Can't sleep w/o meds.

[AHI15]

From personal experience and as others have repeatedly mentioned on this site, I would advise slowly tapering off of benzo drugs and other sleep meds. Taking them for a few days, then resuming just makes it harder in the long run and can be very frustrating when you lack sleep for days on end. For me it took a month to taper off... every few days slicing off a smaller portion with a single edged razor blade. There will be some tough nights but the results are worth it. As a side note: a small group of people report the last 5% is the toughest and they had to go to the doctor to get something to help them over the last week or so. Unfortunately I don't remember what the doctor prescribed for them For more info type in "Tapering off benzo" in a Google search and you will get a lot of hits. Browse around till you find a site you think you can trust.

First of all, the Z-drugs which are the standard sleeping pills these days are not benzodiazepines, though they are similar in effect by being GABA receptor agonists.

There is conflicting information about whether or not the Z drugs pose nearly the same physical dependence danger as benzodiazepines. I doubt that Z drugs are as risky, but I still am wary of the idea of taking them continuously for a month or more. That and the fact that I tend to develop tolerance to psychoactive meds very quickly.

There are some studies suggesting that Lunesta is safe to use for up to 6 months and for continuous use for 3 months can improve sleep architecture. I think this is also FDA approved.

I have my doubts, because when you look further you get into the question of who funded what study?

Basically at this time, I am waiting for CBT-I. They are the professionals, and I will give first dibs at my choice of action to the guidance I receive there. Until then I will do my best to get in as much CPAP as possible and not get hooked on meds.

[AHI15]

What do you think I should do at the very last 1-2 hours of the night, at about 5-7am, when dawn hits and I generally have a VERY iffy chance of getting some more sleep? This last hour of sleep also can make the difference between having a headache and being dizzy with fatigue, ie., an "F" day where I can't work, or a "D" day where I can work.

Should I force myself to try to fall asleep one last time with CPAP, then if I fail just accept the resulting wasted day, hoping that the next night sleep pressure will be stronger making me sleep deeper?

Neither of these ideas what you should be doing in my opinion.

What I'm going to say is highly counter intuitive and your initial reaction will be: That's IMPOSSIBLE!!!!!

But my advice is this: If you wake up between 5 AM and 7 am and are unable to get back to a good sleep with the CPAP on, you probably should just get up for the day. In other words, give yourself a reasonable bit of time to get back to sleep with the mask on. But if you are still not asleep at the end of what feels like 15-30 minutes OR if you find yourself becoming MORE alert and less sleepy, then make yourself get out of bed and start your day.

[

My objective side would tend to agree that in general this is probably the best thing. But I'm still not sure, depending on special circumstances.

I'm sorry if it sounds as though I'm holding your toes to the fire, but you've said something important here: You objectively understand that you should just get up if you wake up an hour or two early and can't get back to sleep with the CPAP on, but you choose to believe that it is still somehow ok for you to sleep that extra hour or so without your mask on.

But unfortunately that is leading to establishment of a very bad habit of "taking your mask off just so you can sleep". And that bad habit will become more difficult to break as it becomes more established. And it is also undermining your therapy. And, although you don't want to admit it, it easily be contributing to your on-going string of F and D quality days. And in the long term, it could be the beginning of a slippery slope that ends with you throwing the PAP machine in the closet, but continuing the downward spiral in your daytime functioning.

I won't be throwing the CPAP away as long as the sleep study says that I have OSA. That is the scientific fact, so I will seek to optimize the treatment until am dead or cured.

My point is simply this: Can you conceive of a case where someone is so distraught from having woken too early, that they should just get 2 more hours of sleep without the mask?

Can you conceive of the possiblity that someone with mild-moderate OSA may actually get SOME restorative sleep without CPAP? Ie., 7 hrs CPAP + 2 hrs no-CPAP may actually be better than 7 hrs CPAP only?

Thus, I think your argument for maintaining ABSOLUTE stricture about never ever sleeping without the mask may be summarized as:

1. The risk of a downward spiral into taking off the mask any time there is difficulty sleeping is so extreme that it must be avoided at any expense, even if that means missing work to wait for a nap time with CPAP, and spending several hours nearly psychotic waiting for the chance to get sleepy again.

AND/OR

2. The effect of sleeping the extra hours without the CPAP, even if it is perceived to be mildly restorative, will undermine the body's inclination to have a deeper and more contiguous sleep the next night. Thus it would pay off in the long run to endure even abject misery for a day to avoid undermining the process of conditioning one's self to sleep only with CPAP.

I think these are strong arguments. But I still doubt things need to be so strict. And I still think this doesn't take into account that there may be people with other conditions such as ADHD, etc. where maintaining absolute CPAP stricture may actually result in more psychological stress and less overall restorative sleep in the long run.

It is very difficult for the human mind to understand experiences outside of it's own.

But I appreciate your efforts to convince me of your point of view. You can be sure that I take it seriously and will try very hard to follow it since it's essentially consistent with the psychological underpinnings of insomnia recovery in general.

Thanks for the input as usual.

[avi123]

I don't know why this thread has been metamorphosed from sleep medication to you name it. I am glad that I have deleted my sleep Rx post. IMO, AHI15, has been a bit too nice but silly by taking the time to reply to all those off topics, instead of focusing on medications.

[AHI15]

I don't know why this thread has been metamorphosed from sleep medication to you name it. I am glad that I have deleted my sleep Rx post. IMO, AHI15, has been a bit too nice but silly by taking the time to reply to all those off topics, instead of focusing on medications.

Because if I am ever to sleep regularly without meds, it will be through proper treatment and management of insomnia.

Besides, I don't have anything better to do.

Good night. I better turn off this PC so I can spend an hour b4 bed not looking at a bright screen.

[RogerSC]

Okay, just a quick note...when I started using CPAP, my plan was to take Ambien every night for a week, and then stop, to help getting used to sleeping with the mask and all. This was after not being able to sleep with it at all the first night. This did work, although my first night after stopping Ambien there was not much sleep, after that things pretty much leveled off. And now I'm using the thing most all of the night most all nights. Occasionally I'll stop early, take off the mask, if I wake up and can't get back to sleep, but that's rare, and I make sure that I always get more than 4 hours with it. But I'm a relative newbie, so there you go.

If I hadn't take the Ambien for a few days, I probably would have given up. But I was strongly motivated not to do that by what I've read about the consequences of sleep apnea. So I made it work *smile*.

[49er]

AHI15,

I have been thinking alot about your situation because I relate to so much of it even though there are differences.

Anyway, I am wondering about the role of Nuvigal which seemed to result in your sleep difficulties which led to the sleep meds. Correct me if I am wrong.

If I am reading your posts correctly, you feel you need it to function but is it possible to look into alternatives such as high epa fish oil which helps some people with ADHD? Also, what about a paleo type diet that might improve your fatigue and concentration?

Just so you know, when you deal with so many issues, as I am finding out, it isn't easy to know exactly what is causing what. Hang in there.

By the way, I tried to pm you but you don't have that feature enabled.

49er

[AHI15]

AHI15,
I have been thinking alot about your situation because I relate to so much of it even though there are differences.
Anyway, I am wondering about the role of Nuvigal which seemed to result in your sleep difficulties which led to the sleep meds. Correct me if I am wrong.
If I am reading your posts correctly, you feel you need it to function but is it possible to look into alternatives such as high epa fish oil which helps some people with ADHD? Also, what about a paleo type diet that might improve your fatigue and concentration?
Just so you know, when you deal with so many issues, as I am finding out, it isn't easy to know exactly what is causing what. Hang in there.
By the way, I tried to pm you but you don't have that feature enabled.
49er

Hi,

I have not tried to enter into CPAP existence "clean" that is, with no stims or sleep meds confusing things. It is something I'm considering doing soon, since I think my next thread will be "can't sleep with sleep meds."

I don't think people with real ADHD will benefit from fish oil. Regardless, I take very high quality fish oil every day for cardio health. And I've tried adding Tyrosine which theoretically can help ADHD. But it doesn't, and predictably so if you understand the rate-limiting role of tyrosine hydroxylase. I'm have decent coping skills for dealing with ADHD w/o meds., so I can get by without them, when I am decently rested. But the structure of my job helps too. It would be very hard to replace it with another job where people wouldn't "notice" my impairment.

Nuvigil is a pain in the butt since yes, it keeps me up. That's why I avoid it except for 1-2, sometimes 3 days a week.

Basically I have to choose: 1. get some work done 25-50% of the time rather than none so at least they are less likely to feel an imminent need to replace me, or 2. just give up working until I get enough med-free restorative sleep to be able to drive safely and keep my eyes open at work--and hope they don't fire me before I come around.

The restorative sleep could take MONTHS if ever. So what would you do? Take a stim. to hold on to your job? Or be absent for 1-2 or maybe 3 months which might be needed to overcome insomnia--most likely resulting in having no job? It's a terrifying choice.

In my field, I can expect to have a challenge to ever find a similar job again unless I can intellectually compete with the 5th percentile of 26 year olds. In other words, the next stop after this is a job with 1/4 to 1/2 the pay if I'm lucky enough to get a job at all, or if there is a point vs. collecting disability.

So here's the question: Can I learn to sleep well with no stims. in my body and with no sleep meds? It is an question that will take risking my job and possibly months to answer.

Regarding diet: I'm very interested in this. I hold out the hope that a significant weight loss could take me below clinical AHI threshold. Motivation is a challenge though, since all my energy now goes into trying to adjust to CPAP. Every time I try to restrict grains and get mildly ketogenic, eating just becomes so boring.

Thanks for the reply.

[49er]

AHI15,
I have been thinking alot about your situation because I relate to so much of it even though there are differences.
Anyway, I am wondering about the role of Nuvigal which seemed to result in your sleep difficulties which led to the sleep meds. Correct me if I am wrong.
If I am reading your posts correctly, you feel you need it to function but is it possible to look into alternatives such as high epa fish oil which helps some people with ADHD? Also, what about a paleo type diet that might improve your fatigue and concentration?
Just so you know, when you deal with so many issues, as I am finding out, it isn't easy to know exactly what is causing what. Hang in there.
By the way, I tried to pm you but you don't have that feature enabled.
49er

Hi,

I have not tried to enter into CPAP existence "clean" that is, with no stims or sleep meds confusing things. It is something I'm considering doing soon, since I think my next thread will be "can't sleep with sleep meds."

I don't think people with real ADHD will benefit from fish oil. Regardless, I take very high quality fish oil every day for cardio health. And I've tried adding Tyrosine which theoretically can help ADHD. But it doesn't, and predictably so if you understand the rate-limiting role of tyrosine hydroxylase. I'm have decent coping skills for dealing with ADHD w/o meds., so I can get by without them, when I am decently rested. But the structure of my job helps too. It would be very hard to replace it with another job where people wouldn't "notice" my impairment.

Nuvigil is a pain in the butt since yes, it keeps me up. That's why I avoid it except for 1-2, sometimes 3 days a week.

Basically I have to choose: 1. get some work done 25-50% of the time rather than none so at least they are less likely to feel an imminent need to replace me, or 2. just give up working until I get enough med-free restorative sleep to be able to drive safely and keep my eyes open at work--and hope they don't fire me before I come around.

The restorative sleep could take MONTHS if ever. So what would you do? Take a stim. to hold on to your job? Or be absent for 1-2 or maybe 3 months which might be needed to overcome insomnia--most likely resulting in having no job? It's a terrifying choice.

In my field, I can expect to have a challenge to ever find a similar job again unless I can intellectually compete with the 5th percentile of 26 year olds. In other words, the next stop after this is a job with 1/4 to 1/2 the pay if I'm lucky enough to get a job at all, or if there is a point vs. collecting disability.

So here's the question: Can I learn to sleep well with no stims. in my body and with no sleep meds? It is an question that will take risking my job and possibly months to answer.

Regarding diet: I'm very interested in this. I hold out the hope that a significant weight loss could take me below clinical AHI threshold. Motivation is a challenge though, since all my energy now goes into trying to adjust to CPAP. Every time I try to restrict grains and get mildly ketogenic, eating just becomes so boring.

Thanks for the reply.

Hi AHI15,

You're in a very tough situation and one I empathize with. I have had to work on adjusting to cpap treatment which has not gone well (long story) while hanging on to a temp assignment.

You might want to check out this new paleo book as it claims to deal with the variety issue. I haven't read it as an FYI.

http://www.amazon.com/Practical-Paleo-C ... vidalow-20

49er

[AHI15]

49er,

Thanks for the interest. I hope you stay employed. Thanks for the book link.

[mzlaura1884]

Okay, just a quick note...when I started using CPAP, my plan was to take Ambien every night for a week, and then stop, to help getting used to sleeping with the mask and all. This was after not being able to sleep with it at all the first night. This did work, although my first night after stopping Ambien there was not much sleep, after that things pretty much leveled off. And now I'm using the thing most all of the night most all nights. Occasionally I'll stop early, take off the mask, if I wake up and can't get back to sleep, but that's rare, and I make sure that I always get more than 4 hours with it. But I'm a relative newbie, so there you go.

If I hadn't take the Ambien for a few days, I probably would have given up. But I was strongly motivated not to do that by what I've read about the consequences of sleep apnea. So I made it work *smile*.

My doctor gave me about 6 months worth of 10mg Ambien refills. But as Pugsy said best "i have taken to this like a duck to water" i am on night #10 and my numbers look amazing. I don't know if the Ambien in contributing to helping these numbers by helping me sleep. I have depended on it every night but 1. That 1 night i was able to sleep without out. I see myself trying to wean off of it within a month or so.

[robysue]

AHI15,

I've been pondering the data you've posted. It's a small sample, but there are some interesting patterns that begin to emerge when you break the data into some natural subsets. First, here's the full set of data you posted back on August 25:

Code: Select all

night t[h]  AHI  med     TIB  result_next_day
8/13  6.3   3.0  Sonata  6.3  D- worked 7hrs
8/14  8.9   2.5  L-th    8.9  D- worked 7hrs
8/15  9.3   3.5  none(1) 11? F can't work
8/16  9.2   2.4  Lunesta 9.2  D- off, barely functional day
8/17  8.9   0.8  Lunesta 8.9  D- (Nuvigil) barely functional day
8/18  7.0   2.7  Lunesta 7.0  F- non-functional day
8/19  8.9   2.0  Lunesta 8.9  F can't work
8/20  8.7   2.1  Temz(2) 10?  F can't work
8/21  5.2   2.7  none    9.0  F can't work
8/22  6.2   1.6  Lunesta 9.0  D- worked 9hrs (Nuvigil)
8/23  6.9   1.8  Ambien  8.3  D (Rhodiola) best day in a long time!
8/24  1.8   3.2  none(3) 9.2  F+ (Nuvigil) barely functional even with stim  :cry: 
8/25  ?     ?    Lunesta   ?   ?   ?

NOTES:

1. Took Sonata at 6:45am after sleeping about 7-8hrs until about 5am after falling asleep with no med., but still horribly fatigued, unbearable to get up, need more sleep.

2. Took Temazepam at 11:45 pm after sleeping a very short time on CPAP--so I fell asleep successfully on the machine but couldn't return to sleep after waking. Don't usually wake after such a short time sleeping. Spiraled into mental hell so took med. After so many days of sleeping pills and now a benny, I decided I was determined to get to sleep the next night w/o a med.

3. no sleep on CPAP

As I recall t[h] = usage = how long you had the mask on. If I'm wrong about that, then please let me know what t[h] stands for because there does seem to be a real correlation between ("t[h] = TIB" and D days) and ("t[h] < TIB" and F days). There is an even stronger correlation between your daytime use of Nuvigil or Rhodiola and your rating of the day.

Let's break the data down three different ways.


Analyzing D vs F days
Let's select out the F-days:

Code: Select all

night t[h]  AHI  med     TIB  result_next_day
8/15  9.3   3.5  none(1) 11? F can't work
8/18  7.0   2.7  Lunesta 7.0  F- non-functional day
8/19  8.9   2.0  Lunesta 8.9  F can't work
8/20  8.7   2.1  Temz(2) 10?  F can't work
8/21  5.2   2.7  none    9.0  F can't work
8/24  1.8   3.2  none(3) 9.2  F+ (Nuvigil) barely functional even with stim  :cry: 

Note that on four of these six F days, you allowed yourself to lie in bed (and sleep) for at least an hour without the CPAP on. The two days where usage = TIB (8/18 and 8/19) are days where you took Lunesta. And notice that you took daytime stuff on only on of these 6 days, and the day you took Nuvigil was an F+, in other words, closer to a D- than the other F days.

Now let's look at those D and D- days:

Code: Select all

night t[h]  AHI  med     TIB  result_next_day
8/13  6.3   3.0  Sonata  6.3  D- worked 7hrs
8/14  8.9   2.5  L-th    8.9  D- worked 7hrs
8/16  9.2   2.4  Lunesta 9.2  D- off, barely functional day
8/17  8.9   0.8  Lunesta 8.9  D- (Nuvigil) barely functional day
8/22  6.2   1.6  Lunesta 9.0  D- worked 9hrs (Nuvigil)
8/23  6.9   1.8  Ambien  8.3  D (Rhodiola) best day in a long time!

Note that on four of these days, usage = TIB---in other words you did not allow yourself to sleep with out the mask at the end of the night. On the two days where you managed D's while also "topping" your sleep off with some "maskless" sleep, you also took things intended to improve your daytime functioning.

In other words, most of your worst days occur on days where you top off the sleep with some maskless sleep AND you don't take anything during the daytime. Your less miserable days occur on days where you don't top off your sleep with maskless sleep OR you take something in the daytime OR both.


Analyzing days where t[h] = TIB vs days where t[h] < TIB
Here are the days where t[h] = TIB, in other words these are the days where you did NOT top off your sleep with maskless sleep

Code: Select all

night t[h]  AHI  med     TIB  result_next_day
8/13  6.3   3.0  Sonata  6.3  D- worked 7hrs
8/14  8.9   2.5  L-th    8.9  D- worked 7hrs
8/16  9.2   2.4  Lunesta 9.2  D- off, barely functional day
8/17  8.9   0.8  Lunesta 8.9  D- (Nuvigil) barely functional day
8/18  7.0   2.7  Lunesta 7.0  F- non-functional day
8/19  8.9   2.0  Lunesta 8.9  F can't work

So t[h]=TIB results in four D- days and only two F's.

And here are the days where you t[h] < TIB (The days you tried to top off your sleep with an hour or more of maskless sleep)

Code: Select all

night t[h]  AHI  med     TIB  result_next_day
8/15  9.3   3.5  none(1) 11? F can't work
8/20  8.7   2.1  Temz(2) 10?  F can't work
8/21  5.2   2.7  none    9.0  F can't work
8/22  6.2   1.6  Lunesta 9.0  D- worked 9hrs (Nuvigil)
8/23  6.9   1.8  Ambien  8.3  D (Rhodiola) best day in a long time!
8/24  1.8   3.2  none(3) 9.2  F+ (Nuvigil) barely functional even with stim  :cry: 

Four of the six days where you "topped" off your sleep are F's. Notably, both of the D's are days wher you took Nuvigil or Rhodiola.

In other words, the days you do NOT top your sleep off with sleeping without the mask have a better chance of being a D/D- minus day than the days where you allow yourself to sleep part of the night with without the mask. Daytime meds seem to help when you choose to sleep maskless for a bit.


Analyzing days where you took Nuvigil/Rhodiola vs days where you didn't
Now let's look at days where you took Nuvigil or Rhodiola to help with daytime functioning:

Code: Select all

night t[h]  AHI  med     TIB  result_next_day
8/17  8.9   0.8  Lunesta 8.9  D- (Nuvigil) barely functional day
8/22  6.2   1.6  Lunesta 9.0  D- worked 9hrs (Nuvigil)
8/23  6.9   1.8  Ambien  8.3  D (Rhodiola) best day in a long time!
8/24  1.8   3.2  none(3) 9.2  F+ (Nuvigil) barely functional even with stim  :cry: 

Three out of four days with Nuvigil or Rhodiola are D's. And the one F is an F+ with a significant difference between t[h] and TIB

And the days without daytime meds? They look like this:

Code: Select all

night t[h]  AHI  med     TIB  result_next_day
8/13  6.3   3.0  Sonata  6.3  D- worked 7hrs
8/14  8.9   2.5  L-th    8.9  D- worked 7hrs
8/15  9.3   3.5  none(1) 11? F can't work
8/16  9.2   2.4  Lunesta 9.2  D- off, barely functional day
8/18  7.0   2.7  Lunesta 7.0  F- non-functional day
8/19  8.9   2.0  Lunesta 8.9  F can't work
8/20  8.7   2.1  Temz(2) 10?  F can't work
8/21  5.2   2.7  none    9.0  F can't work

Only 3 D's and 5 F's. Note that t[h] = TIB on all three of the D- days with no daytime meds.

Breaking the data down this way seems to indicate that you might benefit from using the Nuvigil or Rhodiola more frequently, even if you wind up needing to take a Lunesta or Sonata to get to sleep. And since you've either said or implied that you are dealing with ADHD and/or other conditions that can affect your ability to function, it could be that part of your excruciating continuing problems with daytime fatigue and sleepiness are symptoms of your other medical conditions. My impression of the instructions for taking Nuvigil is that it should be used every day when prescribed to help manage residual excessive daytime sleepiness in OSA patients whose apnea is well controlled via PAP therapy. So perhaps clarifying exactly how your doc wants you to take the Nuvigil is a reasonable starting point on your quest for becoming more functional in the daytime.


Overall impressions
It seems to me that first of all your still at the very beginning of your PAP journey. As others have pointed out, it takes time (as in a month or more) for the brain to really learn to trust that the mask is a friends and not a foe. But you don't believe that you can "hang on" that much longer. Perhaps it's because you've been so tired and dysfunctional for so long or perhaps it's because you are feeling even worse than you did three weeks ago before this CPAP adventure started. And that is NOT an insignificant problem.

There's strong evidence in your data that Nuvigil and/or the Rhodiola may help take the edge off the extreme daytime fatigue issues if you take them as instructed. And that may mean that you need to take them every day for a while. And though it sounds counter intuitive, if you can start feeling more functional (even if it does involve stimulants), that may take some of the pressure off your need to "fix" the insomnia until after you get a chance to start your own CBT-I at Stanford. (It will be very interesting to see what kind of a program they design for you and what your reactions are to what you are asked to do as part of your CBT-I.)

It's also clear to me that there is plenty of evidence in the 12 days of data you have posted that indicates you do NOT benefit from your efforts at "topping off" your sleep off by allowing yourself to sleep without the mask for an hour or two after you wake up sometime between 5 and 7 am.

[AHI15]

Robysue,

OMG. I owe you. Seriously thanks for caring so much to analyze my data like this.

I'm in a strange pickle at this moment. There is another trend you don't know about. I am most awake in the few hours just before bedtime. Yet I am so cognitively impaired that I can hardly stand to even look at my own tables or quote with code. I'll try to respond to your main points:

First, you are correct t[h] means time in hours, logged on the machine. This is just time with mask on, not necessarily sleeping.

The results of the night 8/24 probably should have been a solid F or even F-. It was a brutally miserable day. There is a margin of error to these grades of course, and within a given day, there might be F- times and D times. I tried to give the average for the day, but it's subjective.

8/13 and 8/14 might have been examples of the power of attitude, and may hint at some of the keys needed for my ultimate success. Hey, I like the way I put that!

What I mean is, I was excited that I slept at all on the first 2 CPAP nights, so I felt eager to test the results by forcing myself to go to work and see if I could survive.

I'm not sure what to make of your conclusions, but they are not as I perceived. Maybe you are right. Or maybe it's all just noise and a trend is not yet discernable.

The problem is that now I am getting more averse to any drugs.

Nuvigil keeps me up late. I don't think that is good. BUT--it may actually be telling us something even if I don't ultimately agree with you that I should take it every day, which I don't. That is,

Maybe I simply need to spend significantly less TIB.

I'm a little paranoid about the Rhodiola right now since the night of 8/24 I had much more intense discomfort and pain than usual. I wonder if it was caused by that stuff? I want to try it again in a few weeks, but I need to get into some new form of stabilization pattern with much, much less drugs!

Re ADHD the plot is even thicker, because I am on Ritalin now. I have chosen to take that as well only intermittently. At this point, the Dr. has my dose too low to even do any good, except for about 2-3 hours. If I choose to take the med. for this, I will only be doing so in the morning. I want it out of my system for a long time before bed.

One one hand, the stimulant meds. do significantly help daytime functioning and elevate my grades. There is an argument to be made that just by functioning better, and perhaps getting to work where I might otherwise stay home, that the stimulant meds. may actually be healthy in reducing stress associated with the fear of loosing my job. That said, I am still miles away from being able to do certain analytical aspects of my job even with stims. due to severe cognitive impairment that isn't even touched by stims. I simply MUST get my CPAP working ultimately, to repair this. I know it.

On the other hand, I do fear pushing my body with stims. when it says "I need a rest." So I don't like the idea of taking them all the time. There are other reasons why not to take them daily: 1. I don't want to get to feeling like the stim. effect is "normal" and out of touch with non-drugged reality. This relates to my past. I need to not be on meds most of the time to remain certain that I CAN live without them. 2. I develop tolerance quite rapidly. I don't want to wreck the utility of the meds. by taking them daily and having them "poop out" permanently. 3. I don't believe Nuvigil should be taken daily for pharmacokinetic reasons. I think the the Drs. are wrong here if they prescribe it for daily use.

Overall impressions
It seems to me that first of all your still at the very beginning of your PAP journey. As others have pointed out, it takes time (as in a month or more) for the brain to really learn to trust that the mask is a friends and not a foe. But you don't believe that you can "hang on" that much longer. Perhaps it's because you've been so tired and dysfunctional for so long or perhaps it's because you are feeling even worse than you did three weeks ago before this CPAP adventure started. And that is NOT an insignificant problem.

That I am at the beginning and awaiting professional CBT-I guidance is why I don't believe the world will end if I fluctuate a bit in this waiting period.

I must admit that I thought I was completely surrendered to the idea of CPAP before having these initial difficulties, and now I've developed a new reservation. I'm hoping that I can escape CPAP by loosing significant weight.

Of course it probably won't work and I'll have to use CPAP anyway, since I probably won't completely reduce my AHI below 5, and I have no way of knowing unless I get another PSG. But loosing weight may still be a good idea and contribute to an overall feeling like I am doing multiple things positive for my health.

I will still be putting the mask on tonight. But the question is now, how can I make it not the enemy? And a sleeping pill is just not an option. I still think that sleeping without the mask after giving it a good shot is better than not sleeping at all. I will have to wait until a professional tells me otherwise before I change my mind about this.

Thanks for your support.

[avi123]

AHI15, if you took 5 mg of Zolpidem when you started the above post then you would be now sound asleep, regardless on which body postion you're lying.

[AHI15]

AHI15, if you took 5 mg of Zolpidem when you started the above post then you would be now sound asleep, regardless on which body postion you're lying.

Wrong. A 12.5mg Ambien CR will make me fall asleep quicker than usual, but it won't prevent multiple awakenings, even with CPAP. I've tried it.

Likewise with Lunesta. I can wake up on that after just 1-2 hours of sleep.

Likewise with Temazepam.

Likewise with mirtazepine (Remeron). Try some of that--you'll sleep for 24hrs. Not me.

I've taken two Sonatas and didn't flinch--no sleep.

The pills aren't going to be the answer. They have their place, very occasionally.

[Diablode]

AHI15, if you took 5 mg of Zolpidem when you started the above post then you would be now sound asleep, regardless on which body postion you're lying.

Wrong. A 12.5mg Ambien CR will make me fall asleep quicker than usual, but it won't prevent multiple awakenings, even with CPAP. I've tried it.

Likewise with Lunesta. I can wake up on that after just 1-2 hours of sleep.

Likewise with Temazepam.

Likewise with mirtazepine (Remeron). Try some of that--you'll sleep for 24hrs. Not me.

I've taken two Sonatas and didn't flinch--no sleep.

The pills aren't going to be the answer. They have their place, very occasionally.

I've been in a very similar position, even "F" with occasional "D" on the fatigue scale for... well I kind of lost track but at least 12 years. I've only experienced 2 occasions over those years where I felt like I slept and refreshed from the night before and the change was miraculous, it was seeing color after seeing in black and white all your life! It's impossible for people that havent experienced that what its like.

We've been on many of the same meds and I have had varying degrees of effectiveness. One of the doctors straight up didn't believe I was conscious on a particularly high dose of clonazepam!One drug that will guarantee to get me to sleep is seroquel. It is an antipsycotic though funtions primarily as an antihistamine in lower doses for sleep. some side affects like weight gain but nothing major. I would see if your doctor would prescribe it. There is no staying up on seroquel you take it and sleep for the night, though there may be some caryover effect next day

Nothing else matters more than you getting good quality sleep.

AHI15 I know thngs are tough right now. is there any possibility to take off work for a bit so that stress doesnt worsen the healing process? I doubt there are many here that can really understand what "F" on the fatigue scale feels like over long periods of time. I certainly do, if you wanna PM me to talk, feel free. Misery loves company I guess. Always happy to share what has and has not worked.