problems falling asleep after waking up

[justacpapuser]

I have been using CPAP for about a month now. I have RERA (respiratory event/effort related arousals).
My CPAP pressure is 11cm and it has helped me a great deal. I'm using a full face mask (Quattro FX).
For the first 2-3 weeks, I was able to sleep 6-7 hours straight, which is something unheard of for me (at least in the last 13 years or so).
But then, for whatever reason, I stopped sleeping that well. For a little over a week now, I'm able to fall asleep for 3-4 hours and then I wake up.
I feel the urge of taking the mask of and changing position from sleeping on my back to my stomach (which I can't have the mask on).
I tried to continue using the mask after I wake up but for some reason I just can't seem to fall back asleep (was able to do so in the initial few weeks on the rare occasions when I did wake up at night).
Without the mask I fall asleep eventually but wake up multiple times.

Some of it might be due to the heat. I do feel my face getting hot - weather has changed where I am now quite a lot from about a month ago.
But am not sure if that is the reason. I am going to try the Swift FX nasal pillows and see how that works.
I am still much better than without a CPAP but am missing putting my head on the pillow and waking up in the morning after 6-7 hours without waking up.
I hope that the new mask and sleeping positions it allows will indeed fix my issue.
I do maintain good sleep hygiene and always have been even though I didn't know it.

I called my doctor and he said it is possible that in the initial few weeks I slept pretty good because I was making up for all those lost years but the need to shift positions can be very important for some individuals.
If someone else has had similar issues I will greatly appreciate any help/insight.

[BasementDwellingGeek]

Zeo told me I was awake about 1.5 hours of a 7.5 hour sleep session. I knew I was awake a lot, but Zeo allowed me to quantify. I saw a thread a while back about vitamin D3 and sleep. I now take 10,000 I.U. of D3 a day and have decreased my awake time by two thirds.

[robysue]

justacpapuser,

Welcome to the forum. And I also bid you a sad welcome to the CPAP&Insomnia Club---may your membership in this club be short.

You write:

For the first 2-3 weeks, I was able to sleep 6-7 hours straight, which is something unheard of for me (at least in the last 13 years or so).
But then, for whatever reason, I stopped sleeping that well. For a little over a week now, I'm able to fall asleep for 3-4 hours and then I wake up.
I feel the urge of taking the mask of and changing position from sleeping on my back to my stomach (which I can't have the mask on).
I tried to continue using the mask after I wake up but for some reason I just can't seem to fall back asleep (was able to do so in the initial few weeks on the rare occasions when I did wake up at night).
Without the mask I fall asleep eventually but wake up multiple times.

First things first: 'Tis a very bad habit to get into----taking your mask off in the middle of the night just so you can get some (bad) sleep. Easy to fall into and difficult to break once it's established as a routine.

So try not to do that. When you reach the end of your rope in the middle of the night and can't stand to have that mask on for one more minute because it feels as though you'll never get back to sleep, then it is time to get out of bed, go into a different room and do something soothing and relaxing and sleep inducing. Only go back to your bedroom after you are both calm enough and sleepy enough to face putting on the mask when you get back into bed.

That's really the only way to teach your unconscious mind that you will NOT allow it to keep you awake so long that you will take the mask off and sleep without it.

Yes, I know this advice is counter intuitive. But chances are if you've been lying in bed wide awake fighting with the mask and fighting to get back to sleep for more than about 30 minutes, then you are probably too wired to easily get back to sleep anyway. And you'll actually get back to sleep faster if you go ahead and get out of bed and sit somewhere else and focus on settling yourself down. Sometimes sitting in the semidark for about five minutes is all it takes. Sometimes making yourself a cup of sleepytime tea or warm milk might help.

As for missing sleeping on your stomach. You might try searching the forum for the Falcon position. It's a stomach sleeping position that is possible even for those who use FFMs. A special CPAP pillow with cutouts for the mask to hang down into might help. Sleeping with your face at the very edge of the pillow might help. With some practice, you should be able to find a stomach sleeping position that is close enough to your old favorite position that you don't miss it quite so much.

Some of it might be due to the heat. I do feel my face getting hot - weather has changed where I am now quite a lot from about a month ago.

Heat and humidity do make sleeping more difficult and sleeping with a CPAP hose attached to your nose even more difficult.

My own solution to summer time sleeping was, alas, to throw in the towel on the A/C. I live in Buffalo, NY. And we seldom get that hot here. (Although we will be flirting with 90 the next several days.) But the night time humidity was horrible last year----particularly on nights where the low was in the upper 60s or lower 70s. Hubby convinced me to just buy a new whole-house A/C for my birthday last summer and run the dang thing as cold as I need to at night in order be comfortable with my mask on. For me, that means setting the night time thermostat at around 70 degrees.

[shb]

This is also my main problem..

I've tried a lot of things. Some work for a while, some dont work..

First I agree with basementdwellinggeek, I also use a Zeo, it allows you to quantify and be exact is how many awakenings and their duration.

"sleep hygiene" - and all it encompasses is a big factor. But the bottom line is to gradually improve each area until there is nothing left to cause it.

One low tech solution that I have found - but I worry about overusing it (eg every single night) is simple boring old paracetamol. I go to bed around 10pm - and wake up routinely at 2pm - not overly hot - not wanting to use bathroom - no real explanation. Take one (500mg) paracetamol tablet - and within 15-20mins are back at sleep till 6.30am.

I have been experimenting with Melatonin lately. IT seems to help - but not by very much. I have been using the 3mg Time-release version.. It seems to help get to sleep - but not stay asleep. Also - you got to eat your evening meal a few hours before taking it - so you are taking it on a empty stomach -or it seems to have no effect at all. I am thinking of trying out the 5mg time-lapse - and maybe sticking with the 3mg time release, but also having a bottle of the 3mg fast-dissolve handy to use instead of paracetmol in the middle of the night...

I like BDG's comments about vitamin D - and plan to try it too !

[MaxDarkside]

In the beginning when I started CPAP after I adjusted to the alien on my face I slept for 9-10 hours every night. I craved the mask. I would sleep and sleep and sleep. Fast forward 7 months... my sleep debt is paid up now, I reckon. I go to sleep at midnight and now I wake up every hour after about 4 AM. If I get up way early (4, 5 or 6) I feel like crap because all I get is that many hours. So I go back to sleep and wake up, then sleep then wake, then... Every night now. I'm starting to get tired of it, so to speak I figure there's some things I can do: Clean up my sleep hygiene a bit more (I'm doing experiments right now that may be messing it up) and another thing is to get me more exercise, which may have me sleep more and get fitter, two winning returns for one action. Also I know that aliens come in the middle of the night and flip me on my back ( ) which causes me to have severe apnea events even while treated in the mid-later part of my sleep so I'm looking at ways to prevent that, which may help me not wake up from those events.

[shb]

Here's examples of what I described. The AHI in both cases is between 0.0 and 0.5 (so the breathing/apnea is well controlled, and not the problem).
Each time I take a Melatonin 3mg time-release (Natrol) about 30minutes before bed, and then at the waking I take a single 500mg paracetamol tablet.

I also want to fix/remove this waking - which seems to be every single night... I don't like taking the paracetamol tablet every night - but it seems to work (as the sleep after I take it seems good - confirmed by the zeo graph.).

I am planning to replace the 3mg Melatonin time-release with a 5mg Meltonin time-release, and hopefully will sleep through and not need to take anything else. Or perhaps I will keep taking the 3mg TR - and then when I wakeup take a NON time-release 3mg tablet...

Anyone have any thoughts on this ???

p.s. From the reading I have done, I think that the paracetamol works by reducing core body temperature slightly and this enables better sleep...

[MaxDarkside]

I also want to fix/remove this waking - which seems to be every single night...

Yikes! I can see why. Are you sure the drugs aren't as much a cause as a cure? Paracetamol (acetaminophen) is an analgesic. Take regular high amounts (and "high" probably isn't that much) and you get analgesic rebound (pain, disturbed sleep). According to Wiki: "The onset of analgesia is approximately 11 minutes after oral administration of paracetamol,[5] and its half-life is 1–4 hours." which means it wears off pretty fast and you could have "analgesic rebound" while you are sleeping, causing you to be uncomfortable, awaken, suffering some withdrawals. My sleep hygiene was pretty messed and I was only taking 5-10 Excedrin a day and drank coffee in the evening. My Neurologist-Sleep Doc said, "Whoa... TOO MUCH Excedrin! Stop that now! 5-10 a week is probably too much!". As soon as I stopped the Excedrin cold-turkey, felt like crap for a few days, and stopped coffee in the mid-afternoon, my sleep cleaned up a lot.

[shb]

I was only taking 5-10 Excedrin a day and drank coffee in the evening. My Neurologist-Sleep Doc said, "Whoa... TOO MUCH Excedrin! Stop that now! 5-10 a week is probably too much!".

yeah - but I am taking waaaaaay less than that. First, I have no coffee (or other caffeine) after 10.30am - you say you were having a coffee in the evening. Second, you were taking 5-10 Excedrin tablets a day... I am taking 1 single tablet a day (at about 2am). It contains *only* 500mg of paracetamol -nothing else. I am unclear which exact Excedrin you are taking but the Excedrin® Migraine tablet contains - paracetamol (acetaminophen) , and aspirin, and caffeine... I don't think it is comparable.

[MaxDarkside]

Ya, well, I am still guilty of sneaking a naproxin or two at bedtime (shhhh..., but no caffeine at least) I don't know, just an idea. The analgesics was the first thing that came to mind because a small change in those for me made a big change in my sleep. Your Zeo says you have a sleep architecture in there amongst the wakes, at least on the 1st night shown, but fragmented. Something is causing the wakes and busting up the architecture. Probably not the Acetaminophen then, because that comes after the 1st set of wakes. Maybe something during the day, evening. We're all different, that's for sure. I don't know if you've seen my wife's raw Zeo brainwaves (Delta theta, alpha, betas, etc). OMG, I don't know how she sleeps. It's like she's being zapped, probably propranolol causing it in her case.

Of course, this is coming from a guy who watches his streaming brainwaves, wears an accelerometer on his head and ties himself to his own bed !! Doesn't exactly build confidence in what I say... HAhahahaha...

[robysue]

shb,

I have a couple of questions about your Zeo data. Particularly this chart:

I notice that the really long wake between 1:00 and 2:00 starts out as being scored as REM. Do you actually remember being awake for an extended period of time between 1:00 and 2:00? Or are you basing the length of a wake that you remember somewhat vaguely on the Zeo data?

The Zeo is only about 75% accurate when it comes to scoring sleep stages. Please understand, I don't mean this as a denigration to the Zeo: Given its cost and intended use, that's actually a respectable accuracy rate. But it does mean that Zeo data has to be interpreted rather loosely. If you read through all the documentation, one of the things the Zeo makers point out is that the Zeo can have some real problems distinguishing WAKE from REM. So if you don't remember a very long and protracted WAKE at that time, this "wake" may be nothing more than mis-scored REM sleep.

A second thing to keep in mind is that those bars on the Zeo web site are five minute windows, but the data is gathered in 30 second epochs. The rules for assigning the state to each five minute window are straightforward:

• If WAKE is scored at any point in the five minute window, the whole five minute interval is scored as WAKE on the web site. Hence if there is one 30-second epoch of REM that is mis-scored as WAKE in a five minute window where all the other epochs are properly scored as REM, the whole window shows up as WAKE on the Zeo website.
• If there are NO WAKE epochs scored during the five minute window, then the Sleep State assignment is done by majority vote. Whatever sleep stage (LIGHT, DEEP, REM) has the greatest number of individual epochs scored in the five minute window wins, and that's the stage that's shown on the web site.

Now, don't get me wrong: I love my Zeo. It's given me some real insight into some aspects of my sleep. But in my Zeo data, I am constantly seeing things labeled as WAKE that I don't remember and that do NOT look like wake when I look at the corresponding wave flow data from my BiPAP. Most of them seem to have breathing patterns very similar to the periods scored as REM and I believe that for whatever reason, my Zeo has real trouble distinguishing my REM and WAKE stages.

I also want to fix/remove this waking - which seems to be every single night... I don't like taking the paracetamol tablet every night - but it seems to work (as the sleep after I take it seems good - confirmed by the zeo graph.).

Questions:

1)What is the very first thing that you do when you find yourself aware that you've woken up in the middle of the night? Do you immediately look at the clock and start wondering why you woke up, thinking/calculating how much sleep you've gotten and how much time there is before the alarm goes off, and worrying that you won't get back to sleep? Or do you turn over, snuggle back down into a comfortable position, and expect to get back to sleep without too much problem? Or do you do something else---like get up right away to take the paracetamol tablet before you even try to go back to sleep without it?

2) How long would you estimate this nightly wake is if you did NOT have the Zeo data telling you it's an hour long? In other words, if you left the Zeo off for a night and you woke up as usual, how long would you estimate that it took you to get back to sleep?

[shb]

Ok - this from Iphone so I may leave out some detail...

First - I suspect the zeo is under reporting wakes - not over reporting. I don't doubt that 1 hour wake on 19th. I feel that I was probAbly in bed awake for 20mins b4 I got up.. Then up for 20 mins.. Then took another 20 to fall asleep. I know about the 5min and 30sec data recording. I have downloaded the 30sec data and it shows broadly the same.

What to I do when I wake - first there is no clock in my bedroom and I have no watch at the moment. The zeo is run off my iPhone which will be on charger in another room - I don't worry at that until morning.
Mostly I try to relax and get back to sleep - if I've already tried that or feel uncomfortable I get up.. glass water.. And lately have started to also take a paracetamol if I think it will help me back to sleep..

[robysue]

shb,

Ok, so we know those long wakes are for real.

Next set of questions:

Did this long wake pattern start when you started CPAP or was it present in your sleep patterns before your diagnosis?

And how do you "try to relax" before you wind up getting out of bed and taking the paracetamol? What do you do in the 20 minutes or so that you are out of bed beside taking the paracetamol?

Is your machine an S8 Escape or an S8 Elite or S8 AutoSet? If it records efficacy data have you looked at the detailed data? I know your machine doesn't record the wave form data, but it does record an events table/graph that visually shows when your events happened. Any chance that you're waking up after a nasty series of events?

[gerry]

I have had this problem for several years, using different masks and taking various supplements. But, I am 75 yrs old and my old fart friends, some without apnea, have the same problem. I don't know your ages, but sleeping patterns can be one of the many age related problems.

[shb]

Well I've been on CPAP since 2005 so remembering is a bit hard. It is possible that I've had the pattern before Cpap - periodically - perhaps stress related.

I have s9 auto (with humid). I use both SH and resscan. There are no events that explain the wakes. My AHI # is always under 1.0 and usually about 0.3 (ocassionally at 0.0). I think the breathing / apneas are sorted out and not part of the problem.

I am 47 years old.

[need2snooze]

I was reading this thread with curiosity, as I often wake up after 4-5 hours of sleep. What really hit me, though, was what MaxDarkSide said about Excedrin. I hope he is still reading this thread b/c I would like to know how he quit Excedrin cold turkey. The prescriptive meds for my migraines don't work as well now as Excedrin does, and I usually take approx. 8-10 Excedrin/week. But I know better than to take it late in the day. I thought the effects of it wore off after 6 hours. Having said that, however, if I have a migraine, I'd rather take my chances and take something for it than to suffer with the pain. Either way, I won't be able to sleep. My neurologist/sleep dr. believes that the migraines are related to the sleep apnea. I know there are other things that cause my migraines (i.e., food allergies, weather, stress, fatigues, etc.), but I definitely will get a migraine if I don't get enough sleep. So, it's a vicious cycle. I dream (no pun intended) of being able to sleep for 8-9 hours, waking up and feeling refreshed for the entire day, and then getting consecutive nights sleep like that.