Post CPAP Insomnia

[NCRaiderGirl]

I just completed Day 13 of CPAP. For the past 5 nights, despite going to bed at 11:00 p.m. or 11:30 p.m., I've consistently awakened around 1:30 a.m. and have not been able to go back to sleep - with or without the mask. I phoned my doctor and he suggested that after 30 minutes go into another room and watch TV/read for 30 minutes, then return to bed. Tried it; it didn't work! I'm also experiencing headaches throughout the day which I am attributing to lack of sleep. I've not experienced insomnia prior to CPAP. Any suggestions?

[robysue]

NCRaiderGirl,

As the honorary president of the CPAP & Insomnia Club, I bid you a sad welcome to the club. And I hope your membership is short and you soon leave the club because the insomnia resolves itself very, very soon.

I've had an exceptionally long and difficult time dealing with insomnia ever since starting CPAP three years ago. I always had a tendency to be a night owl and had fought mild-to-moderate insomnia for much of my pre-CPAP life.

You may find some useful tips in the Taming the CPAP-Induced Insomnia Monster link in my signature.

About your own insomnia you write:

I just completed Day 13 of CPAP. For the past 5 nights, despite going to bed at 11:00 p.m. or 11:30 p.m., I've consistently awakened around 1:30 a.m. and have not been able to go back to sleep - with or without the mask.

Do you have much trouble falling asleep when you first go to bed? If not, then you're probably waking up right around the end of your first full sleep cycle. The fact that you can't get back to sleep means you've got "sleep maintenance" insomnia.

I phoned my doctor and he suggested that after 30 minutes go into another room and watch TV/read for 30 minutes, then return to bed. Tried it; it didn't work!

The suggestion about getting up and going into another room is GOOD. The suggestion to watch TV or read is NOT so good: TV and on-line web browsing are particularly effective at messing up your sleep cycles because they can disturb the melatonin cycle. The blue light emitted by electronic devices is not good for establishing the right levels of melatonin and also tend to increase wakefulness. Reading in another room works for some people, but it really depends on the light level. If you can only read with a really bright, intense level of light, then the light itself can wake you up and make it harder to get back to sleep.

There have been times in my life (including my painful adjustment period) when I did have to resort to getting out of bed on a pretty regular basis. I have always found that if I can resist the temptations to start browsing the web, turn on the TV, or read an interesting novel in bright light, then the "get out of bed for a while" method of dealing with the insomnia works pretty well to bring the insomnia under control. I've found that listening to quiet, soothing music in a semi-dark room much more relaxing and much more sleep inducing than watching TV or reading. So you might try that instead.

I've not experienced insomnia prior to CPAP. Any suggestions?

It's important to try to NOT start worrying about the fact that you're up and feeling like you'll never get back to sleep. Worrying about not sleeping feeds the insomnia monster. The more you worry about not sleeping, the less likely you are to get back to sleep in a timely fashion. It's often hard for people to NOT worry about not sleeping, but anything you can do to reduce the worrying, the better off you'll be.

One source that triggers the worries is looking at the clock as soon as you wake up. Or looking at the clock every few minutes when you're lying in bed awake wishing you were asleep. Or looking at the clock when you're out of bed trying to get sleepy enough to go back to bed. Because as soon as you look at the damn clock, you start calculating how little time there is before morning and how little sleep you expect to get for the full night. And the mental work needed to calculate all these "time" numbers requires you to wake up more fully. Which makes it harder to get back to sleep.

So if you've been doing a lot of clock watching, then you need to make it more difficult to see the clock. If you do get out of bed in the middle of the night, don't look at the clock. And don't look at the clock when you finally get sleepy enough to get back to sleep. The less you know about how much time has elapsed since the beginning of the wake, the better off you'll be.

Other tips:

It helps to keep your wake up times as consistent as possible. No matter how tired and exhausted you feel due to the lack of sleep at night, try to force yourself to get up at your normal time. That will help your body work on consolidating the sleep cycles and encourage you to fall back asleep quickly if you do wake up after that first full sleep cycle.

Make sure you get enough physical activity during the day.

Try to avoid all naps. (And you need to mask up for any intentional map.)

Make sure you are sufficiently sleepy before you go to bed. In other words, don't go to bed at 11:00pm if you're not actually sleepy at that time. It may help to temporarily move your bedtime back just a bit---even if you're sleepy at 11:30, it may help to temporarily delay bedtime until midnight. Allowing your body to have less time to be physically lying in bed may help your body to reteach itself how to fall back asleep quickly if (when) you do wake up.

I'm also experiencing headaches throughout the day which I am attributing to lack of sleep.

Do the headaches last all day long? They could be attributed to the insomnia. But it's also worth making sure that you are not overtightening your headgear. Also, have you changed your sleep position to accommodate the mask? Sleeping with your head and neck in less than comfortable position can also trigger a pretty nasty headache in some people. Finally, is there any chance that you are clenching or grinding your teeth at night? That can also trigger headaches.

[49er]

I just completed Day 13 of CPAP. For the past 5 nights, despite going to bed at 11:00 p.m. or 11:30 p.m., I've consistently awakened around 1:30 a.m. and have not been able to go back to sleep - with or without the mask. I phoned my doctor and he suggested that after 30 minutes go into another room and watch TV/read for 30 minutes, then return to bed. Tried it; it didn't work! I'm also experiencing headaches throughout the day which I am attributing to lack of sleep. I've not experienced insomnia prior to CPAP. Any suggestions?

HiNCRaiderGirl,

Can you please use the link in my signature to fill your equipment profile? Hopefully, you have a data capable machine that would allow you to download software to access data in which we could help you determine if there is anything going on that could be contributing to the situation. Sometimes there is and sometimes, there isn't.

49er

[NCRaiderGirl]

Thank you for your responses! I reviewed the Taming the CPAP-Induced Insomnia Monster post and it proved to be extremely helpful. I will once again commit to "trusting the process."

[NCRaiderGirl]

I just completed Day 13 of CPAP. For the past 5 nights, despite going to bed at 11:00 p.m. or 11:30 p.m., I've consistently awakened around 1:30 a.m. and have not been able to go back to sleep - with or without the mask. I phoned my doctor and he suggested that after 30 minutes go into another room and watch TV/read for 30 minutes, then return to bed. Tried it; it didn't work! I'm also experiencing headaches throughout the day which I am attributing to lack of sleep. I've not experienced insomnia prior to CPAP. Any suggestions?

HiNCRaiderGirl,

Can you please use the link in my signature to fill your equipment profile? Hopefully, you have a data capable machine that would allow you to download software to access data in which we could help you determine if there is anything going on that could be contributing to the situation. Sometimes there is and sometimes, there isn't.

49er

Not sure why my signature is not registering my information since I have edited (and submitted) my equipment profile to include that it is a : Resmed S8 Autoset Vantage. The only information that is showing up is regarding my mask. As an aside, I like that a 49er is helping a Raider - at least off the field (smile).

[oak]

put your machine in the comments section. some of the older model equipment wont show up. If you can also put your pressure settings in the comments, that will help if you have more questions in the future.

[robysue]

Not sure why my signature is not registering my information since I have edited (and submitted) my equipment profile to include that it is a : Resmed S8 Autoset Vantage

Are you absolutely sure that your machine is an S8 Autoset Vantage? That machine was discontinued sometime before September 2010, so it's an older model. And you said you'd just started CPAP a couple of weeks ago.

Are you sure you don't have the current S9 model? The two models don't look anything a like.

The older S8 Autoset Vantage is white and blue and the blower unit (without the humidifier attached) looks like this:



The current S9 AutoSet is silver-gray (or pink in the "for Her" model) and the blower unit (without the humidifier attached) looks like this:



If you are indeed using the older S8, it's worth finding out why: Is this a loaner until the DME can get you a current model? Or did they sell you and your insurance company a 3+ year old machine and charge you and your insurance the same amount of money that they'd have gotten for the newer S9?

[avi123]

I just completed Day 13 of CPAP. For the past 5 nights, despite going to bed at 11:00 p.m. or 11:30 p.m., I've consistently awakened around 1:30 a.m. and have not been able to go back to sleep - with or without the mask. I phoned my doctor and he suggested that after 30 minutes go into another room and watch TV/read for 30 minutes, then return to bed. Tried it; it didn't work! I'm also experiencing headaches throughout the day which I am attributing to lack of sleep. I've not experienced insomnia prior to CPAP. Any suggestions?

Reply,

Taking sleep medication while CPAPing.

Taking a 10 mg of Zolpidem ( generic Ambien) helped me a before CPAPing with my fragmented sleep for years. But long before starting CPAP I managed to withdraw from this drug by cutting the doze in half every week.

When I started CPAP, 2.5 years ago for plain OSA, I started to take half a tablet of 10 mg Zolpidem at 11:30 pm as soon as I mounted the mask on my face. This allowed me to fall asleep within 15 min but the sleep lasted for 3 to 4 hours. Then I got up to pee and took another half a tablet (5 mg) which let me sleep for 3 more hours. For the hangover the next morning I took two tablets of Tylenol and for the ingested air I took Pepto Bismol.
After I sort of got used to the CPAP I have decided to withdraw from the Zolpidem. So I repeated my previous method. I think that I could do it easily b/c I kept taking a low dose all along. Otherwise, see here what would be involved in withdrawal:

http://www.non-benzodiazepines.org.uk/zolpidem.html

Presently, I take 0.5 mg of Xanax, once daily for anxiety. Also 300 mg of Gabapentin before sleep for my Peripheral Neuropathy, and sleep. Usually, I sleep for 7 hours, with one or two wake ups for peeing. When I can’t fall asleep within 30 min after masking up, I take 5 mg of Zolpidem, and fall asleep within 15 min. This happens about once a week. Rarely, it happens that I need to take another 5 mg.


In 2012 Consumer Reports reported on a survey of nearly 9000 people with insomnia; the people surveyed were asked what kinds of treatment they had used and whether it had "helped a lot." The reports of this survey as well as other information on insomnia and other sleep problems are posted to the public part of the

Consumer Reports web pages at

http://www.consumerreports.org/cro/maga ... /index.htm

[robysue]

Avi,

You've posted and then removed a link to this same copyrighted Consumer Reports article about their insomnia survey a number of times. It might be less frustrating to readers who discover these threads after you remove the link if you would simply cite the article and give its URL at the Consumer Reports web site:

In 2012 Consumer Reports reported on a survey of nearly 9000 people with insomnia; the people surveyed were asked what kinds of treatment they had used and whether it had "helped a lot." The reports of this survey as well as other information on insomnia and other sleep problems are posted to the public part of the Consumer Reports web pages at http://www.consumerreports.org/cro/maga ... /index.htm

On the CR web page the survey are shown as this jpeg:

(Note: The link is directly to the CR site, and hence does NOT violate their copyrights.)

In case the links are removed by Consumer Reports at some point in the future, here's a brief synopsis of the results of the survey: This article cites a survey of about 9000 people with insomnia problems. The survey said that about 17% of the respondents had used "a newer (prescription) sleep medicine such as Ambien and Lunesta." Of the people who had used one of these drugs, 71% reported the drug "helped a lot." For respondents using other sorts of prescription sleep medication, the percentage of users who reported the drug "helped a lot" ranged from 42% to 67%. For respondents supplements or over the counter sleep medication, the percentage of users who said their treatment "helped a lot" ranged from 29% to 43%.

The most recent comprehensive information about sleeping pills and insomnia on the Consumer Reports cite is posted at http://www.consumerreports.org/health/b ... _drugs.htm and was last updated in January 2012. The full report is available as a free pdf download at http://www.consumerreports.org/health/r ... ly2008.pdf

The pdf article also stresses that sleeping pills (both prescription and OTC) should be thought of as a "short term" solution. But they go on to say:

That said, people with persistent, chronic insomnia---three or more nights per week for months---should seek treatment. We advise cognitive behavior therapy---a form of psychotherapy---that can improve sleep habits, possibly combined with a cautious use of sleeping pills. Research has found this can relieve chronic insomnia.

In addition on page 12 of the report, the CR article offers this advice to people suffering from chronic insomnia:

If you have chronic insomnia, you should be treated with behavioral therapy (in this case, it's probably covered by your insurance plan, but check to make sure). Again you may also want to talk to your doctor about a prescription for sleeping pills to be used as needed on a short term basis.

The article goes on to offer this advice to people over 55 who are dealing with chronic insomnia:

If you are 55 or older and have chronic insomnia, you should be treated with behavioral therapy and avoid taking sleeping pills unless absolutely necessary and only on a short term basis. Studies indicate that older people are at higher risk of all the side effects from these medicines.

If you are interested in the article, I'm sure that your local library can help you find the 2012 CR Health Best Buy Drugs report/booklet if you cannot access the article from the Consumer Reports website.