2 Weeks on CPAP, Also Have Insomnia Issues. Seeking Input.

[robjones1985]

OSCAR #1 - https://i.imgur.com/YH7klcI.png
OSCAR #2 - https://i.imgur.com/x3UtVaK.png
ENT Analysis - https://i.imgur.com/Fyz3U43.png
Overnight Hospital Sleep Study - https://i.imgur.com/XVad9Wp.png
At Home Sleep Study- https://i.imgur.com/nLCaKL5.png

Hello everyone, new here. Glad I found this forum; I’ve read a lot of threads and have been learning. I began CPAP two weeks ago (Resmed Airsense 10, Airfit N30i). Did not intend to post so much information but thought it’d be best to go overboard at least at first.

A bit about myself-

37, Male. Sleep issues for a few years now. Seemed to get worse in early 2020 after having our 2nd kid, and it just hasn’t gotten any better.

*Edit- forgot to add, I do exercise 3-5 times per week. I also eat a pretty balanced diet.

Current sleep hygiene:
I use a weighted blanket, doesn’t really help me much.
Sleep in my own room, comfy bed.
Use blackout curtains.
Use a white noise machine, room is quiet.
Bed for sleep and adult activities only.

Current Meds:
Morning - Olmesartan 40mg, Vitamin D (10,000IU), Rosuvastatin Calcium 20mg. 3-4 cups coffee, never after 11AM.
Night - THC most nights as it relaxes me, Flonase Sensimist, Claritin 24 hr., and saline rinse nightly. I only recently started on the flonase/Claritin/saline – as it was suggested by my sleep dr. I also recently started Temazepam 15mg as my sleep dr. said it may help as I get used to CPAP. It doesn’t do much and I’m about to stop taking it. Just makes me groggy the next day.

I did consume alcohol a few times per week. Not much, just a little at night if we’re watching something. I’ve pretty much stopped late night drinking now that I’m on CPAP. Maybe I have something with dinner occasionally.

I’ve had nasal issues my whole life, including surgery when I was 15, as well as an ENT analysis two years ago for poor air flow primarily through my right nostril. I’ll post my ENT’s analysis in an image. These nasal problems have been consistent all this time (no better or worse) and did not impact my sleep in my 20s or early 30s.

Diagnosed by my GP 2 years ago with insomnia. Tried meds, sleep hygiene, etc. – nothing worked and I’ve just been dealing with waking and not falling back asleep. I’ve been surviving on 4-5 hours of broken sleep for a few years now.

About a year ago did an at home sleep study. I felt like I slept maybe an hour or two during the study. I’ll provide an image below with the results of the study. I went on CPAP at this time (April 2022) but stopped using it.

June 2022 went to a hormone Dr. and did a blood test. All hormones/thyroid were good except testosterone. My total T was very low (237), I am taking a total of 120mg testosterone per week as of June 2022 (self-inject twice per week). Current Total T is around 8-900, and it does make me feel better.

September 2022 is when the onset/chronic insomnia began. Had some pretty stressful martial issues and had my first night ever of zero sleep due to the stress and racing thoughts. Things were better for about a month, then out of nowhere in October 2022 I had a week where I did not sleep for 3 nights out of the week. Nothing at that time appeared to trigger it, I just laid in bed and could not sleep. Diagnosed with chronic insomnia by my GP and was referred to a sleep doctor.

December 2022, had a week where I did not sleep for 2 nights.

January 2023, overnight sleep test at hospital, I will provide an image with the sleep test data for review. AHI=17, was diagnosed with moderate apnea. Was on ambien during study.

Current state:

I’ve been 100% compliant since starting CPAP two weeks ago. Just pushing myself to keep it on all night. Definitely have had some challenging nights, torn it off my face a few times, cursed at it, etc. but it’s starting to get easier for me. Recently began taping my mouth as well. Sinus problems have been tough the last 6 days but as of today seem to be subsiding. Could not get used to the prescribed pressure and have bumped it up to 8. Still takes me an hour or two to fall asleep, at least that’s my perception. I’m definitely waking multiple times per night and struggling to get back to sleep. It almost feels physiological- I don’t really have a racing mind, stressful thoughts, I just lay there even when I’m sleepy and…don’t fall asleep. Wake up feeling like trash. Started reading Sound Sleep, Sound Mind – was recommended by some on this forum.

*anyway*… thought I’d also post a few OSCAR graphs while I’m at it just to see if anything stands out. If anyone has any other suggestions that may help me I’d appreciate it.

[robysue1]

Sorry you are having problems with insomnia.

Current sleep hygiene:
I use a weighted blanket, doesn’t really help me much.
Sleep in my own room, comfy bed.
Use blackout curtains.
Use a white noise machine, room is quiet.
Bed for sleep and adult activities only.

I'll write more later. (I'm heading out to the ski slopes in a few minutes.)

But I want to bring up these critical pieces of sleep hygiene:

Do you have a consistent wake up time? And do you enforce it even if you feel like you haven't gotten enough sleep?

Do you go to bed when you are feeling sleepy rather than when you are feeling tired or exhausted?

Can you tell the difference between feeling sleepy and exhausted? They're not the same thing.

Do you have a bedtime routine that lets your body know it's getting time for sleep?

How much caffeine do you consume each day? And how much do you consume during the late afternoon or evening?

Have you ever considered getting out of bed when you can't fall asleep within about 20 minutes and then going back to bed after you start to feel sleepy?

Once upon a time (when I was still robysue around here), I was more-or-less the "queen of insomnia" and wrote quite a bit about it and quite a bit about my long, but ultimately successful Wars on Insomnia. (I've had two major Wars on Insomnia since starting xPAP back in 2010.) And my old signature had a link to a (old) blog that I used to keep specifically about what kinds of things can be useful in fighting an insomnia monster that moves in when you start CPAP.

[Miss Emerita]

Welcome!

By the numbers, your charts are unremarkable. Your in-lab sleep study shows a high index for periodic limb movements and a pretty high arousal index, along with a bunch of hypopneas. The PAP treatment seems to have addressed the hypopnea problem, but you continue to feel wiped out during the day and experience difficulty falling asleep and staying asleep, if I'm understanding correctly.

You say you felt you barely slept during the sleep study, but you can probably trust the sleep report, which says you actually slept a lot of the time. It's very common to have the subjective impression of wakefulness, especially with a lot of light sleep. It took you a long time to get to your first REM sleep stage, but over the course of the night you got a decent amount of REM, though hardly any deep sleep.

It is possible you're sleeping somewhat more than you think you are. But it's clear something isn't working the way it should. Here are a few thoughts:

Medications:

Here are possible side effects of medications you're taking:

Olmesartan dizzy or tired

Rosuvastin: dizziness, difficulty falling asleep or staying asleep.

You should probably talk with your doctor about whether different medications might be better for you.

PLM:

You'll see a lot of good information about periodic limb movement here:

https://www.ncbi.nlm.nih.gov/books/NBK560727/

Tests for kidney function and iron deficiency might be valuable, and from a different trusted web page I'd add folic acid, vitamin B12, thyroid function, and magnesium levels to the list.

There are several medications that could be of use in treating PLM if the testing doesn't reveal a culprit.

[Rubicon]

The arousal total is the sum of PLM, respiratory and spontaneous arousals.

Need the maff lady to figure out how those guys are doing their rithmotick.

[Miss Emerita]

Rubicon, yes, that baffled me!

[Rubicon]

There are several medications that could be of use in treating PLM if the testing doesn't reveal a culprit.

Yeahbut...

PLMs that do not cause arousal are usually not treated.

Example exception:

PLMs that are so pronounced the bed partner's sleep is disturbed.

Problem with drugs used for PLMs:

Discontinuance of benzodiazepine-class drugs (like klonopin) can result in rebound insomnia.

Which is a problem if you got insomnia.

[Rubicon]

I'm also like "Say what?" in the HST where they claim "Significant Obstructive Sleep Apnea" with an AHI of 5.93.

[Rubicon]

And an ODI of 8.8 in HST? What, the PLMs are causing desats?

If there are desats without hypopneas, how do we know if the hypopneas are really 1B hypopneas, or just a product of PLMs?

[robjones1985]

Do you have a consistent wake up time? And do you enforce it even if you feel like you haven't gotten enough sleep?

Not really.

I'm usually out of bed between 5am-6am. I have a 3 an 5 year old, they are up at that time and I have to get up when they do. I don't always get out of bed at the exact time. Last night for example I got out of bed at 4:50AM because I was wide awake. I rarely stay in bed later than 6AM.

Do you go to bed when you are feeling sleepy rather than when you are feeling tired or exhausted?

I'm not sure... I didn't even realize there was a difference between tired/exhausted/sleepy until last week reading these forums. I am trying to identify when I'm sleepy at night and go to bed then.

Can you tell the difference between feeling sleepy and exhausted? They're not the same thing.

I think I can, like I mentioned I'm being more mindful of this now and will continue.

Do you have a bedtime routine that lets your body know it's getting time for sleep?

My first week on CPAP I'd also started working with a CBTI sleep therapist. She had me on restricted sleep (5 hr) with no electonics at night. As you can imagine the timing was poor due to starting CPAP, I hit pause on CBTI at the end of week 1. I plan on re-visting things with the sleep therapist if I'm unable to get things back on track myself.

How much caffeine do you consume each day? And how much do you consume during the late afternoon or evening?

3-4 cups of coffee every day before 11AM. No caffeine after that.

Have you ever considered getting out of bed when you can't fall asleep within about 20 minutes and then going back to bed after you start to feel sleepy?

I tried this two weeks ago but had a hard time with it as I was also getting started on CPAP. Last night I laid in bed from 11PM - 1AM, then got out of bed in to my recliner to relax. I think I slept for an hour or two in the recliner. Then I was back in bed awake until 4:50AM when I got out.

[robjones1985]

Medications:

Here are possible side effects of medications you're taking:

Olmesartan dizzy or tired

Rosuvastin: dizziness, difficulty falling asleep or staying asleep.

You should probably talk with your doctor about whether different medications might be better for you.

Thanks for point this out. I did research side effects of these two but did not produce what you found regarding sleep issues on Rosouvistatin. After going on testosterone, my cholesterol levels have been trending down and I was considering eliminating the statin if my bloodwork continued the trend. I will also do some of my own research on PLM, thanks.

*edit- correction. I'm on Rosuvastatin Calcium 20mg. I will update my OP.

[Rubicon]

My first week on CPAP I'd also started working with a CBTI sleep therapist...

3-4 cups of coffee every day before 11AM. No caffeine after that.

What'd she say about the coffee?

[robjones1985]

My first week on CPAP I'd also started working with a CBTI sleep therapist...

3-4 cups of coffee every day before 11AM. No caffeine after that.

What'd she say about the coffee?

She did not seem concerned about caffeine intake.

She spent most of the time stressing the importance of stimulation control at night and sleep restriction.

[Rubicon]

[robjones1985]

Thanks Rubicon. I will switch to decaf this week and see what happens.

[Rubicon]

I wouldn't necessarily go cold turkey either. These things must be done delicately:

Caffeine withdrawal can occur in anyone who regularly consumes caffeine and then abruptly discontinues its use. Common symptoms include headache, fatigue, low energy, irritability, anxiety, poor concentration, depressed mood, and tremors, which can last anywhere from 2 to 9 days.

Move your last cup up an hour or so, and change only some to decaf.

Then gradually...