- First: The logs between the February and March appointments show that I had real trouble getting to bed by 1:30 on a regular basis before that March 29 meeting with Keryn. Mostly I was getting to bed between 1:30 and 2:00, with a few outliers later than 2:00 and a few more around 1:20. Latency to sleep, however, now seems pretty secure: It's a very rare night when it takes me more than 10 minutes to fall asleep. That is still novel to me: I've always taken a long, long time to get to sleep even as a young child.
Second: The discrepancy between my bedtime and my husband's bedtime is more than a mild irritant. He doesn't mind me coming to bed late. But I do feel really lonely during that last hour (or two) when he's conked out, but I still have to be awake. *sigh* And (pardon my frankness), it's not doing a heck of a lot for our sex life either. And towards the other end of the night, hubby often wakes up needing to go to the bathroom sometime between 5:30 and 6:30 and try as he might, there's evidence that even when I'm not visibly disturbed by his getting out of bed that it indeed causing me to arouse and is disturbing me.
Third: The "getting ready for bed" routine is getting longer and more tedious. And it's wearing on my patience. I long for the days when all I needed to do was a quick brush of the teeth and then fall in bed. (And spend about 30--40 minutes daydreaming until falling asleep.)
Number of wakes during the night have also reached a plateau of 3--4 wake ups. The logs showed the wakes as getting much less distinct in my memory (which is a good thing). But there's a restlessness pattern beginning to creep into the logs where I wake up, doze, and reawake a number of times---without much clue as to the number of times through the cycle, but a real sense that I'm not sleeping all that well when it's happening. There have been times where by the second, third, or fourth time through the cycle, I've started to wonder whether I needed to get out of bed due to not sleeping very well. (And I'm pretty clueless as to how many times through the cycle I go before I start wondering whether I need to get up.) I even specifically asked Keryn that question. She told me that as long as I thought I was sleeping (some) between the restless periods and not feeling like I was becoming more alert, anxious, angry with each "waking" part of the cycle, that I was probably better off staying in bed. She also said it's possible that I'm remembering drifting in and out of Stage 1 sleep. Which seemed odd to me. And I'm not quite clear that I fully understood her meaning: Did she mean I'm drifting back and forth between Stage 1 (with vague memories) and Stage 2 sleep? Or did she mean I'm drifting between Wake and Stage 1? -SWS or NotMuffy either of you want to comment on this?
Time to get back to sleep after the wakes (except for the "restless periods" mentioned above) are beginning to get nice and short: 5--10 minutes at most for the vast majority of my wake ups. Except for those "restless periods": They seem like they go on forever once they start. I know they don't and when I'm confronted with making an estimate for my sleep log, I usually come up with a vague figure of 20 to 30 minutes. They are definitely long enough to notice and long enough to create problems in the morning with how I feel.
Aerophagia is creeping back as an issue. The S1 is set to Auto mode now, with Min EPAP = 4 and Max IPAP = 8. 90% pressure is definitely running at 8/6, but 50% of the time EPAP is at 4cm. (Over 50% of time, IPAP is at 8.) The AHI is running pretty consistently between 0.5 and 2.0 these days. I feel the apnea when the number of events is above 15 (which would be an AHI of about 2.5 most days); and I feel best when the number of events is below 10 (which is about an AHI of 1.7). The machine scores a lot of snoring. My husband hears little or no snoring and what he does hear is quiet and "cute" (his descriptor, not mine). The snoring drives up the EPAP. The Auto range is tight enough that if IPAP is not already at it's max, any increase in EPAP also increases IPAP. And the Flow Limitation index is ranging from 1.0 to 4.0 (I think), and the FL drives up the IPAP without increasing the EPAP. Increases in pressure due to OA's, H's, and RERA's are pretty rare and increases in pressure due to these events without snoring or flow limitations are extremely rare. Keryn has suggested that I might want to try straight BiPAP again at a setting of 8/4 and see how that controls events since the 7/4 titration level from the last sleep study was letting the AHI get up to 3+ too often for my comfort. Or Auto with a max IPAP of 7.5 to limit that max EPAP to 5.5. It's a shame that on the PR System One BiPAP Auto, you cannot set max EPAP and min IPAP levels directly: Max EPAP seems to be defined as (Max IPAP - 2) and, similarly Min IPAP = Min EPAP + 2. I'd love for there to be a way to set my machine to let that EPAP range from 4 to 6, while forcing the IPAP to stay between 7 and 8. By the end of the meeting, we decided to leave the pressure settings alone for now and gather more data as I move into spring allergy season.
Due to the restlessness episodes and my sense of not making much progress with stabilizing the bedtime, Keryn asked about my use of the Sonata. Truthfully, I'd only taken it a couple of times---once following a horrid disaster of a night and once to prevent an impending disaster at around 3:00 AM (last call for Sonata for me). She didn't have any problems with my extreme reluctance to use the Sonata. She had mentioned melatonin at our February meeting and asked if I'd tried that. I had (once or twice) and not noticed much difference. She encouraged me to try it again and reminded me that it is something our bodies make (so it's natural in that sense) and that even long term use of melatonin should have no serious issues---rather like the the supplemental vitamin D (and the multivitamin) that I take every day. I'd found some one milligram melatonin tablets at a natural foods store and we talked about how starting out at that dose couldn't possibly hurt anything. So I agreed to try the melatonin for a while as well. She wants me to take it two hours before bedtime. So that's what I'm doing now. Still a bit leery about it, but trying my best to rationalize melatonin as a supplement and not a drug. I know I may be splitting hairs here, but they are my hairs and I need to split them for my own sanity sake. Comments are welcome.
And before I left, Keryn took my blood pressure: 108/60. For the first time since my July 2010 physical (110/65), my blood pressure reading has down around where it's been most of my adult life. I hope it stays there instead of the 120/75 and 125/80 readings I've been getting at my PCP, the ENT, the neurologist, and the sleep doctor's office these past seven months.
My next scheduled followup with Keryn is May 5. I'm happy to not yet to hear: Go forward and get on with your own life. Let us know if you have any further problems. Although I think I may be getting closer to that point.
Following this overall rather positive meeting with Keryn, hubby and I drove the 5 1/2 hours to North Creek for skiing at Gore Mountain. First night, we got in late that night (after leaving Buffalo several hours after we intended to), and so I didn't get to bed until close to 2:30. But slept pretty decent. Skiing on Wednesday was awesome. And that night I did get to bed at 1:15 and slept very well. Next day the weather wasn't too great, the forecast was for a snow storm coming in that night, and hubby's knees were sore. So we opted not to ski and enjoyed a day just kicking around town and having an nice supper with the first beer I'd had since New Years. And I got to bed a bit after 1:15 and I slept really well again. Snow storm fizzled in magnitude, but provided enough powder for the top of the mountain to be in good shape on Friday morning. Had a great time skiing again, and another good supper (but no beer since this supper was much closer to bedtime). And a third night of getting to bed by 1:15ish and sleeping pretty good. We drove home on Saturday on a gorgeous day (took the long way out of the Adirondacks for some sight seeing), but I did have some real problems with sleepiness on the drive and only spelled hubby for a short while due to feeling sleepy at the wheel. But after getting home I had a fourth night of getting to bed by 1:15, sleeping well. And Sunday I even (dare I say it?) woke up refreshed. Enjoyed skiing at Holiday Valley even though a minor migraine had set in shortly after breakfast.
But alas, my string of excellent nights was broken last night. (Keryn did say, "There will be setbacks. Don't get discouraged by the odd bad night.") AHI was ok at 1.3 (8 events) and bedtime was slightly delayed (1:20ish). But I had a major restless period this "morning" starting sometime around 5:00 or 5:30 and continuing through my husband's early morning trip to the bathroom. And waking up for the day, I was tired, cranky, had a headache that only got worse when my husband asked me to make a phone call to a bank that then did not go well. (Long story that I don't want to include). No emotional reserves at all today. And major daytime sleepiness again. *sigh* And a night class to teach.
So I don't know if it's the melatonin, the skiing, or the spring break that lead to that remarkable string of four pretty good nights in a row. I do know the need to go back to work today was at least partially responsible for the restlessness last night. Until I woke up, I'd been sleeping pretty soundly. And unlike previous nights with restlessness, I don't remember any other wakes not connected to the restlessness.
My short term goal: Try to get that 1:15 bedtime better consolidated before the end of April or at least the middle of May.
My longer term goals: Once I get that 1:15 bedtime better consolidated, I hope to be able to move bedtime back in 15 minute increments over the summer to the point where by the time my fall semester starts, bedtime is at some decent hour for a 53 year old lady---like midnight or 11:30pm. I know it won't do me any good to try to get to bed any earlier than that with a 7:30 wake up time.
