Help please!

[sleepinow]

Anyone please help me! I keep waking up too early!

My room is dark.
Diet is good. (very good)
Sleep hygiene is okay.
Not stressed or no anxiety

I keep increasing my melotonin dosage and am now at 15+ mg. Every week I increase dosage. It works the more I take!

What tests should I take? What would be a good approach. This is really bad :'(

Thyroid? I can not think of anything else. Please I love everyone

[Julie]

Melatonin helps you go to sleep, but it won't necessarily keep you there longer. You may be sleeping 'shorter' because you no longer need so much (if Cpap is working properly). You're taking a terrible overdose of melatonin and should back right off down to 3-5 mg at a time, but in fact probably don't need it at all.

Do you not feel rested? Is your AHI high? How many hours of sleep do you get? We need more info to help you.

[sleepinow]

Julie I know you are trying to help me. Okay I wake up usually 5 hours after sleeping. I wake up almost fully but am definetely deprived of sleep if I try to stay awake during the day. I usually sleep 10 hours or more to not feel tired throughtout the day. My ahi is average of about 1.3

I have some other issue besides sleep apnea that I believe you guys can help me with

Edit: I will go back to bed but will read comments after waking up. Here goes another 5mg melotonin

[LSAT]

Julie I know you are trying to help me. Okay I wake up usually 5 hours after sleeping. I wake up almost fully but am definetely deprived of sleep if I try to stay awake during the day. I usually sleep 10 hours or more to not feel tired throughtout the day. My ahi is average of about 1.3

I have some other issue besides sleep apnea that I believe you guys can help me with

Edit: I will go back to bed but will read comments after waking up. Here goes another 5mg melotonin

If you have other issues you should be getting advice from a doctor...not from the internet.
Melatonin can be dangerous in high doses...Especially if you are taking other meds.....If 1-5mg doesn't do the trick, forget it.

[Loreena]

This might sound weird, but this is exactly how I deal with waking up too early and/or insomnia and it works like a charm. I've been wanting to say this for a long time so here goes: When I wake up too early, like I did today at 4 a.m., I go to the living room, hook up my "brick" cpap there next to the recliner, get my horshoe-shaped travel pillow, tilt back slightly, use a tight chinstrap, and lean my head to the side of the pillow (to make sure my tongue doesn't drop back and block my airway when I sleep) and within a very short time, I fall asleep (and I usually sleep hard (deep)). I really think the trick is to getting out of a lying-down position. That's just my guess. But this method always works for me.

[robysue]

sleepinow,

You report:

Okay I wake up usually 5 hours after sleeping. I wake up almost fully but am definetely deprived of sleep if I try to stay awake during the day. I usually sleep 10 hours or more to not feel tired throughtout the day. My ahi is average of about 1.3

I have some other issue besides sleep apnea that I believe you guys can help me with

and

My room is dark.
Diet is good. (very good)
Sleep hygiene is okay.
Not stressed or no anxiety

and

I keep increasing my melotonin dosage and am now at 15+ mg. Every week I increase dosage. It works the more I take!

So we know that when you are using the PAP, it's doing its job of managing your OSA. But all the CPAP can fix is the OSA; it can't fix bad sleep that is bad for reasons other than untreated OSA. (And starting CPAP can contribute to bad sleep because there is a lot to adjust to when you're sleeping with a six foot hose attached to your nose.)

Unfortunately in order to give you some decent quality help in figuring out what to do, I need the answers to a bunch of additional questions. Answering these questions will help us here at cpap.com understand your problem more fully and thus help you better:

1) When you say you "usually sleep 10 hours or more"---is that with or without the PAP machine? In other words, were you sleeping 10 hours a day pre-CPAP, but you just can't manage to stay asleep that long with CPAP?

2) How long have you been using or trying to use the PAP machine? A week or less? A month? Three months? Six months? More than a year?

3) What are the "other issues besides sleep apnea" that you are dealing with? Lots of things other t

4) When you say that increasing the melatonin works better, how does it seem to work better? What kind of a problem are you having that leads you to continue to increase the melatonin dosage are above the normally recommended dose of 0.3-1 mg?

5) When is bedtime? When does the troublesome wake happen? When do you want or need to get up by? (These are all part of finding out more about your sleep hygiene.)

6) When you find yourself waking up way too early, what's the first thing you do? Do you immediately look at the clock and start thinking "I only slept 5 hours and I don't know if I'll be able to get back to sleep?" Or do you do something else? Do you ever take the mask off and return to sleep for another 5 hours of CPAP-less sleep?

7) How much caffeine do you consume during the day? And how close to bedtime do you consume it?

Finally, as the others have said, you're taking way, way, way too much melatonin. And as Julie has suggested, you ought to start tapering off that megadose of melatonin 3-5 mg at a time. To give you an idea of just how big that dose you are taking is, consider this: Studies have shown that the usual dose of melatonin for insomnia ought to be 0.3 to 5 mg. At 15 mg, you are taking 15-50 times the recommended dose.

And even though melatonin is a natural hormone, it can cause potentially serious problems when used by people with high blood pressure, diabetes, depression, and seizure disorders. Melatonin has potentially moderate to serious interactions with a large number of prescription medications used to treat these conditions. And some of the side effects of melatonin---particularly at high doses are daytime sleepiness and a "melatonin" hangover (i.e. sleepiness) on waking. (See http://www.webmd.com/vitamins-supplemen ... =MELATONIN)

[sleepinow]

I understand everyones concern over me taking too much melotonin, but what else can I do at the moment? If it were not for melotonin I would be up all the time.



1) When you say you "usually sleep 10 hours or more"---is that with or without the PAP machine? In other words, were you sleeping 10 hours a day pre-CPAP, but you just can't manage to stay asleep that long with CPAP?

It is with the ASV machine. I can pretty much tolerate without too much issues anymore

2) How long have you been using or trying to use the PAP machine? A week or less? A month? Three months? Six months? More than a year?

Umm... about 7 months based on my SLeepyhead data. It has been a rough first three months or so but it gradually has gotten better
.
3) What are the "other issues besides sleep apnea" that you are dealing with? Lots of things other t

I do not know of any other issues but I know that they exist because of my wakefulness. It might be an underlying issue. I have no idea. I am so sorry

4) When you say that increasing the melatonin works better, how does it seem to work better? What kind of a problem are you having that leads you to continue to increase the melatonin dosage are above the normally recommended dose of 0.3-1 mg?

It seems to work better because when I take melotonin, lets say after waking up in the middle of the night, I can fall back asleep after some minutes. Taking more because the effect of my previous dosage wears of rather quickly, or so it seems. The problem is that after waking up in the middle of the night, I feel that the sleepy melotonin effect is worn off because I feel awake, although my mind and body really needs rest

5) When is bedtime? When does the troublesome wake happen? When do you want or need to get up by? (These are all part of finding out more about your sleep hygiene.)

Bedtime is usually around 2:00 am. It used to be about 1:00 am and also 12:00 am. The wake happens usually around the same time. It usually occurs about four to five hours after sleeping. I think many and most of the waking up early episodes are after my dream is complete. So after my dream ends, I wake up as if it is "time" to get up although it actually is not because the lack of hours slept. I want to get up around 12:30 pm because that is when I actually feel refreshed. I should also note that I toss and turn occasionally but it does not make me feel awakened. I go to bed usually around the same time. Sometimes it may be about a half hour to an hour late.

6) When you find yourself waking up way too early, what's the first thing you do? Do you immediately look at the clock and start thinking "I only slept 5 hours and I don't know if I'll be able to get back to sleep?" Or do you do something else? Do you ever take the mask off and return to sleep for another 5 hours of CPAP-less sleep?

It depends. Just recently like the past two to three days I was looking at the time because I felt really awake. The awake feeling is also because I believe I did not increase my melotonin dosage. I usually do not get the wakeful feeling if I am under the right amount of melotonin. I started with about 3mg, and since then, I kept needing more and more to take the wakefulness away. When I wake up, some of the first things I do is read a book, eat something, go to the bathroom, or just lie there. When I look at the clock I see that it is waaay before my actual time and think to myself "crap, It feels like I slept all night, but only five hours!?" I do not take the mask of. The only time the mask if off is if I do it unconsciously which rarely happens.

7) How much caffeine do you consume during the day? And how close to bedtime do you consume it?

0 mg caffeine. I strictly stay away from caffeine or any other substance that might disturb sleep. I also do not take other medications other than the medication for colds and flus that I have developed these past few days, but that is tapering off.

Finally, as the others have said, you're taking way, way, way too much melatonin. And as Julie has suggested, you ought to start tapering off that megadose of melatonin 3-5 mg at a time. To give you an idea of just how big that dose you are taking is, consider this: Studies have shown that the usual dose of melatonin for insomnia ought to be 0.3 to 5 mg. At 15 mg, you are taking 15-50 times the recommended dose.

Yes my dosage is high, but once again, it is the only thing that "seems" to work that I have tried. I have not tried other sleep medication, not even valerian root or anything else, only melotonin. So yeah if any of this information helps you I will be so happy. I am really hoping there may be some sort of indication of what my problem is. I would also like to add that this has been occuring to me for a long time, even before ASV therapy, although I think the therapy helped make it less severe. I always wake up at "around" the same time feeling refreshed although I am truly not. Please if anyone can help me that would be great

[Julie]

You may be accustoming your 'system' to the Melatonin similar to what happens in addiction, so that you need (as you said yourself) more and more, totally counterproductive, and you must do something else. Now, not next week, etc. You're playing with fire.

[sleepinow]

What would be your suggestion for me to do? And what specialist should I see for this problem if that is if you suggest it? I have a pulmonologist but Im not sure that is the right type of doctor for my issue

[MitzyG]

Here's a PURE amateur opinion. I tried Melatonin and it didn't work. I then tried a blue light and it really helped alot...particularly if I'm traveling far to get over jetlag. I use the light to stay awake, my body naturally becomes tired at bedtime.
http://www.usa.philips.com/c/light-therapy/11625/cat/

I didn't notice any side effects...it's just 30 mins of light. You do whatever you want while you're doing it (read, eat, other activities). It helps me get back on a normal "schedule" so that I'm not awake at the wrong time then sleeping at dinner.

[robysue]

sleepinow,

Most adults do not need 10 full hours of sleep each night; eight to nine hours of sleep is usually plenty of sleep. And though it is counter intuitive, too much sleep can be just a problematic as too little sleep.

What was your pre-PAP sleep schedule like?

You have a 10 1/2 hour "time in bed" window from 2:00 AM to 12:30 PM. And you say you wake up four or five hours after you go to bed. So you are waking up at 6:00AM or 7:00AM, which is a pretty typical time in the average circadian cycle for people to wake up. It could be that your typical circadian rhythm is not as far off "normal" as you think it is and you're not as much of a night owl as you think you are. And even if you have blackout curtains on your windows, it could be there's still enough of a change in the ambient light plus other subtle signals (like an increase in traffic noise perhaps) that are providing clues to your body that "It's time to get up" at 7:00am." And that's why you "feel awake, although [you also feel that your] mind and body really needs rest." When the body's circadian rhythm says "It's time to be awake", it's rather difficult to get (back) to sleep regardless of how tired you are in either mind or body.

Out of curiosity: Are you a shift worker who cannot go to bed any earlier than 2:00AM? Or would a 10:30pm to 7:00am sleep window work just as well in terms of your day-to-day life?

If you're a shift worker
If you're a shift worker, part of your problem may be that you're a natural morning lark on a night owl's schedule. Shift workers often have problems associated with sleeping at the "wrong time" for their circadian rhythm. You might want to google "shift worker sleep disorder." (See http://www.webmd.com/sleep-disorders/gu ... c-overview for a good rundown of this problem.) If you are a shift worker and you truly cannot get to bed much before 2:00 AM because of job-related issues, you might want to mention to your PCP or a sleep doctor that you're having trouble sleeping during the time frame that is necessary for your sift work. There are things that can be done to minimize the sleep problems related to shift work. Some of them involve taking prescription medication exactly as the prescribing doctor says to take it.


If you are NOT a shift worker
But if you are NOT a shift worker and there is nothing preventing you from sleeping on an earlier schedule, you just might sleep better if you worked on increasing the sleep at the bedtime end of the night rather than trying to fix the 7:00AM wake with truly massive doses of melatonin. Of course, you can't just expect to move bedtime from 2:00AM back to 10:30-11:00 PM in one fell swoop. If you simply tried going to bed at 10:30 pm, you'd likely lie in bed fighting to get to sleep for several hours on end.

But what you could do is work on moving bedtime back a little at a time. And properly taking the melatonin may help with moving the bedtime back. (More on that in a minute.) You could try making sure that you're getting to bed every night by 1:45 for a week or so. And if you get to sleep ok with the slightly earlier bedtime, then move bedtime back to 1:30 for a week. Keep adjusting the bedtime back by 15 minute increments until you move bedtime all the way back to 11:00 or 10:30 pm.

At the same time, go ahead and get up when you wake up between 6:00 and 7:00 AM. If you feel tired, but you are also feeling "awake", listen to that feeling of "being awake." You can always take a nap later on if you start to feel really sleepy before it's your (current) wake up time of 12:30 pm. The idea is to allow your body's natural circadian rhythm (rather than the massive doses of melatonin) to determine your natural wake up time.

And if you're using melatonin to attempt to shift the sleep schedule, it helps to take 0.3 to 5 mg of melatonin about 6 hours before the desired bedtime instead of taking it right at bedtime. There's a natural lag between when the melatonin our body makes starts to increase and the time that we feel sleepiest. By taking the melatonin in advance of the desired bedtime, you increase the chances of becoming sleepy when you want to be sleepy.

[sleepinow]

sleepinow,

Most adults do not need 10 full hours of sleep each night; eight to nine hours of sleep is usually plenty of sleep. And though it is counter intuitive, too much sleep can be just a problematic as too little sleep.

What was your pre-PAP sleep schedule like?

You have a 10 1/2 hour "time in bed" window from 2:00 AM to 12:30 PM. And you say you wake up four or five hours after you go to bed. So you are waking up at 6:00AM or 7:00AM, which is a pretty typical time in the average circadian cycle for people to wake up. It could be that your typical circadian rhythm is not as far off "normal" as you think it is and you're not as much of a night owl as you think you are. And even if you have blackout curtains on your windows, it could be there's still enough of a change in the ambient light plus other subtle signals (like an increase in traffic noise perhaps) that are providing clues to your body that "It's time to get up" at 7:00am." And that's why you "feel awake, although [you also feel that your] mind and body really needs rest." When the body's circadian rhythm says "It's time to be awake", it's rather difficult to get (back) to sleep regardless of how tired you are in either mind or body.

Out of curiosity: Are you a shift worker who cannot go to bed any earlier than 2:00AM? Or would a 10:30pm to 7:00am sleep window work just as well in terms of your day-to-day life?

If you're a shift worker
If you're a shift worker, part of your problem may be that you're a natural morning lark on a night owl's schedule. Shift workers often have problems associated with sleeping at the "wrong time" for their circadian rhythm. You might want to google "shift worker sleep disorder." (See http://www.webmd.com/sleep-disorders/gu ... c-overview for a good rundown of this problem.) If you are a shift worker and you truly cannot get to bed much before 2:00 AM because of job-related issues, you might want to mention to your PCP or a sleep doctor that you're having trouble sleeping during the time frame that is necessary for your sift work. There are things that can be done to minimize the sleep problems related to shift work. Some of them involve taking prescription medication exactly as the prescribing doctor says to take it.


If you are NOT a shift worker
But if you are NOT a shift worker and there is nothing preventing you from sleeping on an earlier schedule, you just might sleep better if you worked on increasing the sleep at the bedtime end of the night rather than trying to fix the 7:00AM wake with truly massive doses of melatonin. Of course, you can't just expect to move bedtime from 2:00AM back to 10:30-11:00 PM in one fell swoop. If you simply tried going to bed at 10:30 pm, you'd likely lie in bed fighting to get to sleep for several hours on end.

But what you could do is work on moving bedtime back a little at a time. And properly taking the melatonin may help with moving the bedtime back. (More on that in a minute.) You could try making sure that you're getting to bed every night by 1:45 for a week or so. And if you get to sleep ok with the slightly earlier bedtime, then move bedtime back to 1:30 for a week. Keep adjusting the bedtime back by 15 minute increments until you move bedtime all the way back to 11:00 or 10:30 pm.

At the same time, go ahead and get up when you wake up between 6:00 and 7:00 AM. If you feel tired, but you are also feeling "awake", listen to that feeling of "being awake." You can always take a nap later on if you start to feel really sleepy before it's your (current) wake up time of 12:30 pm. The idea is to allow your body's natural circadian rhythm (rather than the massive doses of melatonin) to determine your natural wake up time.

And if you're using melatonin to attempt to shift the sleep schedule, it helps to take 0.3 to 5 mg of melatonin about 6 hours before the desired bedtime instead of taking it right at bedtime. There's a natural lag between when the melatonin our body makes starts to increase and the time that we feel sleepiest. By taking the melatonin in advance of the desired bedtime, you increase the chances of becoming sleepy when you want to be sleepy.

Yes I understand that most adults don't need 10 hours of sleep. I should of clarified that those ten hours includes the time that I spend awake in bed which means that I am not sleeping all the time in the 10 hours. My pre-pap schedule was pretty much the same but I used to go to bed at around 12:00 am and thus wake up even earlier. It seems no matter what time I try to sleep, I always wake up. For instance, I remember waking up this morning around 6ish and saw that there was no light coming through the curtains or on the side of it. I taped up my curtains so that no light passes through and so I would wake up sometimes when it is pitch black outside. It does not work. I have been having this issue for the longest time now and do not know what I should do. I am considering quiting my concierge job because they're scheduling is out of whack all the time. I always get my 3 - 11pm shifts but the job demands a lot of schedule changing which is something I can not do

[Julie]

Are you tired and therefore need more sleep, or just think you should be sleeping more? I only get 5-6 hrs a night if that, and it works for me. Not everyone sleeps to a prescribed number, and while it's 'supposed' to be good for you to get more, if it's a problem, at least for now maybe just go with the flow and relax. Unless you feel the physical need for more.

[sleepinow]

Yes I feel very tired if I do not get at least 9 hours. I always get the need for a nap if I sleep less. If I sleep around 10 hours, I do not need to nap and feel more refreshed. I have been trying to pinpoint what is wrong with me, but still do not come up with an answer. While it may be the small light passing through the side of the shades, it does not make sense that I also wake up when there are no lights

[Julie]

What kind of medical work-up have you actually had, what bloodwork, etc?