CPAP is helping a *little* bit, but...

[syzygy]

Quick summary of my history: probably had UARS for many years (sleep problems as far back as I can remember, sleep study about 9 years ago turned up nothing, couldn't sleep on my back, sweaty feet during sleep, skinny neck, incredibly sensitive to sound, not overweight, etc.). My UARS progressed to sleep apnea in the last few years; I was diagnosed in 2009; gave up CPAP after 2 nights with no sleep; tried dental appliance without success; back to CPAP around a year ago. Could only sleep 2 hours during titration, so my titration (pressure 7-11) was essentially a guess. Tried for months, but any pressure greater than 5 required a Herculean effort to tolerate. After a month, I was a basket case, desperate. My AHI was around 30, most all hypopneas. Some desaturation below 90%, but the majority of the hypopneas were arousals. The best I could do was go to bed with my CPAP and oral appliance; when I inevitably woke up after 1-2 hours, I would take off the CPAP and go back to sleep for a few more hours. If I left the CPAP on, I wouldn't be able to go back to sleep at all.

After a few months, I decided to have an MMA with Dr. Kasey Li. I was a good candidate, given my small chin and lack of excess tissue in the throat.The result: my airway is huge, I can tolerate much higher pressures, but my AHI is unchanged. (This is unusual, by the way. Most people have a reduction on the order of 50%.) While I obviously would have liked to be able to give up the CPAP, the fact that the MMA helped my CPAP tolerance is encouraging. In the 6 months before the MMA, I think I was able to sleep more than 2 hours with the CPAP once. Now I can sleep with the CPAP all night, sorta kinda. I've been sleeping with the CPAP every night for the last 2-3 months.

The problem is that my sleep still isn't very good. In fact, I can't say with absolute certainty that the CPAP is helping at all, although it probably is and it may just be hard to see. The issue that's been bedeviling me the last year or so is that I wake up after 4-5 hours. Without CPAP, that's it--I'm up for good. With CPAP, I can usually fall back asleep, but my sleep is incredibly restless--the pressure changes or noise or something disturbs me; I wake up briefly, and then go back to sleep. Lately, I've been having a lot of dreams, which is supposed to be a good thing--but I wake up sweaty (actually, more sweaty since the dreams started again; this may actually be good, if it means I'm getting deeper sleep). I also feel out of breath during the day, despite the fact that I am in relatively good cardiovascular health (can run a few miles without undue strain, etc.). This is actually a major issue for me. It's often resolved by breathing using the CPAP.

I clearly have a lot of room for improvement, but I'm not sure what to do.

Here's what I've tried:

Mask: besides the nasal pillows, I tried a Quattro FX. Ultimately, I didn't see any advantage, and the technician I worked with agreed. I have no problem taping my mouth, and I also use the pap cap. My leaks are usually measured at 0, and my AHI is usually around 1--it's rarely over 2. The main problem I have with my mask is that my cheeks puff up during deep sleep, but this also happens with the Quattro, so I don't see any advantage to switching. I don't think I'm leaking air; it's just disturbing. I also have soreness in my nostrils, which I plan to try to address using Lansinoh.

Pressure: I've tinkered with this a lot, probably too much. My sleep doctor (whom I trust) suggested I change the 7-11 to 8-12. With these settings, my non-REM sleep pressure usually stays close to 8, and my REM sleep pressure usually ends up at 9.5-10. I've tried increasing the lower pressure limit to 9, but then it messes up my non-REM sleep. I've tried using a straight pressure of 10, but the same thing happens then as well. I could try to have another titration, but the chances of my sleeping through it seem pretty minuscule. I've had 3 sleep studies in the past year, and I've never slept more than a few hours during any of them.

I'm currently wondering whether I've changed the settings too quickly (I usually would try them for a few days before changing), or whether I'm stressing my body too much (caffeine or exercise). But neither of these seem all that likely, and after a year of generating failed hypotheses, I'm still not sure what's going on. I'm also not convinced that I don't have some other problem, but tests haven't shown anything major besides issues related to sleep apnea (borderline blood pressure, slightly elevated blood sugar, low testosterone--maybe I'm delusional, but I'm hoping that if I can solve my sleep problem, these things will resolve themselves before I need to begin taking medication).

I know there's a lot of collective wisdom out there among readers of this site. Any thoughts would be most welcome!

[Thomas F.]

Since you had the surgery are you sure you need to use CPAP? Did you have a follow up sleep study?

I had hyoid advancement and UPPP in Oct 2010. I continued to use CPAP for a few weeks after the surgery as I healed. I also took some powerful pain meds which of course dulled my central nervous system and sleep came easy. However, once I stopped the pain meds I began waking up multiple time a night as I did prior to surgery with CPAP.

I am convinced that I also had UARS which got worse with age and became a combo of UARS and obstructive apnea. The surgery has worked for keeping my airway open during all sleep phases -- I have not used CPAP for about 6 months and feel better than I have in 10 years. But here is the kicker - I use 3mg of Lunesta or I still will wake up during deep sleep -- my brain wakes me because that was it's job for years and years.

People with UARS have very senstive central nervous systems and adjusting to CPAP is very diffucult if not impossible. My AHI was always high with a lot of hypops. I tried for a few years before having the surgery.

In time I hope my brain and CNS will adjust to the new normal which is that I don't have restricted breathing anymore and I can stop using Lunesta (which is stupid expensive)

You may want to try a sleep med or even a tylenol PM without CPAP and see how you feel.

[syzygy]

Since you had the surgery are you sure you need to use CPAP? Did you have a follow up sleep study?

I had hyoid advancement and UPPP in Oct 2010. I continued to use CPAP for a few weeks after the surgery as I healed. I also took some powerful pain meds which of course dulled my central nervous system and sleep came easy. However, once I stopped the pain meds I began waking up multiple time a night as I did prior to surgery with CPAP.

I am convinced that I also had UARS which got worse with age and became a combo of UARS and obstructive apnea. The surgery has worked for keeping my airway open during all sleep phases -- I have not used CPAP for about 6 months and feel better than I have in 10 years. But here is the kicker - I use 3mg of Lunesta or I still will wake up during deep sleep -- my brain wakes me because that was it's job for years and years.

People with UARS have very senstive central nervous systems and adjusting to CPAP is very diffucult if not impossible. My AHI was always high with a lot of hypops. I tried for a few years before having the surgery.

In time I hope my brain and CNS will adjust to the new normal which is that I don't have restricted breathing anymore and I can stop using Lunesta (which is stupid expensive)

You may want to try a sleep med or even a tylenol PM without CPAP and see how you feel.

I certainly didn't expect to have to use CPAP, and I slept without it for a few months. At 4 months, I was complaining to my surgeon that I still wasn't sleeping well, and so he told me to have the sleep study. The result was that I still have borderline severe sleep apnea (30 AHI, no obstructive apneas). It was a shock, both to me and my surgeon, but such is life...

I was told that I have large tonsil pockets and a low-lying soft palate. I may have a UPPP or something like it.

My sleep doctor also has me on 3mg Lunesta. Doesn't seem to help all that much.

[Goofproof]

Is it just me, but XPAP treatment with the software to tweak and confirm how I'm doing seems much smarter, than going under the knife, moreover when the results are questionable, and success rates are low. Jim

Air is non-envasive!

[Fitness Seeker]

Thank you all for contributing. I'm finding all this info very helpful. I was diagnosed w/ UARS a month ago and just started w/ my Apap machine a week ago. After reading some of your posts, I've learned that I have the same issues as fellow UARS sufferers being hypersensitive to everything. Now I feel relieved, but still, very discouraged at the same time.

So are there any UARS sufferers who had success w/ a machine and if so, what type of machine? I'm so annoyed our MDs don't tell us any of this and we have to kinda 'discover" on our own. So if it's highly difficult, or almost impossible to tolerate the cpap's what is the solution?

[archangle]

I'm skeptical about UARS diagnosis. To me, it sounds like "We don't know what's going on. Here's a new term for a condition that's hard to definitively diagnose. We can diagnose UARS and look like we know what we're doing and stop working hard thinking and trying to figure this out."

Yes, I believe UARS may actually happen. I'm afraid it's being used as a "garbage dump" for difficult cases.

[robysue]

The problem is that my sleep still isn't very good. In fact, I can't say with absolute certainty that the CPAP is helping at all, although it probably is and it may just be hard to see. The issue that's been bedeviling me the last year or so is that I wake up after 4-5 hours. Without CPAP, that's it--I'm up for good. With CPAP, I can usually fall back asleep, but my sleep is incredibly restless--the pressure changes or noise or something disturbs me; I wake up briefly, and then go back to sleep.

With or without the CPAP you've got a version of wake too early insomnia. When you sleep without the CPAP, you just get up. And when you sleep with the CPAP, that time in bed after the wake with the troubled restless sleep may be making you feel worse than you would feel if you simply just got up.

The thing you have to do is to teach your body how to sleep longer, and unfortunately lying in bed after that wake up and fighting for sleep because all the sensory stuff about the CPAP is disturbing you is counterproductive.

So first and formost, can you compare how you feel at that big wake up with and without CPAP? In other words, when you wake up 4--5 hours after going to sleep, does it feel better or worse with the CPAP at the time of the wake up? And why?

Sleeping without the CPAP: Why can't (or don't) you go back to sleep after that big wake up after 4--5 hours of sleep? What happens if you try to go back to sleep? And when you get up, are you rested enough to get through the day without too much fatigue and daytime sleepiness? Are you alert enough to function?

Sleeping with the CPAP: Have you ever just tried getting up at the end of 4--5 hours of sleep instead of going back to sleep for a couple more hours of very troubled, non-restful sleep? If not, why not?

Answering these questions may help us tease apart what's really going on concerning your multiple sleep problems. And crazy as it sounds, when you sleep with the CPAP you might feel better if you just got up after 4--5 hours of sleep instead of fighting to get a bit more non-restful sleep at the end of the night. Or you might need some work on stabilizing and shifting your circadian cycle just a wee bit later so you naturally wake up a bit later in the morning and feel more willing to get up.

Lately, I've been having a lot of dreams, which is supposed to be a good thing--but I wake up sweaty (actually, more sweaty since the dreams started again; this may actually be good, if it means I'm getting deeper sleep).

Dreaming is usually good. But consistently waking up sweaty while on CPAP can indicate that the apnea is not well controlled. Have you looked at the data for the nights where you wake up sweaty? Any correlation between nasty event clusters and the waking up sweaty episodes?

I also feel out of breath during the day, despite the fact that I am in relatively good cardiovascular health (can run a few miles without undue strain, etc.). This is actually a major issue for me. It's often resolved by breathing using the CPAP.

CPAP is not designed to treat DAYTIME breathing issues. Even though you feel as though the CPAP seems to help, you NEED to consult with your PPC about the fact that you feel out of breath during the day. Nasty allergies? Asthma? Chronic bronchitis? And a host of other things could be causing your daytime breathing problems. And finding out what's causing that and TREATING it may go a long way in making the CPAP easier to tolerate and it might help with the insomnia.

I clearly have a lot of room for improvement, but I'm not sure what to do.

The rest of your post indicates you've spent a lot of time changing lots of CPAP-related things all at the same time. Making one change at a time and giving it several days to a week before making another change is the only way you can figure out what works and what doesn't.

But the fact remains: You have the wake too early insomnia regardless of whether you use the CPAP or not. And that raises the question: Have you tried tackling the insomnia as a separate, but related problem to the UARS/OSA/CPAP?

You can start with self-help tips for insomnia. They usually focus on cleaning up your sleep hygiene---i.e. working on replacing behavior patterns that encourage the insomnia with behavior patterns that discourage it. You might want to read through my Taming the CPAP-Induced Insomnia Monster to learn more. Not everything that I write will apply to you, but some of it will. And you might get some new ideas to try.

If cleaning up your sleep hygiene doesn't make much difference OR if the problem has been going on for a long time, you might also want to talk to your sleep doctor about the insomnia as its own issue. Be sure to describe when it happens and how you have that same wake both with and without CPAP. Sleep meds might be suggested, but many sleeping medications are much better at dealing with bedtime insomnia. And hence they may not be appropriate in your case. Melatonin might work---and smaller doses may be more effective than larger ones. And asking for ideas on how to adjust your circadian rhythm might be useful.

My guess is that the main suggestion will be: Go to bed and get up at the same times every day. Don't let yourself try to snooze if you are not sleepy or if you start to get frustrated. At the start, it may be useful to delay your bedtime until it is 4--5 hours before you WANT to wake up. In other words, if you WANT to wake up at 6:20, but you are currently going to bed at 11:00 and waking up at 3:00 or 4:00 and find yourself unable to get back to a sound sleep, then it may be easier to delay bedtime until 1:30 or 2:30 and let your body get the 4--5 hours of sleep and wake up at 6:30. Once you are consistently sleeping through until the time you WANT to wake up, you can then work on moving your bedtime back in small 15 or 20 minute increments until you are sleeping more or less soundly for 6--7 hours.

And at that point, you need to evaluate how you feel: Are you getting enough rest with 6--7 hours of sleep every night to feel refreshed in the morning and function all day long? Because not everybody needs 7--9 hours of sleep every night. Some of us genuinely function best on a bit less sleep. Some of us function best on a lot less sleep. And you need to let your body be your guide in finding out how much sleep you actually need.

[Fitness Seeker]

Boy I was in sooo much sleep debt last nite after my 1 wk nightmare on apap. I think i was in so much sleep debt that last nite it went "marginally" better than the past wk since i had the machine. I was sleeping on the side at an angle at some position that made the blower whooshing quite quiet....I normally tuck my arms and hands inside my covers. Is there any problems w/ the mask nozzle being stifled by the comforter? It was so quiet that I had to make sure twice if my machine was actually on and if there was pressure b/c i couldn't hear the swooshing. Man, I hope i can continue to sleep marginally better w/ the machine in days and weeks to come....I don't feel great and refreshed but it sure as heck is better than feeling like i hadn't sleep an ounce like i had for the past entire week.....

[Pugsy]

Is there any problems w/ the mask nozzle being stifled by the comforter?

As long as the little vent holes have some room to vent you are okay. Doesn't need to be a lot of room as long as the comforter isn't actually touching the vent holes and thus blocking the venting.

[ultimatestrap]

I have to give you so much credit for persistence...Good For You. this is not an easy process and it does take lots of time to adjust to CPAP machines and everything that goes along with that...But you say you have no problem taping your mouth shut! NO WAY! Have you every tried any chin straps? Just one more thing to adust to...However, I have tried The Ultimate Chin Strap for Sleep Apnea and it is the best one on the market. I have tried really cheap ones to very expensive ones...which did not work...This one keeps your mouth closed while opening air passages...I guess its the design...ikt is soft and pliable and freaking works... please not more taping mouth shut..Ouch! Good Luck and keep on keep on....Mary

[archangle]

It was so quiet that I had to make sure twice if my machine was actually on and if there was pressure b/c i couldn't hear the swooshing.

If you ever find yourself doubting whether you still have pressure, purse your lips and open your mouth a little and let the air blow through.

[syzygy]

Woah...I didn't realize that this thread was still active. Thanks for your long and detailed post. I appreciate your taking the time to address my concerns.

I agree that I have issues beyond sleep apnea. One is that I'm a really, really hypersensitive sleeper. When I went away to college, for example, I couldn't sleep with the super noisy steam heaters we had in my dorm room. I had a really tough time until I started wearing earplugs; I've been using them ever since (more than 25 years). The other issue that comes to mind is that I have various kinds of stress--young kids at home and don't like my job.

But I actually did make some progress after my last post. I concluded two things:

1) The trouble breathing was related to sleeping medications I was taking. My sleep doctor suggested I take Lunesta because I was really having anxiety about sleeping with the CPAP. It helped me deal with that, but it started causing problems of its own.

2) The CPAP settings were actually too high. I had always been thinking that, since I wasn't sleeping well, I needed to increase the settings. But it never worked. Finally it occurred to me that I could try the reverse. That seemed to help a lot.

I also started taking ribose, which is supposed to help people with chronic fatigue disease. I don't think I have CFD, but I wanted to give it a try, anyway.

The first night I gave up the sleeping medications, I only slept 3 hours. But the breathing problem was gone. I didn't worry about number of hours slept and just tried to function as best I could. Over time, I started feeling better and better. Two weeks ago, I took a family vacation. I still had trouble sleeping, but the fatigue was gone. I finally felt like a normal person (albeit a normal person with sleep issues). I had a good week or so of normalcy.

When I came back, I had very minor surgery (turbinate reduction). Afterwards, I couldn't sleep with my CPAP in order to allow my nose to recover. I started feeling lousy. After 3 days, I was able to go back to the CPAP. Still felt lousy. Now I'm not taking sleep medication, using the good CPAP settings, but still having problems; I feel as if I'm back to square one. My biggest issue now is that the CPAP noise wakes me up (second: my nasal pillows are somehow becoming more dislodged). Two weeks ago, it seemed tolerable, but for some reason today, it's not. Why? I have no idea. Doesn't seem that the surgery could have done all this. Maybe it's the return to real life.

My sleep hygiene is pretty good. I exercise a fair amount and am not overweight. I don't stress out when I can't sleep. (Experience tells me that I almost never can get back to sleep, so I just stay up.) I don't eat junk food much or drink coffee after noon. Despite this, I have borderline high blood pressure, slightly elevated (105) blood sugar, and quite low testosterone (about half normal for my age). My PCP has discussed testosterone replacement therapy, but I'm not sure that would address my sleep issues. His direct response to my sleep problems was to try to put me on Zoloft, which I don't want to do. My own plan right now is to find a new job.

The problem is that my sleep still isn't very good. In fact, I can't say with absolute certainty that the CPAP is helping at all, although it probably is and it may just be hard to see. The issue that's been bedeviling me the last year or so is that I wake up after 4-5 hours. Without CPAP, that's it--I'm up for good. With CPAP, I can usually fall back asleep, but my sleep is incredibly restless--the pressure changes or noise or something disturbs me; I wake up briefly, and then go back to sleep.

With or without the CPAP you've got a version of wake too early insomnia. When you sleep without the CPAP, you just get up. And when you sleep with the CPAP, that time in bed after the wake with the troubled restless sleep may be making you feel worse than you would feel if you simply just got up.

The thing you have to do is to teach your body how to sleep longer, and unfortunately lying in bed after that wake up and fighting for sleep because all the sensory stuff about the CPAP is disturbing you is counterproductive.

So first and formost, can you compare how you feel at that big wake up with and without CPAP? In other words, when you wake up 4--5 hours after going to sleep, does it feel better or worse with the CPAP at the time of the wake up? And why?

Sleeping without the CPAP: Why can't (or don't) you go back to sleep after that big wake up after 4--5 hours of sleep? What happens if you try to go back to sleep? And when you get up, are you rested enough to get through the day without too much fatigue and daytime sleepiness? Are you alert enough to function?

Sleeping with the CPAP: Have you ever just tried getting up at the end of 4--5 hours of sleep instead of going back to sleep for a couple more hours of very troubled, non-restful sleep? If not, why not?

Answering these questions may help us tease apart what's really going on concerning your multiple sleep problems. And crazy as it sounds, when you sleep with the CPAP you might feel better if you just got up after 4--5 hours of sleep instead of fighting to get a bit more non-restful sleep at the end of the night. Or you might need some work on stabilizing and shifting your circadian cycle just a wee bit later so you naturally wake up a bit later in the morning and feel more willing to get up.

Lately, I've been having a lot of dreams, which is supposed to be a good thing--but I wake up sweaty (actually, more sweaty since the dreams started again; this may actually be good, if it means I'm getting deeper sleep).

Dreaming is usually good. But consistently waking up sweaty while on CPAP can indicate that the apnea is not well controlled. Have you looked at the data for the nights where you wake up sweaty? Any correlation between nasty event clusters and the waking up sweaty episodes?

I also feel out of breath during the day, despite the fact that I am in relatively good cardiovascular health (can run a few miles without undue strain, etc.). This is actually a major issue for me. It's often resolved by breathing using the CPAP.

CPAP is not designed to treat DAYTIME breathing issues. Even though you feel as though the CPAP seems to help, you NEED to consult with your PPC about the fact that you feel out of breath during the day. Nasty allergies? Asthma? Chronic bronchitis? And a host of other things could be causing your daytime breathing problems. And finding out what's causing that and TREATING it may go a long way in making the CPAP easier to tolerate and it might help with the insomnia.

I clearly have a lot of room for improvement, but I'm not sure what to do.

The rest of your post indicates you've spent a lot of time changing lots of CPAP-related things all at the same time. Making one change at a time and giving it several days to a week before making another change is the only way you can figure out what works and what doesn't.

But the fact remains: You have the wake too early insomnia regardless of whether you use the CPAP or not. And that raises the question: Have you tried tackling the insomnia as a separate, but related problem to the UARS/OSA/CPAP?

You can start with self-help tips for insomnia. They usually focus on cleaning up your sleep hygiene---i.e. working on replacing behavior patterns that encourage the insomnia with behavior patterns that discourage it. You might want to read through my Taming the CPAP-Induced Insomnia Monster to learn more. Not everything that I write will apply to you, but some of it will. And you might get some new ideas to try.

If cleaning up your sleep hygiene doesn't make much difference OR if the problem has been going on for a long time, you might also want to talk to your sleep doctor about the insomnia as its own issue. Be sure to describe when it happens and how you have that same wake both with and without CPAP. Sleep meds might be suggested, but many sleeping medications are much better at dealing with bedtime insomnia. And hence they may not be appropriate in your case. Melatonin might work---and smaller doses may be more effective than larger ones. And asking for ideas on how to adjust your circadian rhythm might be useful.

My guess is that the main suggestion will be: Go to bed and get up at the same times every day. Don't let yourself try to snooze if you are not sleepy or if you start to get frustrated. At the start, it may be useful to delay your bedtime until it is 4--5 hours before you WANT to wake up. In other words, if you WANT to wake up at 6:20, but you are currently going to bed at 11:00 and waking up at 3:00 or 4:00 and find yourself unable to get back to a sound sleep, then it may be easier to delay bedtime until 1:30 or 2:30 and let your body get the 4--5 hours of sleep and wake up at 6:30. Once you are consistently sleeping through until the time you WANT to wake up, you can then work on moving your bedtime back in small 15 or 20 minute increments until you are sleeping more or less soundly for 6--7 hours.

And at that point, you need to evaluate how you feel: Are you getting enough rest with 6--7 hours of sleep every night to feel refreshed in the morning and function all day long? Because not everybody needs 7--9 hours of sleep every night. Some of us genuinely function best on a bit less sleep. Some of us function best on a lot less sleep. And you need to let your body be your guide in finding out how much sleep you actually need.

[robysue]

I agree that I have issues beyond sleep apnea. One is that I'm a really, really hypersensitive sleeper. When I went away to college, for example, I couldn't sleep with the super noisy steam heaters we had in my dorm room. I had a really tough time until I started wearing earplugs; I've been using them ever since (more than 25 years). The other issue that comes to mind is that I have various kinds of stress--young kids at home and don't like my job.

Stress is a killer, isn't it? I'm someone who tends to be chronically stressed out; hubby reminds me frequently that I need to work hard at relaxing since relaxation (and destressing) don't come natural to me. Do you know (and USE) any conscious relaxation techniques to try to manage the stress?

As for the earplugs: If machine noise and/or the sound of your own breathing are issues when you're using the cpap machine, the earplugs may be part of the problem instead of the solution. By blocking out ambient noise that enters the ear through the outer ear, earplugs have a tendency to seemingly amplify conducted noise---noise that enters the ear by being conducted through the skull and directly into the inner ear. When conducted noise has no competition from ambient noise, it's far more noticeable and irritating. It's also far harder to ignore. And both the noise of the machine and the noise of your own breathing can be amplified by the hose AND conducted into your inner ear through the bones in your head if the hose is touching/resting on your head or touching/resting on your pillow.

1) The trouble breathing was related to sleeping medications I was taking. My sleep doctor suggested I take Lunesta because I was really having anxiety about sleeping with the CPAP. It helped me deal with that, but it started causing problems of its own.

This is GOOD news in light of the fact that later on you say that getting off the Lunesta has resolved the daytime breathing problems.

2) The CPAP settings were actually too high. I had always been thinking that, since I wasn't sleeping well, I needed to increase the settings. But it never worked. Finally it occurred to me that I could try the reverse. That seemed to help a lot.

Makes some sense to me actually. While the chorus here is always, "try a bit more pressure" when folks are having trouble with pressure settings below 8--10 cm, there are some folks (myself included) who do better at lower pressures. For me, aerophagia starts to kick in by 8cm and at 9cm, I get both severe aerophagia and problems with air in the eyes through the tear ducts.

I also started taking ribose, which is supposed to help people with chronic fatigue disease. I don't think I have CFD, but I wanted to give it a try, anyway.

Just make sure you read the full patient's handout provided by your pharmacist and be aware of all the potential side effects.

The first night I gave up the sleeping medications, I only slept 3 hours. But the breathing problem was gone. I didn't worry about number of hours slept and just tried to function as best I could. Over time, I started feeling better and better. Two weeks ago, I took a family vacation. I still had trouble sleeping, but the fatigue was gone. I finally felt like a normal person (albeit a normal person with sleep issues). I had a good week or so of normalcy.

When I came back, I had very minor surgery (turbinate reduction). Afterwards, I couldn't sleep with my CPAP in order to allow my nose to recover. I started feeling lousy. After 3 days, I was able to go back to the CPAP. Still felt lousy. Now I'm not taking sleep medication, using the good CPAP settings, but still having problems; I feel as if I'm back to square one.

In a major way you ARE back at square on: Three days doesn't sound like much time away, but you've been having some really serious problems learning to sleep with the mask. And so that part of your unconscious mind that is still resisting the idea that you must use CPAP for the rest of your life took those three days of subjectively decent enough sleep and decided they were evidence enough to warrant continuing to fight the machine instead of accepting it---in spite of your conscious mind and body recognizing how lousy you felt without the CPAP. On top of that the nasal surgery may have changed things inside just enough to affect both how CPAP feels and perhaps how much pressure you need.

My biggest issue now is the CPAP noise wakes me up (second: my nasal pillows are somehow becoming more dislodged). Two weeks ago, it seemed tolerable, but for some reason today, it's not. Why? I have no idea. Doesn't seem that the surgery could have done all this. Maybe it's the return to real life.

Noise: Chances are that CPAP noise is CONDUCTED noise---noise that's getting into your head through the hose which is lying on your pillow, your bed covers, and/or your head. And the earplugs are aggravating this problem instead of helping it. For a lot more information about what conducted noise is and how earplugs tend to add to the problem, see my response to kieran in this thread machine noise

My sleep hygiene is pretty good. I exercise a fair amount and am not overweight. I don't stress out when I can't sleep. (Experience tells me that I almost never can get back to sleep, so I just stay up.) I don't eat junk food much or drink coffee after noon.

I reluctantly have found that I've had to give up all caffeine . For me, I also find that timing of the exercise is important: If it's too close to bed OR I seriously overdo, then I'm likely to have sleep problems---either the insomnia is worse or I have far more OAs than normal for reasons I don't understand. Or both.

Despite this, I have borderline high blood pressure, slightly elevated (105) blood sugar, and quite low testosterone (about half normal for my age). My PCP has discussed testosterone replacement therapy, but I'm not sure that would address my sleep issues. His direct response to my sleep problems was to try to put me on Zoloft, which I don't want to do. My own plan right now is to find a new job.

The borderline HBP could be related to the apnea and once you've sleeping decently while using the CPAP for several months, it may resolve itself. (Or not.) And the slightly high blood sugar could also be related to the apnea. It bears careful monitoring to see if either of these issues start to resolve themselves after you've sleeping decently while using the CPAP for several months. Patience here is the critical thing: Insomnia itself messes things up and until both the insomnia and the OSA are dealt with, the CPAP can't do all its full magic of helping your body overcome and repair the damage the apneas have caused.

Good luck with your plan for finding a new job. Because a job you don't hate will go a long way in reducing the stress, which in turn will help resolve your remaining issues.

[syzygy]

Do you know (and USE) any conscious relaxation techniques to try to manage the stress?

I do know various breathing techniques, and I do enjoy using them on occasion. I also have a huge set of unexplored links regarding meditation techniques. The problem I've always had is that they haven't really worked that well, and so I associate them in my mind with failure and frustration.

[As for the earplugs: If machine noise and/or the sound of your own breathing are issues when you're using the cpap machine, the earplugs may be part of the problem instead of the solution. By blocking out ambient noise that enters the ear through the outer ear, earplugs have a tendency to seemingly amplify conducted noise---noise that enters the ear by being conducted through the skull and directly into the inner ear. When conducted noise has no competition from ambient noise, it's far more noticeable and irritating. It's also far harder to ignore. And both the noise of the machine and the noise of your own breathing can be amplified by the hose AND conducted into your inner ear through the bones in your head if the hose is touching/resting on your head or touching/resting on your pillow.

This is definitely true. For many months, I didn't use earplugs. But I somehow found the sound of the machine and my breathing to be more irritating than the louder but more constant sound I hear using the earplugs.

The thing is, it was working. I pretended to myself that when I put on the earplugs, I was going on a voyage on a spaceship, or something like that. I remember thinking that the noise just wasn't an issue anymore.

[

I also started taking ribose, which is supposed to help people with chronic fatigue disease. I don't think I have CFD, but I wanted to give it a try, anyway.

Just make sure you read the full patient's handout provided by your pharmacist and be aware of all the potential side effects.

It's OTC medication that seems to be rather benign, but I will watch out.

In a major way you ARE back at square on: Three days doesn't sound like much time away, but you've been having some really serious problems learning to sleep with the mask. And so that part of your unconscious mind that is still resisting the idea that you must use CPAP for the rest of your life took those three days of subjectively decent enough sleep and decided they were evidence enough to warrant continuing to fight the machine instead of accepting it---in spite of your conscious mind and body recognizing how lousy you felt without the CPAP. On top of that the nasal surgery may have changed things inside just enough to affect both how CPAP feels and perhaps how much pressure you need.

This is very insightful; I'm glad to hear your interpretation, since I hadn't been able to fully process the last week. It's most likely true that the surgery changed things just a tad. My left nostril was always blocking when I lay down, and now it's not. And somehow, the pillow position I had grown accustomed to isn't quite right. You may be right as well about my unconscious mind resisting CPAP. The irony is that I had finally come to the point where I felt better about sleeping with the CPAP--that it wasn't a big deal, and that I was better off with it than without it. But I suppose there still was a part of me that wanted to be off of it.

I reluctantly have found that I've had to give up all caffeine . For me, I also find that timing of the exercise is important: If it's too close to bed OR I seriously overdo, then I'm likely to have sleep problems---either the insomnia is worse or I have far more OAs than normal for reasons I don't understand. Or both.

Timing is definitely important. I've gone back and forth a lot about caffeine. I finally concluded it's not the determining factor in my problems. As long as I don't overdo it, I'm fine if other things are fine. If they're not, even abstaining completely doesn't help me. I say this having given up caffeine for a trial run of 2 months. I may try to eliminate it completely in the future, but for now, I feel I'm better off with it than without it.

The borderline HBP could be related to the apnea and once you've sleeping decently while using the CPAP for several months, it may resolve itself. (Or not.) And the slightly high blood sugar could also be related to the apnea. It bears careful monitoring to see if either of these issues start to resolve themselves after you've sleeping decently while using the CPAP for several months. Patience here is the critical thing: Insomnia itself messes things up and until both the insomnia and the OSA are dealt with, the CPAP can't do all its full magic of helping your body overcome and repair the damage the apneas have caused.

Good luck with your plan for finding a new job. Because a job you don't hate will go a long way in reducing the stress, which in turn will help resolve your remaining issues.

All good points. Thanks again for your detailed comments!