Avatar universal

Restless murky sleep in early morning + hard to wake up + daytime fatigue

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!
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Avatar universal
If you've got multiple docs telling you nothing identifiable medically, then it's more likely to be non-medical -- which is actually far more common with insomnia.  This is usually some combo of bad sleep habits and excessive worry about the idea of sleep.  You are describing both.  

I can say that use of a CBT sleep training system is the usual standard of care, and it is helpful for typically 70-80+% of those who use it.  But beware -- you've actually got to use these methods for them to work.  Meaning not just learn them once and forget about them.  They become really part of a healthy sleep supportive lifestyle.

In your case that would mean not allowing yourself to sleep in or nap later; and nipping these persistent negative thought patterns in the bud -- which tends to deny insomnia it's negative fuel.
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Thanks for your reply. It seems to me what I have isn't at all insomnia, though. I agree CBT would have been the go-to therapy for that. But this particular symptom of finding it harder and harder to wake up after a good 6h of sleep, with agitated sleep only in its very last phase, is something I[ve been told is not at all a common sleep disorder. Consequently, I saw no suggestion of how to treat it even as a non-medical condition as you put it.
Try a sleep app. I use one with a subscription that has a lot of narrators clips telling you how to relax and naturally fall asleep. I turn my favorite 25 minute one on when I awake in the night even though I've heard the story 50 times. I had listened to the other ones and picked out some ideas that work for me, and incorporate them when my fav is on. Best tip that I got was to take a few long breaths and imagine the inhaled air goes all through your body to your toes then reverses the journey when you exhale- that gets me yawning within one or 2 breaths and sometimes I fall instantly to sleep.
Main idea is to stop thinking and further awakening/exciting yourself by instead listening to the narrator talk about your body comforts, then your system can automatically do the rest of the job - so the next thing you know it will be hours later because you fell asleep unexpectedly and got the sleep you wanted.  
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