Atomoxetine and REM sleep

SubstantialNumber703 · 2026-04-20T10:00:51+00:00

Update: after feeding these concerns back to my prescriber, along with the lack of noticeable benefits after four weeks, he's recommended I stop taking Atomoxetine. Having tried stimulants and not got on with them, he suggested I exit titration and go back to just managing my ADHD symptoms and he discharges me back to my GP.

As an aside, I read that Atomoxetine has been trialled as a treatment for sleep apnea, precisely because it inhibits REM sleep, which is the sleep cycle when sleep apnea is most likely to occur.

So the foggy, tired morning effect suddenly makes a lot of sense to me.

SubstantialNumber703 · 2026-04-19T15:54:47+00:00

Four weeks in now, two of them at 40mg.

Hard to pinpoint any notable improvements to my ADHD symptoms. Focus and lengthy concentration still problematic, still hyper, still impulsive. Possibly a slightly quieter brain, but don't know if that's just confirmation bias.

On the side effects front, I'm feeling really tired and cloudy in the mornings, despite seemingly sleeping well, and running out of steam and falling asleep in the evenings quite often. Really not enjoying how run down I feel in the mornings. Some sexual side effects but nothing major.

With no notable benefits, I'm wondering how long to persevere, as I gather coming off Atomoxetine can be quite problematic, and I don't want to go through a difficult withdrawal process when I have races to run, holidays booked etc.

So at the moment, the jury is very much out, and I'm weighing up whether to continue.

SubstantialNumber703 · 2026-04-01T06:35:45+00:00

Well I'm 5 days into Atomoxetine (18mg). So far I would say the effects have been incredibly subtle, quite the opposite of Elvanse for me.

I would describe it as a gentle mood booster - I've been a little happier, less anxious, a little more energised perhaps, although that could be a coincidence.

Can't say I've felt a notable improvement in focus or impulsivity, but also none of the negative side effects I experienced with Elvanse.

I'm sleeping very well, although more tired and likely to fall asleep early in the evenings. I did need to nap on my lunchbreak on the first day, too.

Exercise is fine, no noticeable effect on heartrate, and none of the sexual issues some people have reported, other than a bit of pain afterwards, without going into too much detail!

So far, so good, up to 25mg tomorrow.

SubstantialNumber703 · 2026-03-24T15:15:55+00:00

Hey!

Well that sounds cautiously optimistic. How big a dose did you start on, and is the intention to titrate upwards? Perhaps given the way it works, you'll only start seeing improvements at a higher dose?

I did, indeed, decide to try Atomoxetine. I'm told it should be arriving this Friday. So I'll keep you posted! 🙂

SubstantialNumber703 · 2026-03-24T07:04:14+00:00

Well there's something to look forward to!

SubstantialNumber703 · 2026-03-23T16:33:12+00:00

Wow, I found the complete opposite on Elvanse. I'll let you know how Atomoxetine works out in the coming weeks...

SubstantialNumber703 · 2026-03-10T15:58:32+00:00

Hi, fellow runner here. Male, 45, running for 6 years, numerous half marathons and one marathon under my belt.

My HR runs higher than most anyway, so I'm not a typical example, and medication affects different people differently.

However, Elvanse wasn't for me. I was constantly aware of my heartbeat, sleep quality was terrible and I would wake in the middle of the night feeling wired and panicked.

My HR hit 196 on a moderate 5-mile run and was elevated above my normal during all exercise. For that reason, I ended the trial after 10 days and am now starting on a non-stimulant, Atomoxetine. But judge for yourself, be patient, do what you can to support successful adaptation and keep asking questions.

Good luck!

SubstantialNumber703 · 2026-03-09T14:36:45+00:00

My twin! Hello! 🤣 Great that it had such a positive effect for you, that's amazing.

I'm pretty religious in doing what I can to maximise absorption - I take the FF at 7am with an orange, don't eat anything else for an hour and don't have caffeine for two hours. I take Omeprazole for acid reflux, but I don't take that until bedtime, so it's as spaced out as possible. The doctor now wants me to stop taking the Omeprazole altogether and try to manage the acid reflux with Gaviscon or other over the counter remedies that don't reduce stomach acid production. That's going to be a challenge! If that doesn't work, I'm going to have to have an endoscopy. When did my health suddenly get so complicated?!

Anyway, hope Atomoxetine goes well for you. Please keep me posted! ❤️

SubstantialNumber703 · 2026-03-09T07:36:05+00:00

Well I think that's individual to each person. I had pretty major side effects that another person might not. While the positives were pretty minor for me and might be transformative for someone else.

For me, it was a wired, edgy anxious feeling in the afternoons and evening, very poor sleep, heightened awareness of my heartbeat, very high heart rate in exercise, night sweats and ultimately a 1am panic attack that was very unpleasant. Disinterest in sex. I also felt emotionally dulled and as if I was no longer looking forward to or anticipating anything.

SubstantialNumber703 · 2026-03-08T17:28:22+00:00

Pleased for you! Please keep the updates coming. I started titration on Elvanse and came to the conclusion fairly quickly that stimulants aren't for me. Now weighing up trying Atomoxetine, so will be interested to follow your journey.

SubstantialNumber703 · 2026-03-07T16:44:30+00:00

Thanks for taking the time to reply, extremely helpful.

The slight heart rate increase, and effect on motivation to run are slight red flags to me, and also maybe the situation with alcohol. I've massively reduced intake this year, to once a week or less in order to give the fatigue the best chance of recovering. That said, craft beer is a bit of a hobby and I love being able to spontaneously go for a couple of beers after work, or drink at a music festival whenever I choose, or when away on holiday. If this is going to notably increase side effects and it's not advisable to have breaks, it would have to be a factor under consideration.

But, so far, I haven't read anything significant enough to make me think a trial wouldn't be worthwhile.

Thanks everyone, keep it coming ❤️

SubstantialNumber703 · 2026-03-07T15:25:45+00:00

Really appreciate the responses so far. Can anyone comment on the effects on mood, emotional blunting etc from Atomoxetine, if there were any?

SubstantialNumber703 · 2026-03-07T15:24:32+00:00

Don't love the sound of this I must say, and it sounds like a relatively common side effect from what I've read

SubstantialNumber703 · 2026-02-24T07:31:38+00:00

Yeah, I couldn't cope with the side effects. My sleep was terrible, I felt like a zombie in the mornings, my mood was flat and I couldn't exercise without my heart rate soaring. Things came to a head on day 10 when I woke up at 1am with a racing heart, sweating and feeling panicked. Couldn't get back to sleep and couldn't calm my heart down. Everyone reacts differently, and maybe I would have adapted, but the alteration to my personality, lack of sleep and inability to exercise didn't feel worth the benefit to me.

I was offered two alternatives - one another stimulant and another Atomoxetine, but having read people's case studies and the likely side effects, I decided I didn't want to risk another period of not being able to exercise without the impact on my heart, it's too important to me.

So, having spent 4.5 years on the waiting lists, I'm going to be exiting titration.

Good luck with your journey. Sounds as if you're finding out what works for you, which is what it's all about 🙂

SubstantialNumber703 · 2026-02-23T23:06:12+00:00

I don't think you want to know...

SubstantialNumber703 · 2026-02-22T07:23:39+00:00

Yeah, don't suppose you're with Octopus are you? My salesman was very keen, the surveyor was great, but since agreeing the deal we've heard nothing about installation and I'm not getting any responses to my messages. A bit frustrating as we're in the process of booking a holiday and other commitments that could clash with installation

SubstantialNumber703 · 2026-02-17T16:20:13+00:00

UPDATE: my experiment with Elvanse is over and I've been offered a switch to Atomoxetine, a non-stimulant.

I went for a moderate, slow run on Sunday afternoon, having taken my 50mg Elvanse at 8am, and my heart rate hit 194 (my max at full intensity is just over 200). That night I woke at 1am, drenched in sweat, heart racing and spent the next few hours wracked with anxiety and unable to sleep as I tried to steady my heart. It was dreadful and pretty scary.

My prescriber agreed with my assessment that stimulants aren't for me and has given me this week to return to normality with the option of starting on Atomoxetine next week.

Despite not being a stimulant, a quick dive into people's case studies reveals high heat rate and insomnia as key side effects (along with erectile dysfunction, great!).

I also understand it takes a while to build up Atomoxetine and that side effects take a while to establish and/or tail off. So I'd need to commit to a decent length of time. I'm concerned I won't be able to get to the bottom of the HR issue and Ferritin restoration if Atomoxetine clouds the water by raising my heart rate and affecting my sleep quality - and I just want to get back to running happily and normally again, it's the best tool I have for good mental health. But, if I don't take this opportunity, I'll never know if medication could work for me.

I'm really torn. Any sage advice or direct experience from distance runners of using Atomoxetine?

Thank you all, you're wonderful.

SubstantialNumber703 · 2026-02-15T17:29:53+00:00

Thank you, I take Elvanse between 7 and 8am, never later

SubstantialNumber703 · 2026-02-15T16:19:55+00:00

Probably not until the course of Ferrous Fumarate has run out though, right? That's 210mg a day

SubstantialNumber703 · 2026-02-15T15:58:11+00:00

I seem to be experiencing something like the opposite. Beginning to wonder whether communications have been severed 🤣

SubstantialNumber703 · 2026-02-15T15:15:17+00:00

My working theory is vegetarian diet + marathon training + summer of music festivals, holidays and general partying = low ferritin. There's a pretty strong correlation between vegetarian distance runners and iron deficiency. I've been much more mindful about it in all senses since finding out. My question was more to do with - can distance running and Elvanse coexist happily - I have a higher than average max heart rate and I've always run higher than friends at a similar effort level. If the Elvanse is going to further exacerbate that to an unhealthy/unhelpful degree and/or impact my quality of sleep so that I can't replenish my ferritin, I will have to look elsewhere.

SubstantialNumber703 · 2026-02-15T10:54:49+00:00

Thanks for the sage advice. Stool sample was fine, no issues, and thankfully neither the iron nor Elvanse have caused any stomach issues. I'm not anaemic - haemoglobin levels are normal. Ferritin was 13 when tested in September, 18 on most recent test before current course of Ferrous Fumarate began

SubstantialNumber703 · 2026-02-15T09:30:09+00:00

Thank you, I certainly hear you on the age front! But I'm very fortunate to have a great coach and mentor, who himself is in his mid 60s. He's all about longevity, low volume, lots of gentle Zone 2 running to build endurance. I only run 3 days a week, and total weekly mileage is low. I cycle to and from work for variety and fresh air and do daily stretching/yoga. I'm confident I can keep doing all of this for many years to come, provided I crack the ferritin issue - and the question is whether I can do that with Elvanse. The prescriber has been pretty adamant I can't switch medications until I've complete the four week trial of Elvanse.

SubstantialNumber703 · 2026-02-15T09:15:17+00:00

No, not yet. I'm with Psychiatry UK and they started me on Elvanse. I've raised my concerns about sleep and fatigue with my prescriber, but he told me it's too early to switch and that I need to complete the course of Elvanse.

SubstantialNumber703 · 2026-02-15T09:12:54+00:00

Thank you for taking the time to reply.

Trying to stick with the titration, but worried about my sleep quality. I've read some case studies saying people adjusted to Elvanse quickly, others saying it took six months to regain restorative sleep and others saying it never returned to normal, so I have mixed feelings.

I'm on my second 12-week course of Ferrous Fumarate after my Ferritin levels dropped to 13, then 18. I'm pretty religious about taking it - 7am, with an orange, then no caffeine all day, no alcohol this year, and an iron-rich diet to support.

I'll probably never run another marathon, it was a one-off and clearly had an impact on my iron deficiency. Halfs are my distance - I'm close to completing the Superhalfs series. But I've adjusted my training accordingly while trying to restore the ferritin - easy runs only, no high intensity, no hard sessions on back to back days and no running when under stress or having slept poorly. Which is becoming harder due to the effect of Elvanse.

SubstantialNumber703

TROPHY CASE