Waking up and not being able to fall back asleep at night

[Pugsy]

Sometimes it's just "nasal cycle"
https://en.wikipedia.org/wiki/Nasal_cycle

https://www.google.com/search?q=nasal+c ... 8&oe=utf-8

[Wulfman...]

Sometimes it's just "nasal cycle"
https://en.wikipedia.org/wiki/Nasal_cycle

https://www.google.com/search?q=nasal+c ... 8&oe=utf-8

Thanks for those links (again).

I was sure you had posted them sometime in the not-too-distant past, but I couldn't find them. (I'll try to save them now)


Den

.

[borgready]

I just got back from visiting the other ENT. He mentioned that since I don't have issues during the day that the deviated septum may not be the issue that is causing me to wake up. He suggested that I see a sleep disorder psychiatrist and go from there. The one thing I need to call and follow up with him on is why my pulse goes over 100 at night and why only half of my nostrils work at one time. Whatever that numbing medicine they put into my nose has made both nostrils to work now.

He also mentioned that having the CPAP machine would probably cause more stress at the moment and make it even more difficult to sleep.

Your ENT is an educated dumb ass. This seems to run rampant in the medical system. Doctors tend to compartmentalize themselves and you really have to search hard for the doctor that knows one or more of the specializations and has real world experience. Keep looking for an ENT that understands the nose/sinuses during sleep. Afrin will likely work on a temporary basis and you might want to try it to see if this improves your sleeping at night. You say the numbing medicine made your nose work. Did you try sleeping or using the cpap while it was working?

So you go to a sleep disorder psychiatrist? You will likely get sleep meds to put you to sleep. Those sleep meds will make you sleep and will likely not get you restful sleep as you will be struggling to breathe while under influence of the sleep meds. This is how people die.

I don't think there is an ENT that will examine you while you are having a sleep study to see how the nose responds during cpap therapy. Research people might do this but ordinary doctors that see the public won't. They will say your a nut job and put you on anxiety meds and sleep meds. When you die you die of natural causes not the meds you were taking.

[npolite]

I just got back from visiting the other ENT. He mentioned that since I don't have issues during the day that the deviated septum may not be the issue that is causing me to wake up. He suggested that I see a sleep disorder psychiatrist and go from there. The one thing I need to call and follow up with him on is why my pulse goes over 100 at night and why only half of my nostrils work at one time. Whatever that numbing medicine they put into my nose has made both nostrils to work now.

He also mentioned that having the CPAP machine would probably cause more stress at the moment and make it even more difficult to sleep.

Your ENT is an educated dumb ass. This seems to run rampant in the medical system. Doctors tend to compartmentalize themselves and you really have to search hard for the doctor that knows one or more of the specializations and has real world experience. Keep looking for an ENT that understands the nose/sinuses during sleep. Afrin will likely work on a temporary basis and you might want to try it to see if this improves your sleeping at night. You say the numbing medicine made your nose work. Did you try sleeping or using the cpap while it was working?

So you go to a sleep disorder psychiatrist? You will likely get sleep meds to put you to sleep. Those sleep meds will make you sleep and will likely not get you restful sleep as you will be struggling to breathe while under influence of the sleep meds. This is how people die.

I don't think there is an ENT that will examine you while you are having a sleep study to see how the nose responds during cpap therapy. Research people might do this but ordinary doctors that see the public won't. They will say your a nut job and put you on anxiety meds and sleep meds. When you die you die of natural causes not the meds you were taking.

Thanks for your reply. Should I ask for a CPAP machine and see what happens? Worst case I'm out another $100 and either can't use it or it doesn't do anything.

I also have an issue when I eat that I feel heart palpitations. I'm no doctor but I think these two are linked. To what impact it is having with my sleep, I don't know but it seems neither ENT does either. I do need to frequently clean the nostril that is more narrow as it improves airflow.

The first ENT suggested surgery off the bat and he is over 60 years old. This second ENT I went to has done surgery on a member of my family several times and is in his 40s.

I'm really just getting conflicting suggestions, nothing is lining up which is making look at other possibilities.

Also the nose numbing medicine was used to look into the nose. The medicine that was prescribed was Dymista.

[sleepinow]

I have read that 85% of people only breathe through one nostril

[npolite]

Is it me or something that both ENT doctors didn't listen to me about? I mentioned in my sleep study test that I had issues with setting up the breathing monitor. I slept from 11:30 until 1:15 woke up and was back to sleep until 6:30. From the graph it seems that my O2 level was ok and that it didn't stop. Am I reading this correctly?

Edit: Is the issue the OA lines that are showing up?

[Jay Aitchsee]

npolite, I agree that your sleep study doesn't look quite right and I question it's meaning and usefulness.
First, it shows that you have an overall AHI of 5.7(5.7 events per hour) However, that is derived from comparing the number of events (56) to time in bed (TIB) of 588.7 minutes, 9 hours 48.7 minutes. That would be the period from about 8:40 PM until 06:30 AM. You say you weren't asleep during all of that period and your chart would seem to indicate you were not. Typically, AHI is measured as the number of events compared to the hours of Sleep, not time in bed. If your AHI was computed by comparing events to time in sleep, it would not be 5.7. It could be higher or lower depending on how many events actually occurred during sleep.
An AHI of 5.7 is not particularly high, "normal" is considered to be 5.0 or less.
Your major oxygen desat to 78% appears to occur in that period you say you were having trouble with the monitor and is probably a false reading. The readings from the period you say you were asleep appear to be OK.
The number of events in the period of sleep you report don't appear to be exceptionally high, I didn't compute them. You might find some relief from CPAP, but then again, you may not. Edit: it looks like about 30 events of all types from the period 1AM until 6:30, which would be an AHI of about 5.45, again not very high, casting more doubt on the usefulness of CPAP.
Other forum members might differ with my interpretation.
I think you need another opinion, but I am unsure of the specialty. A Sleep certified pulmonologist might be able to dig deeper into the Apnea question, a gastroenterologist maybe for the digestive issues, and another ENT, maybe. How about a good internist? Have you talked with PCP about your symptoms?

[npolite]

npolite, I agree that your sleep study doesn't look quite right and I question it's meaning and usefulness.
First, it shows that you have an overall AHI of 5.7(5.7 events per hour) However, that is derived from comparing the number of events to time in bed (TIB) of 588.7 minutes, 9 hours 48.7 minutes. That would be the period from about 8:40 PM until 06:30 AM. You say you weren't asleep during all of that period and your chart would seem to indicate you were not. Typically, AHI is measured as the number of events compared to the hours of Sleep, not time in bed. If your AHI was computed by comparing events to time in sleep, it would not be 5.7. It could be higher or lower depending on how many events actually occurred during sleep.
An AHI of 5.7 is not particularly high, "normal" is considered to be 5.0 or less.
Your major oxygen desat to 78% appears to occur in that period you say you were having trouble with the monitor and is probably a false reading. The readings from the period you say you were asleep appear to be OK.
The number of events in the period of sleep you report don't appear to be exceptionally high, I didn't compute them. You might find some relief from CPAP, but then again, you may not. Edit: it looks like about 30 events of all types from the period 1AM until 6:30, which would be an AHI of about 5.45, again not very high, casting more doubt on the usefulness of CPAP.
Other forum members might differ with my interpretation.
I think you need another opinion, but I am unsure of the specialty. A Sleep certified pulmonologist might be able to dig deeper into the Apnea question, a gastroenterologist maybe for the digestive issues, and another ENT, maybe. How about a good internist? Have you talked with PCP about your symptoms?

Thanks for your response. I am going to call the sleep center and verify the information. I did talk to my primary physician and he believes it is all stress related.

I just got off the phone with the sleep center. It was difficult and I don't know if I buy it but they believe the physician who interpreted the data did indeed take the period where the device was not working into account. The front office wouldn't actually let me talk to him without of course going in for a consultation. I really just don't know what to do.

I have the cardiologist who said this will go away, I have another one scheduled for 10 days from now and am wondering if I should go. I also think I need to go to the GI to have a look at the after eating and having the heart palps issue too. The director that I spoke to at the sleep study was thrown a bit off as I should have seen a sleep specialist after going back to the ENT for the results.

[Jay Aitchsee]

I did talk to my primary physician and he believes it is all stress related.

Could be. Certainly stress could be a contributor. Your sleep study really doesn't look like you have sleep apnea. But that doesn't mean that you don't have trouble sleeping, though. Unfortunately your sleep study did not provide any EEG information, so it is unknown if you suffered any arousals, not only from respiratory events, but from other sources such as limb movements (PLM) as well. Again, not a very useful study.
You might want to look at lifestyle. Look to those things that promote or inhibit restorative sleep. Googling "sleep hygiene" will provide plenty of information regarding things you can do (or not do) to promote better sleep. (Afternoon naps and late eating are usually not recommended)
You also need to have your PCP do a complete work up looking for those things that might cause fatigue, such as Vitamin D and B deficiencies, underactive thyroid, ferritin levels, etc. again, Google for a complete list.
Finding the cause of poor sleep can be difficult. Pretty much it seems to boil down to eliminating potential causes one at a time. But it starts with good sleep hygiene.

[npolite]

Thanks Jay for the update. I spoke with the ENT and he wants me to go see a sleep psychiatrist and go from there. He also suggested that I take the Ambien and see how it works out. I really don't want to take it but at least will give it a try for a day and see what happens.

I'm also going to be taking off a few weeks so if things improve I'll know work is a huge factor in this.

[Jay Aitchsee]

I did want to mention that cluster of obstructive events you had between 1:30 AM and 2:30. There's about 13 events there counting the hypopneas resulting in an AHI in that period of 13 (Mild Sleep Apnea), if you were asleep. And, if you were asleep, that could certainly cause an arousal and that would fit with your mention of waking around 2:30 in your OP. However, to me it looks as if you might have awakened just before that (increased heart rate and change in position) and the events could have occurred while you were awake. Unfortunately, since no Sleep Stage data was observed it can not be determined if those events should be scored or not. And again we're back to the study not telling us much. At least in my opinion.

If you are going to see a sleep specialist, I think I would start with a pulmonologist, just to settle the apnea question. If apnea were ruled out, then I might move on to a neurologist and/or psychiatrist.

At the same time, if the digestive issues continue, a visit with a GI certainly may be warranted as well as practicing good sleep hygiene and obtaining a comprehensive work-up by your PCP as I mentioned earlier.

Ambien may be useful. In my opinion, it's one of the least offensive sleep aids. Its use may allow you to overcome your anxiety and go to bed and sleep at a more reasonable time. Ambien has a short half life which is good for not producing next day sleepiness and drug hangover, but because of the short half life it doesn't work very well for sleep maintenance insomnia, another term you should Google.

Yes, work could certainly be a stressor and, as your PCP said, stress could be entirely the culprit. Again, see sleep maintenance insomnia.

[npolite]

Jay, Thanks again for your advice.

On Friday night into Saturday I took 2 tums an hour before going to be and was able to sleep until 4:30. I ate a banana and a 1/2 glass of milk but was still up until 6am. I was able to sleep from 6 until 9:30. I felt a little better yesterday. Last night I was up a little late after watching a football game and ate mild wings so I don't know if that caused anything. I went to sleep at 1:15 (took 2 tums) and was up at 5. When I woke up I noticed I was breathing from the right (narrow) side of my nose and it the air was wheezing. My heart beat felt also a bit stronger too. It took me a while to get back and I was up by 8:30 again. I think there is an underlying problem with the nose and it probably will make me breathe a lot better if I just went ahead and fixed the nose. It may/may not fix the underlying issue but I am really struggling as no one can fix on where the issue is and am having issues breathing while in bed. I'm going to suggest to the 2nd ENT to get the surgery scheduled and get that moving. If he still is insistent on the psychiatrist I will suggest possibly getting the pulmonologist to look at this. If I don't have anything to work with I am going to get it done by the first ENT.

I have an appointment with the GI on Friday to see about the digestive stuff. I have some feeling that there is something going on with my stomach but is it causing my heart issues I just don't know.

Does this sound like a good way forward?

Also with the sleep study, I woke up at 1:15am. I don't recall how long I was up though.

[Jay Aitchsee]

Also with the sleep study, I woke up at 1:15am. I don't recall how long I was up though.

I thought that might be the case. If you were awake during the time of those events, or even drifting in and out of sleep, in a true sleep study (polysomnogram), they probably would not have been scored as apneas. My opinion is that you probably don't suffer from sleep apnea - I just have a problem with the study that was done.

There's nothing wrong with seeing a Sleep Psychiatrist, I am just biased from my own experiences. I think most specialists will naturally want to pursue options and procedures common to their field, i.e. ENT's would tend toward surgery, Pulmonologists toward CPAP, Psychiatrists toward meds and CBT. I have seen two Sleep Certified neurologists and was disappointed that neither wanted to do much more than prescribe popular medications, "try this and see what happens". Neither seemed interested in looking at my actual sleep data or sleep studies.

If you don't have apnea, then you don't need CPAP and a Sleep Psychiatrist could be exactly who you do need to help you overcome stress (If that is a factor and it sounds like it is) and establish good sleep hygiene (which I think you need to work on).

Your GI issues could also be caused by stress or poor habits, but it wouldn't hurt to get checked out to rule out something like a hiatal hernia.

And again, If you haven't had a complete blood work-up, not just the ordinary tests that are usually done, but one that includes those items that could be a factor in fatigue as I mentioned earlier, you should have that done.

I have been suggesting a pulmonologist confident that one would rule out or in sleep apnea, probably with a new sleep study. However, a Sleep Psychiatrist could order a new study and do the same - saving a step if you don't have sleep apnea.

You have to weigh the risk/benefits of surgery. I have no particular knowledge of or experience with these procedures so I can't offer an opinion.

BTW, see these Clinical Guidelines for recommendations as to how home testing should be accomplished, including a recommendation for a follow-up visit with an appropriately qualified person to discuss the results of the test (art. 3.6). Probably why the Sleep Center was surprised you hadn't seen a Sleep Specialist. Also see Standards, G-1.

[npolite]

Here is an update. I am scheduled to go in tomorrow with a GI doctor to get my stomach looked at and make sure there is no issue there. I am still having that issue with the palpitations, the pain in the top of my stomach and middle of the chest which gets worse after I eat. And unable to sleep easily without the Ambien as my stomach feels like I ate a lot. I also have a lot of burping.

Last night I tried to sleep with the Ambien and 20 minutes into my sleep I felt my entire body shaking and woke up. It took another 20-40 minutes to get back to sleep. I woke up at 4am and then at 6am. This afternoon I tried to take a nap and as I drifted off I woke up again. I noticed that my nose was on the narrow side.

I have decided to schedule the surgery to have the deviated septum fixed. I don't know if this is truly an issue but it is bothering me. I have to constantly clean that side while in bed to get better airflow.

This past week has been pretty brutal for me. I haven't felt this tired ever. I have decided to scrap ENT 2 as he won't do anything until I go see the psychiatrist.

Is it also possible that my body is just stopping at times to take breaths of air. I'm just wondering if there is anything in which the passageway is open but my body is stopping the breathing.

[Macpage]

Here is an update. I am scheduled to go in tomorrow with a GI doctor to get my stomach looked at and make sure there is no issue there. I am still having that issue with the palpitations, the pain in the top of my stomach and middle of the chest which gets worse after I eat. And unable to sleep easily without the Ambien as my stomach feels like I ate a lot. I also have a lot of burping.

Last night I tried to sleep with the Ambien and 20 minutes into my sleep I felt my entire body shaking and woke up. It took another 20-40 minutes to get back to sleep. I woke up at 4am and then at 6am. This afternoon I tried to take a nap and as I drifted off I woke up again. I noticed that my nose was on the narrow side.

I have decided to schedule the surgery to have the deviated septum fixed. I don't know if this is truly an issue but it is bothering me. I have to constantly clean that side while in bed to get better airflow.

This past week has been pretty brutal for me. I haven't felt this tired ever. I have decided to scrap ENT 2 as he won't do anything until I go see the psychiatrist.

Is it also possible that my body is just stopping at times to take breaths of air. I'm just wondering if there is anything in which the passageway is open but my body is stopping the breathing.

You've gotten some good advice from the folks here on working through with a PCP and a GI. Your symptoms are very much identical to what I experience. In my case, it is certainly anxiety and GI issues brought about by untreated sleep apnea. In your case, it may be just anxiety from the lack of sleep and stressors or it may be a little warning to work on the lifestyle and sleep habits. It doesn't take much anxiey and lack of sleep to really work over your digestive system. You'll know from working with the medical professionals you trust. It wouldn't hurt to get a good interpretation of your sleep data or another study. SDB does happen in younger folks and I wish I had looked into it much earlier in life. In my opinion, if there is no sleep disorder or other underlying condition identified by your PCP, a good GI would be a logical place for your described symptoms. I wish you all the best and hope to hear what you find out.

Best,

Mike