Can you recommend a doctor at Stanford's sleep center?

[Pugsy]

Frequent awakenings will of course mess with the sleepy cycle architecture and if we don't get the "normal" stages of sleep in the quantity that the body needs then it is going to be real difficult to feel decent.
It's also possible that you are waking after a REM cycle which is really a normal thing to happen but we are supposed to go right back to sleep so we can get another set of sleep cycles. It's in the wee hours of the morning that we normally have the most REM.

We need all the stages of sleep cycles for the body to have the restorative powers of sleep help it get to feeling better. It's not just REM stage sleep..they all play their part.

See the hypnogram here that shows the normal cycles.
https://en.wikipedia.org/wiki/Sleep

I know that it is easy to say "you need more hours of sleep" and not so easy to get. Believe me I know that it isn't always easy.
If I could come up with a fix for that problem I would be one rich woman.
Sleep maintenance insomnia (that's where we wake often and can't go back to sleep or there's another term for simply waking earlier than we would really want (I forget that term) is a tough and difficult problem to fix.
We hope that using the cpap machine will fix it but the truth is that the cpap machine can't fix bad sleep if the bad sleep isn't caused by sleep apnea no matter how much we wish it would. We think something is wrong with the cpap therapy when in truth something is wrong with our sleep that the machine can't fix.

[Sticky Fingers]

there's another term for simply waking earlier than we would really want

Premature awakening.

[Pugsy]

there's another term for simply waking earlier than we would really want

Premature awakening.

Thanks, that works along with "early awakening insomnia" but seems like there was another term that was on the tip of my tongue but not in my brain. It's possible that I am thinking of something else.
Anyway...we know what it means...when we wake just a little too early and can't seem to go back to sleep and we want to go back to sleep for a couple more hours.

[Semyon]

I take only Gabapentin which was prescribed to address Restless Leg syndrome.

What dosage(s) and what time(s) do you take it? How long have you been at this dosage?

In general, once I woke up after 5:30 am, I can't go back to sleep. Sometimes when I wake up around 4:30-5pm, I might take the mask off and can sleep another hour or less.

Pugsy is correct. Sleeping without the machine can ruin what you did the rest of the night. If you just can't sleep with the machine, it is better to get up. This may actually help you sleep better the next night (with the machine).

Hi Sticky Fingers,
What dosage(s) and what time(s) do you take it? How long have you been at this dosage?

1200 mg one hour before sleep. I has been taking it for the last 5 years when it was prescribed. I believe it's either a maximum or close to maximum.

Sleeping without the machine can ruin what you did the rest of the night.

Why is that? Can you please expand on it?

[Semyon]

We hope that using the cpap machine will fix it but the truth is that the cpap machine can't fix bad sleep if the bad sleep isn't caused by sleep apnea no matter how much we wish it would. We think something is wrong with the cpap therapy when in truth something is wrong with our sleep that the machine can't fix.

Yes Pugsy,
That's exactly was my thinking. The fact that there was not correlation between decreased AHI and feeling rested might mean that something else causing the problem. As they are considered one of the most advanced in the field, maybe they can find something.

[Sticky Fingers]

Sleeping without the machine can ruin what you did the rest of the night.

Why is that? Can you please expand on it?

As Pugsy mentioned, we usually get a lot of REM sleep in the wee hours of the morning, and typically sleep apnea is much worse during REM. During that hour of sleep without the machine, you might have many apneas and your blood-oxygen level could drop very low. This could explain -

When I wake up I feel:
1. Very, very tired. Can't think very straight. Try to perform automatic tasks because it does not require active thinking.
2. Very irritable.

As I said before, it would be better to get up once the mask comes off. BTW, when you were diagnosed, what was your untreated AHI?

1200 mg one hour before sleep. I has been taking it for the last 5 years when it was prescribed. I believe it's either a maximum or close to maximum.

The maximum dosage is 2700 mg for RLS. It could be that the dosage you are taking "wears off" before you get enough sleep. But increasing the dosage is a gamble because it can make you sleepy and tired during the day and cause other unwanted side effects.

Practice total abstinence of caffeine including sources like chocolate - last cup of not very strong coffee at 10am

You don't say how many cups of coffee you drink. It must be at least two and it could be (???) twelve. Are you aware that caffeine can really "fire up" RLS in many sufferers? And that it can take more than 24 hours for your body to eliminate all the consumed caffeine?

There are two things I recommend at this point. The first is to completely eliminate caffeine because of your RLS. Going cold turkey can cause headaches, so tapering off is recommended. Eliminate one daily cup for a week, and then eliminate another cup for the second week, and so on until you are drinking none.

My second recommendation is to look at ChicagoGranny's excellent list of lifestyle activities. You seem to be doing well on these points, but review the list and make sure you have everything covered.

I would not recommend increasing the dosage of gabapentin at this point because of the potential for worsening the side effects I listed. But that might be something you eventually discuss with your doctor if you eliminate caffeine and then become convinced that gabapentin is wearing off and causing your premature awakenings.

And of course, don't sleep a minute without CPAP.

[Semyon]

Thank you Sticky Fingers for the detail explanations. Following your recommendation, I dropped to 1 cup of still not strong coffee in the morning and do not take the mask off unless I am ready to get out of bed.
I will also try to get a new study done in the near future to get the up-to-date numbers.

I would like to thank everybody for help and great recommendations!

If and when I get advice from a doctor, I will share it with the board.

Meanwhile, if somebody has other recommendations please share them. I am ready to try anything. (within the boundaries of law of course )