HELP PLEASE!!!

[borgready]

Get your vitamin D level checked or just start taking Vitamin D3 for a month or so. You might want to start taking the B vitamins as well. Lay off the drugs. You might want to go to a Bipap. Bipap is easier to deal with than Cpap. Monitor your sleeping data and note any problems you have and look at the data from the machine to see what might be going on. Do you have any dreams? good or bad or what? Lots of dreams and your not getting into deep sleep.

[robysue]

I have never been a morning person it has only been the last 5 years or so that I wake up feeling like I had never slept for the night.

I'm now very confused. You say you're not a morning person, but in a different post you said your sleep schedule is from 9:30 or 10:00 pm to 4:30 or 5:00 am. If you really are not a morning person, then perhaps the problem is that you are trying to force yourself to live on a very early, morning person schedule. (Only a dedicated morning lark willingly gets up at 4:30 am every morning, or so says the night owl in me. The only time I see 4:30 is if I have not yet gone to bed ....)

Can I please try to clarify what's going on NOW?

You take Ambien around 9:30pm. Do you immediately go to bed at 9:30?

You get to sleep around 10 pm. And you sleep until 4:30 am, when you wake up to take your morning meds and then you lay back down until you have to get up to get ready for work. Do you lay back down with or without your CPAP mask on? How often do you fall asleep when you lay back down?

And when you wake up at 4:30, you don't feel like you "slept for the night". Does that mean you feel like you've tossed and turned and have been awake or lightly dozing for much of the night in spite of the Ambien? Or does it mean you are conscious of several distinct wakes during the night, but you know there's some sleep between them? Or does it mean you don't remember waking up at all during the night, but you wake up exhausted and sleepy and not feeling rested in the morning?

You also write:

I don't know why I only sleep for 6-7 hours and wake up feeling really bad.

You may be waking up feeling really lousy simply because you are not getting enough sleep (time in bed). In other words, you may need to allow yourself a full 7.5 to 8 hour window for sleep. So good questions to ask are: Is it impossible for you to sleep any later in the morning? What time do you have to be at work? If it is impossible for you to sleep until 5:00 or 5:30 am because of work, would it be possible for you to try taking the Ambien a bit earlier in the evening----say around 8:30 or 9:00 so that you would have a full 7.5-8 hour time in bed window before you have to get up to take the morning meds at 4:30am?

[sleepyme1964]

I do not like to wake up at 4:30, I just always do. I remove the CPAP then I stay in bed til 5 am and wake up and take the Nuvigil and lay on the couch for about 30 minutes to get woke enough to get ready for work.
I am on 6.5 mg of Ambien and I take it at night and go straight to bed.
I don't know my latency to sleep per-CPAP.
I don't keep the same schedule on the week-ends. I usually wake up at the same time however I nap on the couch on some Saturdays. If I something scheduled that day and don't have a restful weekend I pay for it the next week.

Thanks
Sleepyme

[SleepyBobR]

Sleepyme, you are taking two anti-depressants, a powerful hypnotic to put you to sleep and a stimulant to keep you awake. I don't know why you are taking these drugs but It's hard to imagine feeling good on a cocktail like that. I would seriously consider whether these drugs are actually helping you, especially the Ambien and the NuVigil. Ambien is known for morning hangover and intra-dose withdrawal, and is potentially creating the need for the NuVigil.
Best to you.

[robysue]

I do not like to wake up at 4:30, I just always do. I remove the CPAP then I stay in bed til 5 am and wake up and take the Nuvigil and lay on the couch for about 30 minutes to get woke enough to get ready for work.

Any idea what triggers those 4:30 wakes? Are you just done sleeping? Do you feel even remotely rested when you wake up at that hour?? Do you think there's something in the environment that's waking you up around then? Is it just a habit? In particular, have you by chance inadvertently trained yourself to wake up at 4:30 so that you can take the mask off at that time and then lay back down without the mask on? After you take the mask off at 4:30, how much sleep do you accidently (or intentionally) get without the mask when you "stay in bed til 5 am and wake up and take the Nuvigil and lay on the couch for about 30 minutes"? Do you have an alarm clock set for 5 am to wake up you up to take the Nuvigil?

Overall, it sounds like you might have an hour or so of very drowsy/sleepy time without the mask on your nose every single morning. And if you are sleeping for much of that hour, that might be part of the problem.

And you still haven't answered my question about what you meant when you wrote you don't feel like you "slept for the night". Does that mean you feel like you've tossed and turned and have been awake or lightly dozing for much of the night in spite of the Ambien? Or does it mean you are conscious of several distinct wakes during the night, but you know there's some sleep between them? Or does it mean you don't remember waking up at all during the night, but you wake up exhausted and sleepy and not feeling rested in the morning?

I am on 6.5 mg of Ambien and I take it at night and go straight to bed.

So bedtime is 9:30 but it takes you about 30 minutes to fall asleep with the Ambien? And you stay in bed until 4:30? So that's a 7 hour "Time in Bed window" or 7.5 hours if we count the half hour after you go back to bed without the mask after the 4:30 wake. Perhaps part of your problem is just plain not enough sleep time. And the only fix for that is either going to bed earlier or sleeping later. You could try moving bedtime back to 8:30 or 9:00pm and seeing if you still sleep until 4:30. Or you could try to train yourself to NOT wake up at 4:30 by NOT rewarding yourself by taking the mask off at 4:30 and then returning to bed to lie there until 5:00 am. If you could get rid of that unwelcome 4:30am wake and just sleep until it is time to wake up for the morning that too might make you feel more rested in the morning and better throughout the day.

Also, as SleepyBobR pointed out, that's a pretty big dose of the Ambien---particularly for a woman. The feds recently cut the recommended dose for women back to 5mg since we don't metabolize Ambien as fast as men apparently. And as SleepyBobR points out, Ambien is well known for causing morning hangovers. I'm dealing with that myself---I'm only taking a piddling 2.5 mg dose of Ambien at bedtime and it still takes me a good two hours to become fully functional on most mornings. You might check with your doc about cutting back on the Ambien a bit and seeing if it still allows you to get to sleep ok, but causes less of a problem in the morning.

I also second SleepyBobR's suggestion that you and your docs should consider whether both anti-depressants, the Ambien, and the Nuvigil are all needed. You should talk about all your meds with each your docs, rather than just the meds they prescribed. It's possible that some kind of drug interaction is also contributing to some of your problems.

I don't keep the same schedule on the week-ends. I usually wake up at the same time however I nap on the couch on some Saturdays. If I something scheduled that day and don't have a restful weekend I pay for it the next week.

How much of that weekend nap time on the couch is PAP-less nap time??? Remember that any sleep without the PAP is apnea-filled sleep. It may feel no worse than the CPAP-sleep you get at night subjectively, but objectively it is worse for your body.

Also if you are getting substantial amounts of extra sleep on the weekends that may be making it harder for you to get to sleep and stay asleep during the week.

Some questions:

What time do you need to leave for work in the morning? How long does it take you to get ready for work? How long do you think it should take you to get ready for work in the morning?

If you could set your sleep schedule to be whatever you wanted it to be (regardless of work) AND you woke up feeling fine at the end of the sleep, when would you want to get up in the morning? Could you stand getting up at that time seven days a week?

If you could set your sleep schedule to be whatever you wanted it to be AND you woke up feeling fine at the end of the sleep, when would you want to go to bed each night?

[sleepyme1964]

I am sorry about any confusion that is not my intent. I really appreciate any advise I feel like I have tried just about everything.
I believe that I am in the habit of waking up at 4:30 every morning. I set my phone alarm for 5:30 & 6:00 however I always wake before it rings. I have to leave my house by 7:15 at least to be at work on time.
When I sleep I don't remember anything, no tossing or turning I just remember going to the bathroom maybe one time. I always feel like I sleep hard but when I wake up I feel like I still need to sleep. Not from tossing or turning just not enough sleep time. That feeling would never go away without medication. I would not be able to work or anything.
I have been taking Cymbalta and Wellbutrin for years. I was weaned off of them both for sleep study. The Wellbutrin always seem to give me more energy. It turns out that docs prescribe it to people with narcolepsy. Cymbalta is suppose to repress REM sleep so docs think it is beneficial. I don't know. I know when I was not on anything for last sleep study that I fell asleep every 2 To 3 hours.
I very rarely remember dreams but when not on the meds for sleep study I dreamed like crazy.
I was not aware of the high mg in Ambien. I have been on it for about 6 weeks or so. I was having so much trouble getting use to CPAP doc prescribed the Ambien. She knew that I would have to be knocked out. It was mostly the neck and shoulder pain from the headgear.

Thanks
Sleepyme

[robysue]

I am sorry about any confusion that is not my intent. I really appreciate any advise I feel like I have tried just about everything.
I believe that I am in the habit of waking up at 4:30 every morning. I set my phone alarm for 5:30 & 6:00 however I always wake before it rings. I have to leave my house by 7:15 at least to be at work on time.

Sounds like you need to figure out a way to break the habit of waking up at 4:30 and taking the mask off. Easier said than done, but still, that does seem like a reasonable starting place.

Baby step #1: Don't take the mask off at that wake. This will force your body to realize that you are NOT "rewarding" it by waking up with a bit of "mask free sleep". Or if you just can't stand the thought of having the mask on your nose, don't allow yourself to lie back down after that wake----either in the bed or on the couch. Yeah, it's hard to keep yourself vertical when all you want is to be horizontal and asleep. But you've got to figure out a way of making the body realize that it is NOT a good idea to just wake up at 4:30 out of habit.

When I sleep I don't remember anything, no tossing or turning I just remember going to the bathroom maybe one time. I always feel like I sleep hard but when I wake up I feel like I still need to sleep. Not from tossing or turning just not enough sleep time. That feeling would never go away without medication. I would not be able to work or anything.

Baby step #2: Is it possible to simply go to bed earlier in the evening? What would happen if you simply went to bed at 9:00pm instead of 9:30 or 10:00? Could you try that for a few days?

I was having so much trouble getting use to CPAP doc prescribed the Ambien. She knew that I would have to be knocked out. It was mostly the neck and shoulder pain from the headgear.

The headgear should NOT be triggering neck and shoulder pain. Has this issue been resolved? If you are in pain much of the time that you are asleep during the night, that could easily explain why your sleep remains unrestful.

Baby step #3: Do some troubleshooting on the mask issues. Make sure your headgear is NOT triggering neck or shoulder pain. If it is, review the fitting guide to see if you are fitting the mask correctly. If you are fitting the mask correctly, then return to the DME and explain the problem to them. Request a mask exchange and spend some time examining and trying on headgear for alternative masks paying special attention to how they fit around whatever trigger points you might have. Also consider things like strap pads from Padacheek to help with pressure points coming from the headgear.