Not sure where to begin!

[MissScooter]

Hello all,

Some background:
I'm a 25 year old female who has dealt with insomnia and waking up 4-5 times a night for as long as I can remember. I recently went of sleep meds (ambien) when I moved across the country. When I went to the doctor here, he mentioned that my waking up a lot might be sleep apnea, so I did a sleep study.

They observed hypopneas.
I ended up with an AHI of 6 but an AHI of 19 during REM sleep.
Total arousals were 108, arousal index of 17 per hour.
Percentage spent in each stage: N1: 7.7 N2: 73.2 N3: 4.3 REM: 14.8
Baseline O2: 96%, Lowest O2 was 90% in nonREM and 93% in REM
I don't snore at all. (I already pretty much knew this one)
I'm at a low weight (140 at 5'7"), and they observed hypopneas even when sleeping on my side.

Is it normal that AHI spikes during REM?
Also spending so little time in deep sleep, it seems my numbers were low compared to what I read it should be. Is this from the hypopneas?

My main question is, will I be able to go back on sleep meds with a mask? I I tend to take on average 45-90 minutes to fall asleep with no meds, and 15-25 with ambien. They don't want me on ambien now, but mentioned if I get cpap or dental device that I could go back on them. Do others take sleep meds for insomnia with cpap? I fell asleep in 21 minutes during the test (with ambien) and they remarked on my results that it was long. I was actually pretty impressed with that time.

Another question is that the doctor said I would possibly be a good candidate for mandibular advancement dental device. But mentioned it isn't 100% guaranteed to work, and he mentioned the fact that I don't snore at all is odd, and possibly makes me not a good candidate. I also read online that people get jaw discomfort and have other issues with it.

Should I be looking more into cpap? It just seems so guaranteed to work if you can get the correct mask and get used to it. The dental seems iffy, and a lot of things I read online are remarking on how it improves snoring.

[BlackSpinner]

Is it normal that AHI spikes during REM?

Yes it happens to many people, your body "relaxs" more deeply during deep sleep.

Start by getting a cpap machine and get things under control. It is the gold standard and works well without the side effects that surgery can have and always remember that "success" means something different for surgeons & dentists then it does for you. ("The operation was a success. Too bad the patient died" is an old medical joke)

There is no reason you can't take your meds to sleep with a cpap machine in order to help you get used to it.

[kaiasgram]

Totally common for sleep apnea to be worse during REM sleep.

Likely all those arousals were preventing you from staying in deep sleep.

Re your main question: You should certainly be able to use your sleep med when you're using your machine. Be sure to get a full data CPAP machine so you can watch how your therapy is going (important with or without use of a sleep med). Many people take sleep meds especially during the adjustment phase of PAP therapy.

You're off to a great start, doing your research ahead of time.

[hegel]

Another way to think about this is, perhaps cpap therapy will eventually eliminate the need for ambien.

It may be that your body/mind associate sleep with danger--sleep apnea. Apnea's can trigger adrenaline rushes. It may be that once you re-learn that sleep is safe, restful and rewarding, you will be able to fall asleep more easily.

Just my speculation.

[vitomatt]

I'm going to address other issues non apnea related.

Do you look at a cell phone or ipad type machine before bed?
Those emit blue light which is proven to cause insomnia and to add length of time to fall asleep. If so STOP using them at least one hour before bed if not two hours or at least wear amber colored sunglasses when using... same applies to LED TV -- stop watching that before sleep -- if not turn the brightness and backlight WAY DOWN....

there are many articles about your presleep routine - google them... they can help w/ insomnia.
also try using benadryl (Diphenhydramine) as a sleep aid -- not ambien... it is non-habit forming. its avail OTC. also look at Doxylamine succinate (Unisom). also OTC.

Careful of other stimulants... not just coffee (never past 3 pm) or chocolate which can have alot of caffeine.

[BlackSpinner]

also try using benadryl (Diphenhydramine) as a sleep aid -- not ambien... it is non-habit forming. its avail OTC. also look at Doxylamine succinate (Unisom). also OTC.

No. Not a nice sleep aid. Some of us sleep very badly with that, never getting into deep sleep.

[MissScooter]

Thanks for the help guys!

For sleep aids I've tried about everything, different doses of melatonin, benadryl, doxylamine, even some anti anxiety meds. Nothing really seems to work. I've tried no tv after a certain time. Even as a kid in early highschool when I didn't have a cell phone (I've actually only owned a smart phone for a year) and had to turn the tv off after some time I had trouble.

I will say doxylamine sort of works, to the point where it will make me exhausted but not make me fall asleep. So I'll lay there in kind of an exhausted stupor and that's sort of uncomfortable for me. I'll sleep way longer (I slept like 11 hours last time) and feel way worse in the morning. Doesn't seem to wear off or something. Not sure why.

I've actually been on ambien for years, but went off it for a few months without any real problems when I moved.
I recently gave up energy drinks, and only drink coffee occasionally in the morning. Empty calories anyway!


That's an interesting thought hegel. I'd be curious if perhaps that's why!