I need help with Insomnia AND CPAP

Continuing a conversation that was started in this thread:
viewtopic/t105383/Is-there-any-disorder ... Apnea.html

As a bit of background, robysue is helping me to figure out why my insomnia has gotten worse since starting CPAP four months ago.

Here is the latest post:

robysue wrote:
I'm sorry that instead of telling you something I'm asking more questions.

1) Two of the last five days have large gaps in the data: On 4/29 there's an hour long gap from roughly 1:20 to 2:20 and on 4/30 there's a 2.5 hour gap from 0:30 to 3:00. Presumably you woke up at the beginning of these gaps. Did you take the mask off and return to sleep? Or did you get out of bed and do something else until you felt sleepy enough to go back to bed?

2) On four of the nights it looks like you got at about 2 solid hours of sleep at the beginning of the night. Then there's a cluster of events. Is that a likely wakeful period? Or do you think you are waking up later than that? The exception is on the night of 5/1, when there's a pretty dense set of H's that kick in at right around 90 minutes after you go to bed, which has got the right timing for a REM related cluster.

3) On four of the nights there's a really busy hour long period late in the night. On 5/1 and 5/3, the busy hour is around 3:30-4:30; on 4/30, the busy period is 4:30-5:00, and on 4/29 the busy period is 4:00-5:30. All of these busy periods are made up of a mixture of Hs and CAs. It's possible that some of them might be REM related, but I don't think the number of CAs tends to increase during REM the way the number of OAs and Hs do. And some of these clusters do have a fair number of Hs. Any chance these periods correspond to the wakeful periods you remember?

This is a tough call in my opinion. I was really hoping that those CAs were clusterd near the beginning or closer to the end of the time the PAP was running since it would be easier to dismiss them as SWJ. But it looks like you are getting to sleep at the beginning of the night in a reasonable fashion (even if it doesn't seem that way), but the flow rate graph has a lot of spikes in it that are visible even at the "full night" resolution. Arousals and awakenings are often accompanied by a change in breathing---you will often see a couple of big inhalations that are not immediately following a respiratory event if you zoom in on the flow rate curve. And sometimes these are indicators of an arousal or an awakening. Looking at the flow rate is not a 100% failproof way to determine awakenings or arousals, but these larger than normal breaths that are not following an event have a higher than average chance of being associated with an arousal or an awakening. And you say that you have a long standing insomnia problem. So zooming in on some of those "busy" periods in your data to the point where it's possible to see the individual breaths may be useful.

I've also gone back and taken a look at your other threads. Other than mentioning a long standing insomnia problem that predates your starting CPAP, you don't really talk much about how your insomnia manifests itself, or if you did, I didn't happen to find it.

So let's start there: Can you tell me how your insomnia works? In other words, can you tell me if any of this is accurate:

A) You don't have too much trouble getting to sleep at the beginning of the night.

B) At some point you wake up and once you wake up you tend to have trouble getting back to sleep. You may do some dozing or you may feel like you're drifting in and out of a very light sleep, but you don't really feel like you get solidly back to sleep for quite a while.

C) On a some nights you might take as long as 40-60 minutes to finally really fall back asleep. On some nights once you wake up, you're tossing and turning for most of the rest of the night and you feel (subjectively) like you get very little sleep when that happens. On the worst of the nights, do you get out of bed for a while? And then return to bed when you think you are sleepy enough to get back to sleep?

Have I painted an accurate picture of your insomnia?

Finally, since there does seem to be some evidence of possible REM-related clusters of Hs, you might want to increase the pressure from 6cm to 7cm. I would not go any further than that right now since a bigger jump in pressure may cause more problems with the insomnia issues.

Finally, I'm going to make a suggestion that you may or may not be willing to do. You've ditched the clock (which is a good thing), so you aren't consciously aware of when your wakes start or how how long they last. You can use the PAP machine to track those wakes if you want to. If you can easily turn the machine OFF and back ON without a huge amount of effort, then you can use that to track when the wakes are happening. In other words, when you realize that you are awake, reach over and turn the machine OFF and right back ON. That will show up in the data as a break in the Flow Rate curve, but it won't affect the data for the purposes of evaluating the efficacy of your data. And if we knew when the wakes were definitely happening, we might have more of a clue as to whether the "busy" parts of the graph are being caused by SWJ or whether they are occurring when you are more sound asleep (and hence may be REM-related clusters of H's with some "post H-related arousal" CAs thrown in)



Thank you Robysue, you are right on the mark with many of your conclusions. Let me answer then one by one:
1: Yes I turned it off and got out of bed. When I can't sleep beyond 30 minutes I get out of bed, go into another room and read a book until I get sleepy again
2: Most nights in recent weeks, I have only slept about 2 hours at first and then woke up and have not been able to return to sleep. Any sleep I have gotten after that has been very fitful and mostly dozing. I doubt I have gotten much REM sleep at all in the past couple weeks. That pretty much asnwers #3 as well. Several of those nights I have taken medication to get more sleep (30 mg of Temazepam).

Your conclusions:

A: Right
B: Bingo!
C: Correct

That's basically it, Robysue, My answers above have basically described my sleep pattern for the past couple weeks. I've even begun to doubt my original SA diagnosis. I've also wondered this: Most nights I don't have trouble falling asleep with the mask on. But then I wake up and can't get back to sleep. Could the mask be the problem then? Is all that tossing and turning and light dozing being caused by the mask? I've even debated doing a night without the mask (I have been 100% faithful with using the mask every night since Jan. 1, on the few nights I haven't met compliance, I still used the mask for a couple hours)

I like your suggestion. When I first started using the machine, I put a notepad and pen next to my bed to note when I woke up, but I wasn't diligent in doing that. In the past week, I've moved my machine back to the top level of my nightstand (I put it lower than my bed in the past couple months to avoid rainout but putting it back at bed level recently has not resulted in any rainout returning). So, in essence, it is much easier for me to just reach over and turn it on and off. I will follow your suggestion.

Can we move this to private messaging? Again, I feel a bit guilty about taking over this thread for my personal diagnosis.

I very much appreciate what you're doing, Robysue. I would never get this kind of analysis anywhere else (I would seriously consider paying for it, if someone ever wanted to set up shop doing this kind of thing!) But don't get any ideas

novatom wrote:

robysue wrote: So let's start there: Can you tell me how your insomnia works? In other words, can you tell me if any of this is accurate:

A) You don't have too much trouble getting to sleep at the beginning of the night.

B) At some point you wake up and once you wake up you tend to have trouble getting back to sleep. You may do some dozing or you may feel like you're drifting in and out of a very light sleep, but you don't really feel like you get solidly back to sleep for quite a while.

C) On a some nights you might take as long as 40-60 minutes to finally really fall back asleep. On some nights once you wake up, you're tossing and turning for most of the rest of the night and you feel (subjectively) like you get very little sleep when that happens. On the worst of the nights, do you get out of bed for a while? And then return to bed when you think you are sleepy enough to get back to sleep?

Have I painted an accurate picture of your insomnia?

Thank you Robysue, you are right on the mark with many of your conclusions. Let me answer then one by one:
1: Yes I turned it off and got out of bed. When I can't sleep beyond 30 minutes I get out of bed, go into another room and read a book until I get sleepy again
2: Most nights in recent weeks, I have only slept about 2 hours at first and then woke up and have not been able to return to sleep. Any sleep I have gotten after that has been very fitful and mostly dozing. I doubt I have gotten much REM sleep at all in the past couple weeks. That pretty much asnwers #3 as well. Several of those nights I have taken medication to get more sleep (30 mg of Temazepam).

Your conclusions:

A: Right
B: Bingo!
C: Correct

Ok, so I've nailed the description of your recent sleep patterns. Any interest in how I teased that info out of your data?

I've even begun to doubt my original SA diagnosis.

First and foremost: I don't think you should be doubting the orignial SA diagnosis based on your CPAP data. Only the sleep study data itself can be used to determine whether you have a mild or moderate or severe problem with sleep apnea. If you've previously posted your sleep study data, I didn't happen to see the thread. But unless the sleep data showed the mildest of mild OSA, I think you're doing yourself a disservice by questioning the diagnosis.

I've even debated doing a night without the mask (I have been 100% faithful with using the mask every night since Jan. 1, on the few nights I haven't met compliance, I still used the mask for a couple hours)

Back in the bad old days when my CPAP-induced insomnia was really, really, really bad, the idea of going without the mask for a night or two was suggested to me by a number of people, including some folks on this forum. I never did it out of sheer fear. I was terrified that if I subjectively slept better without the mask that I'd never have the courage, gumption, and/or discipline to force myself to start using it again. And even though my OSA is only moderate, I knew that in the long run I had to use the mask. So I kept on sticking the mask on my nose every single night hoping and praying that this would be the night when things would finally come together. I never did have an epiphany experience of waking up one morning ready to sing "Glory Hallilujah! I feel great because of the CPAP!"

But after I finally realized that I absolutely had to deal with the insomnia as a separate issue from managing the OSA, I was finally ready to get serious about doing the hard work to address the insomnia problem. In my case managing the insomnia has become a far harder job than just slapping the CPAP mask on my nose every night. And in my case, whether I feel lousy or not in the daytime is usually far more closely related to how bad the insomnia data is instead of the AHI data. (That said: If the AHI is higher than usual, I won't feel as good. If both the AHI is high AND the insomnia was acting up, then I'll have a pretty long, miserable day.)

Could the mask be the problem then? Is all that tossing and turning and light dozing being caused by the mask?

Short answer: Yes, the mask may be aggravating the situation. Or the pressure from the machine could be aggravating the situation. Or the varying pressure levels could be aggravating the situation. And the sad fact is, you might never sort out exactly what is causing the problem. However, the good news is that you might not actually need to pinpoint the exact cause of the problem---if you can train your body to just get back to sleep quickly instead of going into "light doze and toss and turn" mode when you first wake up in the middle of the night.

So let's focus on that: Your problem really starts when you first wake up in the middle of the night and you realize you are awake (yet again). If you can teach your mind to shut up enough to allow your body go back to sleep quickly after that first wake, you might find that your subjective view of the quality of your sleep will improve and when your subjective view of the quality of your sleep improves, you might just start feeling better in the daytime.

Some questions to think about:

1) What is the very first thought that goes through your mind when you realize that you just woke up in the middle of the night?

2) You say that if you can't get back to sleep in about 30 minutes, you are willing to get up and go into a different room and read for a while (or do something else for a while). That's a standard suggestion that does help a lot of people. But when you are out of bed, do you spend a lot of time watching the clock and worrying about the fact that you're not in bed asleep? Or do you allow yourself to enjoy the reading (or whatever it is) that you are doing?

3) In a typical night how much actual time do you think you spend sleeping during the night? And how much time to you spend in bed on a typical night?

4) How would you describe good sleep? In other words, what do you think your sleep should look like?

5) When would you like to go to sleep each night? When would you like to wake up each morning?

6) You say that you took 30 mg of Temazepam on several of the nights in the data you posted in this particular post on the other thread. In your opinion, which phrase best describes how well the Temazepam works for you:

• Pretty effective on some nights
• Sort of effective on some nights
• Pretty effective or sort of effective on a FEW nights, but not very effective on most nights
• Not very effective on almost all nights

Also, what are the doc's instructions for taking the Temazepam? Take it only as needed? Or take it every night?

robysue wrote:

novatom wrote:

robysue wrote: So let's start there: Can you tell me how your insomnia works? In other words, can you tell me if any of this is accurate:

A) You don't have too much trouble getting to sleep at the beginning of the night.

B) At some point you wake up and once you wake up you tend to have trouble getting back to sleep. You may do some dozing or you may feel like you're drifting in and out of a very light sleep, but you don't really feel like you get solidly back to sleep for quite a while.

C) On a some nights you might take as long as 40-60 minutes to finally really fall back asleep. On some nights once you wake up, you're tossing and turning for most of the rest of the night and you feel (subjectively) like you get very little sleep when that happens. On the worst of the nights, do you get out of bed for a while? And then return to bed when you think you are sleepy enough to get back to sleep?

Have I painted an accurate picture of your insomnia?

Thank you Robysue, you are right on the mark with many of your conclusions. Let me answer then one by one:
1: Yes I turned it off and got out of bed. When I can't sleep beyond 30 minutes I get out of bed, go into another room and read a book until I get sleepy again
2: Most nights in recent weeks, I have only slept about 2 hours at first and then woke up and have not been able to return to sleep. Any sleep I have gotten after that has been very fitful and mostly dozing. I doubt I have gotten much REM sleep at all in the past couple weeks. That pretty much asnwers #3 as well. Several of those nights I have taken medication to get more sleep (30 mg of Temazepam).

Your conclusions:

A: Right
B: Bingo!
C: Correct

Ok, so I've nailed the description of your recent sleep patterns. Any interest in how I teased that info out of your data?

Yes, I am

I've even begun to doubt my original SA diagnosis.

First and foremost: I don't think you should be doubting the orignial SA diagnosis based on your CPAP data. Only the sleep study data itself can be used to determine whether you have a mild or moderate or severe problem with sleep apnea. If you've previously posted your sleep study data, I didn't happen to see the thread. But unless the sleep data showed the mildest of mild OSA, I think you're doing yourself a disservice by questioning the diagnosis. [/quote]

[/quote]My untreated AHI was 28 when I was tested in November. I had a similar test done in 2002 and then it was 19. I went for titration then but couldn't stand the mask so I never followed up. I have probably gained maybe 5-10 pounds since then (mostly due to just getting older, I think, I turn 55 next month)[/quote]

I've even debated doing a night without the mask (I have been 100% faithful with using the mask every night since Jan. 1, on the few nights I haven't met compliance, I still used the mask for a couple hours)

Back in the bad old days when my CPAP-induced insomnia was really, really, really bad, the idea of going without the mask for a night or two was suggested to me by a number of people, including some folks on this forum. I never did it out of sheer fear. I was terrified that if I subjectively slept better without the mask that I'd never have the courage, gumption, and/or discipline to force myself to start using it again. And even though my OSA is only moderate, I knew that in the long run I had to use the mask. So I kept on sticking the mask on my nose every single night hoping and praying that this would be the night when things would finally come together. I never did have an epiphany experience of waking up one morning ready to sing "Glory Hallilujah! I feel great because of the CPAP!"

But after I finally realized that I absolutely had to deal with the insomnia as a separate issue from managing the OSA, I was finally ready to get serious about doing the hard work to address the insomnia problem. In my case managing the insomnia has become a far harder job than just slapping the CPAP mask on my nose every night. And in my case, whether I feel lousy or not in the daytime is usually far more closely related to how bad the insomnia data is instead of the AHI data. (That said: If the AHI is higher than usual, I won't feel as good. If both the AHI is high AND the insomnia was acting up, then I'll have a pretty long, miserable day.)

Could the mask be the problem then? Is all that tossing and turning and light dozing being caused by the mask?

Short answer: Yes, the mask may be aggravating the situation. Or the pressure from the machine could be aggravating the situation. Or the varying pressure levels could be aggravating the situation. And the sad fact is, you might never sort out exactly what is causing the problem. However, the good news is that you might not actually need to pinpoint the exact cause of the problem---if you can train your body to just get back to sleep quickly instead of going into "light doze and toss and turn" mode when you first wake up in the middle of the night.

So let's focus on that: Your problem really starts when you first wake up in the middle of the night and you realize you are awake (yet again). If you can teach your mind to shut up enough to allow your body go back to sleep quickly after that first wake, you might find that your subjective view of the quality of your sleep will improve and when your subjective view of the quality of your sleep improves, you might just start feeling better in the daytime.

Some questions to think about:

1) What is the very first thought that goes through your mind when you realize that you just woke up in the middle of the night?

I've woken up. What time is it? (although I never check now). And probably subconsciously, "here we go again..."

2) You say that if you can't get back to sleep in about 30 minutes, you are willing to get up and go into a different room and read for a while (or do something else for a while). That's a standard suggestion that does help a lot of people. But when you are out of bed, do you spend a lot of time watching the clock and worrying about the fact that you're not in bed asleep? Or do you allow yourself to enjoy the reading (or whatever it is) that you are doing?

I can see a clock from my couch where I sit and read and yes, i am guilty of occasionally glancing at it after reading a few pages...

3) In a typical night how much actual time do you think you spend sleeping during the night? And how much time to you spend in bed on a typical night?

Last night was sort of typical, although I did go back to sleep several times. I had vivid dreams (a lot of that I think comes from dozing and not actual REM sleep, although I think I've remembered dreams from both stages). All in all, probably 4-5 hours at best. I did as you advised last night and rebooted the machine the several times I woke up. I'll post the results once I've gathered a few nights' data.

4) How would you describe good sleep? In other words, what do you think your sleep should look like?

Probably the early part of the night, when I feel that I get the most restful sleep. More often then not, the rest of my sleeping consists of a lot of light dozing. I should say that last night, for the first time in a while, I actually fell asleep in front of the TV around 8:30 for about 10 minutes or so. I find that that can often disrupt my sleep when I go to bed around 10:15 or so, but last night it didn't seem to disrupt the first part of the night.

5) When would you like to go to sleep each night? When would you like to wake up each morning?

10-10:30. I'm always up by 6, although 7 would be even better. Weekdays I'm up by 6 and out of the door by 6:30. When you live where I do (Northern VA, the DC corridor), you adjust your work schedule for the traffic. That's where being a morning person has its advantages

6) You say that you took 30 mg of Temazepam on several of the nights in the data you posted in this particular post on the other thread. In your opinion, which phrase best describes how well the Temazepam works for you:

• Pretty effective on some nights
• Sort of effective on some nights
• Pretty effective or sort of effective on a FEW nights, but not very effective on most nights
• Not very effective on almost all nights

Pretty effective on some nights

Also, what are the doc's instructions for taking the Temazepam? Take it only as needed? Or take it every night?

[/quote]

Take only as needed. My GP has prescribed Temazepam for several years now I much prefer it to Ambien. The last time I got my prescription refilled was in January and it's always for 30 pills. I probably have 8-9 left, so that gives you an idea of how often I use it. My sleep doctor prescribed Sonata (I think it's either 5-10 grams) for short term sleeping. I take it as needed when I'm up at 2-3 in the morning. I've taken it the past two nights in fact and it doesn't do me any good any more. It worked for the first couple times I started using it a couple months ago but now it's pretty useless.

Something I'm going to be upfront about right now, which could very much have an effect: I am a fairly regular user of cannibis in the evenings after work. I find it helps me to relax. The past couple weeks I have not used it though, and this could very well be having an effect. However, even when using cannibis, I still have insomnia issues, pretty much like what I've described above.

I hope that you are not morally opposed to this. I have been very reluctant to reveal that habit of mine on this board but I have shared this information with both doctors who are unfazed about it.

novatom wrote:

robysue wrote:

novatom wrote:I've even begun to doubt my original SA diagnosis.

First and foremost: I don't think you should be doubting the orignial SA diagnosis based on your CPAP data. Only the sleep study data itself can be used to determine whether you have a mild or moderate or severe problem with sleep apnea. If you've previously posted your sleep study data, I didn't happen to see the thread. But unless the sleep data showed the mildest of mild OSA, I think you're doing yourself a disservice by questioning the diagnosis.

My untreated AHI was 28 when I was tested in November. I had a similar test done in 2002 and then it was 19. I went for titration then but couldn't stand the mask so I never followed up. I have probably gained maybe 5-10 pounds since then (mostly due to just getting older, I think, I turn 55 next month)

Your AHI = 28 is close to the border between moderate OSA and severe OSA. Once the AHI is that high, it's really very unlikely that the test is a false positive. In other words, you've got OSA and it's close to severe. Moreover, you've got data that indicates that in the decade you left your OSA untreated, it worsened from the mild-to-middle part of the moderate OSA range to the borderline severe part of the moderate OSA range.

robysue wrote:Some questions to think about:

1) What is the very first thought that goes through your mind when you realize that you just woke up in the middle of the night?

I've woken up. What time is it? (although I never check now). And probably subconsciously, "here we go again..."

Ok. You have a negative reaction to waking up. And that is going to probably make it harder to get back to sleep.

Are you aware that even people who have perfectly normal sleep tend to wake up a few times every night? It's just that the wakes last less than five minutes and because the wakes are so short and relatively few in number, a person with normal sleep just doesn't remember the wakes. It's not uncommon to wake up after many REM cycles, but when a person without an insomnia problem does so, they pretty quickly realize that "everything's fine" in terms of their sleeping environment and so it's ok to go back to sleep and that's just what they do.

So try to NOT think "What time is it?" and "Here we go again." Rather focus on "everything in the house seems to be ok, might as well turn over and go back to sleep."

robysue wrote:2) You say that if you can't get back to sleep in about 30 minutes, you are willing to get up and go into a different room and read for a while (or do something else for a while). That's a standard suggestion that does help a lot of people. But when you are out of bed, do you spend a lot of time watching the clock and worrying about the fact that you're not in bed asleep? Or do you allow yourself to enjoy the reading (or whatever it is) that you are doing?

I can see a clock from my couch where I sit and read and yes, i am guilty of occasionally glancing at it after reading a few pages...

When you look at the clock, do you get worried about the time? Angry about still being awake? Nervous about how little time there is left before morning? If so, you need to try to make it harder to read the clock when you are on the couch reading.

robysue wrote:3) In a typical night how much actual time do you think you spend sleeping during the night? And how much time to you spend in bed on a typical night?

Last night was sort of typical, although I did go back to sleep several times. I had vivid dreams (a lot of that I think comes from dozing and not actual REM sleep, although I think I've remembered dreams from both stages). All in all, probably 4-5 hours at best. I did as you advised last night and rebooted the machine the several times I woke up. I'll post the results once I've gathered a few nights' data.

So you typically get 4-5 hours of sleep at best. And how long are you in bed on a typical night?

It's hard to do, but when I was fighting really entrenched insomnia, the PA had me on what is called a "restricted sleep schedule." The idea behind a sleep restricted schedule is that you only allow yourself a little bit more time in bed than you are actually sleeping. This can help the body relearn how to fall asleep quickly when you wake up in the middle of the night. But it's not something that works for everybody and it's not something that's easy to do. But in my case it really did reteach my body how to get to sleep at the beginning of the night and stay asleep longer during the night and get back to sleep faster when I woke up in the middle of the night.

robysue wrote:4) How would you describe good sleep? In other words, what do you think your sleep should look like?

Probably the early part of the night, when I feel that I get the most restful sleep. More often then not, the rest of my sleeping consists of a lot of light dozing. I should say that last night, for the first time in a while, I actually fell asleep in front of the TV around 8:30 for about 10 minutes or so. I find that that can often disrupt my sleep when I go to bed around 10:15 or so, but last night it didn't seem to disrupt the first part of the night.

You've told me what your sleep is actually like, but what I ask was a different question: I ask you to describe what you wish your sleep looked like instead of what it actually looks like. In other words, how many hours of sleep do you think you need to get each night in order to feel rested? And how much WASO (Wake after sleep onset) do you think you can (or should) tolerate in order to feel rested?

robysue wrote:5) When would you like to go to sleep each night? When would you like to wake up each morning?

10-10:30. I'm always up by 6, although 7 would be even better. Weekdays I'm up by 6 and out of the door by 6:30. When you live where I do (Northern VA, the DC corridor), you adjust your work schedule for the traffic. That's where being a morning person has its advantages

If you need to be up by 6 on weekdays, in the long run your sleep will be better if you can force yourself to get up at 6 on the weekends as well.

10pm to 6apm is an 8 hour sleep window. But you're currently only capable of sleeping about 4-5 hours each night. That means that there's always going to be a huge amount of WASO. And a lot of WASO relative to the Time in Bed window (TIB) often makes for an exhausting night and leaves you feeling pretty zonked the next day. Sometimes you will feel better with less WASO even if you're not getting much more sleep. That's the idea behind a sleep restricted sleep schedule.

You really might sleep better if you delayed going to sleep until 11:00 or 11:30 or even midnight, but still got up by 6. Once you're sleeping for more of your "time in bed" window, you can work on moving the bedtime back towards 10 or 10:30 in 15 minute increments.

robysue wrote:6) You say that you took 30 mg of Temazepam on several of the nights in the data you posted in this particular post on the other thread. In your opinion, which phrase best describes how well the Temazepam works for you:

• Pretty effective on some nights
• Sort of effective on some nights
• Pretty effective or sort of effective on a FEW nights, but not very effective on most nights
• Not very effective on almost all nights

Pretty effective on some nights

Also, what are the doc's instructions for taking the Temazepam? Take it only as needed? Or take it every night?

Take only as needed. My GP has prescribed Temazepam for several years now I much prefer it to Ambien. The last time I got my prescription refilled was in January and it's always for 30 pills. I probably have 8-9 left, so that gives you an idea of how often I use it. My sleep doctor prescribed Sonata (I think it's either 5-10 grams) for short term sleeping. I take it as needed when I'm up at 2-3 in the morning. I've taken it the past two nights in fact and it doesn't do me any good any more. It worked for the first couple times I started using it a couple months ago but now it's pretty useless.

You might want to talk to the GP and see if he would be ok if you took the Temazepam every night for a couple of weeks just to see if your sleep would stabilize a bit. In other words, if you had a week or two where you slept well enough---i.e had an acceptable amount of WASO for you---to feel decent the next day, your body might then learn how to get back to sleep quickly after that first big wake up in the middle of the night. And if you can learn how to do that even though you are on the Temazepam for a week or two, then as you start cutting back on the Temazepam, your sleep might still stay better than it is right now.

Something I'm going to be upfront about right now, which could very much have an effect: I am a fairly regular user of cannibis in the evenings after work. I find it helps me to relax. The past couple weeks I have not used it though, and this could very well be having an effect. However, even when using cannibis, I still have insomnia issues, pretty much like what I've described above.

I hope that you are not morally opposed to this. I have been very reluctant to reveal that habit of mine on this board but I have shared this information with both doctors who are unfazed about it.

I'm not going to tell you to cut the cannabis, particularly since you've been honest with the docs about it.

I am going to say this, however: Cannabis, like any other drug, can have unintended side effects. And cannabis, like many other drugs, can affect the quality of the sleep.

Some studies have shown that THC (one of the active ingredients in cannabis) can suppress REM sleep, while at the same time it increases slow wave sleep, and while it can shorten the latency to sleep, I'm not sure that it helps keep you asleep. (The fact that THC can shorten the latency to sleep may be why you don't have any problem falling asleep at the beginning of the night.) It is known that THC and CBD (another active compound in cannibas) do improve sleep characteristics for people with serious, chronic pain problems when the pain is caused by something like cancer. See the papers at: http://www.smrv-journal.com/article/S10 ... ract?cc=y= and http://onlinelibrary.wiley.com/doi/10.1 ... C39.f01t01.

But there's also a paper from 2004 (available at http://journals.lww.com/psychopharmacol ... nd.11.aspx ) which studied the affects of the active compounds in cannibas in healthy young people. The abstract says:

Journal of Clinical Psychopharmacology wrote:With the concomitant administration of the drugs (5 mg THC and 5 mg CBD to 15 mg THC and 15 mg CBD), there was a decrease in stage 3 sleep, and with the higher dose combination, wakefulness was increased. The next day, with 15 mg THC, memory was impaired, sleep latency was reduced, and the subjects reported increased sleepiness and changes in mood. With the lower dose combination, reaction time was faster on the digit recall task, and with the higher dose combination, subjects reported increased sleepiness and changes in mood. Fifteen milligrams THC would appear to be sedative, while 15 mg CBD appears to have alerting properties as it increased awake activity during sleep and counteracted the residual sedative activity of 15 mg THC. (emphasis added)

So it's just possible that the cannibas may be aggravating the middle of the night wakes even if it seems like it helps you to fall asleep more quickly.

In the end, you might want to track just how much cannibas you take (and when) and also the quality of the sleep on nights where you do use it and compare it to the quality of the sleep on nights where you don't use it.