Waking up nightly after 3-5 hours - any advice?

[OntarioKevin]

I'm kind of running out of options here - hoping someone has some ideas I can try.

Started using a Resmed S9 instead of a Devilbiss Intellipap. The S9 is a far, far better machine, and my AHIs went down immediately from 2-3 to 0.2-0.6 or so.

Probably some of that is in their algorithms for measuring AHI, but at least some of it is real because I felt a lot better. I just learned how to get detailed data, so hopefully I'll know more tomorrow.

Slept through the night, more or less, once or twice since getting the machine (never did on the Devilbiss).

But for a few weeks now, I regularly wake up after 3 to 5 hours, and can't get back to sleep except sporadically (waking every hour or so).

Before I was tested or used any of these machines, a few years ago I used to wake up after 3-5 hours, not be able to sleep for three hours, then conk out for a few hours before daybreak. But that was when I was drinking too much coffee and using too much Ventolin (an asthma drug with a similar effect to adrenalin).

Now I have at most one green tea in the early morning, and almost never use the Ventolin, and certainly never before bedtime. So that's not the issue.

It doesn't seem to matter if I exercise or not, if I drink alcohol or not, or if I have sex or not (OK, potentially TMI, but I'm testing everything here).

One real change over the past few months is that I can't run anymore (knees just getting old), so I've put on about 5 pounds. Now weigh about 180, 5'9", 46 yo. So not ideal, but not clinically obese. My exercise is still approximately as frequent as it was, though (just use the elliptical now).

Once in a blue moon, like a few nights ago, I wake up as usual in the middle of the night but am able to go back to sleep and I feel totally amazing.

But the other four out of five nights I just want the earth to spin faster so I can try to sleep again.

One other note - humidifier on the S9 is set to 0.5 or off. I've had a hell of a time finding a good mask, and I've settled on the Resmed Liberty, which is a hybrid with a mouthpiece and nasal pillows. At higher humidity settings I just find the wetness makes everything slip around and I wake up from the damn nasal pillows slipping around. I've always breathed through my mouth, so the dryness in my mouth doesn't really bother me - I've always had that.

I'm also using earplugs so I don't have to hear the various whistling noises the mask makes - although admittedly one stat I did find in the Resmed software today is that the max leakage is averaging 25 litres/minute, which sounds awfully high. The median is 0.0, though, so maybe the max is just when I'm taking it off or adjusting it.

Sleep on my back mostly, and on my side sometimes. I'm ALWAYS conscious of changing positions when I do - I think it's been years since I just changed positions in my sleep.

Any helpful suggestions?

Oh - and I saw one sleep doc last year, who set me off on the CPAP trail. BUT - the system in Ontario is pretty screwed up; the doc mostly just tried to sell me their overpriced ($2000) low-end CPAP machine, because the government here covers half. Didn't take long to figure out you can buy better machines cheaper in the US. Downside is I'm not really working with any doctor except my primary care physician, who can subscribe a few different sleep meds if I like. We don't have Ambien in Canada, so most of our sleep meds are essentially just knock-out drugs. Can't really use them for more than one or two nights without turning into a zombie.

Data for the last few weeks:

Pressure - cmH2O
Median: 11.3 95th Percentile: 14.0 Maximum: 14.0
Leak - L/min
Median: 0.0 95th Percentile: 1.2 Maximum: 13.8
AHI & AI - Events/hr
Apnea index: 0.3 AHI: 0.6 Obstructive: 0.1
Central: 0.1 Unknown: 0.0 Hypopnea index: 0.4

[DavidCarolina]

Do you have a sedentery job? I think that makes a big difference in being tired at night.

And im not criticizing elipticals, but ive been an athlete my whole life and youre not getting nearly as much excercise on those that as you may think. They do a lot of the work for you, although granted its a low impact sport. Swimming, biking, walking may be better.

I walk an hour a day, but in reality i need two hours at a medium easy pace.

Also, evaluate other things such as how late you consume your last meal/snack at night, what other meds you
are on, if you have an optimal bed, if you consume caffeine, or even (as in my case) whether you have other
immunilogical issues going on ( i have an auto immune disease that causes multiple food allergies). Digestion issues
can interfere with sleep as it affects blood flow, etc.

These things can get complex, I know this for a fact.

If you can afford it and approved by docs, have you considered oxygen therapy as a supplement at night if needed?

Im one of those who believes that 02 deprivation can cause you to awaken if in lesser deprivations.

Finally, consider melatonin and serotonin levels in your body and even holistic helpers such as soothing tea. I have a food allergy to milk, but I used to benefit from a glass of chocolate milk when I woke up. Chocolate has been shown to be an ultimate natural relaxant and antioxidant, but we prefer eating the dark stuff. Keep experimenting to find what works.

Im not a big fan of sleeping pills because they can interfere with natural respiration. Finally those age old remedies of doing mental excercises when you cant sleep may help. I have a couple of tricks of shaking my leg or foot back and forth as a ritual, and also of playing tennis matches in my head---a lot like counting sheep. It works for me.

[OntarioKevin]

Thanks, David.

Good, thoughtful suggestions.

I know I probably have to re-engage with a doctor at some point - I was just so roundly disappointed with my first one. I'm sure I'd need their help for oxygen therapy. And it just seems so drastic - yet another thing to try to lug around the world if we travel.

Good point about eating late. Last night I had a full meal at around 8:30, much later than usual because of driving around the kids to various activities.

Definitely a sedentary job, but there's a fair amount of walking daily and yesterday I rode my bike to and from work (about 25 mins each way, with a nice uphill on the way home).

What I loved about running was just getting outside for an hour, regardless of the weather.

[Perrybucsdad]

Kevin... I think it will help when you can post some data and it sounds like from another post you will be able to do that tomorrow.

Couple of things... I understand the not being able to run part. I was a marathon runner and after some injuries, I can't run either, but going for fast and/or long walks can help too. Just don't do it close to bed time. In fact, do it early if you can.

Drinking... how many per night? Maybe limit that to one if any. I know alcohol messed with my sleep... that may just be me, but might be something to try and cut out.

What about any caffeine. I know if I have a can of pop after 3pm, I'm up till at least 3am. Maybe if you want a cold bubbly beverage, try club soda on ice with a lime or lemon (or sparkling mineral water). That's all I drink now to try and avoid caffeine.

Anyhow, it will be good to see some data when you have that available. Maybe we will see flow restrictions or you are having a long apnea that wakes you up. The strange part though is why you can't get back to sleep and there are some folks here who have had to deal with that and they can give you more tips than I. Thankfully I have not had much problems ever going to sleep lately (watch, I just jinxed myself now).

- John

[OntarioKevin]

Thanks, Perrybucsdad.

For sure I still drink beer, almost every night. Generally two beers on average - I'd say in a given week, one night nothing, two nights one drink, two nights, two drinks, two nights three drinks. Something like that.

Honestly it doesn't seem to regularly effect anything, but I could be kidding myself. I've had great sleeps after lots of beer, and lousy sleeps after no beer.

I think it contributes more to weight gain than sleep loss, although of course weight gain contributes to sleep loss.

Caffeine I mentioned I drink only in the morning - just one green tea. I find if I skip it I don't have the huge headaches I used to have with coffee. And once every few weeks I'll have a root beer in the afternoon, which includes caffeine.

Chocolate at night also keeps me up, so I don't do that except on rare occasions (like once in the past few months).

I suppose I should keep a better journal to track what's going on, but the source of my frustration is that nothing seems to correlate with good nights versus bad nights.

[robysue]

But for a few weeks now, I regularly wake up after 3 to 5 hours, and can't get back to sleep except sporadically (waking every hour or so).

Before I was tested or used any of these machines, a few years ago I used to wake up after 3-5 hours, not be able to sleep for three hours, then conk out for a few hours before daybreak. But that was when I was drinking too much coffee and using too much Ventolin (an asthma drug with a similar effect to adrenalin).

I have to ask: Pre-CPAP: After waking up in the middle of the night did you just lie there in bed for three hours worrying about being awake and unable to get back to sleep?

And now, after you wake up in the middle of the night do you lie there in bed with the CPAP on worrying about being awake and unable t get back to a sound sleep? And do you check the clock frequently to determine just how long you've been lying there awake and unable to sleep and just how soon it will before morning comes?

Because if you are lying in bed awake, watching the clock, and worrying about not being able to get back to sleep night after night, the clock watching and worrying themselves are feeding the problem and making it worse.

I would suggest that you pick up a copy of Sound Sleep, Sound Mind by Dr. Barry Krakow. He has a lot of interesting things to say about how certain behavior patterns perpetuate insomnia. And a lot of suggestions to try. While some of his suggestions are strongly rooted in the notion of establishing good sleep hygiene, he takes a much more fundamental view of dealing with the insomnia in the context of your whole life and not merely what happens when you are in bed trying to sleep. And many of his recommendations involve prudent bending of good sleep hygiene rules and even selectively ignoring the ones that prove to be counterproductive for you. So pick up his book and work your way through it; it should be enlightening to you to see how some of the things you do each and every day and night are aggravating the insomnia. And how making some real lifestyle changes may go a long way in eliminating the insomnia for good.

[OntarioKevin]

Good suggestion re: Krakow's book. Hopefully it's on Kindle so I don't have to wait to get it!

Re: waiting to fall asleep, it's always a hard call. Sometimes if I just try to go to sleep, it happens. After a while (maybe an hour? 20 mins?) I'll just get out of bed and go read somewhere. If I can manage it without waking my wife (much), I'll read in bed, which I do anyway before sleeping.

Definitely have a lot of stress going on in my life, but I suppose everyone does. Nothing really abnormal - job, kids, wife, etc. Par for the course of any 46-yo married guy!

BTW, my machine has been set on "sleep quality on". Not sure why I'm not getting detailed data - I'll ask in another thread.

[TriKKy]

I probably wake up 4 times per night to flip - probably awake for under 30 seconds. Everyone once in a while though, what happens to you happens to me: sleep 3-5 hours and wake up completely. Oddly enough when I do that I do not feel tired during the day...go figure. I have probably only slept a handful of night in my entire life where I sleep right through the night without waking up to even flip.

[snuginarug]

Hey Kevin

Keeping a sleep journal is a great idea. One thing to note in a journal is whether you feel rested and alert through the day when you have a semi-sleepless night. It is within the realm of possibility that you just have gotten enough sleep, and don't need any more.

I have premature waking also, and it is quite annoying. Unfortunately, in my case, it is not that I have gotten enough sleep, but an old pattern of insomnia from pre-cpap days. I am slowly getting a grip on it and it has been improving.

a few years ago I used to wake up after 3-5 hours, not be able to sleep for three hours, then conk out for a few hours before daybreak

I know you have wracked your brain on this topic, but is there anything else that was going on during your previous bout of insomnia and your current situation? For example, did you have a difficult co-worker, an unpleasant duty at work, special troubles with a child? Were you experiencing something internally, like grappling with mortality? Also... there are positive stressors like a new house, a promotion at work, anticipation of a big vacation. You get the idea.

You are obviously intelligent and thoughtful and probably have already considered these things, but I figured I'd throw them out there just in case.

I wish you lots of luck getting to the bottom of these troubles.

[proctor78]

I had the same problem and not even ambien was keeping me asleep, so i went and got benadryl and i am sleeping like a baby and that is a first....