Reluctant to Sleep

[Mr Bill]

That should be my nick name. I've gone for so long on so little sleep I can't seem to hustle myself off to bed at a reasonable hour. I would not say its a fear, but I am very reluctant to go to sleep. I confess to being a life long night owl. A lifetime of reading into the wee hours of the morning. But at any moment I could always down book and sleep. But now I should not fall asleep without my ASV. I wake up feeling the strain on my body.

Is this a symptom of sleep apnea also, that I have this reluctance every night, despite being very tired? The panic of falling asleep knowing you will stop breathing, that is mostly over. I trust my sleep unit will not suffocate me accidentally. But this reluctance continues.

[Slinky]

If you don't have to get up at a specific hour for work in the morning and thus if you COULD sleep would be able to sleep the hours needed consider getting a new mask - one that allows you to read whilst wearing it.

The old Respironics Simplicity simple nasal cushion allows you to read, even w/glasses. The ProBasics Zzz-Mask full face mask allows you to read, even w/glasses. The Swift LT nasal pillows mask allows you to read, even w/glasses. There are others.

Don your mask, turn your PAP on, and read to your heart's content, put down the book when ready to sleep and HOPEFULLY, go to sleep.

I've shared your sleep habits myself almost all my life. At least as far back as I can remember. It wasn't and isn't a fear of sleeping. It was simply a "fear" of missing something interesting that was going on I guess. Plus I've always HATED having to get up in the dark to start my day. I don't WANT my day to start until there is daylight. I get my BEST sleep between 6 AM and 8:30 AM. Even if those are the only 2 1/2 hours sleep I get those are the days I feel my best and that has pretty much been lifelong as well. At least as far back as I can remember. Of course, this wasn't particularly compatible w/my job so it was a constant battle for some 50 years or so. Generally I'd have a couple of nights a month I would end up "crashing" as soon as I walked thru the door and sleeping right straight thru until necessary wake up time in the AM to get to work. The first thing I did when I retired was toss my watch in the trash. Not even a drawer, IN THE TRASH BASKET!!! I got rid of all the "portable" clocks. The only clocks I have now are the one of the kitchen cupboard and the retirement clock my husband received when he retired. (I wish he would have taken the pocket watch instead!!)

OR you can work on changing your "internal" clock to "acceptable" sleep times. There is a method of "sleep behavior training" to help you do that. Not an easy task but doable.

If you are retired or your work schedule allows it I would go w/changing to a mask I could read with and continue to live my life and sleep time by "my" preferences.

Oh yeah, I forgot, my cell phone does have the time appearing on it. I just don't look at the time unless I HAVE to.

[robysue]

That should be my nick name. I've gone for so long on so little sleep I can't seem to hustle myself off to bed at a reasonable hour. I would not say its a fear, but I am very reluctant to go to sleep.

I bid you a sad welcome into the xPAP & insomnia club.

Your reluctance to go to sleep is a symptom of "bedtime insomnia" or insomnia caused by the inability to fall asleep in a timely fashion even though you want to be asleep---i.e. a very long latency to sleep. Do you also have trouble staying asleep once you get to sleep? Do you ever find yourself waking up earlier than you want to and unable to get back to sleep?

I confess to being a life long night owl. A lifetime of reading into the wee hours of the morning. But at any moment I could always down book and sleep.

Are you reading in bed? If so, that is most likely part of the problem: Silly as it sounds, it is better for insomniacs to do their "bedtime" reading in a different room than the bedroom. Or at least NOT in the bed---i.e. in a chair in the bedroom at the very least. Why? Well, every time you lie in bed doing something that keeps you awake, you are teaching your mind and body that Lying in bed = It's ok to be WIDE awake doing something instead of teaching your body that Being in bed = Time to be ASLEEP. So the first basic tenant of good sleep hygiene is to reserve the bed itself for sleep and sex. In other words, do NOTHING in the bed except for sleeping and sex: So reading, watching tv, web browsing and eating should all be done in a location other than your bed. And if the insomnia is long standing (which yours seems to be), it's best to avoid doing these kinds of activities in the bedroom itself. So move the bedtime reading to a different room.

And brush up on good sleep hygiene practices in general. Two decent versions of the "rules" can be found at http://www.mayoclinic.com/health/insomn ... e-remedies and http://www.umm.edu/sleep/sleep_hyg.htm . Read through these guidelines and honestly and critically evaluate how many of them you routinely ignore and how many of them are part of your lifestyle. And start there: Try to improve your sleep hygiene in general. That may be enough to help with the bedtime insomnia and make it manageable.

In my humble opinion as a life long sufferer of on and off insomnia who has previous to xPAP always been able to manage my insomnia by tightening up on sleep hygiene these are the most critical of the rules:

• * Reserve the bed (and bedroom) for sleep and sex. Do all other activities in a DIFFERENT room---including any bedtime reading.
  
  * Learn to recognize the difference between feeling sleepy and feeling exhausted or tired. You will NOT fall asleep in a reasonable amount of time if you are NOT sleepy when you go to bed. Being tired or exhausted is NOT enough to help you get to sleep quickly.
  
  * Try to maintain a regular WAKE UP time---seven days a week. (This rule is the one that I am now working on---it's the one major rule I never needed before.)
  
  * Try to maintain a regular bedtime---BUT do NOT go to bed at your "regular bedtime" if you are NOT feeling sleepy. Go to bed when you start to feel sleepy for the first time AT or AFTER your regular bedtime. If you are sleepy BEFORE your regular bedtime, try your best to stay awake until your regular bedtime.
  
  * If you have NOT fallen asleep within 20 or 30 minutes (max) of going to bed, then admit that you are not yet sleepy enough to fall asleep. Rather than lying in bed fighting for sleep, go ahead and get up out of bed, go into a different room, and do something quiet, but enjoyable until you start to feel sleepy enough to go back to bed and try again. This rule sounds cruel, but it's really critical for teaching your body that Being in Bed = Being Asleep. Good activites are listenting to quiet music in a semi-dark room or reading something light, non-work related, and NOT too interesting. If you often find that you can't put books down, then you may have to avoid reading books around bedtime. Try working a crossword puzzle or a Soduko instead. Or read a magazine or the newspaper. Watching TV and web browsing, however, are NOT good activities: There's something about the kind of light emitted by monitors and TVs that can be very stimulating and makes it harder to both fall asleep and stay asleep.
  
  * Don't watch the clock. Estimate the 20--30 minutes in the previous rule in your head. It's less important to be accurate about the time and more important to accurately sense that you are NOT making progress on falling asleep. If you cannot resist looking at the clock, turn it around or move it somewhere to make it much more difficult to look at.

But now I should not fall asleep without my ASV. I wake up feeling the strain on my body.

Is this a symptom of sleep apnea also, that I have this reluctance every night, despite being very tired? The panic of falling asleep knowing you will stop breathing, that is mostly over. I trust my sleep unit will not suffocate me accidentally. But this reluctance continues.

Sounds to me like the adjustment period to sleeping with your ASV triggered some (additional) problems with bedtime insomnia and may have increased your overall anxiety about going to bed and not being able to get to sleep in a timely fashion. That happens. I had a really bad case of CPAP-induced insomnia myself, and five months after starting therapy, I'm still working on taming my insomnia beast because i unfortunately let it get wildly out of control due to many other adjustment problems. So you need to work on controling the insomnia in order to fully feel the benefits of using the ASV.

In order to get over the hump of your current reluctance to go bed, first try cleaning up your sleep hygiene by incorporating as many of the guidelines as you can reasonably do into your daily life. If that does not help within two weeks or so---OR if it gets WORSE, then in my opinion it is time to ask for professional help in dealing with the insomnia. At that point, you should definitely call your sleep doctor's office and ask to speak to a nurse or PA or the doctor. Be sure to tell the receptionist that you need to talk to someone about the fact that your insomnia is starting to interfere with your treatment. You will need to make some decisions about how you want to treat the insomnia. Some people do find sleeping pills useful and have no problems with a prescription sleeping mediation, but others are not (I am not willing to do the sleeping pills).

If you decide to use sleeping pills, then be sure to discuss (1) how long you and your doctor are comfortable with your taking the pills and (2) how to wean yourself from the sleep medication. You don't want to trigger rebound insomnia when you go off the pills. And try to clean up your sleep hygiene while you're taking the pills: At a minimum, do your bedtime reading in a different room and before taking the sleeping pills.

If you are not willing to take sleeping pills, then be prepared to do some serious cognitive behavior work on applying all the good sleep hygiene rules and possibly undergoing an intentional kind of (moderate) sleep deprivation caused by an intentional restriction of your time in bed. I've been doing this with the guidance of the PA in my sleep doctor's office since Dec. 30. You can read about what it involves in the following threads:

• The insomnia monster raises its head again and again ..... (I described both my CPAP-insomnia and how it morphed into an out of control full-fledged monster; I also describe (much farther down in the thread) the PA's designed plan to deal with the insomnia.)
  
  1000th post: Update on my insomnia and xPAP therapy (I talk about the very real and substantial progress I've made since starting the hard work involved in this approach to dealing with the insomnia.)
  
  Met with PA about insomnia and got 4th sleep test results. (An update to the previous thread.)

Read through these threads: There are many, many suggestions from the kind folks on this forum for dealing with insomnia.

[avi123]

You have not provided any info about what you actually do such as how many hours you do sleep and what makes you wake up. You only talk about your feelings.

Spending an hour with a psychiatrist could help a lot.

[john.michael]

Wow, this initial post really hits home.
And the replies look really usefule.
I need to go have my day away from this forum, but I'll be back to read more here....

THanks again!
John

[DavidCarolina]

I think youre talking about a lifestyle habit more than anything else. Those kinds of things are deeply
ingrained into your thinking and attitudes, and naturally, fears play a big part in the human psyche and
conscience.

Before I got married, I would literally read, almost compulsively, into the wee hours every night. It
was my "me" time. I would totally lose track of time, be transported to another existence, kind of
like somebody with a hobby they couldnt live without......like some fishermen Ive met.

Since then, with the pap, I tend to drift off pretty quick.

I wouldnt over analyze it, but instead try to wean yourself to 15 minutes of reading 3 or 4 nights a week
to see what happens.

[Mr Bill]

I did not mean to be all dramatic about this and I really will read the posts about insomnia. I'm not married so I have no sleep partner to disturb. I would say, that despite my night owl tendencies, its never before been insomnia. When I decide to hit the sack I fall asleep easily.

I do read a lot, a pulp book every couple of days. If I buy a bag of good books, I and have no work commitments, I might read a book a night for a few days. I'm a geologist but I work as a chemist in a little two man business, the owner and I. When he goes off for a week or two, I can maintain a sleep schedule so I can be at work from 8 to 5. No night reading at those times. When he is in town and in this economy, I work 4 or 6 hours a day and typically come in at from 10am to noon. So, if I stay up to the wee hours, I set the alarm in my cell phone for later to give me 6-7 hours. I keep it face down at the head of my bed. I typically don't need to see a clock very often to have a good sense of what time it is. Before apnea, I had always been OK on 6 to 7 hours a night and reading was nearly as good as resting. If a book is riveting, I don't begrudge a night without sleep, I still feel mostly rested. Most books are not riveting, so having decided to sleep, I down book within half a hour. Once I down book, its easy to fall asleep. Once asleep, its easy to stay asleep.

I am blocking 6-7 hours a night to sleep but I am only managing to get an average of 4.5 hours a night of blower time. In the last month, I have 8 days where I slept 6-8 hours, 8 days where I got less than 3 hours of blower time, and about 13 days right about 4.5 hours. Typically when I go short, I pull the mask off 1-2 hours into the night. I turn off the blower when I do because its blowing and noisy. I usually tell myself its just for a few minutes because I was could not breath because I feel stuffed up or restricted with the mask on. Sometimes I get it right back on. Typically, an hour or two later, I wake up and realize its not on and then put it back on and sleep through the rest of the night. However, sometimes I wake up very tired having had the mask off all night.

I have been thinking after reading all the complaints about masks and finding the right mask, that this may mostly be a mask issue. I have a very big head, on a 19 inch neck and have trouble finding hats big enough; yet they gave me a medium mask. Its mostly comfortable enough but I think maybe the pressure on my face around my nose makes me start having that clogged sinus feeling and a little difficulty breathing and off it comes. So, my initial post is about sitting on the couch in the living room reading a book or reading posts on line and looking towards the bed room and not wanting to go put on the mask to sleep, even though I know I need to. It just seems that since this apnea began, I get really tired, but I don't want to go sleep. Once I have the mask on, its not so bad. I am just reluctant.

[Slinky]

... If a book is riveting, I don't begrudge a night without sleep ...

Yup, yup!! Me too. If I start a GOOD book I just can't put it down until I've read it cover to cover. Been that way all my life. I love books. They are more than just paper and fabric to me.

And ...

... the wee hours every night. It was my "me" time. I would totally lose track of time ...

Yup, yup!! No mother ragging at me to go to bed or get to sleep. Later on in life no kids making a lot of racket, wanting attention, hubby off to work (18 years of third shift), no phone ringing .... ahhhhh, MY time!! Quiet, peaceful, MY time!

[JayC]

It turns out that *much* of my night owlness for much of my life was an attempt to avoid how crappy and unproductive I felt and was on waking in the morning....... And that had to do with sleep disordered breathing going unrecognized/undiagnosed/untreated since around the age of 11 or so!! With some early wakening and other sleep phase or insomnia issues on top.....


So, your night owlness may be in response to something, AND you enjoy the night, too.......

I agree that looking at sleep habits, sleep hygiene, etc might be productive for you as well....

I am finding that my next issue to focus on becomes clear as my CPAP therapy is in a good groove..... CPAP helps so much for me.....but my breathing wasn't the only issue........

J

[robysue]

... If a book is riveting, I don't begrudge a night without sleep ...

Yup, yup!! Me too. If I start a GOOD book I just can't put it down until I've read it cover to cover. Been that way all my life. I love books. They are more than just paper and fabric to me.

This is exactly why I had to give up reading before bedtime (let alone reading in bed). By the time my kids were born (when I was in my early 30s), I just could not function the next day after "pulling an optional all-nighter" caused by reading a book I couldn't put down. That plus the fact that staying up all night reading often created problems with getting to sleep (in spite of being exhausted) the next night or two.

Even now, I have to be very, very careful about reading within an hour or two of bedtime: Because it still can make me WAKE UP and make me much less sleepy, causing the bedtime insomnia to worsen--for a couple of nights AFTER I stay up too late reading. With all the other xPAP related issues and the intentional sleep deprivation for the generalized insomnia, I just can't afford to do this any more.

[BlackSpinner]

The only books I read in bed are those I have read many times before. They create a comfort and familiarity feeling that removes me from my day. Nothing riveting, just pedestrian/fantasy stuff (for me anyway).

[avi123]

Mr Bill you might need a mate to micro manage you.


What's the meaning of Min Vent = 0.0 LPM?

EPAP min 6, EPAP max 15, IPAP 9, PS min 3, PS max 12,
Max Pressure 30, Min Vent 0.0 Lpm, Backup Rate 8 bpm

[Mr Bill]

Mr Bill you might need a mate to micro manage you.


What's the meaning of Min Vent = 0.0 LPM?

EPAP min 6, EPAP max 15, IPAP 9, PS min 3, PS max 12,
Max Pressure 30, Min Vent 0.0 Lpm, Backup Rate 8 bpm

Here is what I think. I found out by trial and error that if I held down the 'silence' and 'right' key on my blower for ~15 seconds it would drop me into a settings menu and I just copied most of them to my signature. I speculate that Min Vent is related to Min Breaths Per Minute. My DME says this machine can ventilate without any patient breathing effort. I expressed to my DME early on my fear that I might simply stop breathing and he put in the 'minimum breath per minute' rate to alleviate that fear. I typically breath at 17-18 bpm but not when falling asleep. We tried a minimum of 12 and it was unbearable. Apparently, when first falling asleep, I tend to breath very slowly, then once asleep, I start breathing shallower and faster. I'm guessing that in addition or as an alternative to a 'minimum breaths per minute', you can specify how many liters per minute it will make you use if you stop breathing.

[Jeffster]

I wrote a reply a few minutes ago, but it seems to have not posted, so I'll try to post again that I am thankful to find this info here. I have been suffering with some bad insomnia for the past 3 months. Mr. Bill, I'll call my feelings a little closer to "fear" than to "reluctance" of going to bed with the APAP, as a fear that once again I'll have a bad night, that whatever changes I've tried won't work, etc.

Two months ago my doctor gave me Trazodone to use as a sleeping pill, a 50 mg pill, with the instructions to try 1 and go to 2 if needed, 1 hour before bed. It does help put me to sleep, but not always stay asleep, and in the morning I feel like I have lost some deep sleep (or REM?) benefits. So I am still working through all this to try to attain the elucive good night's sleep I need.

But I really wanted to say thanks to everyone posting on this topic. The support here is very much appreciated. robysue, your linked posts are amazing to read through. The mentions of Cognitive Behavioral Therapy seem very interesting to me. This is a much appreciated forum by me.

[avi123]

Two months ago my doctor gave me Trazodone to use as a sleeping pill, a 50 mg pill, with the instructions to try 1 and go to 2 if needed, 1 hour before bed. It does help put me to sleep, but not always stay asleep, and in the morning I feel like I have lost some deep sleep (or REM?) benefits. So I am still working through all this to try to attain the elucive good night's sleep I need.

Jeff, before I started CPAPing 4 months ago when my sleep was fragmented, my Internist/Geriatric put me on 100 mg of Trazodone to take at around 7 to 9 p.m. as an anxiety reducer. But it did not help me fall asleep. Luckily, the same Doc sent me to do a Sleep Study which I knew nothing about. It turned out that I had a Severe OSA, and here I am with my CPAP and need to get rid of those damn Trazodone pills. That Trazodone is as lousy as Ambien, Restoril, Valium, and the rest of the thousands of Benzo, and Non- Benzo stuff, which need careful withdrawal time from.