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[guarddog13]

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[Julie]

What types of things have you tried to directly address the insomnia rather than medicate it? Do you drink coffee or eat lots of chocolate (I know it's an 'of course not' Q, but I have to ask)? Are you taking any alternative meds? Do you have software to track your progress - and if so, what do the charts suggest? Are you under stress from entirely unrelated stuff that you've maybe been discounting?

[guarddog13]

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[JDS74]

So try waiting to go to bed until 11 PM or so and see if you can go through the night without sleep aids.
Part of the sleep hygiene thing is not going to bed before its time. Over time you may be able to move bed time forward.

What does your data show about the time just before you wake up? Any events changes in breathing patterns, etc.?

[guarddog13]

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[robysue]

More recently I've started having some issues with middle of night insomnia. My brain seems to think 5-6 hours of sleep is plenty enough and I'm literally wide awake every night after this period, and then tired for about half the day starting at 3PM.

What time is bedtime? And what time is wake up time?

And pre-cpap, when was bedtime? When was wake up time? And just how bad was the untreated OSA? In other words, what was the AHI on the diagnostic sleep test? And if you have this: What was the sleep efficiency on the diagnostic sleep test? How long did you sleep and how long was the sleep period on the diagnostic sleep test?

One phenomenon that some PAPers go through is this: The 5-6 hours of sleep with the PAP is about as much total sleep time as the PAPer was getting in 7-9 hours of OSA-filled sleep before they started PAPing. And the body has grown "used" to that much sleep, so it wakes up feeling pretty good after 5-6 hours of uninterrupted sleep with the PAP, not realizing (until later in the day) that a bit more sleep might be desirable.

In other words, your body has to learn how to deal with the uninterrupted sleep. As to why this might be happening now as opposed to when you first started PAP, well maybe the body was so exhausted that it apppreciated the full time in bed.

I follow sleep hygiene to a T, no electronics, no clocks and getting up when i get frustrated until i'm ready to go back to sleep. After three weeks of this and no progress I contacted my PCP...who is an FNP. He suggested I try Melatonin at 5-10mg, all this does is help me get to sleep a bit faster. However, for some odd reason when I wake up in the morning I have that same day time sleepiness and headache I had before CPAP and it also causes me to wake up every hour on the hour to pee just like before CPAP.

Sounds like the PCP suggested WAY, WAY too much melatonin. And that might be why it's giving you the headache and sleepiness in the morning.

Increasingly the folks who study melatonin are finding that tiny doses work BETTER than megadoses. So you might try 0.5 to 1 mg of Melatonin (if you can find tabs that small). Another thing my sleep doc had me try was to take the melatonin about 6 hours before the desired bedtime. Yes, that's really counterintuitive, but there's a melatonin cycle, and by taking it before bedtime, the "right" concentration is better at and through the sleep period.

Unfortunately for me, even small doses of melatonin seem to cause TMJ problems.

So it was back to calling the PCP. He had his nurse call me this time, she told me to take up to 50mg of Benadryl. I use to be in the medical field as a Paramedic and knew this didn't sound right and I actually asked her if I could get a referral to a sleep doctor as I have NEVER seen an actual sleep doctor. She told me to try this and that would be the next step. So I attempted the Benadryl that night and that was a horrible experiment as I am apparently one of those that it has a paradoxical effect on, it took me hours to actually get to sleep....something that I have had zero problems with.

Benadryl does not make everyone sleepy.

He ended up prescribing me Trazodone 25-50mg a night. At this point, willing to try anything I started on the 25mg dose, for the first five days it was amazing. I was waking up one time to pee so tired that it was simple to go back to sleep; again easily getting around 7.5 hours a night, with almost no side effects. The last 3 days though it's been back to where my brain says ok it's been anywhere from 5-6 hours time to get up for the day.

My next logical step is to try the 50mg dose tonight but again as a former Paramedic I see where this is going. I'll sleep great for another time period and then i'll build up a tolerance and be right back where I started. I'm on a vicious circle of sleep torture and seriously would like to know what I did in a past life to deserve this lol. I'll probably attempt the 50mg because i'm desperate. However I am thinking it may be time to force the issue to see a sleep doctor or change PCPs.

I can understand your reluctance to simply keep increasing the dose of the medication. Trazodone is frequently used off-label for insomnia and it works well for lots of people. But tolerance is an issue. (Tolerance, however, can be an issue with any sleeping pill for some people.)

The next thing I'm about to say may sound silly, but I'm going to say it anyway: The nightly fight to get back to sleep after the wake and/or the daily worrying about the fact that you are now wide awake (and ready to start your day) after 5-6 hours of sleep may be making you more prone to notice the afternoon sleepiness. The melatonin cycle is actually pretty complex, and for a lot of normal people (i.e. no insomnia and no untreated OSA), there's a pretty significant "down time" after lunch with a lot of sleepiness. Some cultures recognize this fact (think Spanish siestas), but ours, alas does not.

And so the last question that I have for you is also going to sound silly. But I have to ask it anyway: Why not try to compromise with your body just a bit? In other words, you might feel better if you went to bed about 45 minutes later than your current bedtime, and for the time being were content to just get up about 30 minutes earlier than you are used to doing. As your body sorts things out, you might actually start sleeping a bit later in the morning. Once you are pretty much sleeping through until your desired wake up time, you can start moving bedtime back in 15 minute intervals every week or so until you reach your desired 7 to 7.5 hours of sleep.

[Pesser]

I have had the exact problem you’re describing all my life. When I was at university it nearly made me fail all my classes in my third year. I had to arrange my classes to allow for it and for the absolutely necessary nap. I found that napping twice helped. Even if I didn’t fall asleep; napping (relaxing) while listening to music made a big difference (1/4 to ½ hour). I my case I am certain something else is going on. While at university I consulted all different doctors of all branches of medicine. Nothing helped. I have discovered something. If you really, really….really want to sleep…..you won’t. When you don’t care and you let go….you will. The sleep you get is entirely dependent on you agenda for the next day. Avoid the agenda! I’m sure you already know that you need a ritual to be successful at sleep. I read while in bed awaiting the feeling of boredom. Then I fall asleep hoping I don’t start caring about life.

[robysue]

So try waiting to go to bed until 11 PM or so and see if you can go through the night without sleep aids.
Part of the sleep hygiene thing is not going to bed before its time. Over time you may be able to move bed time forward.

What does your data show about the time just before you wake up? Any events changes in breathing patterns, etc.?

I have always been a night owl so i sleep now at 1am usually getting up around 9 or 10am. So should I wait longer than 1am? I also have ADHD and usually feel wide awake at bedtime but even when i wasn't taking sleep aids i could always fall asleep once i laid down and put that mask on.

If you fell WIDE AWAKE at bedtime you might very well want to stay up for another 30-60 minutes. But note: If staying up LATER makes it harder to get to sleep in the first place, you've stayed up TOO long. And that case go back to your normal bedtime.

Do you get up between 9 and 10 every day---as in seven days a week? Or do you sleep in even later on weekends? And get up between 7 and 8 on certain days because of a class or work schedule?

What time would you prefer to get up at seven days a week? One real important part of sleep hygiene for middle of the night insomnia is a REGULAR wake up time. And in the short term, that may mean getting up at exactly the same time each morning, regardless of whether you think you've had enough sleep or not. That may mean having a clock in the bedroom (for an alarm). Just put it somewhere you can't easily see when you're in bed and awake.

It doesn't appear there is any patterns just before waking.... maybe an increase in respiration rate, but I'm new to these graphs and some of the meanings of things like tidal volume and what it effects.

The timing of the wake (6 hours after going to sleep) indicates that it may be nothing more than a normal post REM wake. The problem is not the wake; the problem is the inability to get back to sleep after the wake. And right now you say you feel like you're "done sleeping" for the night---i.e. you are waking up rested and ready to start the day after 6 hours of sleep. So go with what your body is telling you to do.

And since you are a college student, if it's possible to take a short 15-30 minute nap (with the PAP) when the sleepies hit at 3:00pm, you could see if that makes things better or worse. Yes, I know "naps are bad" is part of the typical sleep hygiene rules. But "naps are bad" only when they make it harder to get to sleep at bedtime and stay asleep. If your body winds up functioning well on a sleep schedule from 2:00-8:00 AM with a 15-30-minute nap at 3:30pm each afternoon and that sleep schedule fits your current lifestyle as a college student, just go with what your body wants to do.

[guarddog13]

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[Julie]

My personal experience is... that the 5-10 mg Melatonin is outrageous! 1/2-1/4 of a 3 mg pill is all I can live with (after trying the 3 mg ones), because the follow-up just spoils the benefits. And I only take it once in a while when I've let myself have any caffeine after 3 pm (and that includes just a little choc. or 1/4 tsp. of instant coffee... and feel sure I won't sleep well.

But does your sched. preclude you from just working with the problem - i.e. not fighting the early wake-up, but catching up later in the day for an hour? That's what I have to do because I'm also a 5 1/2-6 hr max sleeper, even if I wake up tired but don't go back to bed x a while. Some of us may just be different, and not pathological, so adapting to things rather than struggling might be easier in the end.

[guarddog13]

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[guarddog13]

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[Julie]

Oh... you hadn't mentioned the urinary problems... if the Lasix isn't working, you need to see your MD. It's one thing for Cpap to keep you sleeping without bathroom breaks under usual circumstances, but another if that's not happening and you have more definitive symptoms.

[robysue]

guarddog13,

Not everyone needs 7-9 hours of solid, uninterrupted sleep in one chunk on most nights. 7-9 hours of sleep is the average need for sleep across the wide population of humankind. But some of us need less sleep and some need more. Usually if we listen to our bodies, they'll tell us how much sleep we need. If you wake up feeling rested with enough energy to face the day with 6 hours of sleep, then chance are you are in the (small) minority of people who only need 6 hours of sleep.

Nor can everyone manage to get 7-9 hours of uninterrupted sleep during the night. Before electrical lights had the power to keep us all up until its about 7-9 hours before when we need to get up, most people went to bed shortly after dark and slept for 4-5 hours. They often woke up in the middle of the night for an hour or more. And then went back to sleep until dawn. Sex and prayers and chores and other things occupied that hour long wake, depending on who you were.

If your body refuses to sleep more than 6 hours at a time, then fighting to get more sleep by going to bed earlier or staying in bed later is often counter productive: Lying in bed NOT sleeping usually adds to stress of "not sleeping" rather than reducing it.

There's nothing wrong with nap taking if it does not interfere with your life. And by that I mean, you can find a way to take the nap with the PAP, and taking the nap does not increase or trigger sleep problems at night. In many cultures, "naps after lunch" are considered normal and routine. Unfortunately, here in the US, "naps" are considered a sign of weakness or illness. Our culture is WRONG.
(Unfortunately for me, I can't take naps: If I do, I cannot get to sleep until it's after 4:00 in the morning, which then leaves me very short of sleep the next morning.)

Yes, with the blood pressure and water retention (pitting edema) issues it would be nice if you were sleeping longer hours. But the stress your PCP is putting you under when he keeps insisting that you have to figure out a way to get 7-9 hours of uninterrupted sleep each night when you can't sleep much more than 6 hours right now is also hurting your health.

You might also want to get a hold of a book called Sound Sleep, Sound Mind by Dr. Barry Krakow. It has a high quality explanation of what insomnia is, what insomnia can do to your body, what kinds of things insomniacs often do that make the situation worse, and all kinds of suggestions on what to try. Right now, the suggestions that I think you need to read through and think about are the suggestions that Krakow makes about "accept the wakefulness if you've woken up rested and do something interesting and fun and go back to bed when you're ready to."

In other words, you might seriously try just getting up if it's light outside when you wake up after 5-6 hours of sleep. And then do something interesting and fun. And if you need a nap around 3:00? Take it if possible. And learn not to worry so much about the quantity of your sleep if the quality of your sleep is really very good.

[guarddog13]

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