Adderall, melatonin and other sleep disrupters & fixes

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
User avatar
Songbird
Posts: 287
Joined: Fri Oct 17, 2008 10:13 am
Location: Pennsylvania

Adderall, melatonin and other sleep disrupters & fixes

Post by Songbird » Wed Dec 03, 2008 1:11 pm

On Monday, OldLincoln started his “Insomnia drug helps jet-lag, shift-work troubles” thread (viewtopic/t36706/Insomnia-drug-helps-je ... ubles.html), which had a Reuters report about a new drug that’s supposed to work better than melatonin (http://www.reuters.com/article/lifestyl ... 0G20081201).

Several people posted comments, and I posted a note about specific sleep disruption problems and questions I’ve been having. Kiralynx responded to me in the thread, and SAG and I have been conversing via PMs.

I didn't intend to hijack OldLincoln's post, but it seems that's what I did (sorry, OL!!). Also, I think it’s best to have a discussion like this in the forum, in case others might benefit. For these reasons, as well as the fact that more than two of us are talking about it, I decided to separate it out from OldLincoln’s thread and start this one. Without including any repeated quotes, here are what appear to be the pertinent posts, as well as the PM conversation between SAG and me:
Snoredog wrote:Typical Press Release by a drug company. Every study ever done for jet-lag shows OTC melatonin helps with jet-lag, only difference is you cannot make MONEY on unregulated melatonin. They try to scare everyone into taking meaning-less low doses of OTC melatonin so they can show it don't work. One study done was using 300mcg of melatonin, not strong enough to put a rat to sleep much less a human being. Then they used college students who were under 35 who by age produce more melatonin naturally than those over 50.

Think I'm going to stick with the bottle of 300 tablets of Schiff brand Melatonin I get at Costco for $6 bucks, that bottle lasts me a nearly a year and it works great for me.

All regulation does is pad the price you have to pay for it. We seen how well the SEC has regulated Wall Street, how well the Fed has regulated the banks.
luke wrote:Interesting stuff.....my question is:
What is a normal dose of OTC Melatonin and how much can be tolerated? I take 2 of the little pills..I think they're 3 each. Can't say they help me fall or stay asleep though. Don't want to overdo it.
georgepds wrote:(to Snoredog): What dose is effective? What dose do you use?
Kiralynx wrote:How much melatonin is effective depends on the individual and the situation. I have seen melatonin packaged in .5, 1 and 3 mg. It can also be obtained (usually by prescription) in 20 mg capsules. (This latter has been used by some naturopaths for cancer treatment.)

Snoredog is correct about the "warning" about "unregulated supplements." Melatonin can't be patented, and it's relatively easy to synthesize, hence, there's no profit in it, and it is in the pharmaceutical companies' best interests to steer people away from it. Similarly, niacin is good for cholesterol, but unpatentable. And then there's CoQ10 (CoEnzyme Q10) which is top mark for heart issues, energy, and etc. It's one of the safest and most effective products around for congestive heart failure. (I had the pleasure of reading some discussions with one of the primary researchers in COQ10.) But again, unpatentable, so therefore, no Company research, and relatively few doctors are aware of it. There's also at least one small study which indicates CoQ10 is anti breast cancer.

However, I digress. I typically took one 3 mg capsule of melatonin at bedtime, then read for awhile before turning in. Melatonin never "made" me sleep, but it allowed me to drift off, and usually stay alseep. Well, until my apnea began causing hip pain which woke me up, but that's another story. Took almost seven years for someone to figure out the hip pain was caused by apnea.

Earlier this year, I has a diagnosis of endometrial cancer and my stress levels went through the roof. I ended up taking 6-7 3 mg capsules to get to sleep and stay asleep. After my successful surgery, I dropped back to three 3 mg capsules.

After about two weeks on CPAP, I was finding myself waking up, and then dr-a-a-g-g-ing my way through the day, and wondering what the <bleep> was wrong with my therapy, 'cause I'd mostly gotten the leaks under control and the AHI is decent, if not what I'd like to ultimately achieve. Then it dawned on me. I was sleeping better because of the CPAP and didn't need as much melatonin to achieve the same amount of deep sleep. I've dropped back to my original one 3 mg capsule, and that's much better. However, I may pick up some 1 mg capsules the next time I hit the Vitamin Shoppe, and see if I can get it to the minimum dose necessary.

My suggestion would be to start with one 1 mg capsule and see how you do for a few nights. Then adjust up if needed. Most people I have known use one 3 mg capsule, but it's hard to split one of those if you need to adjust down.
Songbird wrote:Snoredog & Kiralynx (and any other knowledgable someone who wishes to chime in), I'm still chasing that "boy, did I sleep well" feeling, even though I've been on the hose since mid-August, have great leak rates and generally have an AHI of 0.0 to 0.3 w/ 1.5 being the highest since I adjusted my 9 cm Rx up to 12 a couple of months ago.

Actually getting 7 or 8 hours of sleep is a big problem, though, and I'm sure there are other things involved:
-- my age, which is 57.
-- PLMD, which is under control with 0.25 mg. Mirapex daily (0 and 0.1 arousals in titration studies 1 & 2, respectively).
-- Adderall usage for ADD; I'm in the process of weaning off it and have worked my way down from 60 mg. daily to 20 mg. daily w/ last dose ideally no later than 2 p.m. (ideally meaning the toughest thing for someone w/ ADD is to remember to take the stupid medicine). I'll be down to 10 mg. daily starting Sunday and zippo two weeks later. (Aside: If anyone knows of a good Adderall substitute that doesn't disrupt sleep, I'd be ecstatic. But Strattera didn't help with my focus issues at all.)
-- DJD (degenerative joint disease) pain, primarily in both knees, which is somewhat under control (meaning I can keep the sharp pains away) w/ a pillow under my knees when laying down plus 200 mg. Naproxen (Alleve) twice daily and 65 mg. propoxyphene/APAP (Wygesic) at bedtime.
-- Possibly insufficient deep & REM sleep. I hit all the stages during my initial PSG, but mostly stages 1 & 2; stages 1 and 2 and a little stage 3 during the two titration studies I've had since then; and no stage 4 or REM in the two titration studies. Unfortunately, although I have the program, I haven't gotten Encore up and running yet (requires setting up a new computer; working on it; perhaps this coming weekend), so I don't know how much I'm getting in any of the stages. Am I right in thinking that's a key question?

I've been taking 6 mg. melatonin for about a month and have been sleeping a little better, but that time frame also jives with weaning off Adderall, so I don't know if it's due to one or the other or both. But I'm still dragging during the day and still have very little energy.

I know a little about vitamins & supplements in general, and there are some brands that I trust more than others for certain things. What about melatonin? Is one brand about the same as another? In other words, Snoredog, do you go with the Schiff brand because it's the best price (because they're all about the same) or because you believe Schiff has a better product quality than others?

What's a good dosage for CoQ10? And again, is one brand better than another?

Until I actually have facts about my sleep stages, should I be taking a different dosage of the melatonin instead of the 6 mg. I've been taking?
OldLincoln wrote:This [meaning getting the Schiff brand @ Costco that Snoredog mentioned] sounds appealing to me. I currently take low dose Sonata but am considering alternatives. Any idea if Melatonin will do that? What strength do you buy?
Kiralynx wrote: [all of this is in response to Songbird]

(re: reported low leak rate and AHI) <chuckle> I've only been on the hose a month. Most AHIs are around 2.0, and I think, with the purchase of two new side sleeper pillows, I may have found a solution for a decent leak rate, though I still haven't sorted out why I have more hypopneas sleeping on my right side than on my left.

(re: Songbird saying she’s 57) I'm not far behind you, at 56.5 years.

(re: PLMD) Can't speak to this as I know nothing about it, except what I've learned here on CPAPTalk.Com!

(re: Adderall... weaning off & looking for replacement) Look into dietary treatments. Boot sugar, starch, high fructose corn syrup and other crapola in the keister and get it out of your diet. ADD runs in my family. I've gotten my symptoms under control with the Specific Carbohydrate Diet. THere was a short off-topic thread about it here: viewtopic.php?f=1&t=36152&p=312315&hilit=SCD#p312315 <evil grin> My co-author often says she wishes I'd have LESS focus, 'cause I'm driving her crazy.

(re: DJD) That, too, is no fun. I thought I had it... but interestingly, getting my therapy going has significantly reduced my pain issues. Ask about getting water therapy -- and then make it a point to do your therapy at least three times a week. It helps. Really.

(re: possible insufficient deep and REM sleep) Not my area of expertise. I hope to have Encore Pro up when I get the new computer. Then I'll know more about me.

(re: Adderall and melatonin) I don't know enough about Adderall to really say... but you may find that you need less melatonin as your Adderall dose decreases. Too much melatonin at night can result in day-time dragginess. Also, if you have that dragginess, look into taking some B12 first thing in the morning, as that can help your body get rid of excess melatonin, and help you stay awake.

(re: is one brand of melatonin better than another?) I'd look for straight melatonin, without the added B6 that some brands have. B6 can make some folks hyper, although please don't ask me where I got that from.

(re: what's a good CoQ10 dosage, and is one brand better than another?) That depends on what you;re using it for. Prior to my cancer diagnosis, I was using about 100mg in divided doses. I used significantly more when I was healing from the surgery. Now I'm back down again. The older you get, generally, the more is needed.

(re: should I change my current 6 mg. melatonin dose?) If you're dragging during the day, it may be too much for you, especially as you reduce the Adderall. You might consider dropping down to 3 mg.
[conversation between SAG and Songbird]

(SAG) Well, I read though all your posts, and overall it looks like you've gotten a good understanding of everything, and have a good plan. If you want to post all of your sleep studies, there might be some pertinent information there. Yet, if the reason you're cutting down on Adderal is to improve your sleep architecture, and that's in fact what happens, then they might not be really representative any more. Course, you never know till you look.

(Songbird) I don't have a scanner or access to one, and I'm not terrific with computers, so unless there's a way I don't know about, I'm pretty sure I can't post my sleep studies. I could type the info, but that wouldn't show you the graphs. Wouldn't it be the graphs that would show you what you need to know?

(SAG) Yeah, the graphs are quite important, especially the architecture. Maybe you can find a fax machine that scans to pdf files or Staples might have a cheap service that makes scanned files.

(Songbird) Okay, I'll check around. Thanks a lot.
Kiralynx, thanks for your thoughtful response. Just a couple of replies....

I remember reading that post about the Specific Carbohydrate Diet. Well, just the beginning of it. I seem to recall moving on to something else when Babs said chocolate was a no-no. You've inspired me, though, and I would like to actually start living again, so I'll give it a serious look. Thanks.

About reducing melatonin from 6 mg. to 3 mg., I've never been one to remember my dreams, and I've been particularly without them for the past few years (no longer wondering why, though). I gotta tell ya, last night I had a great dream involving Eric Clapton and woke up with a BIG smile on my face and the acoustic version of "Layla" running through my head. Don't think I'm gonna go down to 3 unless there are NO other choices.

SAG (and anyone else), is it your experience that taking any Adderall is always a sleep disrupter, or is it a "try it and see" kind of thing? I'll try to explain my line of thinking...

What moved me to wean down or off the Adderall is that my BP was up to 140/90 and my pulse was running about 108-110, despite the fact that my pulse has always been within the "normal" range and my BP was usually in the neighborhood of 110/70 or so. No doc had suggested that the Adderall might be causing my insomnia, which has been my main problem through all of this (!), and I hadn't thought about it because so much is backwards with my ADD brain (caffeine doesn't keep me awake; Adderall slows down and focuses my superball-like brain rather than making me hyper, as it would with a non-ADD person, etc.). I started reading about meds, vitamins and supplements to see what might up the BP and pulse, and that's when I saw that Adderall can do it AND disrupt sleep. I bounced some questions off -SWS and decided the Adderall had to go, or at least the dosage had to go down. So yes, in part it's about sleep architecture, but also to get my BP and pulse back in the safety zone. BTW, I haven't checked it in the past few days, but my BP's been consistently down to about 120/80, and my pulse in the 80s/90s, for the past 2-3 weeks. Also, I've taken ginko biloba for quite a few years and quit that two weeks ago after quizzing my sleep doc and making him take a serious look at every med, vitamin and supplement I've been taking. He said the GB also could elevate BP.

At any rate, I've been wondering if my 60 mg./day dosage of Adderall was, in fact, helping me to cope with my SA as well as my ADD, and since I'm now getting restorative sleep, that my BP and pulse were elevating because whatever part of the 60 mg./day was "treating" my SA symptoms was no longer needed and therefore sending my system into overdrive. And if that is true, is it possible that I could still take 10 or 20 mg./day without it disrupting my sleep? (If all of that makes sense to you, congratulations!! )

Marsha
Resp. Pro M Series CPAP @ 12 cm, 0 C-Flex, 0 HH & Opus 360 mask (backup: Hybrid) since 8/11/08; member since 7/23/08
A good laugh and a long sleep are the best cures in the doctor's book. ~ Irish Proverb

User avatar
ziggytosh
Posts: 103
Joined: Wed Oct 22, 2008 3:47 pm

Re: Adderall, melatonin and other sleep disrupters & fixes

Post by ziggytosh » Wed Dec 03, 2008 1:41 pm

Hey Marsha. My wife has actually been going through some similar issues.

She doesn't have apnea, but doesn't always sleep through the night. This actually started for her with OTC melatonin, which knocked her out at first but then gradually seemed to lose its effect. She was then having more trouble sleeping than before. Her GP prescribed Ambien, but didn't really tell her what a powerful drug it is. So she ended up taking it every night for a period of a couple of months. Ambien is incredible for putting you to sleep, but if you take it every night you pretty quickly get to where you can't sleep without it. She finally went to a sleep doctor a couple weeks ago, not long after I was diagnosed with apnea. He basically told her she needed to get off any sleep aids, OTC or otherwise. He said the problem is that these sleep aids either replace your natural melatonin (in the case of OTC melatonin supplements) or induce your body to produce it in surges in response to the med (as in Ambien). Pretty soon, you don't produce natural melatonin without some kind of chemical stimulus, as in pill. He put her on Lunesta temporarily, because it apparently clears out of your system completely by morning, so you don't get as dependent on it and its easier to wean off. She's now splitting her Lunestas in half and is supposed to be completely off any sleep aids within another week.

Anyway, I guess that's just a bit of a cautionary tale. Sleep aids have risks that you're probably already well aware of, but if you have to use one, Lunesta is probably best if you use it only occasionally.

Also, as far as Adderall substitutes, I've heard great things about Provigil, again from my wife. It's not as "speed-y" as Adderall. She actually wasn't on Adderall, but I researched both a bunch on the Internet when she took Provigil temporarily (for daytime sleepiness resulting from the above overuse of sleep meds). Provigil is really interesting because it seems to be different from other stimulants (and it's sometimes disputed whether it ought to be considered a stimulant) like Adderall and Ritalin because it seems to just give you the option of staying awake. You can actually take a Provigil and go to sleep afterward if you really want to. But it takes away any overwhelming need to sleep. So its primary use is to treat narcolepsy. I'm sure a lot of people on this forum are on it for daytime sleepiness resulting from apnea. But it's also often prescribed off-label for ADD because the non-speedy wakefulness apparently gives people the ability to concentrate and focus better. It supposedly works even for people who don't have ADD, and a lot of college kids take it as a "study drug."

Downsides, at least for my wife: the effects were so subtle that she wasn't really sure it was doing anything after the first week and she quickly became convinced that she'd gotten tolerant of it and it was a waste of time. She still has a half-used bottle around though, and she'll take one occasionally if she's feeling especially sleepy or we're driving all day or something like that. Seems to work well on an occasional basis.

Anyway, for what it's worth ...

_________________
MaskHumidifier

User avatar
Snoredog
Posts: 6399
Joined: Sun Mar 19, 2006 5:09 pm

Re: Adderall, melatonin and other sleep disrupters & fixes

Post by Snoredog » Wed Dec 03, 2008 2:27 pm

Geeze what a basket case!

but you better stick with the Adderall, it treats severe depression, symptoms of narcolepsy and idiopathic CNS Hypersomnia.

So if you have any of those you better stick with it.

This is a ton of posts here on Melatonin, you just have to search for them.

But I take between 3 and 6 mg and have done so for last 16 years nearly every night. I have stopped for several weeks during that
time. I've had a dream nearly every night so I know it helps, prior to that I never remembered having a dream. I have difficulty turning off my mind when it is time to go to sleep to the point where I fight going to sleep, melatonin gets me past that. I've tried all the drugs out there, they don't work any better and I'm left with more daytime fatigue using them.

I have read many studies on Melatonin and am quite comfortable taking up to 9 mg. After 16 years of using 3 mg I still don't have a 3rd arm growing out of my forehead.

If I took 300mcg of melatonin I would never get to sleep, might as well take a placebo. I take mainly 3 mg but I gage how much I take (1 or 2 tablets) by how I did the night before. Because if I have too much EDS I don't look at it as too much Melatonin, I look at it as I got too much SWS and not enough REM. While SWS (Stage3/4) is thought to be where you get the restorative effects of sleep, I see getting too much SWS meaning I didn't get any/much REM. If I never remember my dreams and I wake up feeling like the walking dead it probably means I woke up from SWS as opposed to REM. Wake up in REM you wake up without an alarm, you wake up refreshed, that is my experience anyway.

Drug companies are full of hype, doctors will always talk down Melatonin as there are no kick-backs like prescription drugs. They claim it is unsafe not tested no dose defined what they really mean is there is no money in it for them.

Facts are:
1. Name a single person found to have overdosed and died from OTC Melatonin.
2. Name a single Senator that took Melatonin and ran into a cement barrier in Washington at 2AM in the morning.
3. Name a single person who took Melatonin and has a 3rd arm growing out of their forehead.
4. Coming up with something to help you sleep has HUGE profit potential.

If you have been using melatonin as long as I have you know that the OTC dose has gradually increased. It has increased because
they are finding higher doses work better than lower doses. Yeah I know about the Mayonnaise study but using a dose
for simple acute insomnia is one thing, using it to obtain better quality sleep and REM is another.

You have to read your own research and weed out what to believe and what not to believe. If a study was anyway funded by a drug company or a grant to a university for purposes of testing a drug companies drug I toss it out. University is not going to pass up several million dollars of grant money, nobody is going to fund a study of melatonin. They will fund a study comparing ambien to melatonin as long as the melatonin dose isn't over 300mcg where it doesn't work. You take low dose melatonin for insomnia you take higher doses for deeper better quality sleep.

To understand how supplemental melatonin works you have to read the research, some of that research includes timetables showing how your levels of melatonin change throughout the day. One study shows it peaks at about 2AM in the morning where it begins tapering off towards 6 AM where it is at its lowest level, about noon or 1 PM it begins building again which is why in Mexico they have afternoon Siestas. Levels continue to build into dinner time where once dark sets in levels more rapidly increase towards the peak again at 2 AM. So when you take OTC supplemental melatonin you are only padding or adding to those natural levels. Supplemental melatonin only stays in the blood stream a short few hours. When you take it you are only adding to your own natural levels. Studies also show we produce less and less melatonin as we age, reason why old people can't sleep.

Like I said, you have to read the research and decide for yourself if it is safe to use and what dose works for you. I use 3 -6 mg (1 or 2 tablets) and have for many years. It is very easy to say "I took it once" and had horrible dreams, well that is what it is supposed to do promote REM where you dream. Just because you had one bad dream isn't why you should give up on it. If you haven't been in REM for a year or had any dreams it could be why the one you had was horrible.
someday science will catch up to what I'm saying...

User avatar
WearyOne
Posts: 1795
Joined: Sat Mar 03, 2007 3:30 pm
Location: USA

Re: Adderall, melatonin and other sleep disrupters & fixes

Post by WearyOne » Wed Dec 03, 2008 2:56 pm

My son has/had a version of DSPS (delayed sleep phase syndrome). He was home schooled, so we didn't push real hard for a medicine solution (non-medicine solutions didn't really help) until about three months before he was to start college. I took him to my sleep doc and he was diagnosed professionally with what I had always known he had---a version of DSPS. (My son's PCP had previously prescribed Ambien. The smaller dosage did nothing; larger dose gave him hallucinations); and then Lunesta, which did nothing.)

Sleep doc gave us samples of Rozerem (used a lot for sleep phase disorders and is supposed to work similar to melatonin), and said we could try that, or just regular OTC melatonin. Rozerem didn't really help either. He had tried melatonin before, but only up to 2 mg. Sleep doc said anything less than 3 was pretty useless (as least for what my son's problem was), and he could easily go up to 6 mg. He went up to 3, and that did the trick. That was the only thing that did any good. That was two years ago. He's in his second year college, and now only has to take it a couple times a week, if that much. Sometimes this sleep phase problem starts at puberty (as with my son), and then gets a lot better, or goes away entirely in a person's late teens to early 20's, which it seems to have done with my son, who is now 20.

Then also make a timed release version of melatonin that is supposed to help you go to sleep, AND stay asleep as well.

Pam

_________________
Machine: DreamStation 2 Auto CPAP Advanced with Humidifier
Mask: Hybrid Full Face CPAP Mask with Nasal Pillows and Headgear
Additional Comments: Oscar Software | APAP: 9-10 [ CMS-50F Pulse/Ox

User avatar
carbonman
Posts: 2526
Joined: Wed Jun 25, 2008 7:57 am

Re: Adderall, melatonin and other sleep disrupters & fixes

Post by carbonman » Wed Dec 03, 2008 3:24 pm

Disclaimer:
This is strictly my example of use of melatonin.
I am not suggesting that you do the same, or
that it will work the same for you, or
discounting anyone else’s experiences.....
this is informational, ONLY.

Before cpap diagnosis, I took melatonin for years, trying to get to sleep,
and stay a sleep. It did help me to get to sleep, but the staying
asleep did not happen until cpap.

After I started cpap and joined the forum, and listening to
the junkyard dog, I added L-theanine to the melatonin.
They seemed to work very well together and did help me fall asleep and stay asleep.


Since my therapy is going so well and I was falling asleep easily,
and just to see if I could help further medical science, I decided
to "test" my therapy. I quit both the melatonin and L-theanine
15 days ago.

I am having no trouble getting to sleep, and the dream
sessions that cpap has brought me have increased.
I have had multiple dream sessions every night since I quit.
A few have been scary, but most I do not remember and none have killed me.
Since I have started dreaming again, with cpap, I really
don't care if the dreams are scary, funny, erotic or what, I am
just thrilled that I am dreaming again and getting quality sleep.

As always, YMMV.
"If your therapy is improving your health but you're not doing anything
to see or feel those changes, you'll never know what you're capable of."
I said that.

User avatar
LSAT
Posts: 13229
Joined: Sun Nov 16, 2008 10:11 am
Location: SE Wisconsin

Re: Adderall, melatonin and other sleep disrupters & fixes

Post by LSAT » Wed Dec 03, 2008 3:37 pm

I also take the 3mg Melatonin...it does relax my mind enough to let me fall asleep relatively quickly, but, I still have trouble staying asleep for the whole night . Prior to the CPAP I was up 3-4 times a night. Now, with the Melatonin to help me get to sleep and the CPAP to help me stay asleep I only get up once a night.

Schiff Sleep Support...3mg Melatonin with 25mg Theanine

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: Fisher & Paykel Vitera Full Face Mask with Headgear (S, M, or L Cushion)
Additional Comments: Back up is S9 Autoset...... Buckwheat hull pillow

-SWS
Posts: 5301
Joined: Tue Jan 11, 2005 7:06 pm

Re: Adderall, melatonin and other sleep disrupters & fixes

Post by -SWS » Wed Dec 03, 2008 9:50 pm

I'm still chasing that "boy, did I sleep well" feeling...

Actually getting 7 or 8 hours of sleep is a big problem, though, and I'm sure there are other things involved:
-- my age, which is 57.
-- PLMD, which is under control with 0.25 mg. Mirapex daily (0 and 0.1 arousals in titration studies 1 & 2, respectively).
-- Adderall usage for ADD; I'm in the process of weaning off it and have worked my way down from 60 mg. daily to 20 mg. daily w/ last dose ideally no later than 2 p.m. (ideally meaning the toughest thing for someone w/ ADD is to remember to take the stupid medicine). I'll be down to 10 mg. daily starting Sunday and zippo two weeks later. (Aside: If anyone knows of a good Adderall substitute that doesn't disrupt sleep, I'd be ecstatic. But Strattera didn't help with my focus issues at all.)
-- DJD (degenerative joint disease) pain, primarily in both knees, which is somewhat under control (meaning I can keep the sharp pains away) w/ a pillow under my knees when laying down plus 200 mg. Naproxen (Alleve) twice daily and 65 mg. propoxyphene/APAP (Wygesic) at bedtime.
-- Possibly insufficient deep & REM sleep. I hit all the stages during my initial PSG, but mostly stages 1 & 2; stages 1 and 2 and a little stage 3 during the two titration studies I've had since then; and no stage 4 or REM in the two titration studies. Unfortunately, although I have the program, I haven't gotten Encore up and running yet (requires setting up a new computer; working on it; perhaps this coming weekend), so I don't know how much I'm getting in any of the stages. Am I right in thinking that's a key question?
Hey, Marsha!

That's a laaaaarge list of possible confounding and contributing factors. I'm glad SAG has kindly offered to look at your PSG to see if there are any sleep problems that might have been overlooked. IIRC you didn't have much of an opportunity to sleep well on CPAP during the NPSG---which means SAG may not be able to see what your current sleep architecture looks like.

I'm not well-versed with the effects of pharmaceuticals. So I don't know what impact your remaining Adderall dosage may have on your sleep architecture. While this study is about ADD/ADHD children, insomnia, and sleep latency, it kind of hints that typical ADD/ADHD stimulant treatments do impact sleep as we might expect: http://www.ncbi.nlm.nih.gov/pubmed/10521009 (too bad they didn't study ADD/ADHD pharmaceutical treatment impact on architecture)

Prescription stimulants and unmitigated pain sure seem like two likely areas to focus on for starters. Emotional stress, depression, worry seem to be common themes on the apnea message boards. And mental stressors can absolutely rob daytime energy and even quality of sleep. Another common theme on the apnea message boards is GERD, that may be undiagnosed, untreated, or even undertreated. I just switched GERD medications, and am refluxing because the new medication is not working well. I wake up tired as a result, and then feel bushed that entire day. Needless to say I'll be resuming the previous, more expensive GERD medicine.

I hope posters manage to generate plenty more ideas and suggestions for you, Marsha. Intuitively I don't think this is going to be a quick and easy fix. It's entirely possible that a variety of factors are contributing to the way you feel when you wake up in the morning. When that situation occurs, I think of the problem as being similar to a car engine that is out-of-tune for a combination of reasons: fouled plugs, clogged jets, poor timing, dirty filters, bad oxygen sensor etc. etc. So in that scenario all the contributing problems need to be addressed to get the car running well again. By contrast another car may have only one salient problem, such as a faulty ignition. Fix that one problem, and voila!

Let's see what other ideas and suggestions people can come up with. I'll keep following this thread and will add to it if I can think of helpful suggestions.

-SWS
Posts: 5301
Joined: Tue Jan 11, 2005 7:06 pm

Re: Adderall, melatonin and other sleep disrupters & fixes

Post by -SWS » Thu Dec 04, 2008 6:11 pm

Prescription stimulants and unmitigated pain sure seem like two likely areas to focus on for starters. Emotional stress, depression, worry seem to be common themes on the apnea message boards. And mental stressors can absolutely rob daytime energy and even quality of sleep. Another common theme on the apnea message boards is GERD, that may be undiagnosed, untreated, or even undertreated. I just switched GERD medications, and am refluxing because the new medication is not working well. I wake up tired as a result, and then feel bushed that entire day. Needless to say I'll be resuming the previous, more expensive GERD medicine.


Marsha, at this point I'm only sharing personal anecdotes. Aside from apnea, the known factors that have all contributed to my daytime fatigue seem to be: 1) unmitigated pain (comes and goes, thanks to trigeminal neuralgia), 2) GERD flareups (also comes and goes despite treatment), 3) worry mode or depression (fortunately infrequent for me, knock on wood---meaning my head), and 4) carrying excessive weight above a certain threshold.

When I was undiagnosed with apnea, I probably carried all four of those energy-robbing burdens simultaneously again and again. However, since CPAP, I would guess that I suffer from only those first two on a recurring and consistent basis. However, item 4 is once again starting to creep up, and I need to once again work hard on making sure that issue doesn't gain an upper hand.

With that said, we're going out to Rock Bottom for beer and a fried dinner tonight.

jnk
Posts: 5787
Joined: Mon Jun 30, 2008 3:03 pm

Re: Adderall, melatonin and other sleep disrupters & fixes

Post by jnk » Thu Dec 04, 2008 9:48 pm

Howdy, Marsha!
Songbird wrote: . . . I'm still chasing that "boy, did I sleep well" feeling . . .
Me too. I had that for a few months. It slipped away. I take solace in the fact that I feel better than I did.
Songbird wrote: . . . have great leak rates and generally have an AHI of 0.0 to 0.3 . . .
That's several things to be thankful for.
Songbird wrote: . . . getting 7 or 8 hours of sleep is a big problem . . .
I hear ya, friend. I'm still working on that, myself. Some say it is normal that we get less sleep and less quality sleep as we get older. Sometimes I think getting older is worse than SDB. But I KNOW getting older WITH SDB is the pits. So at least we do what we can about that, eh?
Songbird wrote: . . . I'm sure there are other things involved . . .
Yep. It's easy to blame all our fatigue on SDB, because we have a machine to adjust for it. And when you got a hammer in your hand, every problem sure looks a lot like a nail, don't it?
Songbird wrote: . . . Adderall usage for ADD; I'm in the process of weaning off it . . .
Any drug that does anything during the day is gonna do something at night too. Maybe it helps our sleep. Maybe it hurts it. But it affects it in some way or other. And taking less of a drug is stress on the body as surely as taking more of it is. That must be factored in until you've been off it a while. I wouldn't be a bit surprised, now that you've been on PAP therapy for a while, if your ADD symptoms improve with time. Oh, if only our lives would get stable enough for us all to get a PSG when some stability hits! But we're always in the midst of changes and adjustments, and it's hard to get a study on an average day when none of our days seem average. Speaking for myself, there.
Songbird wrote: . . . DJD (degenerative joint disease) pain . . .
Well, it's hard to find anything good to say about pain, right? We may not consciously experience it at night, but we experience it. And it can pull us right out of SWS and up into light sleep over and over. Titrating pain meds can be trickier than titrating air pressure. But it is a variable to deal with as scientifically and intuitively as we can.
Songbird wrote: . . . Possibly insufficient deep & REM sleep. . . . no stage 4 or REM in the two titration studies. . .
My opinion is that it can be difficult to judge those things from a study unless it a was a particularly good one. Although, I'm sure that if anyone can figure things out if you have any data, SAG would be the man. I think that ideally, once a person has settled into therapy and is comfortable with the equipment, another PSG to assess those things would be nice. REM decreases with age. I think present theory has it that stage 3 is as good as stage 4 in many respects and they throw those two stages together. So I wouldn't lose sleep over no stage 4. The point is to do all you can to get all of the REM and deep sleep you can. Regular hours of sleep and easing into evening slowdown on the way to bed can help with that.

I think melatonin is a highly individual thing and you have to experiment a lot to find your own personal sweet spot for timing and dosage.

I throw all that out there, even though I didn't really say anything, in case it gives some of the more insightful ones something to react to. Maybe in the process I'll learn as much as you do.

I am really glad you posted all that. Hope you get all your PSG info and charts posted for review too.

jeff
Last edited by jnk on Fri Dec 05, 2008 7:14 am, edited 1 time in total.

User avatar
OldLincoln
Posts: 780
Joined: Wed Mar 26, 2008 7:01 pm
Location: West Coast

Re: Adderall, melatonin and other sleep disrupters & fixes

Post by OldLincoln » Thu Dec 04, 2008 10:39 pm

I have 2 nights without Sonata behind me now. The first one was difficult to get to sleep, but the bad thing was I awoke with the room spinning so bad I could not walk without holding on to something. I tried to have a normal day (no driving) and the spinning slowed down through the course of the day but didn't stop until about dinnertime.

I do not have a clue what that was about, even if it was related to Sonata. So last night I went without meds and went to sleep only after 30- min or so and woke a few times. Today I've felt good and no dizziness.

I got the Melatonin today but will stay off it all to see what happens. Since I don't have a job it doesn't matter as much how well I sleep. My goal is to reduce the short term memory loss. We'll see how it all goes for a while.
ResMed AirSense 10 AutoSet / F&P Simplex / DME: VA
It's going to be okay in the end; if it's not okay, it's not the end.

User avatar
Songbird
Posts: 287
Joined: Fri Oct 17, 2008 10:13 am
Location: Pennsylvania

Re: Adderall, melatonin and other sleep disrupters & fixes

Post by Songbird » Fri Dec 05, 2008 2:21 am

ziggytosh wrote:My wife has actually been going through some similar issues. .... OTC melatonin .... knocked her out at first but then gradually seemed to lose its effect. She was then having more trouble sleeping than before. Her GP prescribed Ambien .... but if you take it every night you pretty quickly get to where you can't sleep without it. She finally went to a sleep doctor .... He basically told her she needed to get off any sleep aids, OTC or otherwise. He said the problem is that these sleep aids either replace your natural melatonin (in the case of OTC melatonin supplements) or induce your body to produce it in surges in response to the med (as in Ambien). .... Also, as far as Adderall substitutes, I've heard great things about Provigil .... often prescribed off-label for ADD because the non-speedy wakefulness apparently gives people the ability to concentrate and focus better.
Wow, Ziggytosh, sounds like your wife’s really been through it. I appreciate and agree with your caution about not taking sleep aids, but I didn’t think that melatonin qualified as a sleep aid. Guess I’d better do some more reading. I’m going to do some reading about Provigil, too. Thanks!
Snoredog wrote:Geeze what a basket case!
So true. And in SUCH good company.
Snoredog wrote:.... but you better stick with the Adderall, it treats severe depression, symptoms of narcolepsy and idiopathic CNS Hypersomnia.

I don’t have severe depression, I’m pretty sure I don’t have narcolepsy, and since I never heard of idiopathic CNS hypersomnia, I guess I’d better get reading.
Snoredog wrote:I have read many studies on Melatonin and am quite comfortable taking up to 9 mg. After 16 years of using 3 mg I still don't have a 3rd arm growing out of my forehead.

Well, I’ve been described as having a third ear growing out of the back of my head, but that’s another story entirely.
I appreciate your comments about melatonin here and elsewhere in the forum. It was only after a lot of reading that I started taking it. I’m thoroughly convinced it’s very safe.
Snoredog wrote:.... if I have too much EDS I don't look at it as too much Melatonin, I look at it as I got too much SWS and not enough REM. While SWS (Stage3/4) is thought to be where you get the restorative effects of sleep, I see getting too much SWS meaning I didn't get any/much REM. If I never remember my dreams and I wake up feeling like the walking dead it probably means I woke up from SWS as opposed to REM. Wake up in REM you wake up without an alarm, you wake up refreshed, that is my experience anyway.
If I came across that info before, it must have gone straight through my eyes and out... uh.... one of the other holes, 'cause it sure didn't stick. I'm glad you included this. (so much to learn!)
Snoredog wrote:If you have been using melatonin as long as I have you know that the OTC dose has gradually increased. It has increased because they are finding higher doses work better than lower doses. Yeah I know about the Mayonnaise study but using a dose for simple acute insomnia is one thing, using it to obtain better quality sleep and REM is another. .... To understand how supplemental melatonin works you have to read the research, some of that research includes timetables showing how your levels of melatonin change throughout the day. One study shows it peaks at about 2AM in the morning where it begins tapering off towards 6 AM where it is at its lowest level, about noon or 1 PM it begins building again which is why in Mexico they have afternoon Siestas. Levels continue to build into dinner time where once dark sets in levels more rapidly increase towards the peak again at 2 AM. So when you take OTC supplemental melatonin you are only padding or adding to those natural levels. Supplemental melatonin only stays in the blood stream a short few hours. When you take it you are only adding to your own natural levels. Studies also show we produce less and less melatonin as we age, reason why old people can't sleep.
If you have links stored for the “good” research, could you post them here? If not, I’ll go have a chat with Mr. Google (whose first name, I believe, is Barney). Thanks for all of this, Snoredog.
WearyOne wrote:My son has/had a version of DSPS (delayed sleep phase syndrome).
More new words!! Aargh!!
WearyOne wrote:Sleep doc gave us samples of Rozerem (used a lot for sleep phase disorders and is supposed to work similar to melatonin), and said we could try that, or just regular OTC melatonin. Rozerem didn't really help either. He had tried melatonin before, but only up to 2 mg. Sleep doc said anything less than 3 was pretty useless (as least for what my son's problem was), and he could easily go up to 6 mg. He went up to 3, and that did the trick. That was the only thing that did any good.
Thanks, Pam. Good info.
carbonman wrote:After I started cpap and joined the forum, and listening to the junkyard dog, I added L-theanine to the melatonin. They seemed to work very well together and did help me fall asleep and stay asleep. Since my therapy is going so well and I was falling asleep easily, and just to see if I could help further medical science, I decided to "test" my therapy. I quit both the melatonin and L-theanine 15 days ago. I am having no trouble getting to sleep, and the dream sessions that cpap has brought me have increased. I have had multiple dream sessions every night since I quit .... and none have killed me.
I missed seeing anything about L-theanine, so am adding that to my reading list, too. (sigh) Thanks for that and all your comments, Carbonman.... especially the part about your dreams not killing you.
LSAT wrote:Schiff Sleep Support...3mg Melatonin with 25mg Theanine
Thanks, LSAT, and especially for the suggested dosages.
-SWS wrote:That's a laaaaarge list of possible confounding and contributing factors.
Yes, it is quite a list. And ADD Woman forgot to mention these: RLS; a hiatal hernia; GERD; pollen allergies; lousy sinuses; nerve troubles in my feet (from extensive surgery in both of them); leg, ankle and foot edema (caused by.... ah, who can know? too many choices); now-you-see-it-now-you-don't benign positional vertigo; sleep talking (have even had rational but not remembered eye-open conversations with others); and my sleep doc, who considers his work a total success (don’t get me started), is referring me back to my GP to investigate chronic fatigue syndrome.
-SWS wrote:I'm glad SAG has kindly offered to look at your PSG to see if there are any sleep problems that might have been overlooked. IIRC you didn't have much of an opportunity to sleep well on CPAP during the NPSG---which means SAG may not be able to see what your current sleep architecture looks like.
Me, too. (thanks again, SAG!! workin’ on it) You do remember correctly about all three sleep studies. Slept lousy/hardly slept/no REM in #2 and #3.
-SWS wrote:I don't know what impact your remaining Adderall dosage may have on your sleep architecture. While this study is about ADD/ADHD children, insomnia, and sleep latency, it kind of hints that typical ADD/ADHD stimulant treatments do impact sleep as we might expect: http://www.ncbi.nlm.nih.gov/pubmed/10521009 (too bad they didn't study ADD/ADHD pharmaceutical treatment impact on architecture)
Thanks. And as SAG mentioned, my Adderall changes might make my studies and graphs no longer representative of my sleep architecture.
-SWS wrote:Prescription stimulants and unmitigated pain sure seem like two likely areas to focus on for starters. Emotional stress, depression, worry seem to be common themes on the apnea message boards. And mental stressors can absolutely rob daytime energy and even quality of sleep. ... Intuitively I don't think this is going to be a quick and easy fix. It's entirely possible that a variety of factors are contributing to the way you feel when you wake up in the morning. .... similar to a car engine that is out-of-tune for a combination of reasons .... By contrast another car may have only one salient problem, such as a faulty ignition. Fix that one problem, and voila! .... Aside from apnea, the known factors that have all contributed to my daytime fatigue seem to be .... unmitigated pain .... GERD flareups .... worry mode or depression .... carrying excessive weight above a certain threshold. .... With that said, we're going out to Rock Bottom for beer and a fried dinner tonight.

Yes, I think you're right about the stimulants and pain. As to the rest, there are times when it feels like my joy's been robbed, but it comes and goes. I doubt that anyone here is a stranger to that. Like I said to Snoredog, though, not severe depression. On the other hand, I know it isn't something to be allowed to run rampant, either. And sometimes the best prescription for dealing with all of that is sharing a beer and a meal with another. Thanks, -SWS.
jnk wrote:
Songbird wrote:I'm still chasing that "boy, did I sleep well" feeling
Me too. I had that for a few months. It slipped away. I take solace in the fact that I feel better than I did.
Good! And there's also solace in knowing others are on the same quest, don't you think?
jnk wrote:It's easy to blame all our fatigue on SDB, because we have a machine to adjust for it. And when you got a hammer in your hand, every problem sure looks a lot like a nail, don't it?
Jeff, that is such a great way of putting it. Since we understand it can cause so many system failures (or at least failings) it's easy for us to forget that LOPE (life on planet earth) involves so much more and that we don't have the luxury of ignoring the rest of LOPE, as if we were putting canned goods into a cupboard, while we're working on our SA therapy.
jnk wrote:Any drug that does anything during the day is gonna do something at night too. Maybe it helps our sleep. Maybe it hurts it. But it affects it in some way or other. And taking less of a drug is stress on the body as surely as taking more of it is. That must be factored in until you've been off it a while.
Yes, I quite agree. All of this discussion is wonderful and so welcome, but I don't think we'll actually be able to chase much of any of the rest until I'm off the Adderall and my system's calmed down from that adjustment.
jnk wrote:Well, it's hard to find anything good to say about pain, right? We may not consciously experience it at night, but we experience it. And it can pull us right out of SWS and up into light sleep over and over. Titrating pain meds can be trickier than titrating air pressure. But it is a variable to deal with as scientifically and intuitively as we can.
Agreed. On a side note, though, much as I hate pain or seeing someone else living with it, I think pain is a necessary part of life for a good reason (good being quite different from joyfully welcome). Phil Yancey, a favorite author of mine, wrote in Where Is God When It Hurts? that pain serves as a sensor to alert us that our bodies are in trouble and/or danger. ("HEY! Something's wrong here!!") The example he used has always stuck in my mind: People with diabetes and leprosy often end up losing fingers, toes, etc. and damaging themselves in many other ways when their warning system of pain quits functioning. So (mumble, grumble) thanks for the pain (not really, but I get it, and I'm still going to do what I can to get rid of it and live with the rest, I guess).
jnk wrote:I think that ideally, once a person has settled into therapy and is comfortable with the equipment, another PSG to assess those things would be nice.
Yes. In fact, that was my sleep doc's plan in scheduling my second titration study. But I'm one of those that will probably never have a good night in a sleep lab.
jnk wrote:I throw all that out there, even though I didn't really say anything, in case it gives some of the more insightful ones something to react to. Maybe in the process I'll learn as much as you do. I am really glad you posted all that. Hope you get all your PSG info and charts posted for review too.
You said lots, Jeff, and all of it very much appreciated.
OldLincoln wrote:I have 2 nights without Sonata behind me now. .... I got the Melatonin today but will stay off it all to see what happens. Since I don't have a job it doesn't matter as much how well I sleep. My goal is to reduce the short term memory loss. We'll see how it all goes for a while.
Sorry about the dizziness, Old Lincoln. I'm glad that cleared up. And even though I understand what you're saying about how well you sleep not mattering as much because you're not working, I have to disagree. How well you sleep matters, work or no work. And yes, I realize that like a little kid, I'm letting myself stay up until 3 a.m. because I have a day off tomorrow. (Note to file: do more reading about that circadian rhythm thing. )

I'll post my studies as soon as I work out a way to do it; there are a couple of possibilities. Thanks again, everybody.

Marsha
Resp. Pro M Series CPAP @ 12 cm, 0 C-Flex, 0 HH & Opus 360 mask (backup: Hybrid) since 8/11/08; member since 7/23/08
A good laugh and a long sleep are the best cures in the doctor's book. ~ Irish Proverb