Maintenance insomnia

[resaco]

Hello people.

I wanted to ask you about my problem, aside from having sleep apnea (fully settled this part with the Auto CPAP, as my average 2 IAH more or less with it) is the maintenance insomnia.

I have a month with the Auto CPAP machine. I'm used to it completely, and I see the results in the computer of all days, and, as I say, the IAH is very low, but I have a problem: I sleep 4 or 5 hours and then, I wake up for no reason. I check the results of the machine and everything is correct, without apneas, but waking up at 4 or 5 hours.

My doctor, for this maintenance insomnia, sent me a pill at bedtime, 100 mg of Deprax (trazodone). In theory, it's for depressive disorders (I have any of this) but says it's also used for maintenance insomnia. He also told me that it takes several months to notice the effects. I have a month with the pills and just noticed improvement, I keep waking up at 4 or 5 hours.

And there's my question, as you see, what possible solutions there (I always go to bed at the same time, but did not solve anything), and , to ask advice on this problem of sleep maintenance insomnia.

A greeting guys!

[Pugsy]

Robysue will likely be along later to offer her thoughts..so giving your post a bump to bring it up to her attention and also point you to her blog about insomnia. She has first hand experience and can offer more specific ideas than I can.
http://adventures-in-hosehead-land.blog ... er_19.html
While it mentions cpap induced...it actually covers more than that because she has battled insomnia in one form or another for most of her life.

A few questions she might ask you though...so might as well give her an answer now as it will help her help you better.

Did you have issues with the awakening prior to using cpap machine or is this entirely new?
Do you have trouble falling back to sleep?
What do you do when you do wake up?....toss and turn? watch the clock? get up for a while? watch tv or play on computer?
How long do you stay awake when this happens?

[lazer]

....My doctor, for this maintenance insomnia, sent me a pill at bedtime, 100 mg of Deprax (trazodone). In theory, it's for depressive disorders (I have any of this) but says it's also used for maintenance insomnia. He also told me that it takes several months to notice the effects. I have a month with the pills and just noticed improvement, I keep waking up at 4 or 5 hours.

I have some past experience with trazodone. It worked somewhat for a few months then no longer worked. I was on 50mg then 100mg. It ended up just seeming to contribute to my daytime tiredness after awhile instead of helping me stay asleep. Since going off the trazodone and starting on APAP, I have tried a couple OTC type supplements and have had some better success. Started with 5-HTTP (I believe it was 100mg) which worked well for a few weeks then it seemed not as effective. About a month ago, I started on (Sorry I'm at work and can't recall the exact name but I posted in another thread on here about it...) something I found at Walmart with 6mg Melatonin and a few other herbal ingredients and this has really helped keep me sleeping throughout the night and not so groggy in the mornings. {I'll add the exact name of it to this thread if I can dig it up, give me a few minutes...}

[resaco]

Hi Pugsy,


Did you have issues with the awakening prior to using cpap machine or is this entirely new?
Yes, for some years, I've woken up several times at night. Now at least I have partly solved the problems of apnea, but I keep waking up at night

Do you have trouble falling back to sleep?
Well, some days if and some not. There are days I wake up and fall asleep within half an hour another time, then I wake up, sleep, wake up,etc ... and other days where I wake up directly and I can not sleep. The problem is that every day I wake up in the middle of the night

What do you do when you do wake up?....toss and turn? watch the clock? get up for a while? watch tv or play on computer?

Sometimes I watch the clock if I "feel" that is too early. The other things you mention do not, I turn around in bed and I get nervous. What can influence a few days is that, looking at the clock, thing that I should not do. The problem is that there are days I wake up, I don't watch the clock or do anything weird, and I do not sleep either: S

How long do you stay awake when this happens?
Normally, as I said, I'm usually awake half hour or one hour awake after another while I sleep, I wake up again, I fall asleep ... a pain.
All I want is, if I wake in the middle of the night, to sleep another 3 hours straight, but never get it

[lazer]

Update to my previous post. The name of the OTC supplement I am having success with is: http://www.schiffsweetslumber.com/ "Sleep Slumber". All I can say is this is personally working the best for me so far and of course your mileage may vary. I would recommend you check with your doctor first if interested in trying it. Good luck

[resaco]

Hi lazer,

Thanks for your help.

I have melatonin 3mg but doesn't help me. I have 5 htp but the same than the melatonin.

Is there much difference with the product you currently use on melatonin 3 mg or 5 htp? I'm interested! If I can find it at iHerb would be interesting.

[lazer]

Hi lazer,

Thanks for your help.

I have melatonin 3mg but doesn't help me. I have 5 htp but the same than the melatonin.

Is there much difference with the product you currently use on melatonin 3 mg or 5 htp? I'm interested! If I can find it at iHerb would be interesting.

Hi Resaco,

The one I am using now has 6mg Melatonin and a few other things:

• Melatonin, produced in the brain, sends a signal to the body that it's time to sleep. As we age, our bodies produce less and less melatonin. At age 70, the body only produces 25% of the melatonin it produced at age 20. Taking melatonin at bedtime supplements healthy melatonin levels and promotes normal sleep patterns.

• Theanine is a compound found in green tea and is known for its stress relief properties. Theanine helps you wind down before sleep, and then once asleep, to sleep more soundly throughout the night.

• GABA (Gamma-aminobutyric acid) is an important amino acid and neurotransmitter that works fast to support relaxation and restful sleep patterns.

• Chamomile and Valerian are two herbs traditionally used for their calming properties.

• Vitamin B6 is critical for healthy production of GABA and melatonin in the brain.

So yes, it does have twice the Melatonin and the other ingredients so it's different than just the 3mg Melatonin and the 5-htp

[resaco]

Hi lazer,

I've been watching, and I being of Spain, they didn't send me the product .

What if I take two doses of 3 mg of melatonin? I also have GABA tablets of 500 mg. Could be a similar effect? What do you think?

[lazer]

Hi lazer,

I've been watching, and I being of Spain, they didn't send me the product .

What if I take two doses of 3 mg of melatonin? I also have GABA tablets of 500 mg. Could be a similar effect? What do you think?

I don't think that could hurt as long as you aren't taking any other (prescription drugs) - in that case, I would check with your doctor first. I would also recommend you try this on a night you don't have to be at work or school, ect... the next day as you never know, the higher dose of melatonin could possibly take your system longer to get used to and leave you groggy for the day. I didn't have this problem with what I'm taking but you never know.

[resaco]

Hi lazer,

Thanks for all, you are right, I will see my doctor first to talk with him about what you said me, and then, let's see what happens!

[robysue]

First,

Welcome to the forum resaco and I also bid you a sad welcome into the CPAP&Insomnia club.

Second---a big thank you to Pugsy for asking some of my standard questions. It's much appecreicated.

In the quotes, Pugsy's questions are in italics.

Did you have issues with the awakening prior to using cpap machine or is this entirely new?
Yes, for some years, I've woken up several times at night. Now at least I have partly solved the problems of apnea, but I keep waking up at night

If the wakes aren't new, it's important to not blame the machine for causing them. It's also important to NOT get into a habit of taking of the mask "just so you can sleep." The real fix is going to require fixing the previously existing insomnia. To quote DeltaDave, "YOU CAN'T FIX BAD SLEEP WITH A CPAP MACHINE!!!" The CPAP is doing its job of preventing the apneas and hypopneas. Now you have to do your job and first figure out what else is contributing to your bad sleep and then work on fixing the bad sleep.

Since you seem to have no idea what might be waking you, a sleep journal might help. You do NOT write in the journal during the middle of the night. Rather---in the morning you make some (short) notes about the following:

• time you went to bed
• time you got out of bed for the morning
• estimated time it took you to get to sleep after going to bed*
• estimate of how many times you woke up during the night*
• an estimate of the total amount of sleep you got during the night*
• a note or two of what you can remember in the morning about the wakes if it seems significant. (Example: "Woke up twice with some aerophagia and once feeling hot" is more than enough detail)

It's important to understand that the estimates do NOT need to be extremely accurate. Your perception of the time it takes you to fall asleep, the amount of sleep you actually got, and the number of wakes is more important than the real accuracy of the information. So do NOT look at a clock to try to figure out the time estimates and do NOT make any written notes about the wakes during the middle of the night.

You also write:

Do you have trouble falling back to sleep?
Well, some days if and some not. There are days I wake up and fall asleep within half an hour another time, then I wake up, sleep, wake up,etc ... and other days where I wake up directly and I can not sleep. The problem is that every day I wake up in the middle of the night

What do you do when you do wake up?....toss and turn? watch the clock? get up for a while? watch tv or play on computer?

Sometimes I watch the clock if I "feel" that is too early. The other things you mention do not, I turn around in bed and I get nervous. What can influence a few days is that, looking at the clock, thing that I should not do. The problem is that there are days I wake up, I don't watch the clock or do anything weird, and I do not sleep either:

I's important to realize that most people---including those without insomnia---wake up a few times during the night. It's remarkably common for people to wake briefly after each REM cycle for example. Many people need to arouse all the way to WAKE to turn over in bed or rearrange their pillows or bed covers in the middle of the night. Transient noises from outside (dogs barking, sirens in the distance, etc. can wake us up but not last long enough for us to identify them as the source of our wake.

But insomniacs and noninsomniacs tend to react to realizing they are awake in the middle of the middle of the night quite differently. One difference between people without insomnia and people with sleep maintenance insomnia is what they choose to do after they wake up. Another difference is that people with insomnia tend to be more aware of when they are awake in the middle of the night AND they can also mistakenly believe they were awake during periods when an EEG would confirm they are in Stage 1 or Stage 2 sleep.

When a noninsomniac wakes up in the middle of the night, they will quickly assess if there is a real reason to be awake (a child crying that needs attention, it's begun to rain and the windows need to be closed, they need to go to the bathroom, etc) or not. If there's a real reason to be awake, they get up, take care of it and when they return to bed, they fall back asleep without giving the wake much thought. If there's no obvious cause for the wake, a noninsomniac is likely to simply turn over, snuggle back into the covers to get more comfortable, and return to sleep without ever even thinking much about why they are awake or what time it is. Heck, a noninsomniac probably won't even remember the wake unless it lasts at least 5 minutes. And so when they wake up in the morning, they often think they slept the whole night without any wakes at all.

When an insomniac wakes up in middle of the night, things are quite different. Most insomniacs tend to resent waking up in a way noninsomniacs don't. And the fact that they are now aware of being awake often makes them become even more alert and more awake and less sleepy. The first thing many insomniacs do is look at the clock and as soon as they know what time it is, their brain is fully engaged in the arithmetic of figuring out: How long has it been since the last wake up? How much time have I been asleep? How much (or rather how little) time is there before the alarm goes off? How long will it take me to get back to sleep? Is it worth trying to get back to sleep or should I just get up now? Of course all this arithmetic tends to wake the insomniac up even more fully and hence make it even harder to get back to sleep. And that can trigger a new round of clock watching and worrying: I wonder what time it is now? How long have I been awake this time? Will I ever get back to sleep tonight?.

And many insomniacs tend to worry when they wake up. Or get nervous about being awake. And of course worrying and nervousness and anxiety in the middle of the night often aggravates the insomnia: It's very difficult to get (back) to sleep when you are worrying about why you are awake in the middle of the night. Or worrying about what went wrong at the office yesterday. Or worrying that you'll be exhausted all day long tomorrow. Or worrying about the starving children in Africa whom you can't do anything about when it's 3:00AM and you're lying in bed awake.

And most insomniacs will focus on how little sleep they got and how long they were awake each night, whereas noninsomniacs tend to think in terms of how much sleep they got. And so most insomniacs under estmate (and sometimes drastically under estimate) how much total sleep they are actually getting during the night.

Whlle sleeping drugs and supplements may provide some help by increasing the arousal threshold (i.e. making it take more external stimulus or more internal effort to arouse/wake in the middle of the night), they are not likely to eliminate all middle of the night awakenings. And hence it can also be very useful to use some cognitive behavior techniques to teach/train your body to react to a middle of the night awakening in a fashion similar to that of a non-insomniac. The idea here is this simple, but powerful idea: If your wakes are few in number and genuinely caused by nothing but "you woke up", and you don't remember the wakes at all or don't remember them as being particularly disturbing to your sleep, then they are NOT disturbing to your overall sleep architecture.

And what can you do to encourage your mind and body to behave more like a noninsonmniac when you wake up for some non-specific reason in the middle of the night?

Not looking at the clock is usually the first suggestion. It sounds crazy, but turning the clock around so that you can't see it, and simply not worrying about what time it is when you are awake can go a long way in helping you get back to sleep. It can take some getting used to and a few people find that they become even more nervous about the wakes the first several days that they try this strategy. But for some people with long term sleep maintenance insomnia problems, getting rid of the clock proves to be strangely liberating: They find they no longer feel the obligation to do the arithmetic when they wake up and that keeps them from starting down the worry path.

And conscious relaxation techniques can help some people get out of the downward worry spiral when they wake up in the middle of the night.

But it's also important to learn to how figure out when you are so alert (or keyed up or anxious or nervous) to be able to get back to sleep in a timely fashion. If you are NOT sleepy, you won't fall back asleep no matter how much you desire it. Which bring us to:

How long do you stay awake when this happens?
Normally, as I said, I'm usually awake half hour or one hour awake after another while I sleep, I wake up again, I fall asleep ... a pain.
All I want is, if I wake in the middle of the night, to sleep another 3 hours straight, but never get it

If you have been lying in bed awake and worrying for 30 minutes or more, then chances are you are NOT making any progress towards getting back to sleep. And as crazy as it sounds, it may be time to get out of bed and go into a different room and do something else for a while. It may only take five of sitting in a semi dark room for your brain to quit the worrying and start to get sleepy again. Or it may take a half an hour of reading a non-violent book. Or it may take playing some solitare or making yourself a cup of herbal tea. But regardless of what you choose to do when you get out of bed, you may find that you get to sleep faster once you return to bed and that enjoying the quiet relaxing activity is much more pleasant that continuing to lie in bed NOT sleeping.

It may be hard to get in Spain, but there's a book by an American sleep doctor that you may find very useful when it comes to figuring out how to deal with your sleep maintenance insomnia in a positive way and eventually get a good night's sleep night after night after night. It's call Sound Sleep, Sound Mind by Dr. Barry Krakow. He has a whole chapter or more on self-help ideas for dealing with clock watching as an insomnia feeder.

Best of luck

[jnk]

I always slept through the night before PAP. I might wake up to go the restroom, but I would fall asleep immediately when I got back to bed. I could sleep nine hours easily that way. Thing is, though, that my OSA was severe and untreated, so the sleep wasn't refreshing. I woke up feeling worse than when I went to bed. My body/brain had learned how to sleep incorrectly, but sleep itself was no problem in the sense of falling asleep, staying asleep, or falling back to sleep if woken up.

THEN I got PAP. For the first week or two, I would sleep about two hours then BAM! I was awake and awake for good for the night. I had no choice but to get out of bed and start my day around two or three in the morning at first. Why? I believe it was because my brain had never experienced uninterrupted cycles, so it woke me up after one or two cycles and considered itself done. It took many weeks before my brain figured out that it could safely go from one sleep cycle to the next all night long for seven hours or so.

I think my experience is common and is why some people stop PAP. They decide that the PAP machine is 'destroying their sleep' because they can't maintain sleep when they first start PAP therapy. They don't stay the course and give their brain enough time to get used not only to the PAP but to the experience of uninterrupted sleep cycles. They don't understand that one complete cycle of 90 minutes or so is better for them than nine hours of fragmented light sleep without consolidated REM and deep sleep. So they don't get that getting LESS sleep on PAP is still healthier than getting MORE sleep without PAP. (I am speaking of those of us with severe OSA.) It isn't just quantity. It is about about quality sleep. It can take a brain a long, long time to settle into a healthy pattern if it doesn't recognize what is going on.

I wish more patients were forewarned that it takes the brain a number of months to learn to sleep correctly after many years, perhaps decades, of learning to survive sleeping incorrectly. I believe that for many of us, a period of sleep-maintenance insomnia is understandable and just part of the process. For many of us, if we stay the course, that aspect of the process will resolve on its own if we don't overreact to it. At least, that was my experience.

That said, I agree that some need temporary medication help to deal with life-disrupting insomnia before it becomes a long-term pattern. I just don't think long-term use of meds is usually the answer for most.

[resaco]

Hi robysue,

THANKS for your help and attention, you're great!

I removed my watch before bed, and is what I will make from now.

The problem is that I awoke at midnight again, as always (I don't know what time was logically), and it took me a long time to go back to sleep, as usual. Then at times, awake, asleep, awake ...

Also notice that I wake up without any reason, I honestly don't see any reason apparent that I wake up. I wake up and I don't know why, 'cause I don't feel heat, or noisy, or something... I just wake up :S

Could it be too, because I've been sleeping poorly for so many years and frequent awakenings and sleep apnea, that my body needs several months to go asleep gradually more and more, and that the insomnia pass over the months?

Thanks again!!!

[resaco]

Hi jnk

I often think that may be what you say, that is, so many years because of bad sleep apnea and insomnia, use the machine does not suddenly go to sleep 8 hours of quality, it takes time .

I hope that is the reason why I sleep so little even with the machine, and see if the recommendations of all of you and the help of my doctor I can go sleep a little more

Thank you very much!