Is insomnia a habit?

[Catnapper]

I just reread a lot of success stories and tips from the light bulb. I am still determined to make this work, and encouraged once again by the wonderful posters here. At the same time, the stories reinforced my part in getting to the success stage.

For years I have had what I thought was insomnia. Then after the OSA diagnosis, I thought OSA was what had caused those long, long nights of lying awake hoping that sleep would come. So now, I am treating the OSA with CPAP, but still waking frequently and still having long periods of not getting back to sleep. This is my question. Do I just have a bad habit of not sleeping well? Is it just me?

I feel sure that the mask issues that bother me are part of it. If I could just get the right mask, I know it would help if the leaks and discomfort would not wake me up. I have tried several and so far have problems with all of them, even though some have very good features.

I want to narrow my pressure range but I have only had this machine for about 10 days and I want to give it some more time. I do like the machine so much better than the previous two. It doesn't seem to be causing the wake-ups.

If insomnia is a habit, how can I break the habit?

I have always been a very light sleeper. For example, when my daughter was little, she could walk in my room and look at me to wake me up. I often play the boom box with ocean sounds or maybe even the "Bedtime Beats" CD to mask any noise that could cause me to wake up.

The software shows me that I am doing pretty well with AHI under 5. I would like to be able to remove the data from when I am lying awake so that I have just information from when I am actually asleep. It seems that those wakeful periods should not be skewing the results as I am sure they do.

I read about people remembering dreams. I have not remembered a single dream since starting CPAP, although I used to remember dreams all the time.

Ambien CR only worked for about a week, then back to insomnia. I didn't want to rely on pills anyway.

Could it be that I am trying too hard?

Thanks for letting me vent.

Catnapper

[curtcurt46]

There can be many things going on with a person who has OSA and SDB. Since, you are having difficulties with therapy plus insomnia I feel that to address your issues we would need more details on your situation.
Daily usage in hours?
Original titration pressure?
Current cpap setting?
Avg. AHI for say 30 days?
Leak average vs. mask rate?
Any PLMD seen during PSG?
Other medical issues?
Have you discussed your issues with a sleep doctor?

I believe that with the proper information your problem is quite solvable. Also, am glad you aren't using the Ambien, its not good for you. I used Ambien when I was struggling with therapy and it caused me to have personality changes and may have caused upper respiratory problems. One last thing until your additional comments, I didn't become compliant until I was convinced in my mind that CPAP therapy was and is absolutely necessary. There is a great bit of denial before we become compliant. Anyone who doesn't believe this is in denial.
I am not yet suggesting you are not compliant, but use the subject to illustrate the complexity of the problem.
Good Luck!!!!!Let us here more!

[kteague]

Sorry to hear you are still not sleeping well. I still get woke up several times a nite by headgear and mask issues. I think if I solved them I'd sleep thru the nite.

When you say you lay awake, is it wide awake the whole time, or lightly dozing and waking repeatedly all nite? People with moderate to severe PLMD feel as though they are restless sleepers, changing positions almost constantly, when in actuality they are waking at the end of a limb movement. PLMD made me see the clock every two minutes, yet I dozed lightly in between. It was a standing joke with my friends that they could call me anytime day or night, that I was always awake. As time wore on (and wore me out) it was no joking matter.

Best wishes at discovering whatever it is that still robs you of sleep.

[ozij]

Insomnia can be a "bad habit" and if you do a search for what they call "sleep hygiene" you'll find a lot of info.

One very basic rule for combating insomnia is this: If you're awake, you get out of bed, go to another room, and do something quiet and relaxing. When you feel ready to sleep, go back to bed. Awake? Out of bed and out of the bedroom.

The aim of that is to build a habit of connecting bed with sleep (and sex) and nothing else. Some recommend not even reading in bed.

Having been choked many times an hour as you slept or tried to sleep, you may have some very unpleasant (albeit unconcious) association with sleeping in bed.

So, rule number 1: You only toss and turn for 20 minutes, and then it's out of bed. Every time. You want to build up you bed and bedroom as the place where you can relax and fall asleep, not the place where you battle for sleep.

Doing that will also solve your possibly skewed results.

I've come to the point of not looking at the clock or watch when I'm in bed, at all. I user my cellphone as an alarm (when I need one), and it's off (the alarm turns it on automatically). If I can't sleep (worried, upset, don't know why) I get up, and leave the room. I let my "sleeplessness" guide me in that, not the watch.


O.

[Catnapper]

Here is more information as you requested curtcurt46. Good thing this is an anonymous posting. I wouldn't care to discuss this with just everybody I know.

The sleep study ended with a titration of 13 cms. The doctor recommended my original machine, the ResMed Escape be set at 15 just in case the study did not catch all the events. That was horrible for me. I changed doctors and the RT had standing orders that allowed a reduction of 2 cm, so after 2 weeks I was at 13. I was "compliant", using the machine every night for at least 6 hours. Not all of it was asleep. That went for a total of 6 weeks.

I had a checkup with the doctor who still felt that I may need more pressure, so I was changed to the ResMed Vantage for a home titration. That lasted for 6 weeks. I was able to talk the DME boss into faxing me the weekly results so I could see what was going on. Average pressure over that time was 11.3. Average AHI was 2.5. I talked the doctor into prescribing the RemStar M Auto so I could keep track of results. He wrote the prescription for it to be set at 7 to 20 cms because he still thinks I may need higher pressure. I cannot imagine why since the data did not indicate that. My compliance is 100% and is for the entire night with both the auto machines, even if I am not asleep all those hours. If I am in bed with head on the pillow, I have the machine and mask on, average about 8 hours.

Leaks are not bad on the graphs. Mostly just irritating to my eyes and waking me up. I change masks sometimes in the middle of the night because I just can't continue with the one that is irritating me.

I had lots of PLMD in the study, 103 per hour, but it went to 22 with treatment and had a normal arousal index.

As for other medical issues, and this is the private part, I have high blood pressure which started about the time I think I started having OSA, but it is controlled with medication. Occasional allergies which don't seem to be problematic since CPAP. I have had extensive sinus surgery 10+ years ago which opened up all the sinus cavities. This is a problem as the pressurized air blasts into my airway with no obstruction. The ENT doc said that anybody who had that much sinus surgery will have CPAP problems. I also have the tear duct leaks that other people have written about, causing dry eyes, and the ear popping from pressure. I have been seeing the eye doctor and using the prescribed drops with 100% compliance. Just saw her again Wednesday and she said they are still horrible. I had been diagnosed with the so called Silent Gerd, and the proton pump inhibitor prescribed for it has the side effect of drying eyes. I discovered this by a Google search. Stopped the drug immediately and had improvement in the pain and itching in my eyes. This is going to be another of the on-going attempts to find a solution.

I have an appointment later this month with an endochrinologist to work on potential thyroid and diabetic issues. I may have Hashimoto's thyroid disease and pre-diabetes or insulin resistance. Great news. She is an excellent diagnostician in my opinion and is the one who told me I needed the sleep study. While doing an ultra-sound of the thyroid, she heard my noisy breathing. She also sent me to the ENT to find out about the LPR or silent GERD. If there is anything going on she will nail it down sooner or later. She will also do a biopsy (guided by ultra-sound) to examine thyroid nodules. I am really looking forward to that visit. Sounds like lots of fun and life changes to come.

Last night my 90% pressure was 9, with average of 7.4. FL was 0.8, OA was 0, H was 2.3 and VS was 0.9.Average leak was 31.64 with the Activa. Highest pressure was 10 for 3 minutes. No large leaks reported. I had put a new cushion on the mask and adjusted the forehead part and the straps. What a mistake. Much noise, whining, moaning, squeeking, etc. until I could readjust through the course of the night. I am a stomach and side sleeper. Never on my back. I have tried the Breeze recently, and struggled with adjustments, even adding a strap to it to keep it from sliding off my head. I have given up on it at the moment because I don't like the feeling of being picked up by my nostrils. Also did another trial of the Swift. I still get that feeling of being picked up by my nose. I worked hard to get past the sore nose from the pillows by using the recommended Ayrgel and chapstick.

I read every single day, and reread from time to time for encouragement and support. Tips here have helped me every day.

BTW, I don't seem to be mouth breathing. I never have dry throat and never have had leak issues that would indicate that.

If any of that long story gives anyone a clue to what I should do, I will be most happy to hear about it.

Thanks so much for listening.

Catnapper

I just read ozij's reply and will do the search he suggested. I have tried the out of bed plan, but if I do that, I stay up even longer. I didn't do it while first starting with CPAP because I had to prove compliance for the insurance company, or so I was told. If that is the solution, I will certainly try it again. One thing I have found is that I sometimes go back to sleep if I stay in bed and sing or count or play solitaire in my head, or even do biofeedback.

[CollegeGirl]

Two thoughts, catnapper:

1) The mask. If you're a stomach sleeper (like rested gal and I are) and you can afford to buy another mask, you'll want to try the Aura (now called the Twilight NP). This mask has changed my life (and rested gal's, too). My numbers (AHI etc) were "acceptable" before, but now they are much, much better - My average AHI now is 0.3, and I spend many nights at 0.0. Logically, a particular interface shouldn't have that much impact on how many apneas we have - but for some reason, it does. The Aura (TwilightNP) allows you to sleep even face-down on your pillow, and, thanks to the placement of the exhaust vents, not have to worry about blocking them. I used to wake up several times a night to adjust my mask - now I sleep all the way through.

As far as feeling like you're being dragged around by your nostrils, have you found a way to position your hose above your head yet? People use different things here, but I like the 3M Command Cord Bundler - works perfectly for keeping the hose up and out of the way, it's cheap, and it travels easily because it's small (and removable). If you have your hose positioned above your head already, sounds like you need to give yourself a little more slack with the hose. I find that this happens to me only when I don't give myself enough hose to work with.

Now,

2) The insomnia. I was suffering from insomnia before I was diagnosed with OSA. In fact, that was what got me to seek treatment. And it was because of that that my GP sent me for a sleep test for apnea. Lo and behold, I had it. About a month after starting CPAP, I no longer had insomnia.

My theory is that, subconsciously, we KNOW there is scary stuff happening to us in our sleep. It takes our subconscious awhile to recognize that okay, it's safe to sleep now. My version of "insomnia" wasn't as much tossing and turning as it was not wanting to go to bed. I would just look at my bed with absolute dread, and I could not figure out WHY I didn't want to go to sleep, especially when I was so tired. I would do anything to avoid it - clean, do classwork, surf the net - just anything I could think of to keep myself away from that bed until I was so exhausted I couldn't stand it anymore. They actually diagnosed these as "manic" episodes. Now I know - I was just afraid.

I still have nights where I stay up way too late for my own good - I truly believe staying up as late as possible is just a habit now, one developed from years of fear of sleeping, and one I have to break. I KNOW it's safe to sleep now - I just have to convince my subconscious of that.

[ozij]

I just read ozij's reply and will do the search he suggested.

I'm a she...and don't apologize for not knowing - you couldn't.

I have tried the out of bed plan, but if I do that, I stay up even longer.

Nothing wrong with staying up later. The aim is to go to be only if you feel relaxed and drowsy, and eventually, to learn fall asleep when you get into bed.

Yes, it makes sense for you to need to wear the cpap for compliance recording reasons... but I take that's no longer part of the equation.

Re your pressure: Sometimes, when I've had a very short, fitful night I'll find my AHI very low - I figure it's the result of my not having fallen into deeper sleep. I wonder if this is what your doctore is thinking about when he thinks you may need higher pressure.

Re being picked up by the nose: Do you hang the hose from above your head ? Do you give it enough slack? oops, that was already written by cg...

O.

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CPAPopedia Keywords Contained In This Post (Click For Definition): hose, CPAP, AHI

[birdshell]

Catnapper,


I really respect your story and efforts. I do not personally think that you should be embarrassed at all by your medical conditions; should we not only be embarrassed by those things which we cause?

For me, the hose-over-the-head idea doesn't work as well as tucking the hose gently between the headboard and the mattress so it is off to the side. Everyone's bed/headboard arrangement is different, so it may take some experimenting to find the right combinations of hose, mask, pillows, bed, covers....You get the drift.

I often think that my headgear has shifted and the nasal interface is too close to my eyes when that "piggy nose" feeling happens. Is is possible that your headgear is shifting? Maybe looking into some of the Swift and CL 2 fixes for slippery headgear will be useful. I agree with CG that there are times when that nagging little thing that keeps us awake is not a conscious thought.

Another thought I had is asking about good "sleep hygiene" practices, or searching the 'net for the topic. You probably have already done so, but just in case....

Good wishes, and good luck. Keep with it! We need your humor-help postings as well as these SERIOUS ones. IMHO, they are both very illuminating.

[Offerocker]

Good luck in finding solutions to your problems Be persistent.

Let us know of your progress. We accept 'slow' also . there's at least one person in this forum who has experienced one of your hurdles.

[curtcurt46]

Catnapper,
Thanks for sharing more of your situation with us. There is just no simple case of OSA and the related issues that abound.
Two thoughts come to mind from the additional info you provided.
You say you have PLMD based on a PSG and its in check with your CPAP therapy. This is a tough one as you can go through cycles or episodes where the PLMD is worse. If this were the case then you may have some insomnia from this. I really doubt it in your case, but you might want to ask your sleep doctor about whether the PLMD could still be an issue.

College Girl wrote about having to deal with insomnia before and after being diagnosed with OSA. I had a similar situation back about 18 months ago when I started treatment. It wasn't until 2 months ago that I believe I got the insomnia behind me. For me it was my putting faith in the fact that the CPAP therapy was forever and I had to accept it and make it work.

One other thought is that many drugs, both RX and non-rx can cause insomnia. this is something you might want to research. Another thing I did was to make a list of the things that had the potential to cause insomnia and I worked on each as a process of elimination. I think you may be doing this. You may want to discuss with your sleep doctor. None of this is easy.
It also looks like you have good results from you therapy.

Please don't get discourged. Keep on keeping on doing what you are doing. You will eventually get it all worked out.

Also, thanks for sharing your story. One thing that gives me calm is the fact that we are all in the same boat together and our working together help us all to cope with these very complicated issues we swim in.

Finally,you have gotten many other excellent comments to consider and it looks like you will be pretty busy working on the advise you have so far.

[OwlCreekObserver]

Just my two cents worth here, Catnapper:

For most of my life I've been a light sleeper, routinely waking up at least a couple of times during the night and arising very early in the morning.

I think that CPAP has been helpful in letting me get more quality sleep. Just eliminating the snoring and gasping for breath will do that. I'm retired now but my sleep pattern is still pretty much the same as when I worked. I consider six or seven hours of sleep, including the wake-ups, to be pretty much a "normal" night. Much less than that, or much more, and I'm in a fog the next day.

I guess what I'm getting at is that if these periods of being awake are affecting you adversely, then by all means keep pursuing a solution. On the other hand, if you're just concerned that your sleep patterns aren't normal, then maybe the answer is that for you they are.

OCO

[53now]

Hello Catnapper
I'm happy you have found a "Home" here at Cpaptalk ..... however I understand your situation with (without) sleep.
Have you had a chance to check out the book by John Weidman ?
("Desperately Seeking Snoozin")

It's a great book ......... (got mine cheap at Amazon)

take care
Rich

[Shedahl]

Hi there,

I share some of your insomnia issues. I had problems sleeping before I started CPAP, and continue to have issues months into my treatment. I sleep in stretches of 1-4 hours at a time - typically 2 - 2-1/2 hours or so, and then I wake up and am unable to get back to sleep. My sleep doc. even prescribed Ambien, but they didn't work for me. She finally advised me to see a psychologist who specializes in sleep, and I can share with you some of what she's advised.

I'm wondering how much you're napping. I'm currently not working, and my sleep schedule got so bad that I was getting about half of my sleep at night, and the other half in the form of naps during the day. She advised me to start keeping a sleep diary, with the first week being just sleeping when I was tired - whether it was day or night. This was to give her a bit of a baseline of what had been going on. For the second & third week, I'm supposed to not nap at all during the day. We're supposedly trying to re-set my sleep schedule. She says that these bad habits can be changed in two weeks time.

Right now, I'm nearing the end of the first week of trying very hard to stay awake during the day (I've dozed off a time or two for a short time), and so far my night-time sleep hasn't improved ... we'll see how the second week goes. Somethings got to give soon. The sleep log shows that I'm only getting 4-1/2 - 6 hours of sleep per night, including the doze-off time. Man, am I tired! Trying to stay awake during the day is turning into torture. I go back to see the doc. tomorrow, so we'll see what she says about when the improvements are supposed to start.

I was also interested in what College Girl said about the idea of just, plain not wanting to go to bed. Hmmm. That could be a possibility with me, too.

I'll let you know what the psychologist says after I go back to see her tomorrow, and if my bad sleep habits can truly be re-set in two weeks time.