NEWBIE - WITH SLEEP STUDY RESULTS

[Phoenix33YearOld]

Hello Everyone.

I'm new to the message board...but have been browsing for the past few months getting advice. I'm hoping someone can point me in the right direction and give me some good settings for my APAP machine based on my Sleep Study Results.

I am currently going through TMJ therapy before trying a dental device...(but the dentist is telling me it will be at least 8 weeks before the TMJ therapy will be completed, so I purchased a used Apap machine in the meantime off Craigslist.) My insurance would only cover one treatment plan at a time...and my brain fog has been effecting my memory, motor skills and relationships. (And it's getting progressively worse.)

First of all,I have a used Philips Respironics REMstar Auto A-Flex. Here it is: http://imageshack.com/a/img922/7871/Ji8Vls.jpg

Here are the links to my sleep study:

http://imageshack.com/a/img921/9461/OHoLFc.jpg

http://imageshack.com/a/img924/7206/VaUrOH.jpg

http://imageshack.com/a/img923/6120/49EO6s.jpg

I'm a total newbie on the sleep test results, so I'm having a hard time telling what most of this stuff is. But I was able to determine that my APAP machine should be set between 5 cm and 10cm...so it's been like that for a few weeks, but it doesn't seem to be helping. (Are there other settings I may have missed?) When I wake up I'm always still at 5cm on the LED panel.

I've tried a few different types of masks (nose was the one that fit the best and didn't leak)...I've also been trying to sleep on my side as it looks like I'm a back sleeper and that was contributing to my apenas. (I've been trying the tennis ball trick to get off my back...so far, still not helping.)

Any feedback or suggestions of vitamins (5htp in the AM seems to waken me up) or diet or APAP machine settings would be helpful. I'm not overweight according to my BMI and 33 years old.Apena does run in my family

[robysue]

Phoenix33YearOld,

Your used APAP is known around here as a Philips Resprionics System One (Series 50) APAP or an PR S1 series 50 APAP for short. The PR S1 series 50 APAP is high quality machine that records full efficacy data, but it was discontinued about 3 years ago. It is also fully compatible with the current version of the Sleepy Head software that we all talk about so much around here. (In fact, Jedi Mark started working on SH because the Encore software for the PR S1 was such a pain in the butt to use and it didn't show you the wave flow data that everybody knew was recorded on the SD card.)

So you've got yourself a nice machine.

Next, you write:

I'm a total newbie on the sleep test results, so I'm having a hard time telling what most of this stuff is.

You might find my blog entry Understanding the data in your sleep test useful for figuring out the meaning of all the numbers in your own sleep test.

Your overall OSA is in the mild range (diagnostic AHI between 5 and 10), but your REM AHI is in the moderate range (AHI between 15 and 30). Given the history of insomnia, the doc who is recommending a CPAP trial may be hoping that treating the OSA will also eliminate or reduce the insomnia: Insomnia can be a symptom of untreated OSA and treating the OSA will fix the insomnia in that case. (But there are lots of things that can cause insomnia in addition to the untreated OSA.)

****************
Hello Everyone.

I'm new to the message board...but have been browsing for the past few months getting advice. I'm hoping someone can point me in the right direction and give me some good settings for my APAP machine based on my Sleep Study Results.

I am currently going through TMJ therapy before trying a dental device...(but the dentist is telling me it will be at least 8 weeks before the TMJ therapy will be completed, so I purchased a used Apap machine in the meantime off Craigslist.) My insurance would only cover one treatment plan at a time...and my brain fog has been effecting my memory, motor skills and relationships. (And it's getting progressively worse.)

But I was able to determine that my APAP machine should be set between 5 cm and 10cm...so it's been like that for a few weeks, but it doesn't seem to be helping. (Are there other settings I may have missed?) When I wake up I'm always still at 5cm on the LED panel.

Without seeing some data in SH, I can't tell you what might be going on. But it could be that 5cm of pressure is all you need to prevent most of your apneas and hypopneas and so the machine sees no reason to increase the pressure. I'd strongly suggest downloading SleepyHead 0.9.8-1 (the most recent version of SH that is still available) and seeing what some of the detailed data looks like.

I've tried a few different types of masks (nose was the one that fit the best and didn't leak)...I've also been trying to sleep on my side as it looks like I'm a back sleeper and that was contributing to my apenas. (I've been trying the tennis ball trick to get off my back...so far, still not helping.)

Is the tennis ball trick not working because it's keeping you up all night? Or are you falling asleep in your side and then turning onto your back in spite of the tennis ball? And then waking up uncomfortable because of the tennis ball?

My own suggestion is to ditch the tennis ball trick and sleep the way you want to sleep. If you're using the APAP, the machine will increase the pressure enough to prevent the apneas from happening even if you are sleeping on your back.

APAP machine settings would be helpful.

We don't know enough about your settings or your data to make any reasonable suggestions yet.

So, what are your settings?

Can you post some daily detailed data from SH for a couple of typical nights?

Can you describe whether you are having trouble falling asleep or staying asleep with the mask on your nose?

Can you describe anything that's making you uncomfortable during the night? Do you wake up with a dry mouth? Are you dealing with a lot of nasal congestion? Do you feel like there is not enough air coming in through the mask to inhale comfortably? Is there too much air coming in through the mask to exhale comfortably? Do leaks wake you up in the night?

[palerider]

Your used APAP is known around here as a Philips Resprionics System One (Series 50) APAP or an PR S1 series 50 APAP for short.

or a 550 for shorter

[palerider]

But I was able to determine that my APAP machine should be set between 5 cm and 10cm...so it's been like that for a few weeks, but it doesn't seem to be helping.

the problem with that setting is that it's a *guess*... well, probably not even much of a guess, just a 'meh, whatever' number.

both the minimum and max pressures are probably too low.

get sleepyhead, pull the data from your sd card, and post a screenshot or two, arranged as shown in the links that are in my sig.

[Phoenix33YearOld]

Thank you so much everyone for the feedback already. I will download Sleepy Head and import the SD card in and get some readings and report back to this thread.

In the meantime, just to answer some of the questions robysue posted:

The tennis ball trick is still kind of a work in progress over the last few days. I find that I'm still rolling over onto my back while sleeping (I've always slept on my back but read that for mild apnea, training yourself to sleep on your side may eliminate the apenas in general. So far no luck.) It makes sense that the APAP machine should kick in on whatever pressure I need and help - whether I'm on my back or not. I'll ditch the tennis ball trick and just sleep on what is most comfortable and keep using the machine.

I also have a tempurpedic bed with an adjustable frame with a Zero G feature. (Almost brand new set-up.) Experimented with this set-up (again sleeping on my back) with the APAP machine - but still no relief. Very bad nights sleeping and constant brain fog the next day.

I don't have trouble falling asleep. Usually within 10 minutes I'm sound asleep. I'm not getting up to use the bathroom frequently...but it does seem like around 3am every night I'm awake suddenly for at least 45 minutes to an hour. No idea how often I'm up in between those times, but according to my sleep study - it showed I woke up 24 times on the night of my study.

I don't wake up with a dry mouth...but I do have constant nasal congestion. (And when I saw the dental device dentist he took scans of my nose and jaw and said that I have a deviated nostril - so one side of my nose is harder to breath through than the other.) Still, the over the nose mask is the only one I've found that I can keep on all night and still get some sleep. (The full face mask made me feel like I'm suffocating.) No leaks that I know of.

I will post the custom Apap machine settings as well. Currently I have it set between 5cm and 10cm.

Thank you so much everyone...and feedback or ideas is greatly appreciated!

[Phoenix33YearOld]

Alright...updated, here are my current settings for my machine.

Any feedback is greatly appreciated !!!


mode: auto
auto max: 10.0
auto min: 5.0
Flex type: c-flex
C-flex: 2
ramp time: 0
tubing type lock: on
tubing type: 22
System One resistance: 0
lock system: off
system one humidifcation: on
humidifer: 3
auto-on: on
auto-off: on
mask alert: off
mask fit check: off
humidifer led backlight: off
show ahi/leak/pb: on
split night: off
silent mode: on
language: english

[robysue]

Phoenix33YearOld,

The settings are perfectly reasonable for a starting point. How long have you been PAPing? Only a few days? If so, you need to gather data for a week or so before changing anything other than the humidifier setting and (possibly) the flex setting.

During the first week or two on the machine, you mainly want to look at the leak data: If there is evidence of a serious leak problem, you have to address it. Watch the AHI, but try to avoid the temptation of adjusting the pressure settings after every single night. You need some long term data before making any adjustments to the pressure settings.

Once you have several days worth of data, it's reasonable to start looking at the AHI and whether there are still clusters of events and whether the machine is detecting and responding to a lot of snores and flow limitations.

[Phoenix33YearOld]

Thanks everyone for the suggestion on SleepyHead. I've downloaded the program and uploaded my results below. (I've been using the machine for a few weeks now so It was very interesting looking through the data.)

Again, since I'm setting my machine myself...I'm really curious to know if the machine is set right for what I need. I'm also wondering if since I have such a slight apnea, if I may have been misdiagnosed and just have insomnia? (Also, I take .05 mg of Levothyroxin for my thyroid...I read on the message boards here that this could be factoring in as well?)

Here is the overview:
http://imageshack.com/a/img923/4854/s2Uv40.png


Here is a good night with the machine. (Felt so rested and alive the next day) :

http://imageshack.com/a/img924/7360/hxuVc7.png

http://imageshack.com/a/img921/3639/TgjXF9.png


Unfortunately the mask i was using sprung a leak and appears to have been discontinued...so here's an average night for me...slept horrible and feel depressed and like a zombie:

http://imageshack.com/a/img921/9049/PZNL0q.png

http://imageshack.com/a/img921/9798/ytSYaZ.png

I really appreciate the feedback everyone !! All suggestions are welcome!!

[Phoenix33YearOld]

Alright...just following up from last nights data from SleepyHead. Slept horrible..tossing and turning all night long.

I've included pics below of the machine settings as well as the sleep data. PLEASE let me know if there is any suggestions on getting a good nights sleep!

http://imageshack.com/a/img921/917/EHEOMl.png

http://imageshack.com/a/img922/7799/s6ADls.png

http://imageshack.com/a/img921/8090/zS64hz.png

[robysue]

Phoenix33YearOld,

It's easiest for me to talk about the data in the order you posted it.

Here is a good night with the machine. (Felt so rested and alive the next day) :

http://imageshack.com/a/img924/7360/hxuVc7.png

http://imageshack.com/a/img921/3639/TgjXF9.png

Unfortunately you had an Official Large Leak all night long. The AHI data for this night is basically useless because the leaks are so large: When the leaks are as large as yours are, the machine cannot properly track the breathing a lot of the time. Hence it may fail to record events that actually occur That's also why the machine did not increase the pressure at all.

The good news is that if you could sleep well enough to feel rested and alive the next day after this kind of a Large Leak, you will be able to teach yourself how to sleep with the machine in time

so here's an average night for me...slept horrible and feel depressed and like a zombie:

http://imageshack.com/a/img921/9049/PZNL0q.png

http://imageshack.com/a/img921/9798/ytSYaZ.png

There's nothing in this data that screams out, "FIX THIS". The AHI is low enough and except for a small cluster of events just after 2:30, all the events are well isolated from each other. The PR Search algorithm is responsible for the spikes in the pressure graph. At around 0:40 the Search algorithm found some small improvements in your flow rate and so it increased the base pressure up to 6.5 and left it there for a while. When the reverse part of the Search algorithm kicked in at around 1:00, no deterioration occurred as the pressure was being lowered back down to your min pressure setting of 5cm. The machine responds as it is programmed to do after the cluster of events around 2:30 by increasing the pressure by 1cm and waiting to see if the breathing stabilizes after a few minutes. Which it does. The leaks appear to be technically under control, but it sure would have been nice to see the whole leak graph

Note: You can resize the vertical height of the graphs to show the Event Table, the Flow Rate, the Pressure, and the Leak graphs simultaneously. And that would be very useful since it looks like you might need to do some work on the leaks.

I've included pics below of the machine settings as well as the sleep data. PLEASE let me know if there is any suggestions on getting a good nights sleep!

http://imageshack.com/a/img921/917/EHEOMl.png

http://imageshack.com/a/img922/7799/s6ADls.png

http://imageshack.com/a/img921/8090/zS64hz.png

There's nothing in this data that screams out, "FIX THIS". But the Leak graph is still cut off, and that could have some important information. Again, the AHI is plenty low enough. The events are isolated except for one minor cluster around 0:40 or so. You did turn the machine off and on twice during the night. But each of the three sessions is over 3 hours long. (Contrast that to my own data: I count myself lucky when all of my sessions are at least 90 minutes long, since that indicates I'm only waking up after each REM cycle.)

Finally, you write:

Alright...just following up from last nights data from SleepyHead. Slept horrible..tossing and turning all night long.

While I understand that you slept horrible and felt like you were tossing and turning all night, there's nothing in this data that points to "dial winging" as a fix for your problems.

In other words, you need to start tackling the horrible sleep and the tossing and turning with an eye to non-CPAP related sleep behaviors (on the one hand) and a bit of patience for getting used to sleeping with the equipment (on the other hand).

Most people take a while to really learn how to sleep with a six foot hose attached to their nose. It's not exactly normal and some people have a steeper learning curve than others. Most people get everything figured out within a month or so of starting PAP therapy and then start to notice real improvement in terms of how they feel. Very few people have an "A HA" moment where they wake up feeling great and then everything stays peachy-keen and wonderful afterwards. There's a lot of two steps forward, one step back in getting used to CPAP therapy.

As for non-CPAP related sleep behavior issues: Can you answer these questions? It will help us help you figure out what else you might want to try:

1) What is your desired sleep schedule? When would you like to go to bed each night? When would you like to get up each morning?

2) Have you had long term problems with tossing and turning that predate your starting CPAP? If so, how long have you had serious problems with tossing and turning?

3) How long does it take you to get to sleep at the beginning of the night? How comfortable or uncomfortable are you when you are wearing the mask while trying to get to sleep?

4) When you wake up in the middle of the night, what's the first thing you do? What's the first thing that goes through your mind when you wake up in the middle of the night? How long does it typically take you to get back to sleep after you wake up in the middle of the night?

5) What do you think is causing you to toss and turn all night? Just can't get comfortable? (Is the mask or the air pressure an issue?) Legs too restless? Too hot? Too cold? Worrying about too many things? Your mind just won't shut up and let you go to sleep?

6) What do you think the phrase "a good night's sleep" means?

[Phoenix33YearOld]

robysue

Thank you so much for the feedback! I really value you taking the time out of your day to help me get a handle on things. And that's good news that the machine seems to be set correctly and doing what it needs to.

Below are links to the data you asked for. This is from last night and the night before (both very rough nights of sleep for me)

http://imageshack.com/a/img924/8264/GGgUv5.png

http://imageshack.com/a/img921/9049/PZNL0q.png

Your questions about my sleep habits are incredibly valid. Do you think I may just have insomnia and was mis-diagnosed? I do take .05 MG of levothyroxin for my thyroid (I'm taking a few day break from it to see if it has an baring on sleep...so far nothing, but i know it can take a few weeks to clear out of my system.)

The last few weeks with the machine haven't been too terrible in the sense of getting used to the mask. It's uncomfortable - but I found an over the nose mask with a headstrap to keep my mouth shut as the most comfortable option. It usually takes me less than 10 minutes to fall asleep with or without the mask.

My daily sleeping routine is usually in bed betweeen 10:30pm-11:30pm and up between 6am-7am. This is my preferred sleep schedule as well. I work regular office hours and exercise several times a week. My BMI is normal, I'm 33 and I don't appear to snore much if any.

I've always fidgeted during sleep...I move around a lot from side to side - but i tend to prefer sleeping on my back. I was trying the tennis ball trick to trick myself into sleeping on my side - but wouldn't the machine compensate for any kind of breathing difficulty I may be having when I'm sleeping on my back?

My sleep issues began 4-5 years ago....it seemed like I would wake up in the middle of the night around 3am a couple times a month randomly. Then as the years went on, it became more frequent until last year I was waking up several times a week in the middle of the night and having horrible brain fog and exhaustion the next day. I always blamed it on stress with moving (moved to another state a few years ago) or work or relationships...until finally in January i went in for a sleep study and they told me i had mild apnea.

When i wake up in the middle of the night, I'm generally wide awake. Sometimes i have to use the bathroom, but generally I don't. It takes me over 45 minutes to get back to sleep after one of these and from then on it seems like I'm not getting well rested sleep (Just drifting on and off) until i wake up in the morning. This pattern has been almost every night for months now.

I don't believe it's noise related, my place isn't obnoxiously bright in any way. I do have a stressful job that i worry about a lot - but I've had these sleep issues before i started the job I'm currently at. I do think about my job when i wake up in the middle of the night, but i don't dwell on it..so it's always more in the back of my mind. I've tried meditating before bed and that doesn't help me much either.

To me, a good nights sleep is more like a memory. (For some reason last week I had a string of incredible days with the machine, but the mask i was using was leaking - as evidence by the sleepyhead report) and since then nothing. I would say feeling refreshed and energetic in the morning is how i would describe a good nights sleep. Not having this brain fog exhaustion that effects my mood, motor skills and ability to think.

I was in my doctors office this past fall to get my blood and thyroid levels checked and everything was fine. (I'll make another appointment on Monday to check again.) I also had an MRI (I had a concussion years ago) and that checked out fine.

Any thoughts on trying the APAP machine with ambien or marijuana or something to calm me down with? Alcohol has never helped me sleep in the past, so i avoid that as much as possible. Does the APAP machine compensate for any difficulty breathing that may stem from any of these substances?

robysue, you've already been more helpful than any doctor up until this point. Thanks again for any suggestions or ideas!

[robysue]

Your questions about my sleep habits are incredibly valid. Do you think I may just have insomnia and was mis-diagnosed?

I've reviewed the sleep study stuff you posted at the beginning of the thread.

The sleep study shows mild OSA in non REM and moderate OSA in REM. Given the tremendous amount of data that is gathered during an in-lab sleep study AND the fact that you slept for a total of 392 minutes (roughly 6.5 hours) during the study, I believe the diagnosis of mild-moderate OSA is correct.

I do take .05 MG of levothyroxin for my thyroid (I'm taking a few day break from it to see if it has an baring on sleep...so far nothing, but i know it can take a few weeks to clear out of my system.)

Is the levothyroxin designed to take care of hypothyroidism or hyperthyroidism?

Personally, I would be reluctant to stop taking the thyroid medication without consulting the doctor who prescribed it if I were you. While the medication may affect your sleep, untreated thyroid problems can also create problems with sleep. And hypothyroidism creates a lot of problems with daytime fatigue as well.

Leak data comments:

You posted data at http://imageshack.com/a/img924/8264/GGgUv5.png. The leak graph in this data is pretty good. Not quite excellent, but good enough where I'd say you don't need to worry about leaks as the issue if this leak graph looks typical. Yes, there are a few places with largish leaks, but they are very short lived and not worth worrying about.

That said: If leaks are waking you up a lot at night, they've got to be dealt with no matter how small they are.

The data at http://imageshack.com/a/img921/9049/PZNL0q.png doesn't show the leak graph.

The last few weeks with the machine haven't been too terrible in the sense of getting used to the mask. It's uncomfortable - but I found an over the nose mask with a headstrap to keep my mouth shut as the most comfortable option. It usually takes me less than 10 minutes to fall asleep with or without the mask.

So sleep onset insomnia is not the problem.

Would you be more comfortable without the headstrap that you are using to keep your mouth shut? If you are not a mouth breather, you may not need that headstrap.

What is the most uncomfortable thing about the mask or the headstrap when you put it on at the beginning of the night? Comfort is very important: If you are uncomfortable when you fall asleep, it can be difficult to get all the way into deep, restorative sleep.

I've always fidgeted during sleep...I move around a lot from side to side - but i tend to prefer sleeping on my back. I was trying the tennis ball trick to trick myself into sleeping on my side - but wouldn't the machine compensate for any kind of breathing difficulty I may be having when I'm sleeping on my back?

The whole point of having the machine is to allow you to sleep in whatever position you want, including on your back. If the pressure is set correctly, it will prevent your airway from collapsing even if you are on your back.

So---ditch the tennis ball. And allow yourself to sleep on your back. If the machine has to increase the pressure to deal with apneas on your back, well, that's what using an APAP is for. You can always increase the min pressure at a later date if you need to.

My sleep issues began 4-5 years ago....it seemed like I would wake up in the middle of the night around 3am a couple times a month randomly. Then as the years went on, it became more frequent until last year I was waking up several times a week in the middle of the night and having horrible brain fog and exhaustion the next day.

Those could have been post-apnea awakenings. And the horrible brain fog is a typical OSA symptom. It's from the O2 desats as well as the interrupted sleep. Most insomniacs have a lot of tiredness and sleepiness, but not so much brain fog.

But once your body starts doing a lot of waking up at a particular time, it can become a self-reinforcing habit. It can take the body a while to learn to trust the machine and not wake up after the (rare) event that gets by the CPAP defenses.

When i wake up in the middle of the night, I'm generally wide awake. Sometimes i have to use the bathroom, but generally I don't.

You're kind of young to wake up needing to go pee. That also could be related to the OSA. If it is, you should see a decrease in the frequency that you wake up at night needing to go. For some people, that's the first sign that CPAP is doing something positive for them.

It takes me over 45 minutes to get back to sleep after one of these and from then on it seems like I'm not getting well rested sleep (Just drifting on and off) until i wake up in the morning. This pattern has been almost every night for months now.

Ok, I think we're now starting to narrow down what the potential cause of your on-going problems may be. Once you wake up, you can't easily get back to sleep, and even when you do, you're drifting in and out of sleep for the rest of the night.

It's not easy to do, but I think you'd sleep better if you could train yourself to fall asleep far quicker after those middle of the night wakes happen.

Right now your body (and mind) think that it is perfectly ok to lie in bed for 45 minutes to more than an hour not sleeping. You need your body (and mind) to learn that being in bed means being asleep. It's counter intuitive, but one thing that can be very useful in teaching yourself to get back to sleep quickly is to just get up out of bed if you are not yet asleep after about 15-20 minutes of trying. Go into another room and do something really boring and relaxing. Like sit in the semi-dark and listen to some soft music. Read a very dull book. Do a crossword. Do NOT get on the web or start watching TV. The blue light messes up the melatonin cycle and encourages wakefullness rather than getting sleepy. Go back to bed once you start feeling sleepy again.

I don't believe it's noise related, my place isn't obnoxiously bright in any way. I do have a stressful job that i worry about a lot - but I've had these sleep issues before i started the job I'm currently at. I do think about my job when i wake up in the middle of the night, but i don't dwell on it..so it's always more in the back of my mind. I've tried meditating before bed and that doesn't help me much either.

I know you say that you're not dwelling on the job. But if it's always in the back of your mind, that also means that your mind is having a very tough time letting go and falling asleep. This used to be a huge problem for me and it can be still be a problem for me when my sleep is not good for several days in a row. I describe the problem to my hubby as, "My mind won't shut up and let me fall asleep."

Meditation before bed works for some people, but not for everyone. Turns out that people who are really serious about mediation often recommend that you NOT meditate close to bed time. You get more out of meditation in general if it's done at a different time. And, as you've discovered, it's not always effective at helping you get and stay asleep. And your problem is more staying asleep than getting to sleep at the beginning of the night.

But what you may need to do is work on closure at the end of the night. In other words, you may need to work on a routine that lets your mind clear itself of "worrying" about things at the end of the day. A relaxing and enjoyable bedtime routine can help a lot.

Any thoughts on trying the APAP machine with ambien or marijuana or something to calm me down with? Alcohol has never helped me sleep in the past, so i avoid that as much as possible. Does the APAP machine compensate for any difficulty breathing that may stem from any of these substances?

I'm going to be very honest and not try to moralize at all.

Alcohol: A big no-no. Alcohol is a depressant and it does affect the sleep breathing. But the bigger issue is it also messes up the sleep architecture in the second half of the night really, really bad. So you might think that you are (temporarily) getting better sleep, but in reality it's lousy sleep.

Ambien: A lot of sleep docs are willing to prescribe ambien to people who are using CPAP. The affect on the respiration is usually minor and the CPAP can handle it. Ambien doesn't drastically affect the sleep architecture. And most people tolerate it pretty well. Yes, there are the stories of Ambien-induced "sleep-eating", "sleep-driving", "sleep-other activity that should not be done in the sleep." But most people don't have any problems. The biggest downside of taking Ambien for a while is that it's much better at treating sleep-onset insomnia than middle-of-the-night insomnia. In other words, the half-life of the usual bed-time dose is something like 6 hours and you are warned to not take it if you don't have at least 6 more hours before you have to get up. Ambien is available in controlled-release forms that are supposed to be better at keeping you asleep. I don't have any personal experience with the controlled-release forms of Ambien, so I don't know how well it works. There's also a new (patented) version of zolpidem (generic for Ambien) called Intermezzo. It's a much smaller dose than the standard dose and it can be taken without water in the middle of the night after you wake up and can't get back to sleep. The guidelines for taking Intermezzo say that you need to take it at least 4 hours before your normal wake up time. Given that you need to get up by 7:00AM, you could take Intermezzo as late as 3:00AM on nights where you wake up and can't get back to sleep. Given your problem of getting back to sleep, Intermezzo may be worth a try.

Other prescription sleeping pills may or may not be worth asking about. At one point in my First War on Insomnia, I was given Sonata because it also can be taken with only 4 hours of "time in bed" remaining.

Right now, I'm taking Belsomra most nights. I don't like the fact that I've been on prescription sleeping pills for over a year right now. But my sleep doc and I are out of ideas on what else to try. And they help me manage to keep my sleep schedule from getting too far out of whack.

Finally marijuana: Pot is known to affect the sleep architecture by reducing REM sleep. So pot may help you get to sleep, but if it supresses enough REM, you're not likely to wake up feeling really refreshed. The brain needs the REM sleep to feel good. So I'd recommend skipping the pot.

I'll end with this: You might want to pick up a copy of a book called Sound Sleep, Sound Mind by Dr. Barry Krakow. The first half of the book deals with insomnia and the second half deals with OSA and its relationship to insomina. The first half of the book not only teaches you something about how insomnia adversely affects your body and mind, it also has a whole lot of self-help suggestions that go well beyond the standard "use good sleep hygeine" that's posted everywhere on the web.