Premature Awakenings

[roster]

Hello Snoredog and anyone else with good information,

I just read Snoredog's comments on the thread "Naps vs. Nights". I did not want to get that thread off track so I am starting a separate thread.

My problem is premature awakenings and both my good sleep doctor and myself are frustrated because we cannot figure out what causes them. If I have a "good sleep hygiene day" I will fall asleep quickly at night and sleep five hours. Then I awaken and cannot go back to sleep even though I usually feel comfortable.

I am treating this with .5 mg clonazepam when I prematurely awake. This will put me back to sleep in 30 to 60 minutes and I will continue to sleep until the alarm sounds. So I am getting 8 hours of sleep minus the 30 to 60 minutes it takes for the clonazepam to kick in. I sure would like to sleep 8 hours straight.

Any ideas on what causes premature awakenings? I am drawing a blank.

rooster

[Bellcrest]

Wish I had the answers. I have similar problems. Wake every 3 or so hours. No reason. Don't have to run to the washroom the way I did pre APAP.

Numbers are good. I fall asleep quickly. Was on 5 mg clonazepam, but there was no difference so went off of it. I hate take meds if not necessary.

Docs don't know why I wake up so often. I feel good, but would like to sleep right through the night if possible.

Possibly our bodies just got used to waking up on a regular basis? I wish I could find the answer.

[Offerocker]

Hello Snoredog and anyone else with good information,

My problem is premature awakenings and both my good sleep doctor and myself are frustrated because we cannot figure out what causes them. If I have a "good sleep hygiene day" I will fall asleep quickly at night and sleep five hours. Then I awaken and cannot go back to sleep even though I usually feel comfortable.

I am treating this with .5 mg clonazepam when I prematurely awake. This will put me back to sleep in 30 to 60 minutes and I will continue to sleep until the alarm sounds. So I am getting 8 hours of sleep minus the 30 to 60 minutes it takes for the clonazepam to kick in. I sure would like to sleep 8 hours straight.
Any ideas on what causes premature awakenings? I am drawing a blank.

rooster

ROOSTER: I underlined part that I'll address second.

First, do you limit caffein in the afternoon? That used to be a 'biggie' for me - I 'thought' I was sleeping OK, but not a deep sleep (this before cpap therapy). My neuro Rx 2mg clonazepam, which helps with a deeper sleep and my PLMD. Instructions were to take it at LEAST 8 hours before I wanted to awake.
Exercise of any kind is also a sleep aid. Mine is gardening. Will have to do REAL exercise now that winter is approaching .

Second, You are LOSING an hour's sleep by waiting on that .5 mg of clonazepan to aid you in getting back to sleep. Have you tried taking that same dosage before you go to bed? (after eliminating caffein, if that's a variable).

Clonazepam is a controlled substance, and it's most likely why your dr. is limiting it to .5mg, but I would ask him. What concerns me is that you are losing an hour, waiting on it to take effrect, when you could be sleeping.

[woozle]

Hhhmmmm
I have had ups and downs with that as well

When I am sleeping well with the swift, I start off being REALLY tired and I get a great 8 hours of sleep, usually, uninteruppted
however, after a few nights of this great sleep, I start waking up around 3 am, after going to bed around ten - and I can't get back to sleep with the mask on - and so I lay on the couch, then almost fall asleep, but don't as I don't want to have apneas, then by the time I have to go to work, I could go back to sleep but can't

so I am trying to figure out why as well - I still feel better with the apnea free nights sleep of 5-6 hours per night versus pre-cpap days, but am running out of books, movies etc to watch or read when I wake up so early before the rest of the family - I keep thinking that my body is so used to getting nil for sleep that maybe it maxes out after getting caught up - or the circadium rhythm is so off that it may take alot of time to get back to normal, if ever?
haven't followed up with my dr on this as he just keeps telling me to switch masks, that's his answer for everything

[JohnD]

I have the same problem, and unfortunately this has been going on for 4-5 years now. I will go to sleep fine, but will always wake up about 5 hours later, no matter what type of sleeping pill I take when I first go to bed. I have tried them all, to no avail. It's really frustrating, as I don't feel that good during the day, especially if I don't allow at least 8 hours in bed. Those 8 hours are not spent sleeping soundly though....5 hrs of sleep and 3 hours of lying in a half sleep so to speak. I don't feel good taking something after those initial 5 hours. I have been a cpap user for 13 years. I wish I knew why it's 5 hours.

[Offerocker]

Hhhmmmm
I have had ups and downs with that as well

When I am sleeping well with the swift, I start off being REALLY tired and I get a great 8 hours of sleep, usually, uninteruppted
however, after a few nights of this great sleep, I start waking up around 3 am, after going to bed around ten - and I can't get back to sleep with the mask on -

Same here; once I wake up, I remove the mask, and sometimes fall back asleep. I have no problem getting to sleep with mask, but once awake, it comes off right away! ...not realizing what time it is...

haven't followed up with my dr on this as he just keeps telling me to switch masks, that's his answer for everything

BUT - The MASK didn't wake you! Too bad he's not a better detective, or care enough about your health! Hmmmmmmmm does he SELL the masks?

[woozle]

ha - he probably does have a big share in the masks

I forgot to say, I just noticed this morning something important

usually when I wake up at 3 I will lay in bed for an hour or 2 to see if I can please get back to sleep - but can't and finally get up, or might fall into light sleep at 6 but then get up OR I will get up at 3, get tired and put the mask back on around 5 or 6 and try to go back to sleep but can't or barely do
my ahi's are around 2's

HOWEVER, this morning I woke up and just decided enough of this, and got up for good at 3 - and thought, hmmm, wonder if my ahis' would be different? and they sure were, it was actually at 5.6
So I have more investigating to do on this and will share if I find anything out but I am in a weird cycle of getting 4-5 nights of good sleep, my family gets used to me going around and moving and doing things and then the cycle of less sleep starts - its like a 2 week cycle - ugh - trying to look on the bright side but when you lay dreaming of being able to sleep, it starts getting to ya

[Offerocker]

Woozle: You mentioned that "It's like a 2 week cycle"

That reminds me of something I read some time ago - that the body takes two weeks to recycle, or 'forget' a pattern - or something to that effect. Maybe someone else knows of that as a phenomenon?

On that vein, a RT told me (validity??) that changes in ones life are best made during the '-9' year,and are most effective that way. I'd say he's probably into Numerology though...

[Wulfman]

I don't know whether this thread from back in June fits into some of this.....or in OCO's "Naps vs. Nights" thread......or neither. But, reading both of the threads brought back the thoughts of the discussion in June. So, I'll list it here in case it does.

viewtopic.php?t=9848

The only time I can get a full 8 hours of sleep is on the weekends. During the week it's more like 6 1/2 to 7.

Do any of you that wake up after 5 hours, do any napping during the day or evening? I'm just wondering whether some people get too much sleep..... I know that if I get too many nights (including naps) of more sleep than that, I have problems getting to sleep.....which I definitely don't during the week. It's kind of "funny" thinking back to pre-CPAP when getting ENOUGH sleep was almost impossible.

Den

[Goofproof]

Naps do interfer with my sleeping at night. You sleep sounder if you need the sleep. For me the more sleep I get the more I want to sleep, too much sleep and I am resless at night. Jim

[woozle]

I don't nap at all - when I first started, I had some difficulty falling asleep
and dont want the initial part of falling asleep to become affected as well
so when I put the mask on at night to go to be, just like pavlovs dog, the association makes me go out like a light - which is great
but the same thing doesnt happen at 3 am after waking up

[Snoredog]

Don't know if I'll be able to help you, but from what I've learned,

Arousal's: There are many types of arousals, the obstructive related ones you know about like those associated with hypopnea and apnea and others from syndromes such as RLS or PLMD and then spontaneous arousals, the latter they don't know much about, for those you get "umm......they really don't know what causes those..". The arousals they see are seen on the EEG.

Some arousals are thought to be caused by muscle skeletal pains from like arthritis these can also interrupt your sleep. I have Sciatica from a bad L4 injury since I was a teenager after crashing a bike. At times I have to use an inversion table to relieve the pain. I take an Aleve nearly every night to fend off the pain that radiates down from the buttocks all the way to the foot and make it bearable. I use a Select Comfort bed which helps.

My understanding during sleep some arousals just interrupt your sleep enough to take you from say REM back to deep or stage 2, while other arousals such as those from central apnea can take you all the way back to a completely Wake state.

SAG had posted some PSG graphs showing this on one of the other threads. Everywhere you seen a central apnea the EEG showed the patient being aroused all the way back to the wake state.

This is why you see me harp so much on watching the Maximum pressure set on autopaps if you are at risk of CA or MA's, these arousals seem much more severe than say spontaneous arousals which may only disturb your sleep enough to lower the quality of sleep you get.

My suggestion: Study your diagnostic PSG and see if there were any arousals noted other than obstructive type (apnea, hypopnea), even if there were only 10 or 20 seen and they say they are irrelevant. They might be irrelevant to them but not to you as you are the one waking up 2-3 times per night. Keep in mind your PSG was only one night's snapshot, they could be much worse the next night or if you have changed medications or other factors.

Next, I would visit the ASAA forum over on:

http://apneasupport.org/

and ask your question again there (go armed with all the pertinent facts), they have a lot of PSG techs posting on that forum and can give you possibly some better pointers to look at.

Personally, I take Melatonin from Costco, not to get to sleep so much but so I can sleep all the way through the night without awakening. For me it works, but I find it is not a gee I can't sleep tonight so I'll take one, doesn't work that way, I take it each and every night tired or not. I've gone on trips before and forgot it at home, I still fell asleep fine but I woke up several times per night where with melatonin I don't. I take between 3 and 6mg of the schiff brand.

If you try Melatonin, I would take it for at least 2 weeks every night, takes about a week before you even see it work. If you are new at taking it, I would not exceed more than 3mg. The kind I take is USP grade and has 10mg of B6 and 86mg of Calcium Carbonate. GNC has some subliminal tabs in same and smaller doses, but it goes under your tongue and dissolves directly there.

List out everything seen on your PSG, then cross them off the list as you address each one:

Hypopnea
Apnea
CA or MA's.
RLS or PLMD's

If you have anything that resembles RLS or PLMD, I would read this suggestion:
http://www.aasmnet.org/News.aspx?ArticleID=203

it is important to understand they are talking about the levels in the basal ganglia and not the levels found in the blood, it is interesting they say basal ganglia, because the basal ganglia is the main communications center of the brain, when it becomes damaged some parts of the brain can have difficulty communicating to other parts of the brain. If there is a chemical imbalance there the same can happen

(abstract):

In summary, there is extensive evidence supporting the contention that iron deficiency in the basal ganglia plays a major pathogenic role in RLS. RLS is also common in patients with systemic iron deficiency. A subset of patients with RLS has low or low normal iron stores as measured by serum iron studies. Although there is a lack of adequate controlled trials, treatment with iron, especially intravenously, has resulted in improvement in RLS symptoms. We believe that the weight of available evidence and expert opinion favor the use of serum iron studies to assist in the management of RLS patients.

After one of my strokes, I had some nerve problems to my left side as the stroke hit the right side of the brain. It was really just nerve endings that terminated in the brain that no longer received a signal from the brain due to the stroke damage. I read where the brain can try and heal itself for 18 month post stroke by actually remapping parts of the brain to those nerves.

So for 6 months it was like those nerves were remapping themselves and using me as the test board, I'd get these firings and my left leg would twitch, next time it was my shoulder that would twitch, even muscles in my back would twitch. They would put me in a closed MRI to take a high res image where it can take up to 45 minutes per scan. I'd get about 30 minutes into that scan and I'd twitch, causing the MRI to be blurry. The gal taking the MRI had taken several from me before she says twitch again and I'll kill ya After that she put my head in that cage thingee so I didn't move from the twitches. Then I read for nerve health that vitamin C and Magnesium helped restore nerve health and healty brain function. My daughter had studied under Dr. Amen from the Amen clinic as a visiting Professor at UCLA, so I got hooked up with that research during that time. So I took supplements of vit C and Magnesium (Mega Minerals from GNC) and that really seemed to help.

I no longer have the twitches and luckily have full physical function restored to my left side, one of my strokes wiped out the caudate head of the basal ganglia. When you loose a function of your body from stroke you study everything you can about the damaged area to find out what you actually lost.

During those studies I read where the symptoms of RLS and PLMD seem to resemble the misfiring of brain signals to the wrong receptor similar to what happens during a epileptic seizure but to a much lesser extent. It makes sense if you see leg or limb movement during a PSG it is the brain activity that is sending the signal to the limb causing it to move. If it is (and they don't know as far as I know) it would seem if you restore healthy brain chemical function that the condition should improve. I would suggest visiting Amen clinic website for more info and another good place is http://www.brainplace.com. Years ago they had some really good papers for reading on improving brain function and health.

[GoofyUT]

Really EXCELLENT advice, Snoredog!!!! VERY well done!!!!!

The ONLY thing I'd like to add is to be careful with the dosing of melatonin. There are studies which suggest that dosing > 300 micrograms (0.3 mg) MAY desensitize melatonin receptors.

But other than that, GREAT ADVICE!!!

Chuck

[Snoredog]

Really EXCELLENT advice, Snoredog!!!! VERY well done!!!!!

The ONLY thing I'd like to add is to be careful with the dosing of melatonin. There are studies which suggest that dosing > 300 micrograms (0.3 mg) MAY desensitize melatonin receptors.

But other than that, GREAT ADVICE!!!

Chuck

I think I seen that Mayo study on the smaller dose being just as effective, and that is only 1 study of many that I have read over the years. I'm glad to see them doing more studies on it. I think that Mayo study was good because it was a peer reviewed double-blind placebo controlled study but it only involved I think 30 patients if not mistaken. Pretty small sampling though in the numbers. But even in those small numbers they were able to dispute that study which showed it ineffective.

I don't think there is a set dosage that works for everyone, I think it has more to do with your level of melatonin production which can change depending on one's age. It is like if you take too much your body naturally produces less melatonin, I can see you don't want that and that is what I think the Mayo study was trying to suggest. Problem is there is no easy way to measure your level, so you have to start on a small dose and increase to the desired effect is reached, for me that was sleeping all night.

I started taking it more than 15 years ago at 300mcg because that was all you could buy, back then 300mcg seemed fine. Later dose jumped to 800mcg then 1.5mg then now 3mg. Some places actually sell it in 6mg dose, I don't buy it in that dose but at times I may take 2ea x 3mg tabs if I need the sleep.

the point is there have been many many studies over the years and there is still no general consensus on what the ideal dose should be, same on side effects, when there are no side effects it is very difficult to determine the correct dose.

I'm sure one of the obvious side effects is fatigue, but that is why we take it. There was a study out of Toronto I believe a few years back that said it found melatonin totally ineffective. Yet the Mayo study shows it is effective even at the smaller dose, and that is what you see, studies are all over the place. Now if there was a John Hopkins study that paralleled the findings of the Mayo study then you could say yes, that is the dose that should be taken.

But I arrived at my current dose (that works for me) from using it for more than 15+yrs taking it nearly every night. Just like you would titrate yourself I kept taking it in larger doses until I found what worked best for me. I'm not a person that takes any prescriptions if I can take something natural instead. Besides the Ecotrin which I take to prevent another stroke and maybe an Aleve for the sciatica pain, melatonin is the strongest thing I take.

Personally, out of all those years taking it, I haven't noticed a single adverse side effect other than expected fatigue. I have taken more than 6mg before and I woke up feeling really groggy. I knew that was too much for me and I used that as a gage until I woke up feeling like I got some sleep. I still have daytime fatigue with cpap use, I even stopped it once to see if the melatonin was the cause of the daytime fatigue, no change actually it got worse because I wasn't sleeping as well at night.

I know it doesn't prevent cancer and some of the other outrageous claims some sites seem to make about it, cause if that were true I wouldn't have had 2 rounds of malignant melanoma and just recently another round of precancerous BCC on my forearm, the latter is no big deal, I burn those off myself now.

[Justin_Case]

I am exploring the possibilty that the CPAP machne may be contributing to sleep disturbance in respect to magnetic field exposure as any electronic device can cause it. It may be nothing, but who knows?