the following strategies:
- Consistent Sleep Schedule: Aim to go to bed and wake up at the same time every day, even on weekends. This helps regulate your body’s internal clock.

- Limit Screen Time: Reduce exposure to screens at least an hour before bedtime. Blue light emitted by devices can interfere with melatonin production, making it harder to fall asleep.

- Create a Relaxing Environment: Ensure your bedroom is conducive to sleep—dark, quiet, and cool. Consider using blackout curtains, earplugs, or a white noise machine if necessary.

- Mindfulness and Relaxation Techniques: Incorporate relaxation techniques such as deep breathing, progressive muscle relaxation, or guided imagery before bed to help calm your mind.

- Physical Activity: Regular physical activity can promote better sleep, but try to avoid vigorous exercise close to bedtime.

In conclusion, your situation requires a multifaceted approach that includes medication management, lifestyle adjustments, and possibly further medical evaluation. I encourage you to maintain open communication with your healthcare providers regarding your symptoms and any changes you implement. They can help tailor a plan that suits your specific needs and health conditions.

Wishing you restful nights and improved well-being.

Best regards,
Doctor Q&A Teams

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