Can't sleep w/o meds.

[AHI15]

Hi,

I thought I was off to a fairly good start, but now the developing trend is troubling. The problem is that I've only succeeded at falling asleep with CPAP on 2 of 12 nights without taking a sleeping pill or at least L-theanine. Keep in mind that before trying CPAP I took sleeping pills roughly once or twice every few months, and NEVER more than 2 nights in a row. Consequently I have accumulated an inventory of different types over the years, barely used.

In the table below, "t" is time on CPAP, AHI you know what that is, TIB=time in bed. For my letter grade meanings, see viewtopic/t81385/Fatigue-rating-grades.html

On the first night of CPAP, this was a peculiar day since I took Nuvigil to drive safely to the DME to get my machine, worked for 7 hrs that day, and I expected to have trouble getting to sleep for the first time with the machine and the stupid Nuvigil. I usually put myself to sleep after that stuff with natural supplements and just waiting until a later bedtime. So this time I took Sonata to just ensure an easy acclimation to the machine. I didn't get enough sleep, but slept the whole time with CPAP.

The second night, 8/14 I wanted to take no med. But I cheated a little and took L-theanine. I fell asleep with no pharmaceuticals, fell back asleep on CPAP after 1-2 awakenings, and worked part-time the next day (I have 9hr days, with every other Fri off).

3rd night, took nothing. Fell asleep! Slept with machine for about 7hrs then woke miserable. Took Sonata at 6:45am. I don't usually do that, but I just couldn't fathom how I could get through the day so fatigued.

After this, I decided that since Lunesta is approved for long term use, and there are some studies indicating that it can help "normalize sleep architecture" I decided to try an experiment of 4-5 days of taking it. I didn't like this idea, since it goes against my "very occasional use only" philosophy toward meds, but it seemed like I was approaching the very bottom of my life in terms of unbearable fatigue, and folks here convinced me that I should "just get some sleep on the machine."

So I started logging nice results with low AHI and fell back to sleep several times each night on 8/16 through 8/19. But I was still dead in the daytime except for Fri 8/16 or unless I took Nuvigil.

Determined to try to get back to natural sleeping with the machine, I tried to do so 8/20 with horrible results leading to taking a benzo. in the middle of the night to avoid self-destructive contemplations.

Still determined to sleep on the machine again w/o meds, I decided to relieve psychological pressure about getting back to sleep after the expected mid-night awakening. So I chose to remove mask after sleeping partially through the night, and sleep in the morning hours until getting up w/o CPAP. This seemed to work, as I got a lot of sleep, but still non-functional. So you see the machine hours logged on 8/21 dropped to 5.2hrs, though TIB was 9hrs. Still F the next day.

Now I am confused and loosing any sense of resolution to any principles, and I just want to sleep again with the machine. So I took meds. for 2 more nights, but didn't stay on the machine after 1 or 2 awakenings.

8/23 was remarkable in that I felt really good for some periods during the next afternoon (a "D" grade these days is cause for celebration, that's how pathetic my situation is). But I took Rhodiola, so I'm not sure about this. With my spirits high, I planned to sleep with no meds. again, but disaster struck again...

8/24 Determined this night to sleep without meds. But couldn't sleep at all with CPAP. I started getting severely uncomfortable, then pain developed in shoulders and neck. Got up after 40min. Tried again with CPAP later for another 40-60min. Failed to fall asleep on machine and got severely uncomfortable and in pain. Took Ibuprofen but no sleeping med., then went back to bed w/o machine. Fell asleep after pain subsided, but next day (today) very bad.

So I am very confused, as you can probably figure out. These are the dilemmas:

Sleep without meds and without CPAP? Not a good option.

Sleep with meds every night and CPAP? Not a good option.

Somehow I must sleep without meds and WITH CPAP, but I'm actually not doing well with that.

What's worse, these days the only way I can work is with Nuvigil or ADHD meds., and if I take Nuvigil it makes me loose several hours of sleep. So I have to make the terrible choice of: be absent from work every day until I hopefully recover, or take Nuvigil 1-2 workdays a week and have it interfere with my getting recovery sleep. I'm getting so fatigued that I actually don't even want to take the stimulant meds. anymore, because they are either too weak to help (!) or else I just don't want to push my body like that.

At this point I'm very worried that even if I can learn to fall asleep with the machine most nights, that I will have frequent awakenings, be unable to fall back asleep with the machine, and still not get refreshed.

The only brightness on the horizon is that I go to Stanford for CBT-I in about 3 more weeks.


Got any suggestions in the mean time? Thanks.

Code: Select all

night t[h]  AHI  med     TIB  result_next_day
8/13  6.3   3.0  Sonata  6.3  D- worked 7hrs
8/14  8.9   2.5  L-th    8.9  D- worked 7hrs
8/15  9.3   3.5  none(1) 11? F can't work
8/16  9.2   2.4  Lunesta 9.2  D- off, barely functional day
8/17  8.9   0.8  Lunesta 8.9  D- (Nuvigil) barely functional day
8/18  7.0   2.7  Lunesta 7.0  F- non-functional day
8/19  8.9   2.0  Lunesta 8.9  F can't work
8/20  8.7   2.1  Temz(2) 10?  F can't work
8/21  5.2   2.7  none    9.0  F can't work
8/22  6.2   1.6  Lunesta 9.0  D- worked 9hrs (Nuvigil)
8/23  6.9   1.8  Ambien  8.3  D (Rhodiola) best day in a long time!
8/24  1.8   3.2  none(3) 9.2  F+ (Nuvigil) barely functional even with stim  :cry: 
8/25  ?     ?    Lunesta   ?   ?   ?

NOTES:

1. Took Sonata at 6:45am after sleeping about 7-8hrs until about 5am after falling asleep with no med., but still horribly fatigued, unbearable to get up, need more sleep.

2. Took Temazepam at 11:45 pm after sleeping a very short time on CPAP--so I fell asleep successfully on the machine but couldn't return to sleep after waking. Don't usually wake after such a short time sleeping. Spiraled into mental hell so took med. After so many days of sleeping pills and now a benny, I decided I was determined to get to sleep the next night w/o a med.

3. no sleep on CPAP

[BlackSpinner]

First of all it has only been 12 days. It can take up to a month for your brain to adjust/accept to using a cpap machine.
This off and on again is doing you no good.
Take the meds to sleep, do it consistently for at least a month to adjust to sleeping with the cpap machine THEN try to adjust to sleeping with cpap and without meds. Learning to sleep with the cpap machine consistently and deeply is more important then "sleeping naturally". Rewarding your self by taking the mask off is WRONG. Reward your self for sleeping and keeping it on is what you need to be doing.

[MaxDarkside]

I'm with BlackSpinner on this (and also "improvement management" in general). First, I would get consistent, then make moderate stepwise adjustments towards better, and whatever aid I would use, I'd make it the most benign (mild, non-CNS, etc.) as possible. It took me about 8 months to get off mild sleep aids, and only just recently (last few weeks). I found they were worsening my next day feel, generally in the D range, give or take, of your scale. Now that I'm off them, I'm more like "C".

[Guest]

A couple of thoughts.

If you're using a range of pressures on your APAP, that would be my first suggestion of things to change......switch to CPAP mode with a single pressure. Pressure ranges can really mess up your sleep.

From my own personal perspective, if I had to try to sleep with nasal pillows shoved up my nose, I'd need to be heavily medicated to try to get to sleep, too.


.

[AHI15]

I'm with BlackSpinner on this (and also "improvement management" in general). First, I would get consistent, then make moderate stepwise adjustments towards better, and whatever aid I would use, I'd make it the most benign (mild, non-CNS, etc.) as possible. It took me about 8 months to get off mild sleep aids, and only just recently (last few weeks). I found they were worsening my next day feel, generally in the D range, give or take, of your scale. Now that I'm off them, I'm more like "C".

How can a sleep-aid be non-CNS?

The mildest sleep aid I can think of is perhaps a Ca+Mg+vitD supplement. This isn't a drug, but it certainly is essential to CNS.

Then the next might be L-theanine which is found in green tea. Max, have you looked into L-th. much? It's very interesting. It seems to be a genuinely psychoactive unregulated drug with extremely gentle but effective anxiolytic but not depressant effects.

Steering into the full "drug" classification, but non-CNS are pain relievers such as ibuprofen. I tend to take only Naproxen before bed because NSAIDs reduce body temp. a bit. So it can be a sleep disturber to take ibuprofen then have it wear off 6 hours into sleeping, with the resultant body temp increase making sleep during the last 2 hours of the typical 8hrs harder. Note, this is a "makes sense" but not scientifically proven theory about ibuprofen.

I'm afraid that I'm going to get addicted to Naproxen, because it seems I'm developing a tendency to get discomfort leading to nexk and shoulder pain almost every night now. It seems to begin before bedtime, just due to physical fatigue of the upper body.

I've been fortunate to be tolerant of NSAIDs, with no adverse stomach bleeding problems, for many years. But there is no guarantee that my luck won't suddenly end one day.

It seems fatigue is a downward spiral. The damaging effects of fatigue make you have more trouble sleeping, exacerbating the fatigue and accelerating the process of deterioration. Hence, the non-linear plot of getting sick you showed once before.

I'd nearly kill to get some C days. These days a D is a big relief and cause for celebration.

[AHI15]

First of all it has only been 12 days. It can take up to a month for your brain to adjust/accept to using a cpap machine.
This off and on again is doing you no good.
Take the meds to sleep, do it consistently for at least a month to adjust to sleeping with the cpap machine THEN try to adjust to sleeping with cpap and without meds. Learning to sleep with the cpap machine consistently and deeply is more important then "sleeping naturally". Rewarding your self by taking the mask off is WRONG. Reward your self for sleeping and keeping it on is what you need to be doing.

What do you think I should do at the very last 1-2 hours of the night, at about 5-7am, when dawn hits and I generally have a VERY iffy chance of getting some more sleep? This last hour of sleep also can make the difference between having a headache and being dizzy with fatigue, ie., an "F" day where I can't work, or a "D" day where I can work.

Should I force myself to try to fall asleep one last time with CPAP, then if I fail just accept the resulting wasted day, hoping that the next night sleep pressure will be stronger making me sleep deeper?

Ie, this is basically the "sleep restriction" theory.

Or should I allow myself to "top off" the last hour of sleep with no hose after accumulating a solid 6-8 hrs of CPAP sleep but which still isn't enough to take that last disabling edge off?

This is a tough one, because I'm convinced at this point that every additional "F" day is very damaging physically and psychologically. It may also cost me my job if I don't pull into at least consistent D territory within 1-2 months.

Thus I would argue that F days should be avoided at all costs, even if that means topping off with 1 hour of non-CPAP sleep.

I did so this morning. I got 7.7hrs on the machine with AHI-3.3, then slept another 1.5 hours.

I am possibly at a miraculous D today! I may be able to take my family shopping without having to take a miserable stimulant.

But had I not topped off, I think I would be at F again. And it would have been very unlikely that I could have fallen back asleep at 5:30 with the machine.

All of this points to a deeper issue--why do I still keep waking up so often, 3-4 times a night even WITH a strong sleeping med. AND with the CPAP which SHOULD be making me have much less tendency to awaken? Thus, if there is NO statistical difference between the number of awakenings with vs. without CPAP, then I seem to have a very strong underlying predisposition to awaken from another cause besides OSA.

Thanks for your interest.

[MaxDarkside]

How can a sleep-aid be non-CNS?

Well, I may be mis-speaking saying "non-CNS", but what I mean is that if you MUST, use drugs that have the least brain chemistry modifying effect... the most benign so you don't get all screwed up.

Max, have you looked into L-th. much?

I don't need to look into any sleep aids. I've successfully weaned myself off all of them and I sleep much better for it. I also no longer take NSAIDs or any analgesics so I don't get rebound during sleep and I sleep much better for it too. Sleeping "chemically naked" is the best way LOL ! Naproxen does make me sleepy, taking 2 tablets at OTC doses which I do if I have some pain that I just MUST get rid of, but I avoid it like the plague unless I MUST. I have back problems and neuropathy (maybe plural types) and so sometimes I have to take something... only Naproxen.

[AHI15]

A couple of thoughts.
If you're using a range of pressures on your APAP, that would be my first suggestion of things to change......switch to CPAP mode with a single pressure. Pressure ranges can really mess up your sleep.
From my own personal perspective, if I had to try to sleep with nasal pillows shoved up my nose, I'd need to be heavily medicated to try to get to sleep, too.
.

guest, you seem to have experience with CPAP, yet speak vicariously as if you don't actually use it yourself.

This is an interesting idea, but probably not a problem in my case. That's because, the max pressure I've actually seen the machine go to seems to be around 9, averaging about 7.5. This is quite mild compared to many people. My prescribed setting is 6-11.

I don't yet have the ability to see the machine data, until I get the SD card reader, which is in shipment.

Thanks for input.

[AHI15]

How can a sleep-aid be non-CNS?

Well, I may be mis-speaking saying "non-CNS", but what I mean is that if you MUST, use drugs that have the least brain chemistry modifying effect... the most benign so you don't get all screwed up.

Yes, that is why I stop at the Z-drugs for more than once in a very while use. Ie., benzodiazepines I would reject if prescribed for regular sleep aid use. They are downright dangerous to use regularly.

I still have uncertainty about the risks inherent in Zs, but they seem to be mild and well tolerated. But the debate about their safety for regular use isn't settled, so I'm torn btw. the issue of taking them regularly for up to a month perhaps to get some recovery sleep, vs. intermittent use which may result in intermittent CPAP.

I think the CBT-I will be enlightening. I hope I get a good one.

Max, have you looked into L-th. much?

I don't need to look into any sleep aids. I've successfully weaned myself off all of them and I sleep much better for it.

Well I think I meant that even if you weren't interesting in taking it, just that it's an interesting supplement if you appreciate things neurological--possibly in the rare category of ones that actually do something supported by science. For instance:

http://www.ncbi.nlm.nih.gov/pubmed/18006208
http://www.ncbi.nlm.nih.gov/pubmed/18681988


I wish you continued improvement, Max.

[MaxDarkside]

Well I think I meant that even if you weren't interesting in taking it, just that it's an interesting supplement if you appreciate things neurological--possibly in the rare category of ones that actually do something supported by science. For instance:

http://www.ncbi.nlm.nih.gov/pubmed/18006208
http://www.ncbi.nlm.nih.gov/pubmed/18681988

Ya, that IS interesting. Tea, eh?

I wish you continued improvement, Max.

Thanks. I still have grog I'm fighting. Maybe I need a cup of tea. I have another problem that has cropped up, gastroenterological, that I'm fighting presently, my colon seems to be disfunctional (gack!) which landed me in the ER 2 weeks ago and is not abating. I don't think it's related to OSA, but perhaps to medicines (I hope). Doc is doing a wide array of tests to try to locate the cause.

[robysue]

What do you think I should do at the very last 1-2 hours of the night, at about 5-7am, when dawn hits and I generally have a VERY iffy chance of getting some more sleep? This last hour of sleep also can make the difference between having a headache and being dizzy with fatigue, ie., an "F" day where I can't work, or a "D" day where I can work.

Should I force myself to try to fall asleep one last time with CPAP, then if I fail just accept the resulting wasted day, hoping that the next night sleep pressure will be stronger making me sleep deeper?

Neither of these ideas what you should be doing in my opinion.

What I'm going to say is highly counter intuitive and your initial reaction will be: That's IMPOSSIBLE!!!!!

But my advice is this: If you wake up between 5 AM and 7 am and are unable to get back to a good sleep with the CPAP on, you probably should just get up for the day. In other words, give yourself a reasonable bit of time to get back to sleep with the mask on. But if you are still not asleep at the end of what feels like 15-30 minutes OR if you find yourself becoming MORE alert and less sleepy, then make yourself get out of bed and start your day.

Yes, you'll be exhausted well before your normal bedtime. But you may find that during the part of the day that you are semi-functional, you will be more functional without that last hour of "damned if you do (use the CPAP) and damned if you don't (use the CPAP)" quality of sleep that you are currently dealing getting. Try to stay up to your normal bedtime, but since bedtime insomnia is not a huge issue, it's ok to let yourself go to bed an hour or so earlier than normal if you want under the circumstances. Likewise, if a late afternoon or evening nap is not going to cause serious problems with getting to sleep at bedtime, you can allow yourself the luxury of a nap with the PAP machine.

Ie, this is basically the "sleep restriction" theory.

What I'm proposing is not technically "sleep restriction". It's a combination of another tool from CBT for insomnia: Don't lie in bed for long periods of time NOT sleeping combined with a very useful rule for adjusting to CPAP: Don't allow yourself to consciously fall (back) asleep without the mask on.

Sleep restriction is an artificial limit on the time spent in bed for the entire 24 hour day. When I was in the sleep restricted part of my CBT I was not allowed to spend more than 6 hours in bed at night---period. I had to be out of bed by 7:30AM regardless off how much or how little sleep I got. And I could not go to bed until it was 1:30AM or later. And NO naps were allowed. So six hours of sleep was the absolute maximum amount of sleep as I might possibly get in a 24 hour period.

What I'm telling you to do is this: Get as much "morning" sleep as your body is willing to get WITH the mask on your nose. But if the body won't sleep well after that 5-7AM wake occurs, assume your body is telling you that its done sleeping for the night and get up and start your day. If you need to go to bed a bit earlier the next night, fine, do that. If you need an afternoon nap and it's not going to add to your nighttime troubles, go ahead and take one---but only if you mask up.

Or should I allow myself to "top off" the last hour of sleep with no hose after accumulating a solid 6-8 hrs of CPAP sleep but which still isn't enough to take that last disabling edge off?

and

Thus I would argue that F days should be avoided at all costs, even if that means topping off with 1 hour of non-CPAP sleep.

That last hour of apnea filled sleep is what your body is going to remember if you try to " ''top off" the last hour of sleep with no hose". Think of it this way: If someone spent an hour or so choking you for about 10 seconds or so every 5 minutes or so, how do you think you'd feel after the repeated choking episodes ended?

In other words, that last apnea filled hour or two of sleep is contributing to how lousy you feel during the day rather than marginally improving how you feel during the day. It could well be that last hour of apnea filled sleep is what's pushing you into the F category during the daytime.

[robysue]

AHI15,

Two important questions:

1) How much time in bed do you spend each night? By "time in bed" I mean how much time is there from the time you lie down intending to go to sleep for the night until the time you throw the towel in and get up for the morning to start your day.

2) How much time do you estimate you are actually asleep during that time in bed period?

Sleep efficency = (Time asleep)/(Time in bed) is an important parameter for measuring the quality of sleep.

[BlackSpinner]

What do you think I should do at the very last 1-2 hours of the night, at about 5-7am, when dawn hits and I generally have a VERY iffy chance of getting some more sleep? This last hour of sleep also can make the difference between having a headache and being dizzy with fatigue, ie., an "F" day where I can't work, or a "D" day where I can work.

Should I force myself to try to fall asleep one last time with CPAP, then if I fail just accept the resulting wasted day, hoping that the next night sleep pressure will be stronger making me sleep deeper?

Ie, this is basically the "sleep restriction" theory.

Or should I allow myself to "top off" the last hour of sleep with no hose after accumulating a solid 6-8 hrs of CPAP sleep but which still isn't enough to take that last disabling edge off?

No never sleep without it. Get up if laying in bed annoys you. Take a nap with the mask later.

All of this points to a deeper issue--why do I still keep waking up so often, 3-4 times a night even WITH a strong sleeping med. AND with the CPAP which SHOULD be making me have much less tendency to awaken? Thus, if there is NO statistical difference between the number of awakenings with vs. without CPAP, then I seem to have a very strong underlying predisposition to awaken from another cause besides OSA.

Thanks for your interest.

12 days is not long enough to learn a new habit. Or to unlearn old ones. It is simple not. It could totally be that your brain is not giving up years of waking you up to keep you alive, it doesn't trust the mask/cpap yet, to let you sleep deeply. YOU CAN'T JUDGE BASED ON 12 NIGHTS!

Use which ever meds you need to help you sleep for the next couple of months. Give your body a chance to heal from the damage done by OSA. Battle one big issue at the time and don't sweat the smaller stuff. Tell your family to help or to suck it up, short time of inconvenience so that you will be around in the long term.

[AHI15]

What do you think I should do at the very last 1-2 hours of the night, at about 5-7am, when dawn hits and I generally have a VERY iffy chance of getting some more sleep? This last hour of sleep also can make the difference between having a headache and being dizzy with fatigue, ie., an "F" day where I can't work, or a "D" day where I can work.

Should I force myself to try to fall asleep one last time with CPAP, then if I fail just accept the resulting wasted day, hoping that the next night sleep pressure will be stronger making me sleep deeper?

Neither of these ideas what you should be doing in my opinion.

What I'm going to say is highly counter intuitive and your initial reaction will be: That's IMPOSSIBLE!!!!!

But my advice is this: If you wake up between 5 AM and 7 am and are unable to get back to a good sleep with the CPAP on, you probably should just get up for the day. In other words, give yourself a reasonable bit of time to get back to sleep with the mask on. But if you are still not asleep at the end of what feels like 15-30 minutes OR if you find yourself becoming MORE alert and less sleepy, then make yourself get out of bed and start your day.

My objective side would tend to agree that in general this is probably the best thing. But I'm still not sure, depending on special circumstances.

Yes, you'll be exhausted well before your normal bedtime. But you may find that during the part of the day that you are semi-functional, you will be more functional without that last hour of "damned if you do (use the CPAP) and damned if you don't (use the CPAP)" quality of sleep that you are currently dealing getting. Try to stay up to your normal bedtime, but since bedtime insomnia is not a huge issue, it's ok to let yourself go to bed an hour or so earlier than normal if you want under the circumstances. Likewise, if a late afternoon or evening nap is not going to cause serious problems with getting to sleep at bedtime, you can allow yourself the luxury of a nap with the PAP machine.

Ie, this is basically the "sleep restriction" theory.

What I'm proposing is not technically "sleep restriction". It's a combination of another tool from CBT for insomnia: Don't lie in bed for long periods of time NOT sleeping

Yes, I agree with this and try to practice it most of the time.

combined with a very useful rule for adjusting to CPAP: Don't allow yourself to consciously fall (back) asleep without the mask on.

This is a new rule, which is probably correct, that I will have to try to accept.

Sleep restriction is an artificial limit on the time spent in bed for the entire 24 hour day. When I was in the sleep restricted part of my CBT I was not allowed to spend more than 6 hours in bed at night---period. I had to be out of bed by 7:30AM regardless off how much or how little sleep I got. And I could not go to bed until it was 1:30AM or later. And NO naps were allowed. So six hours of sleep was the absolute maximum amount of sleep as I might possibly get in a 24 hour period.

I will have a big problem with CBT-I if sleep restriction is a part of it. I frankly disagree with sleep restriction. Unless I can see some solid science which says that it transforms people's absolute amount of deep sleep. Ie., do you get MORE deep sleep AND more real restoration in qualitative ability to function--and are there decent studies backing it up or is there just the theories of psycho-therapists and the anecdotal experiences of patients filtered through selection biases by both the patients and therapists? That's what I want to know before I even consider complying with sleep restriction.

That is because--this is no joking matter--an incompetent and dangerous therapeutic direction at this point could very well wind up leading me into a self-endangering state of mind I get into the F- territory for a prolonged period and loose hope of getting back out. The mind just cannot take this for long. That is why severe sleep deprivation is a TORTURE technique. People will rat out their own children even if they will get executed in order to get a chance to eat or sleep if you deprive them enough. We are dealing with primordial instincts here, to live or die if there is no point living, and the mind is NOT rational about it when it hurts enough.

What I'm telling you to do is this: Get as much "morning" sleep as your body is willing to get WITH the mask on your nose. But if the body won't sleep well after that 5-7AM wake occurs, assume your body is telling you that its done sleeping for the night and get up and start your day. If you need to go to bed a bit earlier the next night, fine, do that. If you need an afternoon nap and it's not going to add to your nighttime troubles, go ahead and take one---but only if you mask up.

This I agree with. In other words, we set a hard and fast rule about sleeping only with CPAP, AND a hard and fast boundary on sleep hygiene at the wakeup end--don't sleep in. But the bedtime end has some flexibility to go to bed a little earlier if the last night was bad.

Or should I allow myself to "top off" the last hour of sleep with no hose after accumulating a solid 6-8 hrs of CPAP sleep but which still isn't enough to take that last disabling edge off?

and

Thus I would argue that F days should be avoided at all costs, even if that means topping off with 1 hour of non-CPAP sleep.

That last hour of apnea filled sleep is what your body is going to remember if you try to " ''top off" the last hour of sleep with no hose". Think of it this way: If someone spent an hour or so choking you for about 10 seconds or so every 5 minutes or so, how do you think you'd feel after the repeated choking episodes ended?

In other words, that last apnea filled hour or two of sleep is contributing to how lousy you feel during the day rather than marginally improving how you feel during the day. It could well be that last hour of apnea filled sleep is what's pushing you into the F category during the daytime.

No that is backwards from my limited experience, which is, that a top off w/o CPAP does make me feel better than when I got up at 5am.

If I get up at 5am after only 6-7hrs of CPAP I will be an F and can't work. Yes I may be able to "function" at some crude level at home for a few bursts of useful activity during the day, but I can't predict when and will have to rest often. I will have a constant headache and dizzying fatigue.

That is why I said that this outcome is to be avoided at all costs, even if that means a top off without CPAP. Because you said above:

Yes, you'll be exhausted well before your normal bedtime.

Which concerns me a bit that you don't really understand the true extent of my fatigue level. There is no concept of "exhausted before bedtime." There is just constant F level fatigue from the beginning of the day to the end. Actually, it's a little more complicated and backwards:

Usually, if it is going to be a D day I wake up with a burst of energy. I may feel convinced that today I may be in pretty good shape. This lasts for about 30-60 minutes, until I sit to eat. Then after breakfast I begin to fade into a deeper tiredness. I may sink into D to F+ where I was at C when I got up. On days like this I may actually feel the least tired in the 2-3 hours before bedtime, and go all the way up to a C- to D+. This is very perplexing, as it means I can never accurately predict if the day will go well if I feel good when I wake up.

However, if I wake up too early and don't have the initial sense of partial refreshment, ie., I am agonizingly fatigued from the moment I wake up, then that predicts a solid F to F- all day.

This is intolerable! I can't see how any argument can be made that anyone should go through a day like this since--this is borderline suicidal!

Thus, I am still having a hard time accepting the idea that I should get up in that condition. If it was just a matter of pulling hard to get through a bad D- day with the hope that the next night will be better, I would agree because I managed to live like that for several years.

But it's worse than that now. A person in F- should either take a medicine that will prevent psychosis, or if it is a simple matter of getting an extra hour of sleep without CPAP, then IF IT WORKS it should be better than being borderline psychotic all day.

Don't get me wrong, I am an intellectual and will argue about things. Please don't take it personal or think it means that I don't respect your input. I will continue to think about it, learn, research, and I may change my mind once I'm convinced.

To summarize this is what I think:

1. In general sleep ONLY with CPAP even if that means not sleeping until your desired wake up time--for people in grades D- and above.

2. For people in F territory, we have to be much more careful not to precipitate a medical and psychiatric emergency. If you wake early and can't fall back to sleep with CPAP after an honest last try (ie, adhering to good sleep hygiene, no more than 20-30 minutes) AND if it is empirically observed that for this patient (most likely someone with mild-moderate OSA, or OSA dominated by arousals without desats--like myself) that if a non-CPAP top-off nap "takes the edge off" that can make the difference between near psychosis and stability, then do whatever is necessary to avoid endangering your life!

If that means a nap without CPAP to take the edge off then do it.

Do what preserves life and mental stability first, then optimal OSA treatment second.

[AHI15]

AHI15,

Two important questions:

1) How much time in bed do you spend each night? By "time in bed" I mean how much time is there from the time you lie down intending to go to sleep for the night until the time you throw the towel in and get up for the morning to start your day.

My planned bed time is about 9:45 to 10:15pm to 7:15am. I often unset the alarm and allow myself to sleep in up to about an extra 30 minutes in the morning.

2) How much time do you estimate you are actually asleep during that time in bed period?
Sleep efficency = (Time asleep)/(Time in bed) is an important parameter for measuring the quality of sleep.

I estimate that I sleep 7-8 of the allotted 9-9.5hrs. I have ADHD and ADHD people have an average sleep latency of 45 minutes. This is a fact. This complicates sleep hygiene rules which say don't lie for more than 20 minutes. Well, what do we tell ADHD people then?

Also, since I wake up at least 2-4 times a night even with the CPAP, and even with a sleeping pill, I have to face the possibility of an ADHD-style sleep latency multiple times a night. So it is very hard to get high sleep efficiency. I might get 70-80% most of the time, with occasional bouts of 85-90%.

Although, due to not working much these days and thus having less technically complex stuff whirling in my head, I am tending to fall asleep maybe in 20-30 minutes. It is very difficult to be sure of this without EEG, as you certainly must know, we can have drastic mis-perceptions about our sleep time.

On Lunesta or another Z-drug sleep aid, I think I have been falling asleep faster, maybe in 15-30 minutes. I seem to drift into a light sleep a few times for just seconds, then wake up and I have to wait again. I keep trying to fall asleep on my back first since it's more uncomfortable and time consuming to fuss with the mask on my side. Though, before CPAP I could ever sleep on my right side no matter what I do.

Thanks for taking the time to listen and respond.