Macpage wrote:robysue wrote:My own personal take on when to start looking at other factors outside of SDB if one isn't progressing as well as one thinks s/he should?
Thanks so much for the detailed response. I guess I've thought a lot about all of these aspects, but I must be honest. Even with reading vast amounts of posts and data, I'm just not knowledgeable enough to really judge my situation.
Start with the objective stuff: How does your CPAP therapy look on paper? Can you post a typical night? And think really hard about whether you are still dealing with
comfort issues.
Then move on to:
I'm also not sure I really trust myself to accurately assess things at the moment. If my mental state is being influenced by anxiety/depression, stress, sleep fragmentation, etc., I might be steering myself into conclusions or assumptions that might not be accurate, logical, or for my best.
Sometimes the best thing to do is to try to step out of figuring out whether A causes B or B causes A, and just document what's going on objectively.
You might also find it useful to keep a very short, objective journal of what symptoms (anxiety, depression, stress, sleep fragmentation, etc) you actually have each day and some kind of quick 0-5 scale for rating the intensity of each symptom. Once you know
how much anxiety, depression, stress, and/or sleep fragmentation you are dealing with from day to day, it may be easier to sort out which of these things are the largest influences on how you feel each day.
It's seems like I would have remembered some [dreams] here or there before treatment just by chance if the SDB wasn't messing things up. I have to think that it's a step in the right direction now.
In regards to dreaming and waking from dreams: If you are on (or have recently discontinued or changed the dose of) any medication for your mood problems or your anxiety problems, you should look at the potential side affects. Some of them tend to suppress REM sleep and some don't.
Untreated OSA can suppress REM sleep pretty severely: If the number of apneas increases significantly when you enter REM, then the body's response is to arouse every time you hit REM and the number of events increase. Intuitively you can think of it this way: If your body feels as though it's in danger of suffocating every time you got into REM, the body learns to avoid as much as possible and/or get out of REM as soon as possible. For some people with untreated OSA, they never remember dreaming because they're getting so little REM sleep. For other people with untreated OSA, they remember lots of really bad dreams (often with a choking/suffocation theme in them) because they're waking up gasping for breath every time they hit REM, and the dreams we remember are the ones we wake up from.
So once CPAP is initiated, what happens? The body can enter REM without feeling like it's going to suffocate. And so the body tries to make up for lost time by (temporarily) increasing the time spent in REM.
Now if you never dreamed much before because you hardly ever went into REM, all this dreaming is a new phenomenon, and the fact that it's perfectly normal to briefly wake up post-REM is also a new phenomenon. And since you're not used to brief post-REM wakes, every time you have one, the mind tells itself: Why the heck am I awake in the middle of the night? And the fact that the wake is post-REM maximizes the chances that you also remember a dream---so you also wake up thinking, "Boy that was a weird dream." It turns out that a lot of normal dreams are pretty weird, and even disturbing, but until they cross into being bad enough to be an out right nightmare, most people don't wake up enough to remember their disturbing dreams on a regular basis. But if the whole dreaming thing is new to you, then you have no idea that these kinds of dream experiences are pretty typical, and the mind grabs hold of the weirdness/disturbed nature of the dream while it's in the normal post-REM wake and the mind wakes itself up more thoroughly and starts to
ponder the dream. And that extends the post-REM wake to the point where it's long enough to remember the next morning. And long middle of the night wakes are more disruptive to the overall sleep quality than short post-REM wakes that you don't remember.
But on the other hand, if you are someone who woke up a lot in the middle of OSA-inspired "choking" REM dreams with a feeling of choking or gasping for breath before you started CPAP, then after you start PAPing, you quit having apneas in the REM cycles, so you quit waking up in the REM cycles and the dreams you have are no longer inspired by the OSA-caused sensation of suffocation. And because you are no longer waking up in REM, you no longer remember your dreams.
I guess it's time that I post a detailed account of my experience. I know I have appreciated how you and others have shared. It's only fair if I'm looking for help that I should take the time to post everything in one place. It's also logical that the best chance for the greatest insight comes from others being able to look at the picture as a whole.
Yes, the more we know about your particular experience, the easier it is to help.