Stomach Sleeper, Desperate, SleepyHead Pic Within

[tdus1]

I mostly lurk since I haven't figured this out yet. This board has always been informative and helpful. I'm afraid that I am now desperate for help and thought I would start here.

History:
- About 2.5 years ago I had a sleep study and measured 60 episodes/hour.
- I failed compliance with nasal mask and machine went back.
- About a year ago I bought a machine off Craigslist and I'm trying to sort out on my own due to high deductible health plan. I have found that I can tolerate FX pillows.
- About six months ago I lost my job due to buy out. Its been a downward spiral since and I need help.

I'm a zombie. I've been sleeping 4-5 hours a night for about a year (when I found out I was losing job). I have no energy to interact with people, look for jobs, exercise, etc. Massive depression is setting in. I am a stomach sleeper since infancy (can't change) and also battle insomnia. I have been using either Ambien, trazodone, or Diphenhydramine once every three days. They help me get to sleep but I usually can't sleep anymore after 5 hours. I feel markedly better when taking these but don't want to get dependent on them by daily use. I may re-think this since I feel like I am slowly dying anyways due to lack of sleep (maybe dramatic but I don't feel like it). When I take this stuff I cannot easily get to sleep the next night.

I'm concerned that my Respironics 550P is not working right as I don't feel like I am benefitting from its use. I don't want to go to doctor and pay for another sleep study because I know I have Apnea and they force me to sleep on my back, so, expensive & not helpful/accurate for me personally.

Would someone be kind enough to analyze my Sleepyhead pic? Any constructive advice would be appreciated. I can add other items as needed. Snoring and Pressure Pulse events stand out to me but I don't know how to fix.

[sleepy1235]

When I was unemployed due to the employment in my industry being reduced by about 60 to 70% I used to wake up early at about 4 am and worry about the future.

What I have found that works is to get up and turn the lights on and do chores around the house and then go back to sleep sometime later. Somehow getting up and moving would get my mind off things and stretching etc. I would get the house cleaned up or job searching done and later that morning go back to sleep.

That way instead of being in bed trying to fall back asleep and worrying, I was up getting things done and then with my mind off the problems I could go back and get some more sleep.

This worked for me, it may very well not work for you.

i can't interpret your charts, sorry.

[Pugsy]

The snores are far from being excessive. I doubt that they are your problem.

The pressure pulses are tiny very brief puffs of air that the machine uses to help it decide if your airway is open or closed off by sagging tissue. It's just part of the functions of the machine doing its job. Nothing you can do about them and there's no need to do anything about them anyway...they aren't bad.

How many times to you wake up each night? How long?
Trouble going back to sleep?
How many hours of sleep are you averaging? Any of those hours without the machine, if so...how much?
Do you take many meds of any kind other than what you mentioned above?
At what time do you take the meds you mentioned above? What dose of each do you typically take?
Any other meds????
Any other health conditions?

Nothing in the report above really stands out that needs fixing. BTW the only graphs of any real importance right now on the right side...Events, Flow Rate, Pressure and leak. On the left side the AHI bar graphs telling us the event category breakdown...the number of events tab...not needed.
It's possible that the variations in pressure could be disturbing your sleep quality so you might consider a trial with a single pressure...like maybe 10 minimum and 10 maximum so that the pressure doesn't bounce around. Some people find the bouncing around disturbs sleep.

To be honest it sounds more like some sort insomnia issue going on and insomnia isn't always caused by sleep apnea and the cpap machine fixes sleep apnea stuff. If the insomnia is related to something that the cpap machine can't fix...it's tough. Very common but tough. Often we expect the machine to fix all our problems and it simply can't.

Are you still extremely sleepy during the day or is it mainly huge fatigue that is your prime complaint?

[tdus1]

Thanks for the input Sleepy and Pugsy. You understand my situation, Sleepy. Were you in Finance? Prior to learning my job was being lost I slept 7-8 hours a night. I can appreciate how getting up early and sleeping again later might help. However, I am so tired upon waking... when I do not take sleep meds my eyes 'flutter' with exhaustion from the time I wake up until about 8 PM when my tiredness starts to disappear.

How many times to you wake up each night?
How long? I typically sleep 2-3 hours and then go in and out of sleep every 15-30 minutes for 2-3 more hours.

Trouble going back to sleep?
I can usually get right back to sleep until I've had about 5 hours of actual sleep.

How many hours of sleep are you averaging? Any of those hours without the machine, if so...how much?
Most nights (67%) I use the machine the entire five-hour duration. Sometimes I fall asleep without the machine but wake myself up with snoring within 15-120 minutes. The nights I don't use the machine I use a mouthpiece. I find I dream more with the mouthpiece and rarely ever with the machine.

Do you take many meds of any kind other than what you mentioned above?
No other meds.

At what time do you take the meds you mentioned above? What dose of each do you typically take?
I usually take them about 10:30/11:00 PM. Ambian (5 mg), or Trazodone (25 mg), or Diphenhydramine HCI (25 mg) once every three nights.

Any other health conditions?
I am 195 and probably should be 170 lbs (or a lot taller). Also,Testosterone below 'normal' ranges so I qualify for treatment. Super high triglycerides (not diet related).

Every day I am fatigued to the max. So dirt tired on days I don't take a sleep aid...I can feel my eyes continually flutter and want to shut most of day. However, if I lay down for a nap I simply cannot sleep.

I'll try with a static setting and see how that goes. My general MD thought I should take 50mgs of Trazodone daily...that concerns me but maybe should just do it so we can keep going with the dialogue. About six months ago I was using a sleep aid 1-2/week. The need is picking up at an alarming rate.

Thanks again!

[Pugsy]

Ambien is designed to help people fall asleep but it doesn't always address sleep maintenance insomnia very well...meaning the bulk of its sedation properties fade away after 2 or 3 hours. There is a CR version...controlled release available.

All the meds you take to help you sleep also have a sedating side effect for possible drowsiness symptoms the next day.
Hangover effect sort of. Benadryl being probably the least depending on how your body metabolizes it.

But since you have extreme sleepiness even when you don't take the meds...probably can't blame it on the meds.
You might try taking earlier to lessen any hangover effect that might be a factor.

Remembering the dreams when using a mouth guard and not when using cpap doesn't really mean all that much. Not like people might initially think anyway...People think that if they don't dream remember them then they aren't getting into REM sleep and that doesn't really mean that. It's said that we don't remember dreams if we sleep soundly...it's when we wake up during a dream or right at the end of a dream that we remember them. Remembering the dreams when using a mouth guard could simply be from waking often.

5 hours of sleep...not nearly enough even if it wasn't fragmented with multiple wake ups.
Fixing poor sleep is easier said than done unfortunately.

Google "sleep maintenance insomnia" and "good/bad sleep hygiene"...see if you happen to have any bad habits that could maybe be improved upon in an attempt to improve your sleep quality...hours of sleep and reduce the awakenings.

I suspect that stress is playing a big part in the problem...both in how you feel during the day and your sleep quality.
Nasty little circle it creates...feeding off each other.
Google "fatigue"....stress alone will do it....not to mention the short hours of highly fragmented sleep.

Instead of rotating the meds so often...try one for a week...then try another for a week.

Talk to your doctor about the situation.
The low testosterone could also be a small part...I don't think it is the sole cause for your problems. Most often in these situations it's a complicated problem with several factors involved.

Talk with your doctor about maybe adding Amitrypline 10/20 mg as an evening med. It's a very mild antidepressant which has been used for various other issues...10/20 mg isn't nearly enough to be therapuetic levels for depression (those levels will knock an elephant on its ass) but in very small doses like 10 or 20 mg...they can help with getting to sleep and staying asleep. Don't take it late in the evening though...it packs a punch in terms of hang over effect for some people...like around 9 PM.
I take it for my sleep maintenance insomnia....for me it works a LOT better than Benadryl and about as well as Ambien but without the ugly side effects or potential addictive properties of Ambien...I have never used Trazadone so I can't compare it.

There is a book that I suggest you get and read. Sound Sleep Sound Mind by Dr Barry Krakow
http://www.amazon.com/Sound-Sleep-Mind- ... 111851601X

Also read RobySue's blog...you aren't alone with your sleep issues.
http://adventures-in-hosehead-land.blog ... er_19.html
I know that cpap isn't your entire problem but she makes really good points here for even those people without OSA complicating the sleep.

So...check the half life for those meds you take...see if taking them earlier helps at all.
Do a lot of reading about what you have going on.
5 hours of sleep even if solid without wake ups and a nice pretty CPAP report...not enough to expect to feel all that great. I wish it were that easy.

[chunkyfrog]

Being un- or under-employed can create some of the worst stress ever.
Is it possible to enter a different field--with or without training?
Just doing something constructive about your situation could help.