Insomnia from bad to worse

[Doug42]

Tonight I waited until late and made sure to take my Epimidum on an empty stomach and after one hour and twenty minutes I was up wide awake. 'when I saw the sleep doctor a couple of days ago and told her that for the last two weeks I was averaging two to three hours of sleep a night she told me that was impossible and that there is no way I could function on that little of sleep. She said to cut back on coffee and to try and get a schedule down---which I have done. I have to have an average of four hours a night or my insurance will not pay. I guess tomorrow night I will try to take two of the sleeping pills and see how that works.

Maybe now would be a good time to mention that during my sleep study my AHI was 80.

[Hang Fire]

take my Epimidum

Do you mean epimedium? If so, quit taking that crap.

[Doug42]

take my Epimidum

Do you mean epimedium? If so, quit taking that crap.

Don't know were I came up with epimidum just looked at the medication bottle and it is zolpidem.

[robysue]

when I saw the sleep doctor a couple of days ago and told her that for the last two weeks I was averaging two to three hours of sleep a night she told me that was impossible and that there is no way I could function on that little of sleep.

Are you in bed for only 2-3 hours? Or are you in bed much longer but think you are only getting 2-3 hours of sleep? There's a big difference between the two statements.

She said to cut back on coffee and to try and get a schedule down---which I have done. I have to have an average of four hours a night or my insurance will not pay.

Or do you mean you are only using CPAP for 2-3 hours and you are sleeping the rest of the night without the CPAP?

I guess tomorrow night I will try to take two of the sleeping pills and see how that works.

You say you are taking zolpidem (aka generic Ambien). What is the dosage? And how long do you wait between taking the zolpidem and going to bed? Does the zolpidem work in the sense of helping you get to sleep more quickly after you go to bed?

Maybe now would be a good time to mention that during my sleep study my AHI was 80.

Ok, you've got very severe OSA. And you need the CPAP. And you are worried the insurance company not going to pay for your equipment because of non-compliance.

We need to know the following in order to help you:

1) When do you go to bed each night?

2) When do you get up in the morning?

3) Do you mask up when you go to bed each night?

4) Do you wake up after 2-3 hours, take the mask off and then go back to sleep?

5) Do you lie awake trying to get to sleep for 2-3 hours with the mask on and then give up, take the mask off and go to sleep?

[Sir NoddinOff]

I'm glad you're not taking Epimedium, Doug... below is what the wiki says it consists of. Yikes. Not that ambien is much better Ambien is very short acting for a lot of people and is often associated with sleep maintenance problems like waking up after several hours. That's been my experience with ambien and to a lesser degree lunesta over the years.

"Epimedium, also known as barrenwort, bishop's hat, fairy wings, horny goat weed, rowdy lamb herb, randy beef grass or yin yang huo , is a genus of flowering plants in the family Berberidaceae. The majority of the species are endemic to China, with smaller numbers elsewhere in Asia, and a few in the Mediterranean region." Sounds delightful. It's supposed to be mother nature's boner pill, tho there doesn't seem to be a lot of evidence to that effect.

[Julie]

He's not taking Epi... but zolpidem (he made a mistake).

[Sir NoddinOff]

[quote="Julie"]He's not taking Epi... but zolpidem (he made a mistake).

Julie, did you read the first six words of my reply above

I was just mentioning the Epimedium mostly to make a little joke about boner pills... I guess that slipped by some tho I thought 'horny goat weed' was sort of a tip-off. I did briefly discuss my experience with ambien.

[Doug42]

when I saw the sleep doctor a couple of days ago and told her that for the last two weeks I was averaging two to three hours of sleep a night she told me that was impossible and that there is no way I could function on that little of sleep.

Are you in bed for only 2-3 hours? Or are you in bed much longer but think you are only getting 2-3 hours of sleep? There's a big difference between the two statements.

She said to cut back on coffee and to try and get a schedule down---which I have done. I have to have an average of four hours a night or my insurance will not pay.

Or do you mean you are only using CPAP for 2-3 hours and you are sleeping the rest of the night without the CPAP?

I guess tomorrow night I will try to take two of the sleeping pills and see how that works.

You say you are taking zolpidem (aka generic Ambien). What is the dosage? And how long do you wait between taking the zolpidem and going to bed? Does the zolpidem work in the sense of helping you get to sleep more quickly after you go to bed?

Maybe now would be a good time to mention that during my sleep study my AHI was 80.

Ok, you've got very severe OSA. And you need the CPAP. And you are worried the insurance company not going to pay for your equipment because of non-compliance.

We need to know the following in order to help you:

1) When do you go to bed each night?

2) When do you get up in the morning?

3) Do you mask up when you go to bed each night?

4) Do you wake up after 2-3 hours, take the mask off and then go back to sleep?

5) Do you lie awake trying to get to sleep for 2-3 hours with the mask on and then give up, take the mask off and go to sleep?

I'm in bed for one or two hours if I''m lucky then I wake up and get out of bed.
The Zolipidem is 6.5 controlled release. I'm in bed no later than 15 minutes after taking Zolipidem. I have no trouble falling asleep with or without Zolipidem, it's the waking up that's a problem.
Yes, I'm worried that the insurance company is going to take my equipment for non-compliance.

1) I go to bed at midnight
2) I wake up and get up around 1 or 2 in the morning.
3) yes, I mask up every night,
4) I wake up after 1 or 2 hours take the mask off and get out of bed

[Hang Fire]

I wake up after 1 or 2 hours take the mask off and get out of bed

What do you do the rest of the night?

[Sir NoddinOff]

That's not nearly enough sleep but don't despair, there's so much to discuss regarding your therapy, your meds, your diet, your life in general... some members here are very good at that stuff. I recommend you PM Robysue and get her to run thru her excellent checklist of possibilities. She's a whiz at insomnia, however you have to be absolutely honest in your replies (but you sound pretty straightforward and concise so far ).

[Julie]

Sir NO - You're right... kind of skipped over them.

[Doug42]

I wake up after 1 or 2 hours take the mask off and get out of bed

What do you do the rest of the night?

watch tv, browse the internet.

[robysue]

1) I go to bed at midnight
2) I wake up and get up around 1 or 2 in the morning.

What do you do after you get out of bed at 1 or 2 in the morning?

There are a lot of things that you might be doing after you get up that is making it harder to sleepy enough to go back to bed and try, try again.

The Zolipidem is 6.5 controlled release. I'm in bed no later than 15 minutes after taking Zolipidem. I have no trouble falling asleep with or without Zolipidem, it's the waking up that's a problem.

I'd let the doc who prescribed the controlled release zolipidem know that it is NOT working for you.

Some things you need to understand about most forms of zolpidem (either regular or controlled release): It's best at helping with "I can't get to sleep when I go to bed" insomnia. And that's not your problem. It's not particularly good at "I wake up and I can't get back to sleep" insomnia because it's not particularly good at preventing wakes after the first or second sleep cycle. And it sounds like you are waking up after the first sleep cycle is complete.

The sad fact is, there aren't many sleep meds that are good at preventing middle of the night wakes.

There is one form of zolpidem called Intermezzo that is specifically designed to be taken after you wake up and can't get back to sleep. Intermezzo is a very small dose of zolpidem that comes as a sublingual tablet so it can be taken without the need to get out of bed to get a glass of water. The dose is very, very small: I think they usually start people out on the 1.75mg sublingual tablet, but there is also a 3.5mg tablet. There are some pretty important rules about taking Intermezzo:

• Intermezzo is not supposed to be combined with any other sleep medication. In particular, you are not supposed to take any form of zolpidem at the beginning of the night if you want to take Intermezzo in the middle of the night.
• You are supposed to take Intermezzo only if there are at least 4 hours left in your usual "time in bed" window. In other words, if it's less than 4 hours before you intend to get up, you are not supposed to take Intermezzo.
• You are supposed to take only ONE dose of Intermezzo during the night. In other words, if you go to bed around midnight and wake up at 1:30am and take Intermezzo, you can't take a second Intermezzo if you then wake up at 3:00am even if you don't intend on waking for good until 8:00.
• Intermezzo is still under patent. So many insurance companies either won't cover it, or they will cover it as a tier 2 or tier 3 drug, so your copay will be much higher than the copay for generic zolpidem.

Back when I was still fighting the First War on Insomnia that my PA switched me from zolpidem to a generic form of Sonata at one point because the Sonata has a much shorter half life than zolpidem and she was comfortable telling me I could take the Sonata after waking up and not being able to get back to sleep instead of taking it at the beginning of the night if I wanted to.

So you might want to talk to your doctor about the specific problem of waking up about 2 hours after going to sleep and finding yourself unable to get back to sleep. See if the doc is willing to switch you to a sleep med that can be taken at the time of the wake instead of at the beginning of the night.

Yes, I'm worried that the insurance company is going to take my equipment for non-compliance.

The usual advice given to people who are really worried about this is to use the machine during the daytime. In other words, drag the machine out to the family room, mask up and watch the TV or read while the machine is on. If you are getting 2 hours of usage at night, aim for using it for 2 hours while watching tv or reading.

[Doug42]

1) I go to bed at midnight
2) I wake up and get up around 1 or 2 in the morning.

What do you do after you get out of bed at 1 or 2 in the morning?

There are a lot of things that you might be doing after you get up that is making it harder to sleepy enough to go back to bed and try, try again.

The Zolipidem is 6.5 controlled release. I'm in bed no later than 15 minutes after taking Zolipidem. I have no trouble falling asleep with or without Zolipidem, it's the waking up that's a problem.

I'd let the doc who prescribed the controlled release zolipidem know that it is NOT working for you.

Some things you need to understand about most forms of zolpidem (either regular or controlled release): It's best at helping with "I can't get to sleep when I go to bed" insomnia. And that's not your problem. It's not particularly good at "I wake up and I can't get back to sleep" insomnia because it's not particularly good at preventing wakes after the first or second sleep cycle. And it sounds like you are waking up after the first sleep cycle is complete.

The sad fact is, there aren't many sleep meds that are good at preventing middle of the night wakes.

There is one form of zolpidem called Intermezzo that is specifically designed to be taken after you wake up and can't get back to sleep. Intermezzo is a very small dose of zolpidem that comes as a sublingual tablet so it can be taken without the need to get out of bed to get a glass of water. The dose is very, very small: I think they usually start people out on the 1.75mg sublingual tablet, but there is also a 3.5mg tablet. There are some pretty important rules about taking Intermezzo:

• Intermezzo is not supposed to be combined with any other sleep medication. In particular, you are not supposed to take any form of zolpidem at the beginning of the night if you want to take Intermezzo in the middle of the night.
• You are supposed to take Intermezzo only if there are at least 4 hours left in your usual "time in bed" window. In other words, if it's less than 4 hours before you intend to get up, you are not supposed to take Intermezzo.
• You are supposed to take only ONE dose of Intermezzo during the night. In other words, if you go to bed around midnight and wake up at 1:30am and take Intermezzo, you can't take a second Intermezzo if you then wake up at 3:00am even if you don't intend on waking for good until 8:00.
• Intermezzo is still under patent. So many insurance companies either won't cover it, or they will cover it as a tier 2 or tier 3 drug, so your copay will be much higher than the copay for generic zolpidem.

Back when I was still fighting the First War on Insomnia that my PA switched me from zolpidem to a generic form of Sonata at one point because the Sonata has a much shorter half life than zolpidem and she was comfortable telling me I could take the Sonata after waking up and not being able to get back to sleep instead of taking it at the beginning of the night if I wanted to.

So you might want to talk to your doctor about the specific problem of waking up about 2 hours after going to sleep and finding yourself unable to get back to sleep. See if the doc is willing to switch you to a sleep med that can be taken at the time of the wake instead of at the beginning of the night.

Yes, I'm worried that the insurance company is going to take my equipment for non-compliance.

The usual advice given to people who are really worried about this is to use the machine during the daytime. In other words, drag the machine out to the family room, mask up and watch the TV or read while the machine is on. If you are getting 2 hours of usage at night, aim for using it for 2 hours while watching tv or reading.

Thank you very much for the informative feedback.

[PEF]

I would like to comment here because I have really bad insomnia, have had it all my life. I have a very dangerous kind. I have gone as much as 9 days and nights with only about 1 to 2 house of sleep per night, but laying in bed the whole time. When I was 38, the death of my 32 year old husband caused a spell of it that landed me in the hospital for 3 weeks. After that, they had me on a small dose of a combination of Amitriptiline and Perphenazine(2mg). This worked like a miracle for 20 years. Then, because I got older, I could no longer tolerate the Perphanazine , so I just kept taking the 25 Amitriptiline. So then I had trouble getting to sleep, but I was able to stay asleep. My doctor substituted Ambien for the Perphenazine. The Ambien does not work as well. I only take about 3mg per night because, if it does not work in the first hour, it is useless and I never take more.

I have tried everything imaginable to get rid of insomnia including mindfullness meditation, all kinds of tapes, sleep hygiene, you name it. They would all work for a few night and then the insomnia would come back.

I was hoping that the CPAP would help with the insomnia, but it has helped with everything but that.

Actually, there is one thing that does work better than anything else. That is getting up and eating carbs like cookies or brownies. Go figure, all that sugar right before bed puts me to sleep right away. I can only do this once in awhile.

If anyone has any ideas, I would be happy to hear them.