Can't Sleep

[EO_123]

I've missed you fellow cpap-ers the last few months. Overall, CPAP has been going well for me, but I've developed a problem. I wake up about 4 a.m. and can't go back to sleep (alarm goes off at 6:30) I lay in bed analyzing all the possible reasons I woke up or can't get back to sleep. My AHI and leaks are so low that I'm not sure that's the cause, although I guess it only takes one episode to potentially wake you up. Does anyone have any idea of what this could be or how I can find restful sleep again? I have no problem falling asleep, I'm dead tired by 10 p.m. (early for me) but my system is out of sync.

[teknomom]

I was getting sleepy very early and going to bed at 8:00 or 9:00. I woke between 3:00 and 4:00. Since I started using a SAD lamp in the evening, I can stay up later but still wake at the same time. Since I don't work, I just get up at 3:00 or 4:00 and start my day. I'm hoping that I'll gradually adjust to later bedtime and later awakening by using the light. I've always been a morning person but this is too extreme. Good luck with your situation!

[chunkyfrog]

Several insomniacs here--someone will chime in presently.
Some are up fairly late--my sympathies.

[brick]

Eat more tacos. Tacos, as studies have shown, help with sleep maintenance insomnia.

[robysue]

I've missed you fellow cpap-ers the last few months. Overall, CPAP has been going well for me, but I've developed a problem. I wake up about 4 a.m. and can't go back to sleep (alarm goes off at 6:30) I lay in bed analyzing all the possible reasons I woke up or can't get back to sleep. My AHI and leaks are so low that I'm not sure that's the cause, although I guess it only takes one episode to potentially wake you up. Does anyone have any idea of what this could be or how I can find restful sleep again? I have no problem falling asleep, I'm dead tired by 10 p.m. (early for me) but my system is out of sync.

First suggestion: It sounds like you may be overanalyzing things while lying in bed. And that can cause your brain to wake up even further and make it harder to get back to sleep. Do you watch the clock at the same time you're lying in bed analyzing things? That too could add to the problem.

Instead of trying to figure out what's going on in the middle of the night, first try to ignore the clock, get comfortable, and literally count backwards from 100 or count sheep to see if you can keep that brain from starting to think, analyze, and worry about why you're awake at 4:00 AM.

If you can't get back to sleep within about 15--30 minutes (and ESTIMATE that time, don't cheat and look at the clock) OR if you just can't keep that mind from turning ON and starting to analyze what's going on, then I think you should seriously think about going ahead and getting UP out of bed. Go to a different room. Do something to get your mind OFF the insomnia. Just make sure that whatever you do is relaxing, soothing and sleep inducing. Go back to bed when you are sleepy enough to get back to sleep without too much chance of the brain starting to over think what's going on.

And if you don't actually get back to bed before it's time to get up? Struggle through the day as best you can WITHOUT taking a nap. Try to make it all the way to bedtime and then go to bed as normal. After a couple of weeks to a couple of months, the body should figure out that it doesn't WANT to be up at 4:00am any more and when you wake you should be able to get back to sleep relatively quickly.

That feeling that your body is out of sync might indicate you've got a slight circadian rhythm problem. They're not that uncommon at this time of year. You say you're feeling wiped out by 10pm now and that's "early" for you. What time do you WANT your bedtime to be? You can also try to help force your body to give up part of that nightly 4:00 AM "wake too early" wake by trying to move your bedtime back where you want it. Start slowly: Try to stay up until 10:15 every night for a couple of weeks. Once you are easily making it to 10:15 before feeling like you absolutely have to get to sleep, then push bedtime back to 10:30. Keep adjusting the bedtime by 15 minutes at a time until you reach your desired bedtime.

For even more ideas of what you might be able to do with self-help measures to get over this insomnia hump, see the link for Taming the CPAP-induced Insomnia in my signature.

[EO_123]

Robysue, you're a genius, thank you. I didn't have the words for it, but that was exactly my fear, cpap induced insomnia. Loved your article. I wake up to my mind rushing like a hundred trains and I'm ultra aware of my mask. I stil can't get the straps on the swift fx to behave. I wonder if trying another mask would help change things up. At any rate, I think I need to get out of bed if it happens again. Thanks everyone!

[robysue]

[quote="EO_123" I stil can't get the straps on the swift fx to behave. I wonder if trying another mask would help change things up.[/quote]
What problems are you having with those Swift FX straps?

Backstrap sliding around too much? A bit of velcro might help.

Silicone strap getting caught in the hair? A full strap pad from Padacheek might help. You'll have to tell her what you want because the last time I checked she doesn't yet have the full pad that covers the whole silicone strap on her web page. But she's made me two of them and they work wonders.

And remember that this mask is supposed to be worn really, really loose.

And thanks for the complement on my blog.

Hoping you get over the insomnia soon.

[EO_123]

Thanks Robysue. Sleep has been a little bit better. Making myself get out of bed seems to have convinced my brain that it might as well go back to sleep.

The issue with the swft fx straps is them sliding around, I do have them fairly loose, but occasionally I do wake up to realize they are in the wrong spot and have to slide them up or down. I'm having a hard time picturing what I would do with a piece of velcro.... I'm resigned to the fact that my head is probably not the perfect shape for this mask, but if there is anything that can make the straps more stable that would be great. The silicone strap doesn't bother me too much other than that it doesn't stay in place - it doesn't get caught as much as it slides around - do the pads help with that?

On a side note - hubby just left for his sleep study! I think I'm more excited than him.

[EO_123]

I realize I'm committing thread necromancy here, but since it's my own thread, I'm going to do it anyway, because it serves a purpose. I have come back to this board for the exact same reason I started this thread. My CPAP and I are having trouble in the bedroom, or, as Robysue to beautifully phrased it, CPAP induced insomnia. I was shocked to see the date on this thread and realize that I've been dealing with this problem since 2011. I had no idea it had been that long. A lot has changed since then. I've changed beds, furniture, husbands and masks, and still I have CPAP insomnia. I can fall asleep fine. I can't stay awake. If I make it to 9:30 pm I'm lucky, and I hate that. I wake up at 4-5 a.m. and can't go back to sleep. This was the original reason I stopped CPAP therapy. In the years in between I've been to several doctors very often with the complaint of not being able to fall back to sleep, and often waking up with anxiety. The clever doctors would see the CPAP in my chart and ask why I stopped using my machine. I would cite the same complaint - and we would laugh. I blamed the waking up at 5 on the CPAP, but I have several years of complaints (aka data) that are cpap free. A good friend has convinced me to try to get back on the hose and I think today makes 1 solid week for me. I feel better, and I'm remembering why I fell in love with cpap to begin with. But guess what? I'm still waking up 4:30/5:00 in the morning, completely unable to go back to sleep.

Robysue - I reread your article, and it's helped me all over again. But I'm left wondering is it really possible to get past this? Will I ever be able to sleep until the reasonable hour of 6 am?

Is there any point in going to another sleep doctor (I was never truly followed by a sleep doctor, strange situation involving military doctors and falling into a gap in service) Should I ask my doctor for a referral to the civilian sleep doctor? Are they any help with this kind of thing? I wake up feeling like the mask is suffocating me - like air isn't moving through it - but of course it is. Are there reasons for this sensation?

[Wulfman...]

I realize I'm committing thread necromancy here, but since it's my own thread, I'm going to do it anyway, because it serves a purpose. I have come back to this board for the exact same reason I started this thread. My CPAP and I are having trouble in the bedroom, or, as Robysue to beautifully phrased it, CPAP induced insomnia. I was shocked to see the date on this thread and realize that I've been dealing with this problem since 2011. I had no idea it had been that long. A lot has changed since then. I've changed beds, furniture, husbands and masks, and still I have CPAP insomnia. I can fall asleep fine. I can't stay awake. If I make it to 9:30 pm I'm lucky, and I hate that. I wake up at 4-5 a.m. and can't go back to sleep. This was the original reason I stopped CPAP therapy. In the years in between I've been to several doctors very often with the complaint of not being able to fall back to sleep, and often waking up with anxiety. The clever doctors would see the CPAP in my chart and ask why I stopped using my machine. I would cite the same complaint - and we would laugh. I blamed the waking up at 5 on the CPAP, but I have several years of complaints (aka data) that are cpap free. A good friend has convinced me to try to get back on the hose and I think today makes 1 solid week for me. I feel better, and I'm remembering why I fell in love with cpap to begin with. But guess what? I'm still waking up 4:30/5:00 in the morning, completely unable to go back to sleep.

Robysue - I reread your article, and it's helped me all over again. But I'm left wondering is it really possible to get past this? Will I ever be able to sleep until the reasonable hour of 6 am?

Is there any point in going to another sleep doctor (I was never truly followed by a sleep doctor, strange situation involving military doctors and falling into a gap in service) Should I ask my doctor for a referral to the civilian sleep doctor? Are they any help with this kind of thing? I wake up feeling like the mask is suffocating me - like air isn't moving through it - but of course it is. Are there reasons for this sensation?

What are ALL of your machine settings?
And, along with that, what settings have you used over the course of your therapy?
Also, if you could clarify what times you're going to sleep and how many hours are you sleeping?
Are you monitoring your therapy with software?


Den

.

[EO_123]

The machine is set to auto detect/adjust pressure between a range of 6 and 10. Most common it is between 7-8. I assume ramp doesn't matter, but it's off. Humidity is about 4, cranked it up recently and dry sinus' have improved.

Average sleep is 10 pm to 5 a.m. I have an app on my phone that tracks sleep and says my average over the last month is 6.8 hours. My complaint with this is I'm always tired and never sleepy. (this has improved some this week)

I haven't used software, I did several years ago, I'm not sure what to look for.

[Wulfman...]

The machine is set to auto detect/adjust pressure between a range of 6 and 10. Most common it is between 7-8. I assume ramp doesn't matter, but it's off. Humidity is about 4, cranked it up recently and dry sinus' have improved.

Average sleep is 10 pm to 5 a.m. I have an app on my phone that tracks sleep and says my average over the last month is 6.8 hours. My complaint with this is I'm always tired and never sleepy. (this has improved some this week)

I haven't used software, I did several years ago, I'm not sure what to look for.

Well, what you'd look for is what happened just before you woke up.
Since you're using a range of pressures, it's quite possible that the pressure changes are disturbing your sleep......to the point of waking you up.
What happens is that as you enter a deep sleep stage or REM, your breathing changes and since the Auto machines use "air flow" as a detection mechanism, the algorithm may sense that it needs to increase pressure and the pressure bumps may bump you out of that needed sleep stage and into a lighter one......including waking you up.

It's hard to say without looking at a report, but if as you say your pressures are in the 7 - 8 range, then I'd suggest trying setting the machine with the minimum and maximum pressures to one of those pressures and see how "fixed" pressure works. If it helps, you know you're on the right track.


Den

.

[49er]

Is there any point in going to another sleep doctor (I was never truly followed by a sleep doctor, strange situation involving military doctors and falling into a gap in service) Should I ask my doctor for a referral to the civilian sleep doctor? Are they any help with this kind of thing? I wake up feeling like the mask is suffocating me - like air isn't moving through it - but of course it is. Are there reasons for this sensation?

Any possibility that nasal obstruction issues are a factor? Sorry, due to suffering similar type problems to yours, I haven't mustered the cognitive power to read the start of the thread. So if I am asking a repeat question, please forgive me.

Has your experience been any better with full face masks or not?

[Julie]

Always tired/never sleepy = many other things beside OSA that could be going on (we are all getting older after all ). When did you last have a good check up, with labwork, etc? Maybe talk to your MD about thyroid, low Vit. D levels, hormonal changes, etc. etc... not everything's about OSA.

[yaconsult]

Everyone is different, but I find that works best for me is to have a distraction - it keeps one from focusing on why you're wake, what you have to do tomorrow, etc. My preference is a National Public Radio station that has talk programs on all the time. They are usually sufficiently interesting to be a distraction. I think that, for me, this is more engaging and distracting than music would be. And by using the sleep function on the radio, it turns off automatically after 15, 30, or however many minutes you like. If you are still awake, you can reset the timer.

Also, there are podcasts available that you could use instead if you don't have a suitable local radio station. Things like Radiolab, This American Life, Car Talk - there's something for everyone.