My sleep issue is making my life miserable.

[Swim_Bike_Run]

Almost unbearable. I just cannot figure this damn stuff out and it is wearing me down physically and mentally. Diagnosed with Moderate/Severe OSA back in Dec 2009, I started CPAP right away. Fast forward to almost 8 months later and I have seen almost no improvement as to how I feel. My nightly AHI is consistantly 2.9 or lower with AI of .1 or zero with minimal leaks. My 95% pressure is usually at 8.6 or lower. My mode is APAP and range is 6.0-13. I have tried reducing the range to 8-13 and 9-13 and there is no improvement. I have tried CPAP mode and there is no improvement. For the first 6 months I never went without my mask at night even though it did not make me feel any better to wear it. I have since slept a week solid without it and no change - better or worse. I have dropped 37 lbs since my diagnosis and am now about 11% BF and probably the fittest I have been in a long, long time. I have not had alcohol in a year. Yet my sleep is still very screwed up. I have been to THREE sleep clinics, the last that ordered a new round of sleep studies - only to tell me that, even with my weight loss I still have pretty moderate OSA. My titration number is 9-10. The new doc is nice and says that I am just not getting any stage 3-4 sleep but that the CPAP clearly reduces events during the night. No real PLM"s or leg movement. No problem, I will keep wearing it, if that is the case. I have switched from a nasal to a FFM and at first thought I was feeling better but ultimately I still feel like crap, each and everyday. Numbers are basically the same with the nasal as with the FFM. FFM is a little better to me as I dont have to wear the papcap which sucked. My body, health-wise is in great condition and all my bloodwork is basically perfect. My GP is very, very happy with all my bloodwork and says my sleep has to be the problem. Here is my night...every single night:

I go to bed at 11 PM and I take 6mg of Melatonin an hour before bed to help me go to sleep. Without it, I will literally lay there for 3-4 hours exhausted but unable to fall asleep.
I generally drift off to sleep in a dark, non-tv or distracting bedroom after about an hour of laying there. I then wake up EVERY night at 1:00 AM - 1:07 AM. Every night. Get up, go to kitchen or wherever, for about 5-10 mins, then back to bed and fall back to sleep pretty fast. Wake up again about 3:30 AM EVERY night. Get up again. Go back to bed and then wake up at my normal time of 7:30 AM. Wake up tired.

This is my routine for the last 6-8 months. I cannot sleep or nap during the day even if I wanted to. Just have a groggy, glazed over feeling all day. I swear I felt better when I was 40 lbs heavier and drinking every night. I am seriously considering having a few drinks to see if that makes me sleep any different. I have just been so happy with no alcohol for a year now - it was a big step for me. Just don't know what to do. I tried Ambien and Lunesta and both made me feel hungover the next day. I am very, very frustrated and just do not know where to turn. I cannot deal with this fatigue forever, that much I know is certain.

Thanks for listening.

[bootz]

I am in a similar boat in the sense that my numbers are always very low, yet I still often have that exhausted feeling the moment I wake up. It sounds like you have your bases covered better than mine as far as sleep prep goes. One thing I'd ask is what is your caffeine intake throughout the day and more importantly before bed? That may play a role in your difficulty falling asleep. I'm very sensitive to caffeine - if I have 1 can after 9pm I won't fall asleep until 1 in the morning... good luck.

[Swim_Bike_Run]

I drink a little caffeine ...coffee in the morning and maybe 1 diet drink about 2 PM. Thats it - the rest of the day it water and lots of it. Maybe I will cut out caffeine altogether. Can't hurt.

[carbonman]

I go to bed at 11 PM and I take 6mg of Melatonin an hour before bed to help me go to sleep. Without it, I will literally lay there for 3-4 hours exhausted but unable to fall asleep.
I generally drift off to sleep in a dark, non-tv or distracting bedroom after about an hour of laying there. I then wake up EVERY night at 1:00 AM - 1:07 AM. Every night. Get up, go to kitchen or wherever, for about 5-10 mins, then back to bed and fall back to sleep pretty fast. Wake up again about 3:30 AM EVERY night. Get up again. Go back to bed and then wake up at my normal time of 7:30 AM. Wake up tired.
Thanks for listening.

SBR, do you have clock in your bedroom,
that you can see?
If you do, get rid of it.
Clock watching/calculating is a sure sleep killer.
It will keep you from going to sleep
and will prevent you from going back to sleep.

I recommend this often.
Sound mind, Sound sleep
7 keys to sleeping through the night
Barry Krakow

I use these techniques nightly.

[Swim_Bike_Run]

Thanks Carbon. I am doing the Kona IM in October and need to get better rest asap. I will check that out - thanks again.

[jdm2857]

I found this thread and this particular post very interesting: viewtopic/t54226/Hey-you-experts-exactl ... ml#p505797

A sleep tech basically says that sometimes one needs a pressure slightly higher than a normally titrated pressure to handle small hypopneas that are not being detected by the lab equipment. The need for the extra pressure is determined via the EEG which shows lack of REM until the pressure is raised.

So you might try raising your pressure a bit above your titrated pressure, on the theory that your sleep tech might not have been carefully watching your EEG and REM sleep. A minimum pressure of 11 (or even 12) just might help. And it can't do any harm.

[carbonman]

SBR, if you will indulge me.....
do you have a clock in you bedroom?
Are you clock watching and calculating through the night?

Removing the clock for me was like trying to quit smoking.
Now when I think I HAVE to know what time it is....
I repeat my CBT mantra...."I only have time to sleep."

[Wulfman]

Almost unbearable. I just cannot figure this damn stuff out and it is wearing me down physically and mentally. Diagnosed with Moderate/Severe OSA back in Dec 2009, I started CPAP right away. Fast forward to almost 8 months later and I have seen almost no improvement as to how I feel. My nightly AHI is consistantly 2.9 or lower with AI of .1 or zero with minimal leaks. My 95% pressure is usually at 8.6 or lower. My mode is APAP and range is 6.0-13. I have tried reducing the range to 8-13 and 9-13 and there is no improvement. I have tried CPAP mode and there is no improvement. For the first 6 months I never went without my mask at night even though it did not make me feel any better to wear it. I have since slept a week solid without it and no change - better or worse. I have dropped 37 lbs since my diagnosis and am now about 11% BF and probably the fittest I have been in a long, long time. I have not had alcohol in a year. Yet my sleep is still very screwed up. I have been to THREE sleep clinics, the last that ordered a new round of sleep studies - only to tell me that, even with my weight loss I still have pretty moderate OSA. My titration number is 9-10. The new doc is nice and says that I am just not getting any stage 3-4 sleep but that the CPAP clearly reduces events during the night. No real PLM"s or leg movement. No problem, I will keep wearing it, if that is the case. I have switched from a nasal to a FFM and at first thought I was feeling better but ultimately I still feel like crap, each and everyday. Numbers are basically the same with the nasal as with the FFM. FFM is a little better to me as I dont have to wear the papcap which sucked. My body, health-wise is in great condition and all my bloodwork is basically perfect. My GP is very, very happy with all my bloodwork and says my sleep has to be the problem. Here is my night...every single night:

I go to bed at 11 PM and I take 6mg of Melatonin an hour before bed to help me go to sleep. Without it, I will literally lay there for 3-4 hours exhausted but unable to fall asleep.
I generally drift off to sleep in a dark, non-tv or distracting bedroom after about an hour of laying there. I then wake up EVERY night at 1:00 AM - 1:07 AM. Every night. Get up, go to kitchen or wherever, for about 5-10 mins, then back to bed and fall back to sleep pretty fast. Wake up again about 3:30 AM EVERY night. Get up again. Go back to bed and then wake up at my normal time of 7:30 AM. Wake up tired.

This is my routine for the last 6-8 months. I cannot sleep or nap during the day even if I wanted to. Just have a groggy, glazed over feeling all day. I swear I felt better when I was 40 lbs heavier and drinking every night. I am seriously considering having a few drinks to see if that makes me sleep any different. I have just been so happy with no alcohol for a year now - it was a big step for me. Just don't know what to do. I tried Ambien and Lunesta and both made me feel hungover the next day. I am very, very frustrated and just do not know where to turn. I cannot deal with this fatigue forever, that much I know is certain.

Thanks for listening.

I don't believe you've stated just how much sleep you ARE getting.

You also didn't say how long you "tried" CPAP mode.

Your profile shows that you have software......do you ever look at your reports to see what's going on prior to your waking?
Are you leaking air, having events, etc.?

Your waking times may indicate that your awakenings have something to do with your sleep stages......all things being equal, sleep stages cycle through at approximately 90 - 120 minute intervals. Your wakings come pretty close to fitting that time frame.

If you're going into a certain (deep) stage of sleep and you start having "events" that will cause the machine to jack up the pressure, the pressure changes could very well be waking you up. Even the normal pressure changes of an APAP can make you feel like crap.

Now.......I gave you some clues. Whatcha gonna do?


Den

[DreamOn]

That book mentioned by Carbonman gets very good reviews. Reading that may help you a lot. And there have been some other good suggestions to consider as well.

Also, 6mg of melatonin may be too much for you. Too much melatonin can contribute to "morning fog" and daytime sleepiness and may be affecting your sleep pattern adversely. Perhaps you could try gradually reducing the dose. If you've used that for a while, your body (and mind) are going to need time to adapt to changing doses, so try to ride that out to see what effect lower doses have over time. You can't expect instant results, and you may have a little trouble falling asleep at first, until your body adjusts.

I know that you've had a rough time, and I sure do hope things are better for you soon. Please let us know when you find what works for you.

I'll be looking for you in the Iron Man competition. We watch it every year on television.

[Swim_Bike_Run]

Thanks everyone. The IM race is about 8-9 weeks away so I am right in the middle of my training. I am going to try and stay away from any TV cameras, although the IM media dep't is fascinated with the fact that I had pulmonary embolism last year and am now doing this crazy race. I have done a couple interviews - one on Sirius Satellite about the stuff I have dealt with over the past year. I have another newspaper interview in a couple of weeks. We will see how it goes. 140.6 miles is a long way to go...especially when sleep is not your friend =)

Carbon - there is a clock and I can only see it when I take my mask off and lift up over my wife. It is on her side of the bed. I may ask her if we can remove it as she uses her phone as her alarm so it is really not needed.



Den - I am not sure how much sleep I get. The Resmed gives a "sleep time" but I am fairly sure that is the time that I turn the machine on. Literally "asleep"..I am guessing 5 hours a night, maybe 6. I am in bed 8+ for sure. I used to look at my software but that computer crashed and I could not get it to work with my MAC or on Windows XP. I had just purchased the downloadable software on ebay. I have not looked at in months as I am not able to currently. I have tried the CPAP only a couple nights and each time work up with a bloated stomach and still tired. Should I try it again at my titrated pressure or perhaps turn the minimum up to my titrated pressure?

Brian

[carbonman]

Are you over training??

Do you give yourself rest days.....
where you do no physical activity?

Are you training/exercising within a
few hours of going to bed??

[Wulfman]

Den - I am not sure how much sleep I get. The Resmed gives a "sleep time" but I am fairly sure that is the time that I turn the machine on. Literally "asleep"..I am guessing 5 hours a night, maybe 6. I am in bed 8+ for sure. I used to look at my software but that computer crashed and I could not get it to work with my MAC or on Windows XP. I had just purchased the downloadable software on ebay. I have not looked at in months as I am not able to currently. I have tried the CPAP only a couple nights and each time work up with a bloated stomach and still tired. Should I try it again at my titrated pressure or perhaps turn the minimum up to my titrated pressure?

Brian

First of all, that's not nearly enough sleep. In my opinion, you need at least 7 hrs. average per night.
At what (CPAP) pressure were you getting the "aerophagia"? Have you changed or tried different masks since then? If you're not getting aerophagia NOW, there must be a pressure that doesn't cause it.......and you need to find that pressure.

If you have GERD, you can try sleeping on your left side, elevating the head of your bed, taking an antacid before bedtime and watch what you eat (make a list or keep a diary and see if any of that is contributing to it).

Actually, waking up at regular intervals during the night is not all that uncommon.....it's just something that needs to be worked around or find the reason for and make some changes.

There may be a trade-off with a little lower CPAP pressure for a little higher AHI (or maybe not) to get a better (quality), longer night's sleep.
I would recommend TRYING CPAP mode again at 9 cm. If you experience aerophagia there, or if some of those other things don't work, try dropping the pressure till you find the point just below where it occurs. If your 95% is 8.6, than maybe you could give that a shot, too.

Note: I just read Carbonman's post.....the point of which I was also going to address.......about training/exercising too close to bedtime.


Den

[Swim_Bike_Run]

Not overtraining...I am doing about 11-14 hours a week depending on the coach's schedule. No exercise within 3-4 hours of bed. Not many days off...I figure I can rest after the race.

[carbonman]

Not many days off...I figure I can rest after the race.

....or when you're dead.

I just about killed myself over training.....pancreatitis.

Good luck! I hope it's worth it.

[kempo]

White noise, a floor fan running, and a damn good mattress does wonders for my sleep. Make your bedroom as sleep friendly as possible for yourself. I like it very dark, cool with a fan blowing a breeze on me, and my memory foam mattress. Oh yea, like someone else said, get rid of the lighted clock. I use an iPhone as my alarm clock. I do not eat or drink past 7:30.

Our bodies change as we get older and most of us have to make adjustments to get a good night's sleep.

I hope you find out what works for you soon.