Is interupted sleep considered insomnia?

[Ruinednose]

is it a type of insomnia? interupted sleep? i have no problem getting to sleep or returning to sleep any time after an awakening, but i toss and turn mainly on the second half of the night, i wake up a lot.
is that insomnia? or something else?

[robysue]

Some docs will refer to it as "sleep maintenance insomnia" and some will refer to it as "fragmented sleep".

It doesn't really matter what the heck they call it. The problem is that this kind of problem can seriously affect the quality of your life AND it can be devilishly difficult to fix. Sometimes CBT-I tools will help; sometimes they don't seem to do much. Most of the time sleeping medication like Ambien, Sonata, Lunesta don't do much good.

My current sleep doc and I are both frustrated by a similar pattern in my own sleep that's been present for at least a year. (And this is in addition to my circadian rhythm problems.) We're in a "holding" pattern with me taking Ambien as necessary to try to keep the circadian rhythm problems manageable and attempt to relieve part of the night time wakes, but knowing full well that Ambien doesn't do much to actually keep you asleep during the second half of the night. The doc is aware of a new sleep medication that has not yet obtained FDA approval, but which works in a very different fashion than the current sleeping medications. Once it obtains FDA approval, he wants me to give that a shot since it looks much more promising for this kind of problem, at least according to him. I don't recall the name of the drug off the top of my head. If you really want to know, let me know and I'll try to spend some time this evening finding my written copy of what it's called.

[49er]

Here it is RS,

http://www.drugs.com/suvorexant.html

I may give this a shot if it seems appropriate for my situation. I am sure I will have no problem getting PCP to prescribe it.

49er

Some docs will refer to it as "sleep maintenance insomnia" and some will refer to it as "fragmented sleep".

It doesn't really matter what the heck they call it. The problem is that this kind of problem can seriously affect the quality of your life AND it can be devilishly difficult to fix. Sometimes CBT-I tools will help; sometimes they don't seem to do much. Most of the time sleeping medication like Ambien, Sonata, Lunesta don't do much good.

My current sleep doc and I are both frustrated by a similar pattern in my own sleep that's been present for at least a year. (And this is in addition to my circadian rhythm problems.) We're in a "holding" pattern with me taking Ambien as necessary to try to keep the circadian rhythm problems manageable and attempt to relieve part of the night time wakes, but knowing full well that Ambien doesn't do much to actually keep you asleep during the second half of the night. The doc is aware of a new sleep medication that has not yet obtained FDA approval, but which works in a very different fashion than the current sleeping medications. Once it obtains FDA approval, he wants me to give that a shot since it looks much more promising for this kind of problem, at least according to him. I don't recall the name of the drug off the top of my head. If you really want to know, let me know and I'll try to spend some time this evening finding my written copy of what it's called.

[SleepyToo2]

I would not be so sure about rushing to my doc to get him to prescribe it for me. The higher doses have some safety concerns, and I note that there has been impairment of next day driving. Not exactly the ideal treatment. Also, there is a concern about drug interactions with some fairly common drugs that need to be clarified. Finally, I note that they are considering making it a controlled drug, which would make it less accessible. I would be looking hard for alternative treatments for interrupted sleep. Stress is certainly one for me. A dog that won't sleep through the night is another! A low dose of melatonin (1 mg) usually helps me stay asleep, although it can be quite difficult to find a dose that low.

[Nick Danger]

Hi, RuinedNose,

Frequently interrupted sleep (if it meets certain criteria) is also a type of insomnia: the DSM V (the diagnostic manual used by psychiatrists and psychologists) lists 3 different sleep problems that can be diagnosed as insomnia (if they meet certain conditions): (1) difficulty falling asleep; (2) difficulty maintaining sleep; (3) early-morning awakening with inability to return to sleep.

Nick

[49er]

I would not be so sure about rushing to my doc to get him to prescribe it for me. The higher doses have some safety concerns, and I note that there has been impairment of next day driving. Not exactly the ideal treatment. Also, there is a concern about drug interactions with some fairly common drugs that need to be clarified. Finally, I note that they are considering making it a controlled drug, which would make it less accessible. I would be looking hard for alternative treatments for interrupted sleep. Stress is certainly one for me. A dog that won't sleep through the night is another! A low dose of melatonin (1 mg) usually helps me stay asleep, although it can be quite difficult to find a dose that low.

I totally understand what you are sying SleepyToo2 and normally, I would stay the heck away from new drugs. But I am at the point where I may not have a choice.

Hopefully, if I can solve the problem of not feeling drugged after dinner and falling asleep prematurely that it can lead to a stabaliziation of my sleep cycles. But even if I solve that problem, I still may need some help pharmaceutically at least for a while.

I have tried various meds and non med remedies when I have managed to not fall asleep prematurely to no avail. Melatonin has particularly been a disaster no matter what dose I try.

[Wulfman...]

is it a type of insomnia? interupted sleep? i have no problem getting to sleep or returning to sleep any time after an awakening, but i toss and turn mainly on the second half of the night, i wake up a lot.
is that insomnia? or something else?

What machine and pressure setting(s) are you using?
If you're using an APAP in a range of pressures, I'd be suspicious of the pressure changes disturbing your sleep before thinking of something like "insomnia".


Den

.

[ems]

http://www.drugs.com/suvorexant.html

49er

Thanks! When it's approved I'll definitely discuss with my doctor. I doubt if it's worse than any of the other sleep meds out there... and may even be better.

[robysue]

Here it is RS,

http://www.drugs.com/suvorexant.html

I may give this a shot if it seems appropriate for my situation. I am sure I will have no problem getting PCP to prescribe it.

Yep. That's the one. I recognize the name, but can't "recall" it from scratch (yet). Both my psychiatrist and my sleep doc think its a very reasonable thing for me to try once its available. I'm still having a significant number of wakes each night, and I don't remember them all. But they're enough to cause real problems with how I feel in the morning and how I function during the daytime.

[JDS74]

I track awakes by turning off my CPAP machine and immediately turning it back on. That leaves a gap in the wave form data which allows counting, and more important, tracking by time.

You can see them in the pattern of use display (Respironics & Encore). The green bar shows the break lines.

In this really bad case, you can see 8 awakenings over a period of 8 1/2 hours.

It will likely work with ResMed and other manufacturers but I don't know what the display would look like.

SleepyHead would show separate sessions so that would be a way to track using SleepyHead

[robysue]

I would not be so sure about rushing to my doc to get him to prescribe it for me. The higher doses have some safety concerns, and I note that there has been impairment of next day driving. Not exactly the ideal treatment. Also, there is a concern about drug interactions with some fairly common drugs that need to be clarified. Finally, I note that they are considering making it a controlled drug, which would make it less accessible. I would be looking hard for alternative treatments for interrupted sleep. Stress is certainly one for me. A dog that won't sleep through the night is another! A low dose of melatonin (1 mg) usually helps me stay asleep, although it can be quite difficult to find a dose that low.

Any one who's been around long enough to know my whole story knows I'm a strong believer in non-drug treatments for insomnia in all its forms. I've done serious CBT-I work and it helped tremendously to get me over a serious persistent insomnia crisis situation back in 20101-11.

And yet: I've still spent the last three and a half years fighting insomnia and fragile, fragmented sleep problems----mostly through CBT-I. I've worked hard on my sleep hygiene. I've worked hard on stress reduction. I've learned how to build closure into the end of my day and not spend time worrying when I'm in bed. I don't stress out about finding myself awake in the middle of the night. I don't attempt to remember each and every wake that I have, and the truth is I don't remember most of the wakes any more. I want to believe that the wakes I don't remember are not important in terms of my over all sleep quality . In short: I've worked hard and yes my sleep is much better than where it was 3 1/2 years ago when I was dealing with a truly fearsome insomnia monster caused by the agony of my CPAP adjustment trials. But my insomnia has continued to wax and wane with the seasons and years, and overall my sleep remains quite fragile and fragmented in spite of 3 1/2 years of very hard work at making non-drug insomnia treatments work.

And yes: I'm aware of the need to manage stress; and I use yoga and meditation as ways of handling stress and building positive mindfulness in my life. (I enjoy and get a lot out of yoga and meditation.)

And yes, in the last year at the insistence of my 4th sleep doc, whom I trust, I've even reluctantly added judicious use of 2.5mg of Ambien to my arsenal of weapons in the Insomnia Wars. Both the sleep doc and I know the Ambien doesn't do diddly squat to help with my middle-to-late night wakes and arousals, but it can provide me with a solid three hours of sleep now and then without a wake. And I've learned to balance out the need to get some real sleep now and then with the fact that I do have problems with "Ambien hangover" even at a 2.5 mg dose.

As for 1 mg melatonin: Been there, done that (TWICE on the advice of my sleep doc), and all I have to show for it is another new TMJ nightguard (or two). Seriously: Both times I tried melatonin, it severely aggravated my TMJ problems and did nothing to fix the fragmented sleep.

Last summer when things were going downhill again in terms of the quality of my sleep, my sleep doc suggested another round of sleep tests which showed the PAP controls the OSA, but the insomnia is still pretty rampant in spite of all the behavioral changes I've made through the years to address the typical causes of insomnia. And the kicker (for me) was that my sleep was far more fragmented objectively than it felt subjectively: Last summer I was remembering 2-4 wakes per night and was happy enough about that. The sleep tests and actigraph test showed, however, that I was waking up an average of 9 times a night in 6-6.5 time in bed sleep window. In short, I was waking up frequently enough to make it difficult to get through a full sleep cycle without some kind of interruption. No wonder I was waking up not refreshed.

And so in light of all I've been through in the last 3 1/2 years, I am willing to try suvorexant once it comes on the market. Both my sleep doc and my psychiatrist believe that the fact that it does not work in the same way as Ambien, Sonata, Lunesta, etc, means that it's worth a try. Because right now something new needs to be added to the arsenal, and we're all (me, the sleep doc, and the psychiatrist) out of other new ideas to try. If I have side effects, well, there's always "discontinue the medication" and I won't be any worse off than I am now.

[Jay Aitchsee]

It seems to me we're pretty much in the "try this and see what happens" stage of sleep science. Once the obvious culprits have been ruled out, ie, sleep hygiene, SDB, PLMD, pain, hormonal, vitamin, and mineral deficiencies, as possible causes of sleep fragmentation, the medicos seem to be pretty much at a loss. I see references to "alpha intrusions" as possible indicators or causes of arousals, but nothing about how to quiet them. Maybe, this new approach (suvorexant) will work, maybe not.

[robysue]

I track awakes by turning off my CPAP machine and immediately turning it back on. That leaves a gap in the wave form data which allows counting, and more important, tracking by time.

Yep. I do this. It started off not as a way of tracking my wakes, but rather as an aereophagia "defense." Way back when when I woke up and I was worried about air in the tummy, I'd just hit the ramp button. But with a min EPAP = 4, the ramp is diabled. So I started turning Kaa (my BiPAP) off and on whenever I woke up in order to reset the pressures to 6/4 and minimize my discomfort.

Well it's become a habit: I wake up and turn Kaa off/on and resettle myself down and go back to sleep. I don't remember most of these Off/On cycles the next morning, and I'm glad I don't. If I remembered all my wakes, I'd feel even tired during the day that I do feel.

But this is interesting: When you look at the SH data for the nights that also had data from the actigraph test the sleep doc, I turned Kaa off and on about 5-6 times, but the average number of wakes was 9. So there are times when I'm waking up and NOT automatically turning Kaa off/on and getting back to sleep pretty quickly to NOT do my automatic turn Kaa Off/On routine.

My real problem is: On the worst nights, the overall number of mid-sleep wakes is large enough to make it difficult to get a full sleep cycle in between wakes regardless of whether I remember them or not. And even on the good nights, my longest "session" is seldom much longer than 90 minutes. In other words, on the good nights, I get one or two uninterrupted cycles of sleep and then another one or two pretty fractured cycles of sleep.

[JDS74]

On my bad nights, I get a single sleep cycle followed by a sequence of 45-50 minute sleep intervals. My best guess, looking at the data, is a sleep latency of less than two minutes when all that is going on.

Even so, after my switch to ASV, I do feel better.

[OhHelpMe]

What machine and pressure setting(s) are you using?
If you're using an APAP in a range of pressures, I'd be suspicious of the pressure changes disturbing your sleep before thinking of something like "insomnia".


Den

.

Agreed.