apap, flow limitations, weight loss...

[robysue]

You currently have a (roughly) 10:00 or 11:00 pm bedtime and you tend to get up by around 5:30 am on a daily basis. So you have a sleep window that is between 6.5 and 7.5 hours long. You take the Ambien so that you can fall asleep by 11:00 because if you didn't, you wouldn't get sleeping until much, much later. You also say that if (when?) you take the Ambien right before going to bed, you lie in bed for "several hours" tossing and turning before being able to fall asleep.

Did I say that? I might have, but I GENERALLY take the Ambien at 9 and go to bed around 10. (last night I took it at 10, and went to bed by 10:30 I'm sure, I remember looking at the clock when I went to bed.... but sleepyhead says I started using the machine at 11:30?! But it says I woke up at 4, and I did wake up at 4?! (I did not look at the clock, but I was awake enough/tummy rumbling to know I wasn't getting back to sleep.)... Then I tried for 40 minutes to go back to sleep, but, no luck. So, I guess I'm up for the day.

Though I had NO obstructive apnea's last night, I did have 10 clear airway apnea's, but those didn't really look like anything more than hypopena's (not really sure how serious those are, but the breathing pattern looks almost normal during them.)

As I've said before, chances are the remaining issues are NOT being caused by untreated or under treated sleep disordered breathing. You could post an image for me to look at if you wanted.

But I really think you need to think that the solution to the sleep maintenance insomnia issues lies in a directiong other than dial winging the PAP.

So let's look at last night in more detail from what you've written here:

• Ambien was taken at 10:00.
• You went to bed around 10:30 (according to the clock)
• Sleepyhead says the machine was not turned on until 11:30
• Sleeyphead records a wake at 4:00.
• You remember a long wake, but you're surpised it was at 4:00 (instead of5:00?)
• You couldn't get back to sleep for 40 minutes or so. You weren't looking at the clock, so is this a guesstimate or is it based on what you see in your SleepyHead data?

So some questions:

1) What do you think happened between 10:30 and 11:30 pm? Is it possible you fell asleep for an hour and then woke up to put the mask on your nose when you realized that you'd forgotten to do so? Is it possible your machine's clock is off? There's no way to tell what a PR machine's internal clock is set to, but if the data times in SleepyHead are consistently off by the same amount, the System One's internal clock may be off. Mine's off by about 21 minutes (too fast) for example. You can correct this in SleepyHead if you know there's a problem with the clock time.

2) When you woke up and couldn't get back to sleep in 40 minutes, what were you thinking about?

3) You write:

I was awake enough/tummy rumbling to know I wasn't getting back to sleep.

Since you were awake enough to be aware of the tummy rumbling, why didn't you just get up as soon as you knew you were hungry, fix a small snack, and then go back to bed after eating the snack?

[robysue]

1) How long do you think it should take you to get to sleep at night when you first go to bed? How long does it take you to get to sleep when you take the Ambien in the way that seems to work the best for you?

Everyone else I know lays down and falls asleep almost immediately. I would be happy if I could do it in under 10.

A person with totally normal sleep patterns usually takes about 15-20 minutes or so to fall asleep after going to bed. And it can actually a sign of either sleep deprivation or a sleep disorder if someone consistently falls asleep a lot sooner than 15 minutes of lying down for the night.

2) How long do you think it should take you to get back to sleep after you wake up in the middle of the night? How long do you give yourself to get back to sleep before throwing in the towel and just getting up out of bed for a while?

I think after waking up in the middle of the night, I should be able to fall back asleep within a few minutes. Sometimes that happens, sometimes it doesn't. and generally I 'know' when I'm going to be able to get back to sleep so I'll close my eyes, and poof, I'm out. But other times when I'm not completely sure, or have a small hope it could happen, I'll try for 30-60 minutes.

A person with totally normal sleep patterns usually takes about 3-5 minutes to fall back asleep after waking up in the middle of the night.

The usual guidelines that are given to insomniacs is to allow yourself an estimated 15-20 minutes to get back to sleep after waking up in the middle of the night. If you are still (wide) awake at the end of what feels like 15-20 minutes of trying to get back to sleep, you're probably NOT sleepy enough to get back to sleep and you should go ahead and get out of bed.

So you are trying a bit too hard to get back to sleep when you lie in bed for what seems like 30-60 minutes.

How uncomfortable are you if you find yourself lying in bed for 15-20 minutes before falling asleep or falling back asleep after a wake? Is the discomfort mainly physical---i.e. your stomach is uncomfortable from the CPAP air being blown down your throat or your hips or back start to hurt from lying down in a certain position? Or is the discomfort mainly mental---i.e. you start to worry about not getting to sleep or you start to feel anxious because you are sure you won't be able to get (back) to sleep?

the only discomfort would be when I wake up hungry. The CPAP rarely causes me any pain. Sometimes (often for spells, then none for a while) I'll wake up with a dry throat, but a quick drink, and I'm fine. Though the anxiousness kicks in after laying awake for even only a few minutes (or, of course, if I have something I have to do the next day.) (emphasis added)

First you need to figure out a way to keep the anxiousness down. As soon as you get anxious about being awake, you're making it harder to get back to sleep AND you are making it more likely that the wake will be an extended one that you will clearly remember the next morning. And it's these extended wakes that are making you feel so rotten the next day.

So you need to think hard about what you can do to short-circut the anxiety cycle that starts within a few minutes of your waking up in the night.

So when you wake up, the first thing is to attend to any comfort issues: Get up and eat something if you're hungry. Take a sip of water if you're thirsty. Don't bother thinking about these needs; just attend to them.

The next thing you need to attend to is figuring out a way of NOT getting anxious when you've been lying in bed for 5 or 10 minutes and you're not yet back asleep. In the short run, you need something to distract your mind from focusing on the sleep (or lack thereof) issues. Next you need the distraction to NOT be something that winds up waking you up even more---the distraction needs to be something you find soothing, calming, and hopefully sleep inducing. It would be useful if you could think of something you could do in bed for 5-10 minutes to see if that's enough time to allow your body and mind to realize that there's nothing particularly wrong that caused you to wake up, and then to relax enough for sleep to come back. And then you need some additional things that you can use to distract yourself from the fact that you are AWAKE if you do have to get out of bed because you have not fallen back to sleep in about 15-20 minutes after the wake.

[BryanC]

ok, Robysue here's a reply (lack of quoting though so I can try to answer things quickly and compactly )

I do have at least a few bad sleep habits. I tend to drink a lot of soda, up to bedtime (non-caffeinated after like 3 though) and even through the night when I wake and need a sip of something. I go to bed with the TV on (though I have it set on a timer so it goes off about an hour after I go to bed, I fall asleep before it goes off though) Temperature in the bedroom is usually cold, cause I NEED a blanket to sleep

I'm getting better about the net fretting about going to sleep, though lately my bed time has become much later more to the when I'm tired point rather than a set time (though that's typically 12-1am) Though I think the trazidone(sp?) is working better than the ambien, but it's only been a few days, so we shall see. my wake up time has been pushed back a little and I'm WAY tired when I wake up, but today I woke up, at 3 servings (2 cups) of serial, then went back to bed, and slept till 10! So I ended up with close to 10 hours of sleep last night

I did wake up after 1 1/2 hours last night, but went back to bed and fell asleep fairly quickly.

I also don't watch the clock anymore. Though light still shines in the window (well, not really that much, the window has some thick curtains, though you can still a little light around the edges so I know when I've actually slept to the end of the night.

(wow, I've spent 2 days on and off writing this so far so I may be repeating stuff)

The new drug is making me tired enough to usually get back to sleep fairly quickly. But around 5 or 6 I still wake up and feel the need to get up and have breakfast. for the last 2 days I've gotten up, ate breakfast. I stay up for around an hour, then go back to bed. I only got 6 1/4 hours last night cause I had things to do today, and my son kept me up very late helping him hash out ideas. VERY bad thing to do at bedtime, but he's a teenager, I try to get him not to do it, but sometimes he still does... unfortunately, I think he's going to be like me. I'm trying to break him of this bad sleep habits before he gets as set with them as I am.

as for relaxing, you are correct. When I actually worked, I was a computer programmer. I would go to work and play on the internet all day, then I'd go home and do my work (much easier to relax when no one is around to distract you, or try to get you to do things (hey, I was an incredible programmer, and I got everything done faster than it was expected, so my boss(s) didn't care how I did it ) Though that DID NOT help with sleep, probably only compounded the problems. But unfortunately, my brain gets active at bedtime, and I just don't know how to stop it Now that I don't work, I could probably sleep all day, but that goes back to the 'I "KNOW" I should not sleep all day long, I should sleep at night!'

(please don't take any of this as me making excuses or trying to 'disprove' your answers/suggestions. I do think your answers are right, and I really appreciate the help (and I don't THINK I've said anything that might be sound like I'm disagreeing or anything), and I am trying to figure out how to put them in action, it may take me a while, but I'll get there )

I do take anti-anxiety medicine... As needed, not every day and I don't think I've ever taken it twice in one day (adavan) and something that starts with S sero something? And I think the tradone is a depressant too? (wait, the S stuff I think is a stimulant? but I take it in the morning) I would love to relax, I try. I try to sit back and watch TV, and about halfway though the show, I have to get on the computer cause I feel like I'm wasting time when I could be checking my finances or something else, maybe writing a program (it still happens on occasion. Usually something to do with my finances (I wrote a checkbook program, that auto populates my normal monthly income and bills so I know what I have to spend on any given date. Of course, it doesn't always work as planned cause my income is from rental property.) but I am trying to relax, much more so than before, and since practice makes improvement, hopefully soon I'll be able to relax at least for a few minutes

breathing techniques sounds quick and easy, and probably something I can learn to do while doing other things to relax.

I do (for the last few nights, but gotta start somewhere!) turn my machine off and take the mask off for a few minutes WHEN I feel like I'm not getting back to sleep quickly. I do generally know right when I wake up if I'm going back to sleep quickly or not. When I lay there for 45 minutes or more, it's generally when I first lay down, and haven't taken any sleeping pills. though there of course occasions when I'm (gasp) wrong about getting back to sleep.

I have not looked at my phone for the last few nights (I think I said that early). Though it does kind of throw me. like a few days ago, I went to sleep pretty quick, then woke up later, and I was SURE it was almost 5, so I got back up, went to the kitchen, started to get my breakfast, and noticed it was only an hour after I had gone to bed! So I went and laid back down, and did fall asleep rather quickly (again, the tradone makes me really tired, usually for 10-12 hours, I may need to reduce the dosage, if I can get past the getting up at 5/6 and stay sleeping things would probably work a lot better!)

caffeine actually has always had a weird effect on me. It has actually always helped me fall asleep. non-drowsy meds knock me out, and most sleeping pills don't do anything for me (though the trazone (though not actually FOR sleep) does put me to sleep, and ambien puts me to sleep). Chocolate I do eat later in the evenings, though I'm switching that to carrots to see if that helps any

my pre-bedtime snack consist of 1 serving (3 tablespoons I think?) Though that's probably not considered snack size I decided I needed to lose weight (I was 270, 5'10") so I gave up EVERYTHING, and ate bran flakes for breakfast (with splenda ) then salad for lunch and dinner, and always diet soda. (lost 75 pounds in like 8 months).. it didn't help my sleep any, though I do feel a lot better when I'm NOT tired and, I've kind of fallen off the extreme shedding plan, and am now only losing like 1-3 pounds a month. I've added a serving of popcorn, I eat 2 cookies after breakfast and lunch, and maybe 2-4 more (or a half to a whole candy bar)(again, just switched that back to carrots, though I still eat the 2 cookies at lunch after breakfast and lunch, and am currently doing a lot of move stuff from a house to a storage shed. So seems to me, I should NOT have a lot of energy, and should be very tired come bedtime. But without the sleeping pill, it just doesn't happen that way Though I think maybe I need to eat closer to bed, and separate my lunch more from breakfast to increase the times I'm NOT eating, so as to not 'need' breakfast so early.

saying I wouldn't get tired till 6 does happen sometimes, but mostly it's around 1 or 2. When I do stay up to 6 I feel really bad cause I know I shouldn't have and make myself just miss the night of sleep. Again, another very bad thing.). My mom says that all the time 'when I get in bed, I stop worrying about everything, there's nothing I can do about it at that point, so why worry about it?' I just come up with some really great ideas when my mind is free from the necessary daily thoughts/actions. I think it's because while laying there, I lose touch with all the 'normalities' and come find new ways to do things, then the ideas are so awesome, I have to write them down, then since my brain is fresh on the subject, I wanna plan out more... I know, bad bad bad. but, I'm trying to stop

after taking my ambien (which I don't do anymore, now that I take the tradone), I used to sit at my computer and play games on facebook (non-action games, but word-search kind of games, which is probably as bad for sleep the action games.) though that did not start till I got tired of not getting tired/falling asleep after laying in bed for an hour. I have the TV on most of the time, but I rarely pay attention to it. I just gotta have sound. (I have tinnitus, so I gotta have other noise so I don't focus as much on the ringing in my ears.)

As for what I do when I get up cause I can't sleep, depending on my level of alertness, I may sit in bed and play solitaire on my tablet (no sound, room lights still off though generally that's when I first lay down and the TV is still on, or only for a few minutes (no more than 10) and it does make me tired, or I'll come out to my computer and play word search games. both those things DO cause my brain to slow down and help me back to sleep, more often than not.

I don't care much for the pet smell, so the pets have free roam of the house, but not my bedroom. the kids let the dogs/cat in their room all the time.
if working a crossword puzzle or sudoku is good, maybe my word search games are too? (I had a program that tinted the color of the screen to more relaxing colors (more or less blue, I forget which way it worked) but I forgot what it was called and lost it when I reformatted my computer.)

I can't read a boring book, that always puts me to sle..... hmmmmm... (honestly, it does, when the light is bright and reflecting off the white pages, making me squint...I donno for sure if I've every tried that at night... maybe I'll have to! That's a really good idea. And it probably would work, even in dim light, cause I'm sure like the games, it would slow my brain down...)

I have cut the clock checking out, unless I'm up in the kitchen then I pretty much can't avoid seeing it.
I haven't had to worry about not falling back asleep quickly (the worrying generally doesn't start till I've been laying there for a bit. unless of course I have to get a good nights sleep for some reason.)
again, (in response to your list of things that are bad to do to get back to sleep)

you are correct, planning for tomorrow or do any kind of work, looking at th
ad activities to do when you are out of bed because you can't sleep:

• Paperwork for the job; anything job related at all, looking at the clock, worrying about not being asleep do wake me up more, but getting online and browsing and computer games DO seem to help me get back to sleep. (really, when I'm not doing anything, my brain races a million miles a minute, searching for words, or where to put a card does slow my brain down. Though, that, and even the caffeine may trigger a 'learned' response that doesn't provide GOOD sleep.
  
  never tried the intense exercise, cause, well, I'm lazy.
  
  ok, I think I responded everything in your message, some of it twice maybe. I see you've also posted 2 more messages, so, I'll go read those now.

[BryanC]

As I've said before, chances are the remaining issues are NOT being caused by untreated or under treated sleep disordered breathing. You could post an image for me to look at if you wanted.

But I really think you need to think that the solution to the sleep maintenance insomnia issues lies in a directiong other than dial winging the PAP.

I increased my pressure to 14, though I did it in the middle of the night, and it seems to stay steady at 14, so I have to check and make sure I didn't set it back to CPAP mode. And I added a ramp up at the beginning because now for some reason 14 seems to strong to go to sleep with
(update-- looks like I did set the min to 14, but I also had the max set at 14. (I ramped it from 8, so it says the min is 14)

So let's look at last night in more detail from what you've written here:

• Ambien was taken at 10:00.
• You went to bed around 10:30 (according to the clock)
• Sleepyhead says the machine was not turned on until 11:30
• Sleeyphead records a wake at 4:00.
• You remember a long wake, but you're surpised it was at 4:00 (instead of5:00?)
• You couldn't get back to sleep for 40 minutes or so. You weren't looking at the clock, so is this a guesstimate or is it based on what you see in your SleepyHead data?

So some questions:

1) What do you think happened between 10:30 and 11:30 pm? Is it possible you fell asleep for an hour and then woke up to put the mask on your nose when you realized that you'd forgotten to do so? Is it possible your machine's clock is off? There's no way to tell what a PR machine's internal clock is set to, but if the data times in SleepyHead are consistently off by the same amount, the System One's internal clock may be off. Mine's off by about 21 minutes (too fast) for example. You can correct this in SleepyHead if you know there's a problem with the clock time.

Well, possible. I just switched to a new machine, so I haven't really paid attention to how far it's off, though I'm sure my old one was an hour off. Though it didn't always seem constantly an hour off. I suppose it is possible I fall sleep before putting my mask on (cause sometimes I don't put my mask on when I say my prayers, and I have been known to fall asleep while saying them. generally I wake back up fairly quickly (so I think!) but because I think it was only a few seconds, I don't check the clock, so I don't really know how long it was!

2) When you woke up and couldn't get back to sleep in 40 minutes, what were you thinking about?

getting back to sleep.

3) You write:

I was awake enough/tummy rumbling to know I wasn't getting back to sleep.

Since you were awake enough to be aware of the tummy rumbling, why didn't you just get up as soon as you knew you were hungry, fix a small snack, and then go back to bed after eating the snack?

I do get up right away when I'm hungry, usually, unless I think if I stay in bed I'll fall back asleep and can eat in the morning, cause I shouldn't be eating in the middle of the night (cause I've read so many places that you're not suppose to snack in the middle of the night. But obviously, if you're hungry, you're not going to (easily) get back to sleep, sooooo?!?

[BryanC]

A person with totally normal sleep patterns usually takes about 15-20 minutes or so to fall asleep after going to bed. And it can actually a sign of either sleep deprivation or a sleep disorder if someone consistently falls asleep a lot sooner than 15 minutes of lying down for the night.

Well, I have at least one of those. If sleep debt is real, I have to sleep for at least a year straight to catch up.

A person with totally normal sleep patterns usually takes about 3-5 minutes to fall back asleep after waking up in the middle of the night.

The usual guidelines that are given to insomniacs is to allow yourself an estimated 15-20 minutes to get back to sleep after waking up in the middle of the night. If you are still (wide) awake at the end of what feels like 15-20 minutes of trying to get back to sleep, you're probably NOT sleepy enough to get back to sleep and you should go ahead and get out of bed.

So you are trying a bit too hard to get back to sleep when you lie in bed for what seems like 30-60 minutes.

again, you are probably right. Hopefully I won't have that problem anymore with the tradone, but I don't know if it's something I'll get used to and need more to make it work, something I'm gunna get addicted to or what, so, I will get up after what I think is 20 minutes if I can't get back to sleep.

First you need to figure out a way to keep the anxiousness down. As soon as you get anxious about being awake, you're making it harder to get back to sleep AND you are making it more likely that the wake will be an extended one that you will clearly remember the next morning. And it's these extended wakes that are making you feel so rotten the next day.

So you need to think hard about what you can do to short-circut the anxiety cycle that starts within a few minutes of your waking up in the night.

So when you wake up, the first thing is to attend to any comfort issues: Get up and eat something if you're hungry. Take a sip of water if you're thirsty. Don't bother thinking about these needs; just attend to them.

The next thing you need to attend to is figuring out a way of NOT getting anxious when you've been lying in bed for 5 or 10 minutes and you're not yet back asleep. In the short run, you need something to distract your mind from focusing on the sleep (or lack thereof) issues. Next you need the distraction to NOT be something that winds up waking you up even more---the distraction needs to be something you find soothing, calming, and hopefully sleep inducing. It would be useful if you could think of something you could do in bed for 5-10 minutes to see if that's enough time to allow your body and mind to realize that there's nothing particularly wrong that caused you to wake up, and then to relax enough for sleep to come back. And then you need some additional things that you can use to distract yourself from the fact that you are AWAKE if you do have to get out of bed because you have not fallen back to sleep in about 15-20 minutes after the wake.

I'm going to take a few days to see how this all works out, what works and what doesn't (hopefully what works will come quickly then I don't have to worry about that doesn't! ) again thank you, all of you, that have offered me help, I will post results as soon as I see a real pattern of the changes working, and/or if I see things aren't working...

[robysue]

Bryan,

Again, I'm still on the road. I'll write more when we get home; we should be home late tomorrow night. So expect to see something in more detail from me on Friday night or Saturday sometime.

For now, I'm going to leave it at three posts.

I'm beginning to wonder if you've got a sleep phase problem instead of or in addition to what you identify as a sleep maintenance insomnia problem. Sleep phase problems are when your body or mind wants to at hours that are not "normal" or not "desirable."

How big of a problem a sleep phase disorder is depends largely on the person's overall lifestyle combined with just how far off "normal" the person's natural sleep phase is. For example: Some people with significant delayed sleep phase issues simply prefer jobs on the night shift: They're going to be awake all night anyway, and a night shift job fits their sleep schedule better than a day shift job does. And the night job schedule allows them to sleep when their body wants to be asleep.

In my case, as a college professor, my department knows that I prefer to have late morning and afternoon classes rather than early morning ones. This allows me to sleep with a target sleep window of a 2-3 AM bedtime to a 8-9 AM wake up time. (I seldom get more than 6 or 6.5 hours in bed; but if I sleep for 90% of the time I'm in bed, I usually feel pretty good during the day.)

You've written how your brain "wakes up" at bedtime and how you used to spend a lot of the night time doing the programming work that you didn't do in the daytime:

When I actually worked, I was a computer programmer. I would go to work and play on the internet all day, then I'd go home and do my work (much easier to relax when no one is around to distract you, or try to get you to do things (hey, I was an incredible programmer, and I got everything done faster than it was expected, so my boss(s) didn't care how I did it )

and

saying I wouldn't get tired till 6 does happen sometimes, but mostly it's around 1 or 2. ...
...
I just come up with some really great ideas when my mind is free from the necessary daily thoughts/actions. I think it's because while laying there, I lose touch with all the 'normalities' and come find new ways to do things, then the ideas are so awesome, I have to write them down, then since my brain is fresh on the subject,

Those kinds of habits are pretty common among folks with delayed sleep phase issues. But you go on to write:

Though that DID NOT help with sleep, probably only compounded the problems. But unfortunately, my brain gets active at bedtime, and I just don't know how to stop it Now that I don't work, I could probably sleep all day, but that goes back to the 'I "KNOW" I should not sleep all day long, I should sleep at night!'

and

When I do stay up to 6 I feel really bad cause I know I shouldn't have and make myself just miss the night of sleep. Again, another very bad thing.). ...

The thing about delayed sleep phase is that your body and mind really don't want to sleep "at night" when everybody else is asleep: Your body has it's own circadian rhythm and its own idea of when it wants to be asleep. And it could very well be the case that you are someone who is simply NOT "supposed to sleep at night" if you could just pay more attention to what your body is telling you about when it wants to be asleep.

In other words, when I read your posts, I see a lot of angst or anxiety about the fact that you are not sleeping at the time when society says you should be asleep even though your mind is fresh and active at those times. And since you are not working, I'm not sure why you are twisting yourself into knots trying to sleep at a time when your brain is simply not yet sleepy enough to fall asleep without medication.

So you might want to think about whether accomodating sleeping on a schedule that makes sense to your body (rather than "the clock says it's time to be asleep") might help some of your remaining sleep issues.

In other words it possible for you to sleep on a different schedule? Would it be feasible for you to allow yourself to stay up to between 2 and 4 AM every night and then sleep later in the morning without it creating problems for you and your family? In other words, if it were possible for you to get 7-8 hours of decent sleep that occurred between 3 or 4 AM and 11 AM or noon, would that be "acceptable" to you or not?

If moving the sleep schedule is simply out of the question, then you really do need to tighten up a lot on your sleep hygiene issues (more on that in the next post) AND you need to start figuring out a way of bringing closure to your day when you go to bed so you DON'T start having the anxiety kick in when you find yourself awake during your desired sleep window. AND you will probably need to rely on sleep medication for quite some time just to help your body get to sleep at the beginning of the night. And hopefully the trazadone will be of more help in allowing you to more quickly get back to sleep when you do wake up in the middle of the night.

[robysue]

Now onto sleep hygiene issues.

1) The caffiene is probably affecting you more than you think it is. Try to eliminate all the caffeine after NOON if you really want to maintain a 10:00 pm bedtime.

2) I'd turn the TV off and kick it out of the bedroom if I were you. The blue light from the TV screen badly messes with the melatonin cycles and that can cause additional wakefulness througout the night. The fact that the TV is on a timer may also be encouraging you to wake up shortly AFTER the TV goes off---that would happen to me back when we still had a TV in our bedroom. The fact that your first wake is often 90 minutes after you first go to bed indicates it's often a normal post REM wake, but what might be bringing you to full alertness is the fact that your semi-awake brain notices the difference that the TV is no longer ON ...

3) You need to get off the computer and tablet well before bedtime. It doesn't matter that you're not playing action games. The fact is that the word games and the facebooking are feeding your active mind that doesn't want to be asleep yet anyway. You need to replace them with something that's more sleep inducing for at least 30 minutes or so before bedtime.

4) You write:

I have the TV on most of the time, but I rarely pay attention to it. I just gotta have sound. (I have tinnitus, so I gotta have other noise so I don't focus as much on the ringing in my ears.)

I sympathize with the tinnitus: I've got it pretty bad myself. And I know how awful it is when there's no other noise around.

But the TV is NOT the best "noise" generator for you to use with the sleep problems you have. And, again, given the fact that you've got all those middle of the night wakes that are so problematic, I'm wondering if the lack of the TV noise is part of what causes you to go from "sort of awake because of a normal post-REM wake" to "fully wide awake and can't get back to sleep" mode.

I'd strongly recommend that you consider using an iPod or MP3 player to play soft music all night long rather than having the TV on a timer. Or leave a radio on all night long. That way when you wake up in the middle of the night, the ambient noise that you need to distract you from the tinnitus is already there. So there's one less difference for your mind to notice when you wake up. And that may make it easier to keep from getting fully roused and becoming so wide awake that you have trouble getting back to sleep.

5) When you do get up in the middle of the night, resist getting on the computer or tablet. Yes, I know you think that it helps you get back to sleep, but again, the light those devices generate play havoc with your melatonin cycle AND they're allowing your brain to become too focused on the wakeful activity of playing with the tablet. You need to be bored in the middle of the night so your brain will get sleepy. Try sitting in the dark in a different room from your bedtime. And let your brain have fun roaming in your thoughts even if it is racing along at a million miles a minute. Just sit back and enjoy the ride and don't focus on the the thoughts. Let them sweep you along and allow yourself the luxury of NOT worrying about when the brain will shut up for a while. If you need to direct the brain, try doing some elaborate daydreaming to keep yourself from falling into "planning mode." If you're hungry, make a SMALL snack for yourself. Eat it while listening to music or the radio rather than watching the TV.

6) In response to my comments about too much exercise close to bedtime, you write:

never tried the intense exercise, cause, well, I'm lazy.

You should start trying to get some moderate physical exercise everyday---just not close to bedtime. If you never get any exercise, the body never gets to the proper kind of "tired, but 'happy' state" that is condusive to falling asleep and staying asleep.

7) Finally, you write:

2) When you woke up and couldn't get back to sleep in 40 minutes, what were you thinking about?

getting back to sleep.

Whatever else you choose to do, lying in bed for 40 minutes while thinking about getting back to sleep[/quote] is just going to make it harder to get back to sleep. If you start thinking about getting back to sleep and you can't think of anything else, it's time to get up out of bed and leave the bedroom for a few minutes to regroup and allow your brain to become sleepy again.

[robysue]

Your notion of how much sleep you actually need is not particularly accurate. You write:

So I ended up with close to 10 hours of sleep last night

Most people do NOT need 10 hours of sleep to function. (A few do, but they normally are able to get 10 hours of sleep in a 10.5 hour "sleep window" without much effort.)

Most adults only need 7.5-8 hours of decent quality sleep to feel at their best. And getting too much sleep can leave you feeling just as bad as getting too little sleep.

Next: Food, anxiety, and an inability to relax all seem to be big issues for you both at night and in the daytime.

Your diet seems to be out of whack:

but today I woke up, at 3 servings (2 cups) of serial, then went back to bed, and slept till 10!

I tend to drink a lot of soda, up to bedtime

my pre-bedtime snack consist of 1 serving (3 tablespoons I think?) Though that's probably not considered snack size I decided I needed to lose weight (I was 270, 5'10") so I gave up EVERYTHING, and ate bran flakes for breakfast (with splenda ) then salad for lunch and dinner, and always diet soda. (lost 75 pounds in like 8 months).. it didn't help my sleep any, though I do feel a lot better when I'm NOT tired and, I've kind of fallen off the extreme shedding plan, and am now only losing like 1-3 pounds a month. I've added a serving of popcorn, I eat 2 cookies after breakfast and lunch, and maybe 2-4 more (or a half to a whole candy bar)(again, just switched that back to carrots, though I still eat the 2 cookies at lunch after breakfast and lunch

But without the sleeping pill, it just doesn't happen that way Though I think maybe I need to eat closer to bed, and separate my lunch more from breakfast to increase the times I'm NOT eating, so as to not 'need' breakfast so early.

I do get up right away when I'm hungry, usually, unless I think if I stay in bed I'll fall back asleep and can eat in the morning, cause I shouldn't be eating in the middle of the night (cause I've read so many places that you're not suppose to snack in the middle of the night. But obviously, if you're hungry, you're not going to (easily) get back to sleep, sooooo?!?

It sounds like you're eating a pretty carb-heavy diet and that alot of the carbs are not all that healthy. It also sounds like you're not eating at very regular meal times and that you are constantly hungry---particularly at night. You might want to bring up the constant nighttime hunger with your primary care physician. You might also want to work with a dietician if possible.

It ought to be possible for you to go to bed an hour or two after your last snack and sleep for 7.5 to 8 hours without waking up hungry. And once you do wake up in the morning and eat breakfast, it ought to be possible for you to avoid going back to bed. If the trazadone is making you feel exhausted for 10-12 hours after taking it, you need to talk to the prescribing doc about that issue and see if the dosage should be adjusted.

Anxiety is a clear issue. You're on medication for the anxiety:

As needed, not every day and I don't think I've ever taken it twice in one day (adavan) and something that starts with S sero something? ... (wait, the S stuff I think is a stimulant? but I take it in the morning)

As I recall, you said that you'd tried taking the adavan at night, but were not able to continue doing so because of unwelcome (nighttime?) side effects.

How well do the anti-anxiety meds work for you? How long has it been since the prescribing doc and you had a good long chat about their effectiveness?

And you also write:

And I think the tradone is a depressant too?

The trazodone you are taking as a sleeping pill is technically a tetracyclic antidepressant that is pretty often prescribed as a sleeping pill and/or an antianxiety pill. If different docs prescribed the adavan and the trazodone for you, it's worth talking to both of them (and the pharmacist) about any potential interactions between these meds.

Relaxation is apparently a huge issue for you:

I would love to relax, I try. I try to sit back and watch TV, and about halfway though the show, I have to get on the computer cause I feel like I'm wasting time when I could be checking my finances or something else, maybe writing a program (it still happens on occasion. Usually something to do with my finances (I wrote a checkbook program, that auto populates my normal monthly income and bills so I know what I have to spend on any given date. Of course, it doesn't always work as planned cause my income is from rental property.) but I am trying to relax, much more so than before, and since practice makes improvement, hopefully soon I'll be able to relax at least for a few minutes

I think part of the issue is that it's not clear you what you think "relaxation" actually means in the context I'm using it.

The word "relaxation" means many things. Among them are:

• Anything you do for fun that keeps your mind from worrying excessively about issues you can't do anything about. (Work can be relaxing for some people in this context.)
• Things you do to regenerate your mind and body so that they're more capable of continuing to do all the things you need to do on a daily basis. Vacations and hobbies fall into this category.
• Things you do to allow your body or mind to settle from a very active state to a less active state. Note that "very active state" does NOT mean a highly anxious state or a worried state. Warm baths work for some people. Meditaion works for some people. Reading works for some people. Mindfulness exercises or deep breathing works for some people. Mindless, but routine activities (like brushing teeth) work for some people if their mind doesn't keep yakking at them a mile a minute in the meantime.

But one thing that "relaxation" is NOT is a waste of time: We all need some down time when we are NOT working on things that are NOT fun for us to do----it's how we recharge our batteries. Now if checking on your finances or writing that computer program is actually more fun for you than watching TV is, then it may just be that those things are how you relax. (To each their own.)

But at a certain time of the night, we need to be able to bring the day to a close and settle our mind and body into a more restful and relaxed and less active state. And that can be hard work for some people; but it's never a waste of time. We simply cannot fall asleep or stay asleep if we never manage to "let go" of all those pesky things that don't get done every day or we continue planning for tomorrow.

This allowing our minds and bodies to "settle" doesn't necessarily need to take an excessively long period of time. But most people do need about 30 minutes of quiet relaxation-settling time before going to bed if they're going to get to sleep.

Much of that 30 minutes is often spent in bedtime rituals---the things we do each night that signal to the body and mind it's time to go to sleep. For some people that might involve a warm bath. Or a small bedtime snack followed by brushing and flossing the teeth without actively thinking of other things. Or even doing something mindless like loading the dishwasher.

So I'll close with a question that I asked before, but you haven't yet answered: Other than taking a sleeping pill, do you have a bedtime routine? Something you do each night simply to get ready to go to bed?

It's now far later than I intended to stay up and I need to attend to my own (shortened) 10-15 bedtime routine tonight:

• Fill my machine's humidifier
• Set up my computer to play my chant music all night since I'm traveling without my iPod's speakers and dim the monitor all the way
• Possibly eat a small snack
• Change into my pjs and brush my teeth
• Take my nighttime medicines
• Mask up, turn the machine on, and snuggle into Hubby
• Do some daydreaming while listening to the chants if I don't fall asleep right away. The daydreaming is LOW KEY and won't focus on the things I have planned for tomorrow or the things that didn't get done today.

If I were at home, I'd do a cross word or sudoku on paper before brushing my teeth.

[BryanC]

Robysue, your sleep phase sounds similar to mine, maybe even a little later (I'm typically in bed by 1 (recently. I kinda gave up on the try to go at 10)) I am still getting about 6 to 6.5 hours a night. Though, what's weird is, I keep lowering my pressure to see how high it will raise itself, but it I've lowered it to 10, and (last night) it went to about 11.5 27 times and then right back down to 10, ONE time it went up to about 12.5, and a couple times it went up to only like 10.5. But as my pressure gets lower, my clear airway apneas have gone up!

I never really have been one to do what everyone else does, so I donno why I try to go to bed then. I guess it's mostly cause that's when my family generally does, and I'd like to get up around the same time they do, but it never really seems to work that way. (I also like the alone time, which fuels the staying up late )



are these clear air apneas actually my not breathing? cause its not motionless (though that could be the pressure pulse, but (if) that didn't fix it, shouldn't it have gone to a higher pressure?).

I have also started turning the TV OFF when I lay down (I say also as in addition to giving up the 10/11 bedtime and going when I feel tired, plus it allows me to drink caffeine till about 3 )

as for getting off the computer, that's probably not going to happen. I take my trazadone; turn off the tv and play a game on my tablet for about 15 minutes then lie down, and fall asleep pretty quick. Since the beginning of may, I'm more along the lines of 2 sessions a night, I do think I'm sleeping better, and feeling less tired, though I still have an occasional stretch where I feel super tired (if I'm not busy. If I'm busy, I don't get tired.)

as for using headphones or something to listen to music to go to sleep, I lay on my side and I think I roll around at night, so headphones would come off and/or make it painful to sleep on my side, and earbuds would poke my eardrums out I've tried them before... I do think they've got some ultra thin ones that might work, but I don't have them

when I get up in the middle of the night, it's because I'm wide awake, if I do something to get myself sleepy, I'll become anxious because I'm afraid I'll fall asleep without my machine (I'm very dependent on the machine. I don't have nearly as much of a problem (at least treated) as I see a lot of people posting (though in my sleep study they tell me it's severe?!) but because I often catch myself not breathing as I pass to dream land, I refuse to sleep or even chance it without it.

While I tend not to 'exercise' as in working out, I am currently I'm spending about 5 hours a day move heavy boxes up from the basement (on a dolly) up into the truck (by hand) to the storage place, then move them (by hand) into the storage shed, so I'm getting a decent work out lately. (you would not believe how much crap I've hoarded! though moving it from the house to the storage shed, it really looks like a whole lot less than I thought. but, still, a lot!)

I don't think I need 10 hours of sleep a night, I figure(d) around 8, but being that I've built up so much 'sleep debt' 10 hours would help me catch up (I guestimated the other day that I would have to sleep 24 hours a day for a year to catch up...)

As for my hunger, I'm sure I'm always hungry now because I'm trying to lose weight (still over weight, but lookin good! ) I know I'm eating less than I should (but again, ya gotta eat less to lose weight. If ya throw in exercise, you gotta eat more, but less than you would normally if you exercised.) I'm also 'stretching' the distance between breakfast, lunch, and dinner, because eating when I get up (now around 8, but used to be 5) then at noon (4 to 7 hours later) then 5 (5 hours later) then maybe a snack over the next 12 to 15 hours until I eat a meal again?! of course I'm going to be hungry! What times do you eat at?

with my lack of visitation here, I don't remember if I told you or not, but I cut my trazidone in half so as I don't feel so tired in the morning. (plus, I don't like sleep walking )

Sertraline is the med I take in the morning. it is anti-anxiety. doc bumped that up to 200mg, and I only take the adavan when I feel a panic attack coming on (though I generally I try not to, I prefer to try to 'work it out' in my head.)

I talk to my doc always a month after the meds change, then again if I notice anything out of the ordinary, or just want to ask questions.

I always ask my pharmacist if the meds have any problems with each other.

as for relaxing, I do a lot of useless things I enjoy doing to relax, but then I get upset that I wasted the whole day (or even an hour) doing something worthless when I have so much other stuff to do. But, I am (trying) to focus more on a single project at a time, and refusing to let myself work on another until the previous is finished (it doesn't ALWAYS work out like that, like I have things I need to do at my mom's house, and I need to empty out one of my houses, but I need to get her stuff done in a timely fashion (your parents raised you, you need to do for them anything you can ) so I take a day here and there to get her stuff done.

as for settling stuff for the day, I don't know how to do it. I'm not even sure if I get my back log of projects done if I'll be able to. Though, fortunately( not really ) I tend to forget a lot of my projects occasionally, so I don't feel like I have as much to do

I believe I have ya my standard sleep routine up above, I'll expand on it a little though. Everyone else goes to bed, or leaves the living room around 10. I stay out there paying little attention to the tv, writing really long messages on cpaptalk or playing games on facebook till I start feeling a little sleepy, then I go take my trazadone, go to the bathroom, turn off the bedroom tv, get in bed, play one game of spider solitaire (2 if the first is really quick), put my mask on (my wife usually fills it before she goes to bed), lay down, say my prayers, then go to sleep. It usually works for me. BUT I still only sleep 6-6.5 hours, feel tired (anytime I STOP doing things.) and wake up once or twice (that I'm aware of. I'm pretty sure the breathing pattern shows when you're awake or asleep, and even dreaming, but I'm not trained enough to know )