I can't fall asleep, nothing works.

CatherineF · Post by **CatherineF** » Tue Jul 19, 2011 12:37 pm

I have major problem with sleeping with CPAP. I can't fall asleep no matter what. I've tried trazodone, mirtazapine, didn't help. After Ambien I slept for 4 hours, but I can't take it due to my GERD and previous addiction. I am still trying CBT but I am so sleep depreived that I am not able to lay down with my mask for 2-4 hours with no sleep at all. I am taking the mask off and then fall asleep and here my experiments with CBT ends :/ I've tried some herbs - no help. Now I am trying to lay down with CPAP during the day, it is quite comfortable, Swift FX mask is really cool. But still i can't fall asleep with it. I don't know why? Because of my nervous system overactivity? I am nervous and anxious, lately much more due to sleep deprivation. I really don't know what to do. I can't take benzodiazepines, it would cause more apnea episodes. All Z-drugs are not an answer for me (zolpidem, zopiclone etc).

Please tell me I will get use to CPAP...

Dojers · Post by **Dojers** » Tue Jul 19, 2011 12:44 pm

Sleep onset insomnia - I have that. I take 20 mgs of Ambien at 9pm (when I remember to take my night time meds and I take a lot of 'em!! Many of them supposedly sedating - but that's a whole 'nother ball of wax) and I'm still wide awake at midnight/1am. When I got my sleep test and my titration test that was the first thing on the report - I have sleep onset insomnia - and no meds that I have taken, neither prescription nor over the counter has helped that. It's possible you have the same thing. Ask your doctor about it and see if there's a special medication that helps with that particular type of insomnia (other than Ambien since you appear to have addiction problems with it and I understand that - had that problem initially with it too - quit taking it for a couple of years - developed a super high tolerance to medications and now it doesn't do a whole heck of a lot).

Good luck to you.

avi123 · Post by **avi123** » Tue Jul 19, 2011 1:02 pm

CatherineF wrote:I have major problem with sleeping with CPAP. I can't fall asleep no matter what. I've tried trazodone, mirtazapine, didn't help. After Ambien I slept for 4 hours, but I can't take it due to my GERD and previous addiction. I am still trying CBT but I am so sleep deprived that I am not able to lay down with my mask for 2-4 hours with no sleep at all. I am taking the mask off and then fall asleep and here my experiments with CBT ends :/ I've tried some herbs - no help. Now I am trying to lay down with CPAP during the day, it is quite comfortable, Swift FX mask is really cool. But still i can't fall asleep with it. I don't know why? Because of my nervous system overactivity? I am nervous and anxious, lately much more due to sleep deprivation. I really don't know what to do. I can't take benzodiazepines, it would cause more apnea episodes. All Z-drugs are not an answer for me (zolpidem, zopiclone etc). Please tell me I will get use to CPAP...

I don't think that this is correct:I can't take benzodiazepines, it would cause more apnea episodes.

See here that Zolpidem is recommended for Central Sleep Apnea syndrome:

Due to the heterogeneity of the central sleep apnea syndromes, different medications have been used under different circumstances. No single medication can be considered a drug of choice.[1] Several different medications aimed at improving central sleep apnea include acetazolamide, theophylline, and sedative-hypnotic agents.

•Acetazolamide (Diamox): Acetazolamide is a carbonic anhydrase inhibitor that causes bicarbaturia and metabolic acidosis, which presumably shifts the apneic threshold of PaCO2 to a lower level. It has been shown to be effective therapy in primary central sleep apnea and CSB in patients with heart failure and in the treatment of high-altitude periodic breathing.
•Theophylline: This agent has been studied in patients with heart failure and was found to be effective in attenuating CSB.[34] It may also be effective for high-altitude periodic breathing.
•Sedative hypnotics: These agents have been used successfully in treating nonhypercapnic central sleep apnea. Temazepam and zolpidem have been shown to be effective under these circumstances and are believed to work by consolidating the sleep pattern, thus minimizing the instability in ventilation induced by sleep-wake transitions. A case series showed zolpidem reduced central apneas, and the overall apnea-hypopnea index, without worsening obstructive events.[35]

Source for above:

http://emedicine.medscape.com/article/304967-medication

Another source:

Improvement of Idiopathic Central Sleep Apnea with Zolpidem
Syed Quadri, M.D.,1 Christopher Drake, Ph.D.,2 and David W. Hudgel, M.D.2

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2670330/

You could do it also with benzoDiazepine such as Valium.

BrianinTN · Post by **BrianinTN** » Tue Jul 19, 2011 1:05 pm

Most of the people I've read on this board have indicated that they haven't seen their AHI affected by small amounts of benzos, and that was my experience with clonazepam too. However, I found I built up a tolerance to any sleep-inducing effects on it faster than I did with either Ambien or Lunesta. These days, I go a few weeks at a time on Lunesta, then a few weeks on Ambien, and repeat. Nothing works very well for me, so I share your frustration. :\

Dojers · Post by **Dojers** » Tue Jul 19, 2011 1:09 pm

Boy, you guys wouldn't even want to know what I take every night LOL

CatherineF · Post by **CatherineF** » Tue Jul 19, 2011 1:10 pm

Thanks for answers. This sleep onset insomnia only happens when I have mask on my nose. Without it I am falling asleep in less than 5minutes. And I really want to use CPAP, but I don't know how. Benzo are rarely good choice, I've been taking them often in the past. I don't want to come back to it either. I will try some herbs like gotu cola, brahmi and theanine, maybe it will help me soothe my nervous system, along with mahnesium it may work...

Dojers · Post by **Dojers** » Tue Jul 19, 2011 1:13 pm

What about valerian root? Heard that works pretty good for both anxiety and relaxing - maybe you're feeling anxious about the mask since you don't seem to have problems with sleeping until you put the mask on - possibly some subconscious claustrophobia??

archangle · Post by **archangle** » Tue Jul 19, 2011 1:15 pm

How long have you been trying? Have you tried CPAPing in front of the TV or stereo with the CPAP and seeing if you doze off? Got a recliner? Couch?

How about no drugs and eating something just before bed? Especially some delicious and nutritious turkey breast and milk?

Heck try some weird things. Drink some coffee or cola before bedtime and see what happens.

Mike6977 · Post by **Mike6977** » Tue Jul 19, 2011 2:12 pm

CatherineF wrote:I am taking the mask off and then fall asleep.

That's a good sign.

I couldn't sleep the night without 10 mg of zolpiderm (generic ambien) and 1 mgs of clonazapam (a benzo sedative) and 3 full glasses of wine. That allowed me 2 or 3 hours sleep and I'd have to start the meds and wine cycle again, once or even twice more to get a nights "sleep"

This was true before I started CPAP.

As I acclimated (the right mask is everything and I'm only 75% satisfied with my activa LT), I was able to reduce my cycles to a single glass of wine, and a 5 mgs of zolp and 0.5 mgs of clonz.

I slowly continue to try to reduce my dosages.

-------------------------------------------------

As for what to do.

I know exercise helps, but is very difficult when you are sleep deprived.

For sleep, nothing beats a short anaerobic exercise routine of wind sprints or stationary bicycle runs at full tilt. You go as fast as you can for 30 seconds to a minute, rest 2 minutes, then start again. Begin with two cycles, work your way up to 5 or 6.

This is a very short commitment of your sleep deprived time (and you'll struggle at first), but it can produce great sleep results, much better than weights or 40 minute aerobic routines. I do it 3 or 4 hours before going to sleep, and it has help me cut back on the drinking and meds.

--------------------------------------------------

If you still need help, get might your doctor to prescribe 5mg doses of zolpiderm. It is half the strength of the full ambient pill. You may still wake up after 3 or 4 hours of sleep, and need to take another, but I'd do it for the short term, until I got used to my CPAP.

Once that happens, you can ween yourself off this small dose, since you don't have a problem falling asleep normally.

xenablue · Post by **xenablue** » Tue Jul 19, 2011 2:21 pm

I've never had much trouble falling asleep, but when I started on CPAP it was a whole different matter. I felt claustrophobic, restricted, hot and a bit panicky that I wasn't getting enough air.

Someone on here suggested putting the mask on at times OTHER than when you're ready to lay down to sleep. Times such as watching TV or reading, so that you can get comfy and used to wearing the mask - even during the day when you have no intention of sleeping. Just to get comfy with the gear.

For the past 8-months since Dx, this is what I've done every night. My ritual before sleep has always been to watch a DVR'd episode of Jeopardy, so I hose up first, then as I'm watching TV mess with my mask until it's comfy and I'm breathing without being conscious of it. Occasionally I'm still not relaxed or ready for sleep so watch some more TV for a few minutes.

Watching TV or reading takes my mind off the mask and breathing, so that by the time I'm tired enough for sleep everything's working and falling asleep is easy.

Cheers,
xena

BrianinTN · Post by **BrianinTN** » Tue Jul 19, 2011 2:53 pm

I don't want to put the cart before the horse here, but it would remiss if someone didn't mention one other possibility. After you've exhausted all possible avenues, if you continue to have problems getting to sleep, you may simply be one of those rare people who is intolerant to positive airway pressure therapy. My doctor theorized I'm one of them, and that that's the reason we've been playing whack-a-mole with my sleep and various machines for over a year without much luck.

cflame1 · Post by **cflame1** » Tue Jul 19, 2011 3:49 pm

have you tried melatonin Catherine?

HerbyPeg · Post by **HerbyPeg** » Tue Jul 19, 2011 4:14 pm

I hope this doesn't repeat an earlier post which crashed and burned.

I suggest a cup of camomile tea, really. A cup after dinner and one before bed. If it is too bitter you could add a little honey or real sugar...no chemical sweeteners.

Or look in the supermarket for sleep teas. They usually have lemon balm and camomile and other herbs. Some brands have Valerian root. Be careful with herb teas since anyone could have an allergy to any herb and about 5% of all people get tachycardia (racing heart beats ) from Valerian.

Check out a local herbalist to see if you can get a sleep pillow. These are large sachets full of lavender, lemon balm, oats, and other herbs likely to be local. Some sleep pillows and teas contain hops strobiles which are potent sleep inducers (I can't be in the same room as an open container of hops -- instant naptime). You could make one for yourself.

Pure essential oils also have a place in helping people sleep but you should research the pros and cons of that before you spend money on them. They are dangerous if ingested or used without dilution for a massage oil, etc., Careful.

(And you thought my tag was about another herb). I wish everyone a good night's sleep.

Peg

avi123 · Post by **avi123** » Tue Jul 19, 2011 7:54 pm

CatherineF wrote:I have major problem with sleeping with CPAP. I can't fall asleep no matter what. I've tried trazodone, mirtazapine, didn't help. After Ambien I slept for 4 hours, but I can't take it due to my GERD and previous addiction. I am still trying CBT but I am so sleep depreived that I am not able to lay down with my mask for 2-4 hours with no sleep at all. I am taking the mask off and then fall asleep and here my experiments with CBT ends :/ I've tried some herbs - no help. Now I am trying to lay down with CPAP during the day, it is quite comfortable, Swift FX mask is really cool. But still i can't fall asleep with it. I don't know why? Because of my nervous system overactivity? I am nervous and anxious, lately much more due to sleep deprivation. I really don't know what to do. I can't take benzodiazepines, it would cause more apnea episodes. All Z-drugs are not an answer for me (zolpidem, zopiclone etc).

Please tell me I will get use to CPAP...

And your previous addiction was.......................?

ozij · Post by **ozij** » Tue Jul 19, 2011 8:58 pm

The first thing you have to do is to make a firm decision that you will not let yourself fall asleep without the mask. This is something within your control.

Your brain is like a wily child, and it has learned that if it will just refrain from sleeping with the mask, you will eventually take the mask off and sleep without it. So that's exactly what it's doing: waiting wide awake, not letting you sleep, until you to take that mask off.

That is a habit you have to break out of, by changing the rules.
Here's how you do it:
If you aren't asleep within 30 minutes, sit up, take the mask off and get out of bed. Do some pleasant, relaxing things, and then, when you feel drowsy, put the mask on and try to sleep. Not falling asleep? Sit up, take the mask off, and get out of bed. Repeat the above as many times as necessary - your brain has to learn that keeping you awake till you take the mask off is not going to work. Don't stay in bed awake 2-4 hours with the mask on.

And, since you can wear the mask comfortably, don't use it out of bed.

When we start using CPAP we have to learn a new way of sleeping - it doesn't come easy to some of us. This new way of sleeping means that bed time is mask time.

I think you're right in doing your best to avoid habit forming drugs.

http://www.benzo.org.uk
http://www.benzo.org.uk/profash.htm

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