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[Davis1]

Hi, I would appreciate some feedback from the community, this is my first post.

I have had insomnia for many years. I tried Imovane, 5 mg, to no effect. Then tried 10 mg which worked a couple times, then stopped working and had unpleasant side effects, such as loss of libido and not fully working, ie. being drowsy but still unable to sleep. I have tried almost everything, from melatonin, to herbs, and to tyelonol 1 which has a small amt of codeine in it, which sort of works, better than anything else. Smoking pot also helps.

I should have sought treatment long ago, but finally was referred to a clinic and had a sleep study. Apena was the diagnosis, 88 events per hour, lowest O2 saturation recorded was 88%. So I bought a mask and am using it set on 7 pressure reading.

It is so far worthless. Well, nearly. It worked the first night or 2 that I could bear wearing it. Its not a pleasant contraption, but you all know the new user issues. So I wore it more and more each night, getting used to it slowly. Its now about a month into it and the thing doesnt work at all.

Firstly, it takes a long time to fall asleep, even with the mask. Second, I awake, just like I always did, about an hour into the sleep and even with the mask on, I cannot go back to sleep. I eventaully after an hour or more of tossing with the thing on my face, take it off and resort to my old method, move around a bit, smoke a bowl of weed and drift off at about 6:00 AM and sleep until 11:30ish or so, and try to catnap during the day.

The thing seems utterly worthless.

My thought is that 7 pressure is too low. I have a titration study coming up in early March and will go to that.
Any thoughts?
W

[jbn3boys]

How did you come up with a pressure of 7 if you have not had your titration study done?
What kind of machine do you have? What other settings are you using? (ramp? c-flex, epr?)
What kind of mask are you using? Have you tried any others?
How is your sleep hygiene? I'm guessing that needs some work.

[imtired]

It does sound like the pressure may not be right. you havnt had your titration yet? what kind of machine, it would help if you go into the user control panel and fill in the equipment so we know what your using. Welcome to the forum

[LSAT]

Hi, I would appreciate some feedback from the community, this is my first post.

I eventaully after an hour or more of tossing with the thing on my face, take it off and resort to my old method, move around a bit,smoke a bowl of weed and drift off at about 6:00 AM and sleep until 11:30ish or so, and try to catnap during the day.

The thing seems utterly worthless.

W

Well, I don't know if weed is going to help you get adjusted to your machine and mask. Part of making this work is having a positive attitude about it. Maybe you are thinking too much about the weed.

[Slartybartfast]

Hmmm. Funny you should mention weed. When I was getting wired up for my first night's sleep study, the tech found out I worked in pharmaceuticals and kept asking questions about cannabinoids and all the wonderful new treatments that (he had been lead to believe) were coming from it. I couldn't seem to convince him that there was a whole universe of other, less troublesome drug classes to choose from.

I wish you the best of luck with your sleep study. Insomnia is a difficult problem to remedy because it is symptomatic of so many physical and psychological disorders. Seems like a full medical workup is in order. But you probably already have been through that.

And purely FWIW:

Marijuana withdrawal symptoms:
Withdrawal symptoms to marijuana can be somewhat characterized as the opposite to the intoxicating effects of the drug…instead of hunger, a loss of appetite, and instead of drowsiness, an inability to sleep.Some additional symptoms of marijuana withdrawal can include headache, nausea, anxiety (common) paranoia and even irritability or aggression.
These sensations will endure with some intensity for several days before gradually subsiding, and it is during this period that the cravings to use are strongest, and there is the greatest risk of relapse.
source: http://hubpages.com/hub/Marijuana-withd ... --headache

http://www.choosehelp.com/detox/marijuana-detox

I'm just sayin'

[robysue]

Hi, I would appreciate some feedback from the community, this is my first post.

I have had insomnia for many years. I tried Imovane, 5 mg, to no effect. Then tried 10 mg which worked a couple times, then stopped working and had unpleasant side effects, such as loss of libido and not fully working, ie. being drowsy but still unable to sleep. I have tried almost everything, from melatonin, to herbs, and to tyelonol 1 which has a small amt of codeine in it, which sort of works, better than anything else. Smoking pot also helps.

Sounds to me like you've tried all kinds of chemical "solutions" to the insomnia problem. But have you tried any cognitive behavior approaches to solving the insmonia?

A cognitive behavior approach to fighting insomnia is designed to help your body and mind make a very firm connection that Being in bed = Time to be asleep. Such an approach requires the self-discipline to make (possibly significant) long term changes in your behavior and the willingness to accept a non-quick and non-easy solution to the insomnia. The idea is to make slow, but steady progress in teaching your body to (1) associate being in bed with being asleep and (2) teach your body how to sleep through the night.

I bring up this alternate, non-chemical approach to dealing with the insomnia because I am a person who has had on-again, off-again bouts of insmonia my entire adult life and as someone who successfully managed my insomnia for years by doing nothing more than practicing extremely good good sleep hygiene practices. Two decent versions of the basic "rules" of good sleep hygiene can be found at http://www.umm.edu/sleep/sleep_hyg.htm and http://www.sleepeducation.com/Hygiene.aspx .

You owe it to yourself to read through these rules and see how many of them you violate on a nightly basis. And how many of them you do practice on a semi-regular or regular basis. My advice is to start there: Get more serious about changing your behavior in regards to sleep. If you have a TV in the bedroom, kick it out first. Don't do anything in the bed except for sleep and sex. If the insomnia is really bad and has been around for a long time, you may even need to avoid doing anything in the bedroom itself except for sleep and sex.

I should have sought treatment long ago, but finally was referred to a clinic and had a sleep study. Apena was the diagnosis, 88 events per hour, lowest O2 saturation recorded was 88%. So I bought a mask and am using it set on 7 pressure reading.

It is so far worthless. Well, nearly. It worked the first night or 2 that I could bear wearing it. Its not a pleasant contraption, but you all know the new user issues. So I wore it more and more each night, getting used to it slowly. Its now about a month into it and the thing doesnt work at all.

In addition to seconding the comments others have made it being likely that a pressure of 7cm possibly being too low to prevent most of your apneas and the comments about the need for a proper titration study to determine your proper before you give up on CPAP, I will add these thoughts:

1) CPAP by itself will NOT solve your insomnia problems. It sounds to me as though you have many issues in your life that could be causing the insomnia since you have been using both prescribed medication and self-treatment involving both OTC drugs, herbs, and recreational drugs to "self-medicate." Do you often feel stressed out? Do you have a hard time "shutting your brain up" when you want to go to sleep? Do you get anxious about how much time you are NOT sleeping when you are lying in bed? CPAP won't fix any of these problems because all CPAP is designed to do keep your upper airway open.

2) CPAP will only help the physical symptoms and the potential health issues connected with OSA if you use it every night, all night long. And if you are using it every night, all night long and you KNOW (from hard data) that your AHI is now in the normal range (below 5.0 with CPAP therapy), then you can be assured that the CPAP is doing its job and while your sleep remains seriously fractured and your daytime symptoms continue to seriously plague you, at least you've reduced ONE source of physical stress on your body (but not your mind).

3) You will NOT start feeling the benefit of using the CPAP until your insomnia is under control. Right now, every smidgen of extra energy and improvement in the physical quality of your sleep provided by the CPAP therapy is being sucked right back out of you by the insomnia monster roaming your bedroom every night. Get the insomnia under control, and you will likely then start seeing slow, but real positive changes in how you physically feel due to the CPAP and in how you function during the daytime.
[/list]
I want to be very clear about item #3: I know this through my own very hard won experience. Within three days of starting CPAP therapy, I was starting to develop a very nasty case of CPAP-induced insomnia. I tried my best to manage this insomnia on my own through my tried & true tightening up on the good sleep hygiene rules and I was using my CPAP every night, all night long. And my daytime functioning quickly and seriously deteriorated due to the the growing insomnia monster.

Three and a half months after starting therapy and after two pressure prescription changes, a second titration study, a switch from CPAP/APAP to BiPAP, and many, many meetings with the PA in my sleep doctor's office, I finally began to realize that my problem was no longer "getting use to the machine" My problem was the raging insomnia monster that had moved in when I was first learning to deal with the machine. And now that insomnia monster had grown fat and powerful and was feeding on a whole variety of issues that went far beyond my remaining problems with the discomfort of sleeping with the BiPAP every night.

And so, on December 30, I admitted to the PA that the insomnia was the issue that I had to work on. (She had tried to tell me this as early as the beginning of November.) And that I could not deal with my insomnia on my own. She knew my reluctance to simply take sleeping pills, so she designed a cognitive behavior strategy for slowly, but surely dealing with the insomnia. The critical piece of this strategy is a sleep restricted schedule with a mandatory wake up time for all seven days of the week. I described both the insomnia monster and (much farther down in the thread) the PA's designed plan in The insomnia monster raises its head again and again ..... The very real and substantial progress I've made since starting the hard work involved in this approach is talked about in 1000th post: Update on my insomnia and xPAP therapy and Met with PA about insomnia and got 4th sleep test results. Read through these threads: There are many, many suggestions from the kind folks on this forum for dealing with insomnia.

Firstly, it takes a long time to fall asleep, even with the mask. Second, I awake, just like I always did, about an hour into the sleep and even with the mask on, I cannot go back to sleep. I eventaully after an hour or more of tossing with the thing on my face, take it off and resort to my old method, move around a bit, smoke a bowl of weed and drift off at about 6:00 AM and sleep until 11:30ish or so, and try to catnap during the day.

Pot is NOT a good way to self treat the insomnia. Like alcohol, pot disrupts the structure of the sleep cycles. And so, while smoking some weed may seem like it helps you "drift off to sleep by 6:00AM, it's likely causing you to stay awake until 6:00 AM as well.

As for what to do: Report the problems with insomnia to your sleep doctor immediately and ask for help: Stress that you've already tried chemical solutions including more than one type of sleeping pill. And ask for help in working through a cognitive behavior approach to the insomnia.

And in the meantime: Quit the pot at bedtime. Quit lying in bed for an hour or more waiting (fighting) for sleep to come. Start working on all aspects of your sleep hygiene. Try to force yourself to get up at the same (decent) hour each day. Try to get OUTSIDE for a bit of sun each day. And try to make using the mask every time you sleep a habit---the same way brushing teeth is a habit.

Finally I said before, it sounds to me like you are using the weed to self-medicate some issue or issues in your life away. And those issues have likely been feeding your insomnia for years. And until the insomnia is firmly under control, all the CPAP does is let your body tread water instead of sinking further into the abyss of highly fragmented sleep.

Best of luck,
Robysue, the honorary president of the CPAP & insomnia club here at cpaptalk.com

[roster]

My thought is that 7 pressure is too low. I have a titration study coming up in early March and will go to that.
Any thoughts?
W

Since you have not had a titration study, there is a high probability that your pressure is too low and you are still having apneas during the little time you do sleep. So here is the most important recommendation. Make sure you get a CPAP machine with software that will report every day data such as apneas, hypopneas, snores, mask leak, etc. This is critical to achieving a good therapy.

Regarding weed, at one time I had high hopes it would help. But looking into it, I found that maurijuana(THC) increases sleep latency, but decreases REM and insufficient REM makes for an unhealthy person. Weed has also been known to increase apneas in some patients.

You also need to start practicing strict sleep hygiene - see http://www.mayoclinic.com/health/insomn ... e-remedies

Start immediately and have some nights in before you go for the titration study.

[Davis1]

Thank you for your wonderfully generous posts. I sincerely appreciate it.

Firstly, I told my Dr. about the insomnia and he told me that sleep hygiene does not work. He did refer me to some work on cognitive behav therapy by Carnie Carlson of Ryerson University.

As far as my habits, I have tried; regular bedtimes, using bedroom only for sleep, making myself stay in bed, I never use caffeine, I never use alcohol. I do not eat sugars of any sort for a few hours before bed. If I force myself to stay in bed by putting myself on a schedule, it doesnt do a thing. I just lie there restless for hours and hours. I had a psych evaluation to screen for bipolar and other disorders and all came out neg.

The pot use, its not a big part of it. I use it as a last resort at 6 AM when its clear my entire day is going to be screwed. Its the ONLY thing that calms me down enough to let go of my many life troubles and just be in the moment. Its not my self medication of first resort. It is my last resort. I avoid it for weeks at a time, but sometimes, when the clock is moving toward 7 AM, I smoke a small bowl and yes, it works. Its not a cure, otherwise I would use it to sleep. It takes the edge off things enough to get some slee. Honestly, without it, I would have numerous 24 hour awake cycles. So its not a big part of my self therapy, and I dont use it recreationally.

Yes, my life is a disaster, and thats stressful. My mother is in deteroriating health in a nursing home for Alzhemiers and other disorders and I have no brothers, sisters or other family members alive who can help. Its all on me and I have been struggling for employment for 2 years now. I have a PhD and 2 masters degrees and cant even find a simple retail job to pay the bills. So I tend to become overcome at night with the incoming Tsunami wave of financial devastation that will hit in about a year, reducing the both of us to poverty.

I feel this insane restlessness in bed, its hard to describe. Its like a constant psychological irritation. That keeps me awake, and overcomes the CPAP>

As far as the titration study, all that happened is...did a sleep study, he put me on 7 pressure, then sent me downstairs to the girl who sells masks. I had no idea what to choose at all, so I picked a full face mask. What else was I to do? I phoned today and he suggested a pressure of 9. I am scheduled for anotehr sleep study in 2 weeks. Sleep study...what a horrible experience that was. And now I get to repeat it. But there you go........



A

[Davis1]

Sorry had to continue this response in a separate post, since any attempt to continue made the screen jump up and down, seems like a bug with the posting here when the message exceeds a certain lenght.

Other facts, I dont use any other medications or drugs. I teach karate and am physically active with cycling, kayaking, hiking and other sports. My diet is very good, I understand nutrition. I am non obese.

Again, on the sleep hygeine, my family Dr. firmly assured me that clinical trials have shown it to be worthless and in my experience, hes right.

I think the story is that we are far from understanding how sleep works and most therapies are hit and miss, really a guessing game. I am about to see a naturopath or homeopath, or maybe an acupuncturist, who knows, explore some other options, since modern medicine seems lacking here.

At the same time, I am faithfully following my sleep doctors advice and staying with is program. Perhaps my pressure is too low. I have heard of some folks using up to 18.

My gear, is the Fischer Paykell Icon, with a Tiara Mask, small. I rejected the nasal pillow, because it was the first day i had been diagnosed and it seemed like it would be hard to sleep with something jammed up my nose. And then the sales girl, a Resp Tech, said that i might be a mouth breather and I should stay with the face mask for a month or so.

Whats interesting here is that insomnia is a separate issue from sleep apnea? I thought my insomnia was caused by sleep apnea. Now I am confused. Any comments are stil welcome, I have learned so much just reading your replies.

[SleepingUgly]

Wow, you are under a lot of stress. I don't think I would be able to sleep either. Your insomnia can be caused by a variety of factors, including inadequately treated OSA, stress, sleep hygiene issues, circadian rhythm disturbances, etc. It's a lot to deal attack at once. Have you ever tried something like Ambien? Something like that might help you acclimate to CPAP and if it's the OSA that has caused the insomnia, it may remit with treatment (at the right pressure). You could talk to your doctor about that.

[ozij]

Sorry had to continue this response in a separate post, since any attempt to continue made the screen jump up and down, seems like a bug with the posting here when the message exceeds a certain lenght.

If you're using Internet Explorer 8 a click on the compatibility button (right next to the address bar) will solve that.

At the same time, I am faithfully following my sleep doctors advice and staying with is program. Perhaps my pressure is too low. I have heard of some folks using up to 18.

From your description, I'm guessing the doc. wanted to give you a chance to adapt to the having a mask on your face, before he figured out the right pressure in a titration.

Whats interesting here is that insomnia is a separate issue from sleep apnea? I thought my insomnia was caused by sleep apnea. Now I am confused. Any comments are stil welcome, I have learned so much just reading your replies.

Insomnia may have many causes concurrently. The mental/emotional stress you're going through can be one of them.
The sleep apnea may play a role too. Think of what happens to your body and brain during the night:
Your brain is changing mode; it's slipping into sleep - letting changes happen in your body at the same time.
As a result of those bodily changes, your upper airway relaxes, close up and makes your blood stream lose oxygen.
Of all body parts, the one most sensitive to loss of oxygen is your brain, so it is pre programmed, in its most basic level, to switch you back to wakefulness, open that airway and make you breathe. That's the most basic, primitive, automatic, life preserving part of your intact brain doing that.
Meanwhile, back at the ranch, all other parts of your brain are registering all those low oxygen alarms, that sense of immediate danger connected to sleep. After years of this, all of your brain has learned that sleep is dangerous, and all of it, higher levels included, is vigilant.
For some of us, the first night of correct pressure is greeted with a huge sigh relief, and wonderful sleep ensues.
For others though, the correct pressure doesn't have such a quick effect, and we maintain the higher level vigilance that keeps us from sleeping -- insomnia. In those cases our brain (not only our mind) needs time to learn to trust the machine that keeps our breathing nice and ordered. It takes some of us time to learn that sleep is no longer dangerous. And some of us need CBT to help us learn that.

O.

[imtired]

Firstly, I told my Dr. about the insomnia and he told me that sleep hygiene does not work.

Many doctors are still net yet educated about sleep disorders. The first doctor (gp) i went to asking to be referred for a sleep study told me that he doesn't believe in sleep apnea. He claimed the real cause of the disorder is when someone is so obese that the weight of all the fat pushes on your chest making it difficult to breath. He only sent me for the test because i insisted.

I dont know how much following the sleep hygiene guidelines will help, but it definitely wont hurt to put yourself in the best possible situation for your therapy to work. Most people in this forum believe in doing your own research and taking charge of your own treatment. I would not recommend ignoring your doctors opinions, but educate yourself enough to know which questions to ask when he gives you advice.

[Mr Bill]

...And so, on December 30, I admitted to the PA that the insomnia was the issue that I had to work on. (She had tried to tell me this as early as the beginning of November.) And that I could not deal with my insomnia on my own. She knew my reluctance to simply take sleeping pills, so she designed a cognitive behavior strategy for slowly, but surely dealing with the insomnia. The critical piece of this strategy is a sleep restricted schedule with a mandatory wake up time for all seven days of the week. I described both the insomnia monster and (much farther down in the thread) the PA's designed plan in The insomnia monster raises its head again and again ..... The very real and substantial progress I've made since starting the hard work involved in this approach is talked about in 1000th post: Update on my insomnia and xPAP therapy and Met with PA about insomnia and got 4th sleep test results. Read through these threads: There are many, many suggestions from the kind folks on this forum for dealing with insomnia.

I think this has the potential to be helpful to me, thank you robysue. I will be reading these links soon.

Davis1, welcome to the fight for your life. My PT has made it clear to me that apnea strains the heart and kills your internal organs if not treated. When I am tired, I start experiencing awake, the symptoms I get when I sleep without a mask. Even if I cannot sleep, I will don mask and read because then at least I know I am breathing right. Which reminds me, I need to get to bed right now. Good luck.

[robysue]

davis1,

You write:

Whats interesting here is that insomnia is a separate issue from sleep apnea? I thought my insomnia was caused by sleep apnea. Now I am confused. Any comments are stil welcome, I have learned so much just reading your replies.

While the sleep apnea is a contributing factor to your insomnia, it is most definitely NOT the only cause: As SleepingUgly and ozij point out in their posts, you have a number of very serious issues going on that are contributing to the insomnia. And until ALL the things that are feeding the insomnia are dealt with, your insomnia is likely to continue to rage on out of control. You've got to develop a MULTI-PRONGED approach to (unfortunately) deal with ALL the insomnia feeders before you will start feeling better.

As far as my habits, I have tried; regular bedtimes, using bedroom only for sleep, making myself stay in bed, I never use caffeine, I never use alcohol. I do not eat sugars of any sort for a few hours before bed. If I force myself to stay in bed by putting myself on a schedule, it doesnt do a thing. I just lie there restless for hours and hours.

You are VIOLATING the FIRST CARDINAL rule of good sleep hygiene by making yourself stay in bed when you are NOT sleeping and lying in bed restless for hours and hours.

The FIRST principle of good sleep hygiene is: Do NOT lie in bed for hours on end NOT sleeping, and do NOT lie in bed while AWAKE trying to force yourself to go to sleep.

The establishment of a regular sleep schedule follows learning how to NOT lie in bed for hours NOT sleeping. And it is substantially LESS important that the FIRST CARDINAL rule of Do NOT lie in bed for hours on end NOT sleeping, and do NOT lie in bed while AWAKE trying to force yourself to go to sleep.

I know that you are skeptical of the whole good sleep hygiene thing. But please try this for TWO weeks:

• Step 1) Get up out of bed, go into a different room, and do something FUN and PLEASANT to try to relax both your mind and body whenever you find yourself lying in bed getting
  • * MORE restless
    * and MORE anxious (about ANY of the many serious problems in your life)
    * and MORE intensely worrying (about ANY of the many serious problems in your life)
    * and MORE unable to sleep.
  Stay out of the bedroom until you feel sufficiently relaxed and as calm as you can get yourself to be. Go back to the bed and mask up ONLY if you are relaxed, relatively calm, no longer focusing on your worries, anxieties, and problems, AND sleepy. Under NO circumstances should you keep yourself in bed if you are anxious, worried, frustrated (about not sleeping or anything else), or awake. If you are NOT asleep within 20-30 minutes (MAX) of lying down (or after waking up and trying to get back to sleep), force yourself to get out of the bed and go into a different room to do something more pleasant until you start to feel sleepy.
  
  Step 2) Pick a reasonable WAKE UP time that you can live with SEVEN days a week. For now, it doesn't really matter how early or late it is---as long as it fits into your life and you honestly believe that you can and will be able to get up by this time SEVEN days a week. And though it sounds very cruel, make yourself get up AND stay up once wake up times comes---regardless of how little you sleep during the night. And try to avoid daytime naps completely.
  
  Step 3) Do your absolute best to stay up (without naps) until it is NO MORE than 7 hours before your desired WAKE-UP time. Go to bed at the LATER of the following times:
  
  • Seven hours before WAKE UP time OR when you first feel SLEEPY after it's within seven hours of WAKE-UP time.
  For example: If you want to get up at 10AM every single day of the week, then make your target bedtime 3:00 AM. And don't go to bed until you first feel sleepy AT or LATER than 3:00 AM. And in order to stay up to your tentative bedtime, do fun things that help you get your mind off your many problems. Since your mind and your body don't seem to want to sleep anyway, you might as well be awake doing something you enjoy. The point is to try to get your mind OUT of worry-mode before you lie down for the night.

Now let me be clear: This will NOT cure your insomnia. But it should help you learn to avoid making the insomnia WORSE by lying in bed awake for hours on end getting more and more tense and restless. What (little) sleep you manage to get should be more relaxing and more restful simply because you're not fighting so hard for it. And just maybe, you will learn how to be more relaxed in bed and let sleep come on its own accord instead of continually battling your body to try to force sleep to come. Be aware, you may well be exhausted in the daytime with this approach. Don't worry about that: Just try to get through the day as best you can and try not to nap.

Now I know that you are very skeptical about the whole good sleep hygiene thing. In part because you write:

Firstly, I told my Dr. about the insomnia and he told me that sleep hygiene does not work. He did refer me to some work on cognitive behav therapy by Carnie Carlson of Ryerson University.

and

Again, on the sleep hygeine, my family Dr. firmly assured me that clinical trials have shown it to be worthless and in my experience, hes right.

In my humble opinion, your doctor is being highly irresponsible here: My guess is he says "sleep hygiene doesn't work" because it is NOT a "quick" solution and it requires a great deal of self discipline, hard work, and patience on the part of the insomniac. Folks not willing to do the hard work will not see the long term benefits. It's rather like telling a type II diabetic to just take the pills and not worry about doing the hard work needed to make real life-long adjustments to their diet to properly manage the disease. As for the clinical research: Can you post a link to a reliable, peer-reviewed paper to back up your doctor's claim?

And as I've pointed out above, though you think you've tried sleep hygiene and had it fail, you continue to violate the CARDINAL RULE of good sleep hygiene, which is (again): Do NOT lie in bed for hours on end NOT sleeping. And if you've never tried to enforce this particular rule on your behavior towards sleep (or more correctly, towards not sleeping when you are in bed), then you really have NOT given practicing good sleep hygiene a real, honest effort.

Will practicing good sleep hygiene solve all of your problems? It will help---perhaps only slightly, but by itself, it will not solve all of your problems with getting a decent night's sleep: Because good sleep hygiene is only going to target one set of problems---just like CPAP only targets one set of problems. And until ALL of your problems are properly addressed, you will likely still have major problems dealing with your sleep. But I also feel that as long as your sleep hygiene is messed up, you WON'T be able to make any real progress on any of the other issues because both your mind and your body will continue to behave as though Being in Bed does NOT mean Time to Sleep.

And my guess is that if you follow up with the referral for cognitive behavior therapy, you will be told (among many other behavior modifications for your many other problems) to do serious work on cleaning up your sleep hygiene. And hopefully the therapist (Carnie Carlson?) will help you learn what you need to do to stick with cleaning up the sleep hygiene as well as teaching you positive behavior patterns to deal with the incredible number of serious stresses that you are currently facing in your life. Because until you learn to manage to deal with the emotional stresses, the financial stresses, and the health-based stresses in your life, nothing is likely to "fix" your sleep problems completely.

Finally, I'd strongly suggest that you get a copy of the book Sound Sleep, Sound MInd by Dr. Barry Krakow. There is much in this book that will give you plenty of food for thought about how to address your multiple, intertwined sleep disorders---including, but not limited to your out of control insomnia.

[roster]

My gear, is the Fischer Paykell Icon, with a Tiara Mask, small. I rejected the nasal pillow, because it was the first day i had been diagnosed and it seemed like it would be hard to sleep with something jammed up my nose. And then the sales girl, a Resp Tech, said that i might be a mouth breather and I should stay with the face mask for a month or so.

It is not clear to me which type of mask you are using. A full face interface (FFM) covers the nose and mouth. A nasal interface (nasal pillows or nasal mask) covers only the nose. I am assuming your second sleep study is for titration as this is common. Unless they observed considerable mouthbreathing during your first study, they will probably start you with an oral interface on the titration night. If you begin mouthbreathing, they should switch you during the study to a FFM. Or they might slap a chinstrap on you to try to hold the mouth shut (usually doesn't work).

Whats interesting here is that insomnia is a separate issue from sleep apnea? I thought my insomnia was caused by sleep apnea. Now I am confused. Any comments are stil welcome, I have learned so much just reading your replies.

One doctor uses a rule of thumb that 90% of insomnia cases are caused by sleep-disordered breathing (SDB). Of course that leaves 10% (rule of thumb) that are caused by something else. You could be a person who has SDB and a second condition that causes insomnia. Since you did not mention it, I will assume that no comorbidities that would cause insomnia were found on your sleep study. In this case, if the rule of thumb is correct, you have a greater than 90% chance that your insomnia is caused by SDB. Even with successful CPAP treatment of SDB, you may continue to have problems with insomnia until your brain learns to "trust" your body to provide it with sufficient oxygen when you fall asleep.

You have been dealt a difficult hand in life (so far) and now you have the chance to do something to change it. You know the expression about eating an elephant one piece at a time and that is the way I always approach big problems. Then the question in your case is which piece to eat first?

Since you know with a very high degree of certainty that you have a severe case of obstructive sleep apnea ( "... the diagnosis, 88 events per hour"), I believe you should work on the treatment of your sleep apnea as first, and maybe only, priority. This means having the sleep study and trying to relax and let the technicians do the work. All you need to do is sleep and breathe. You should ask the doctor for a prescription for one or two doses of sleeping pills or sedatives in case you are unable to fall asleep the night of the titration. The sleep lab should have instructions to ask you to take the drugs if you have not fallen asleep within a reasonable amount of time.

So get the titration, get the new machine settings, start sleeping with it, and see if the insomnia improves during the first week at home.

Now if you want to start thinking about the second piece to eat, have a look at this - viewtopic/t60874/Why-I-always-insist-on ... tware.html