Medication to stop Early Awakenings --seems to be helping me

[johntee]

Hi. I've been on CPAP almost 5 years, and have been through the ringer trying to feel "well" or "rested".
Went through over a year of seeing the sleep clinic doctors, addressing the sleep hygiene basics, cognitive behavioral therapy, sleep consolidation retraining, sleep restriction, anti-depressants, etc. I was helped a bit by many of those attempts, so that I went from:
pre-CPAP: An hour or 2 to fall asleep, then asleep for 20-60 minutes, then awake for an hour or more, asleep for 60 minutes, awake for an hour, etc...
to:
post-CPAP and all those things: Fall asleep within 10 or 15 minutes (no pills); stay asleep until I wake up. My issue is that I wake up too early, after only 4 - 4.5 - 5 hours. Seems I only get 1 full REM cycle, and part of the second REM.

So I've been fighting the excessive daytime sleepiness over the years with various things like Wellbutrin, Provigil, Adderall, Ritalin. (Not all at once, lol. Tried each of them for varying lengths of time, until realizing I still hadn't found the good solution.)

I wanted to post this because I recently was referred to a psychiatrist to get dosing advice on the Ritalin we're currently trying. (Seemed I needed a mix of Instant-Release and Extended-Release Ritalin, which my primary care doctor didn't have any real experience prescribing, so she thought she'd be using me as a lab rat to find the right dosage/timings. So she suggested I see a psychiatrist who would have had more experience in prescribing Ritalin in its various forms to adults.)

The psych did tweak the Ritalin (changed it to Concerta 2x36mg tablets, each morning, which is a higher dosage than I was on), but he also wanted to try to address the early awakenings. (Which was a pleasant surprise since I always figured that since the sleep clinic doctors had taken me as far as they could years ago, that there was no hope for me for any improvement in that department. So I had only expected him to tweak the stay-awake medications.)

He prescribed 2mg of Klonopin plus 25mg of Seroquel at bedtime. Apparently the Seroquel accentuates the sleep-inducing qualities of the Klonopin. The first night, I slept for approximately 7.75 hours! (The down-side was that I felt completely drugged and groggy and uncoordinated the entire next day; he said my body would adjust to it in a week or two, but for now we've cut those dosages in half, and I take the Seroquel 1.5 hours before bed now (Seroquel is the longest-lasting of the two meds).

So while I'm still a work in progress, I wanted to post this info in case it helps anyone to address their own early-awakening issues.
(The psychiatrist specializes in "medication management", not counseling, so I think I got lucky to have been referred to him. I didn't know such a specialty even existed, lol.)

If anyone has any questions, please feel free to contact me..... I've gotten alot of help from these boards in the past 5 years, and am more than happy to try to give back if I can...

The generic for the Klonopin is Clonazepam, and I don't think there is a generic for Seroquel (it was $200 for 60 tablets, $100 cost for me + $100 Insurance company payment). But that will last me several months, since we've cut the Seroquel dosage down.

Thanks!
John

[Julie]

Hi - sorry you've had such a hard time, but do you know that Klonipin is addictive? And have you been monitoring your OSA stats via computer to see what it's doing to your sleep (apart from extending it)? I know you're looking for answers, but you need to be sure the ones you get are good for you all around, not just in one area.

[Bons]

That should keep you asleep. I had to travel by train just after 9/11 and my PTSD was giving me a lot of trouble. The doc gave me klonopin and seraquel.... took the meds when I got on the train in Chicago and never woke up until we arrived in Harrisburg, PA 14 hours later! Good thing I'm a tosser/turner or the other passengers might have thought I was dead.

My sleep doc wants me to start meds because of my 175+ limb movements during the sleep study. I'm reluctant to do that because I sometimes get called for deaths or other emergencies during the night and need to be able to function. So I'm going to be working on biofeedback to try to get to sleep quickly the 5-6 times a night that I'm aware of being awake.

[johntee]

do you know that Klonipin is addictive?

No, the Dr. didn't mention that. But then again, so is the Adderall, the Ritalin, etc. (Not sure about the Provigil.)

And have you been monitoring your OSA stats via computer to see what it's doing to your sleep (apart from extending it)?

Actually, I did check my Encore Pro stats and I was pleasantly surprised... My AHI was running about 4.5 the day before I started the Klonopin and Seroquel, for 5.75 hours of mask time.
Then they became:
AHI 0.6, for 7.75 hours of mask time.
AHI 0.9, for 7.5 hours of mask time.
AHI 1.5, for 6.75 hours of mask time.
AHI 1.1, for 5.25 hours of mask time.

(Decreased sleep times are from cutting dosage, leaving out the Klonopin, etc as directed by the Dr.)

I may post the graphs of the "pressure runs" when I have more time because they have one element that concerns me -- one extended period per night (45 minutes) at the highest pressure. (Where the night's only Obstructive Apnea happened near the beginning of that long run.)

[kteague]

My sleep doc wants me to start meds because of my 175+ limb movements during the sleep study. I'm reluctant to do that because I sometimes get called for deaths or other emergencies during the night and need to be able to function. So I'm going to be working on biofeedback to try to get to sleep quickly the 5-6 times a night that I'm aware of being awake.

I'm still having good success using the TENS Unit for my limb movements and there's no side effects of meds. Since you have to be able to wake up and be functional during the night, maybe it would help you too. I can't say enough for the difference it has made for me.

Johntee - When needing a lot of meds it is good to have a doctor who is experienced in their interactions. Sounds like your doctor is. Hope this continues to be helpful for you, at least till you can find something better for you with all considerations.