interrupted sleep versus sleeping all night.

OK, I guess we all know it is better to sleep deeply for all night, to get to the most restorative levels of sleep for the needed time period.

But how much is really best?

Example, I am faced with Arthritis pain waking me up after four hours, when the blood level of Tylenol (2 500 MG) goes down.

Alternatively, I can take long term Tylenol (2 650 MG), which means I would take less Tylenol during the day, as my doc has commanded me to not take more then 4 grams a day.

Another way to say that: I can take the full four grams during the day, and hurt less during the day,

OR I can take two five hundred twice a day, plus the two 650 MG at bedtime and hurt more during the day, but be reward with perhaps six hours seemingly uninterrupted sleep.

Door number three is that I have a prescription for Tramadol, which is also a CNS depressant, and I would guess will not work so well for the rest of a sleep apnea person.

perhaps there is another pain medication you could take at bedtime instead that would be time-release?

I have seen a number of doctors since I first started Sleep Apnea treatment. Specifically about ten days ago when I saw the Doc who prescribed the Tramadol. The Doc acknowledged the possibility of Tramadol causing problems, but it is one of those prescriptions, take it if you need it. I am starting Physical Therapy, and I feel sure the Therapist will make sure I need it.

But I can take it during the day, and not during the evening and last hours before going to sleep. There is some question whether I should take Tramadol intermittently, or whether I should take it on schedule. As I do not like the side effects of the Tramadol, it will be intermittently, if at all. Although that might not be the best way to use this drug.

maybe with the physical therapy you wont need the tramadol except on rare occasions. I will keep my fingers crossed for you. i can see why you wouldn't want to take it at night after looking it up. sounds like door number 3 or some close resemblance, huh?

Tramadol doesn't do much for me at all, day or night, but I never sleep more than an hour at night without waking up. I flip and flop all night long and I think most of the time what wakes me is pain and periodic limb movement disorder. I would LOVE to sleep for even 6 hours without waking. If you find something that works please share.

dieselgal, There are some other things you might try first, if you have not already done so. Take a full on Multi Vitamin Multi Mineral supplement. Add to that a supplement of Magnesium, which is known to be related to sleep problems. For a Diabetic like me, there is also taking a large amount of Vitamin D3, plus something that boosts my intake to the same was what I would get in an ARREDS Two Preserve Vision Multi Vitamin. (Problem is that ARREDS Two multi supplement, plus a multi mineral would give me a toxic amount of some things, like Zinc.) Also notice I said ARREDS Two supplement, not the earlier different ARREDS supplement.

Of course your doc has told you that there is a drug for Restless Leg Syndrome. In fact, was Restless Leg diagnosed during the sleep test?

There are a coupla other supplements which are known to help with sleep, as I have not taken them, I do not want to mention them.

The next thing would be, and I bet you know this one as well, is so called Sleep Hygiene technique.

Despite the Arthritis pain, I find that walking helps to make me to rest better. If it is not Arthritis pain that keeps you up, then perhaps you have a different problem than me.

I have had similar discussions with my sleep doctor's PA along with my PCP about my arthritis in my lower back and pelvis causing so much pain that every time I move in bed that the pain would wake me up...I move a lot because it hurts to stay in one position very long in bed. Pros and cons to anything but we finally settled on a sort of decently working regiment.
I do take tramadol during the day and it does a very decent job with the pain reduction. I would love to be able to take it at bedtime but it wires me up...does the opposite of what it does to most people. If I take one in the evening I might sleep 2 hours then I am wide awake the rest of the night.

So a couple of years ago we started a low dose of amitryptilline at bedtime...very low dose like 10 mg tablets and I can take 1 or 2 as needed. It does a very decent job. When I have run out I have nights where I wake up 20 to 30 times and remember it...so probably more that I don't remember. There have been some studies where the amitryptilline in low doses sees to help with the pain and not just act like a knock out drug. I have had good luck with it. If things are hurting really bad for some special reason I have the okay to take a little hydrocodone tablet (so a little low dose opiate with tylenol in it). That gets used mainly when I have done something stupid and the pain is so bad I can't walk to bed. I have watched my reports...nothing unusual going on when I take the opiate.

My doctor and I had a long talk about which meds would help with the pain and allow me to sleep and have minimal impact on the OSA sides of things. I can't be having 40 wake ups a night...that's no way even close to getting good quality sleep. Something has to give and if I have to take drugs to get the pain relief...then I will take drugs.

The amitryptilline has done very, very well in the low dose. Some nights I don't remember waking up at all, some nights maybe 2 or 3 times when I have to turn over in bed but I go right back to sleep. At these low doses its almost like it is a totally different drug than the old 150 mg three times a day for depression. I am not a morning person, never have been even as a kid. But I don't have a drug hangover...I just need my space and time and my coffee each morning for about an hour before I am fit person to be around.

So if pain is an issue....might be worthwhile to talk to your doctor about a little dose of amitryptilline. Side effects at 10 mg dose is minimal.

I have taken Tramadol periodically during the worst times. It seemed to take the edge of the pain though not totally relieve it. I asked the ortho doctor if this was the kind of med that needed to be taken consistently and he said no, to take it as needed. My sleep doctor had some concerns about if it could cause my jumpy legs to be worse so I quit taking it at night. I never saw a difference in my CPAP data when I took it.

I rarely wake with arthritis pain in the night any more and I have had Rheumatoid Arthritis for 22 years and some osteoarthritis. For many years now (15 years maybe or more) I have taken a 24 hour slow release morphine at a low dose. If I go into a flare I need more of this drug. I don't have any side effects that interfere with my life or sleep on this. At bedtime I also take 2- 650 time released Tylenol. I rarely wake with any pain in the night ( I am usually up once to go to the bathroom). I generally sleep for 6 - 7 hours a night.

I do take DMARDS - disease modifying drugs for RA as well. These are to slow the progression of the disease and help prevent deformities.

I have been on this drug regime for longer than I have had sleep apnea. My AHI is almost always below 1. I am monitored by my Rheumatologist - blood work, etc for any side effects - so far all is fine.

purple,

I have no advice concerning the Tramadol.

But I do have something to offer concerning Doors #1 and #2:

purple wrote: But how much is really best?

Example, I am faced with Arthritis pain waking me up after four hours, when the blood level of Tylenol (2 500 MG) goes down.

Alternatively, I can take long term Tylenol (2 650 MG), which means I would take less Tylenol during the day, as my doc has commanded me to not take more then 4 grams a day.

Another way to say that: I can take the full four grams during the day, and hurt less during the day,

OR I can take two five hundred twice a day, plus the two 650 MG at bedtime and hurt more during the day, but be reward with perhaps six hours seemingly uninterrupted sleep.

I think this is the kind of situation where journaling might help. Keep a journal of both how well you sleep during the night and how well you feel during the day and also some kind of an "overall" score for how well you functioned and felt (in all areas, not just pain level) for the whole 24 hour period. For week #1, stick with Door #1 (no extended Tylenol at night). For week #2, stick with Door #2 (extended Tylenol at night.) Repeat the cycle a couple of times if necessary. If there's a noticeable difference between the two, you'll have your answer: Pick the one that makes you feel better overall.

Boy, do i know where you are coming from. I've got severe hip arthritis and then last week i fell and severely separated my shoulder ( the end of my clavical is on my back like a golf ball). I take up to 4g of Tylenol a day and 4 X 800mg of Ibuprofen along with it. I'm regularly getting my liver enzymes tested as my sister-in-law needs a liver transplant because of tylenol. Some other things to do: don't drink any alcohol ever when on this level of pain killer, add anti-oxidants to your diet when you take the tylenol. Animal studies show that it can prevent the liver damage caused by tylenol. For example, here's one herbal supplement, Moringa oleifera, that you can get online or at a health food store. In general i'm not a big fan of herbs because they are so poorly tested. Better to take lots of fruits and vegetables along with your tylenol.

Pharm Biol. 2013 Mar;51(3):279-88. doi: 10.3109/13880209.2012.720993. Epub 2012 Oct 8.
Therapeutic potential of Moringa oleifera extracts against acetaminophen-induced hepatotoxicity in rats.
Sharifudin SA, Fakurazi S, Hidayat MT, Hairuszah I, Moklas MA, Arulselvan P.
Source
Department of Human Anatomy, Universiti Putra Malaysia, Selangor, Malaysia.
Abstract
CONTEXT:
Moringa oleifera Lam. (Moringaceae) is a rich source of essential minerals and antioxidants; it has been used in human and animal nutrition. The leaves and flowers are being used by the population with great dietary importance.
OBJECTIVE:
The present study was to investigate the therapeutic effects of the hydroethanolic extract of Moringa oleifera (MO) leaves and flowers against hepatotoxicity induced by acetaminophen (APAP) in rats.
MATERIALS AND METHODS:
In the hepatoprotective study, either flowers or leaves of hydroethanolic extract (200 or 400 mg/kg bw through IP injection) were administered an hour after APAP administration. N-Acetylcysteine (NAC) was used as the positive control for this study. Liver and kidney function tests including lipid peroxidation levels were analyzed and histopathological changes of liver and kidney were also observed.
RESULTS:
Acetaminophen-induced hepatotoxicity increased the activities of liver marker enzymes. Histologically, the liver was observed to have inflammation and bridging necrosis. Liver marker enzymes were significantly reduced when treated with flower and leaf extracts of MO in animals with APAP induced toxicity. In addition, there were no significant changes observed in clinical markers of kidney function. Histological observation on liver tissue from the rats treated with MO flower and leaf extract showed reduction in the severity of the liver damage.
DISCUSSION AND CONCLUSION:
These results indicated the possible therapeutic action of flower and leaf extract from MO in protecting liver damage in rats given an over dosage of APAP.