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I think I am going to go to a doctor, my alternative one.

Wednesday. I feel half rested; no body fatigue but still tired.

The last time you used your ResMed AutoSet...
was last night (on Tuesday, May 12, 2015)
You had an AHI of 2.40, which is considered reasonably good
You machine was on for 8 hours, 44 minutes and 11 seconds.
You had a small but acceptable amount of major mask leakage.
Your pressure was under 12.96cmH2O for 95% of the time.

Its the same pattern. One day refreshed but a deep body fatigue, the next will be unrefreshed / wired and tired. Its like every other night I don't go into a deep sleep, but then I'm so tired that the next night I do.

Calling a new doctor tomorrow; my fear though is that I have low testosterone; and what I understand is that testosterone therapy makes sleep apnea worse.

Noctuary wrote:...my fear though is that I have low testosterone; and what I understand is that testosterone therapy makes sleep apnea worse.

Some people have sleeping issues with Low T. Not all. Some have it with T therapy, many don't.

Not all issues affect everyone, people are different and have different symptoms and issues and causes.

Thank you for responding, Krelvin.

Noctuary wrote:Its the same pattern. One day refreshed but a deep body fatigue, the next will be unrefreshed / wired and tired. Its like every other night I don't go into a deep sleep, but then I'm so tired that the next night I do.

Calling a new doctor tomorrow; my fear though is that I have low testosterone; and what I understand is that testosterone therapy makes sleep apnea worse.

Several things:

1) CPAP/APAP only fixes sleep disordered breathing. If there is any other cause for your bad sleep or your daytime fatigue and sleepiness, then optimizing the CPAP/APAP therapy is only one step in the process of fixing the problems. And until the other problems are identified and dealt with, you might very well not notice much improvement or only have part-time improvement.

2) Calling the doctor is a good idea. But you need to take the time to tell the doc your symptoms instead of your ideas about what might be causing those symptoms. If the doc suspects low T and suggests a test, fine. Deal with any potential problems caused by treating the low T with testosterone therapy if/when you are actually put on it and are having trouble with it.

3) How long have you been taking the Temazepam? Let me be clear: I don't mean how many days in a row have you taken it. Rather, I would like to know how long ago this drug was prescribed to you for treating insomnia. And were the instructions to take it "as needed" or were you told to take it every night? Also: Has there been any follow-up by the doc who prescribed it? In other words, does the doc who prescribed the temazepam know about your on-going sleep problems?

4) The last two nights' data that you posted continue to show some CA clusters at times when you may well have been dozing or drifting between WAKE and SLEEP. But notably neither of these nights shows an hour or more of obvious restlessness in the middle of the night. I do think that capping the pressure at 13 is allowing you to get a bit better quality of sleep. It's still not the kind of sleep you want to be getting, but it's at least marginally better than what you were getting when the pressure was allowed to go as high as 15 or 16cm.

5) The obstructive part of your AHI is very, very low. So OAs and Hs are not causing the machine to increase the pressure to 13 and stay there. Is the Flow limitation graph or the snoring graph busier? If the pressure increases are being driven by Flow Limitations, you may be one of the minority of people who have a flow limited breathing pattern that is not particularly significant in terms of your OSA (perhaps because). Since you have previously speculated that the pressure itself may be causing you to wake up, it may be worth experimenting with lowering the max pressure to 12cm. Again, your pressure is sure to max out at 12 and stay there for a significant amount of the night, but if the number of OAs and Hs doesn't increase much, you might sleep marginally better. And at this point, even small steps forward are good.

6) You've mentioned depression in some of your previous posts. Depression can severely affect the quality of the sleep, and that can happen even with relatively mild depression. Depression can also cause a lot of daytime fatigue, and in particular, it can be responsible for a sense of never feeling "normal" but having some days that are "less bad" and other days that are "more bad" in terms of exhaustion, fatigue, and other daytime problems. If you have not had a chat with your doc about your depression, you should mention this problem as well as your on going issues with the lack of high quality sleep.

3) How long have you been taking the Temazepam? Let me be clear: I don't mean how many days in a row have you taken it. Rather, I would like to know how long ago this drug was prescribed to you for treating insomnia. And were the instructions to take it "as needed" or were you told to take it every night? Also: Has there been any follow-up by the doc who prescribed it? In other words, does the doc who prescribed the temazepam know about your on-going sleep problems?

I have five months refills I can get. I guess it was as needed.

5) The obstructive part of your AHI is very, very low. So OAs and Hs are not causing the machine to increase the pressure to 13 and stay there. Is the Flow limitation graph or the snoring graph busier? If the pressure increases are being driven by Flow Limitations, you may be one of the minority of people who have a flow limited breathing pattern that is not particularly significant in terms of your OSA (perhaps because). Since you have previously speculated that the pressure itself may be causing you to wake up, it may be worth experimenting with lowering the max pressure to 12cm. Again, your pressure is sure to max out at 12 and stay there for a significant amount of the night, but if the number of OAs and Hs doesn't increase much, you might sleep marginally better. And at this point, even small steps forward are good.

I will bump it down.

6) You've mentioned depression in some of your previous posts. Depression can severely affect the quality of the sleep, and that can happen even with relatively mild depression. Depression can also cause a lot of daytime fatigue, and in particular, it can be responsible for a sense of never feeling "normal" but having some days that are "less bad" and other days that are "more bad" in terms of exhaustion, fatigue, and other daytime problems. If you have not had a chat with your doc about your depression, you should mention this problem as well as your on going issues with the lack of high quality sleep.

I've been depressed my whole life. But this condition of sleep apnea, or whatever is causing my poor sleep, literally came on overnight. I had been sleeping well for years, then one day I woke up feeling terrible. This was incidentally a few days after I went to the hospital for pains in my shoulders and neck (it wasn't a heart attack after all). I often wonder if I caught something there. My current doctor knows about my depression; I won't tell him the extent of it nowadays. He knows of my fatigue and prescribed me Provigil, which is worthless. I am going to call my alternative doctor tomorrow and set up an appointment.

Thank you for replying to my post!

The last time you used your ResMed AutoSet...
was last night (on Wednesday, May 13, 2015)
You had an AHI of 3.38, which is considered technically "treated"
You machine was on for 7 hours, 6 minutes and 1 seconds.
You had no major mask leaks (maximum was 15.60 L/min).
Your pressure was under 12cmH2O for 95% of the time.

I slept six hours or so, but feel so sleepy. I dropped my upper level down to 12cm last night, but I feel like I didn't get into deep sleep. Recently I have lost about 8 lbs.; I don't know if that would have any effect.

Noctuary wrote:

robysue wrote:3) How long have you been taking the Temazepam?

I have five months refills I can get. I guess it was as needed.

Which came first: The temazepam prescription or the start of CPAP therapy?

Regardless of which came first, I'd talk to the doc who prescribed the temazepam if I were you. While hypnotics are typically intended for short term use for transient, severe insomnia, there are times when they are an important tool for dealing with chronic, severe insomnia problems. However, it's important that both the doc and the patient understand what the goals of the drug therapy are and what the exact instructions on taking the drug are.

For example, two summers ago my CPAP-induced insomnia returned big-time and the usual attention to sleep hygiene just wasn't cutting it in terms of keeping the insomnia monster under control. After doing additional testing that documented the problem, but did nothing to identify the underlying cause, my sleep doctor explained to me why he wanted me taking Ambien every night for a month or two. I had been very reluctant to do that, but I agreed to trying it his way. While taking the Ambien nightly for a couple of months didn't "solve" all my problems, it did help bring the insomnia back under control enough where I was no longer feeling like I wasn't getting any restorative sleep on half or more of the nights. And at that point I was able to back off to taking the Ambine on an "as needed" basis.

Noctuary wrote:

robysue wrote:6) You've mentioned depression in some of your previous posts.
...
If you have not had a chat with your doc about your depression, you should mention this problem as well as your on going issues with the lack of high quality sleep.

I've been depressed my whole life.
...
My current doctor knows about my depression; I won't tell him the extent of it nowadays. He knows of my fatigue and prescribed me Provigil, which is worthless. I am going to call my alternative doctor tomorrow and set up an appointment.

You need to tell the doctor(s) the extent of your depression nowadays.

Seriously: Regardless of how you wish to treat your depression symptoms, you need to be open with your doctor(s) about the extent of those symptoms. Untreated or undertreated depression can lead to both daytime fatigue and nighttime sleep problems. If the depression has gotten worse since you've been put on CPAP, that's an important thing that the doc needs to be made aware of. Yes, I can understand that you may be very reluctant to tell the doctor about the worsening depression because you are worried about having unwanted medication being pushed as a solution. But you still need to have this conversation with the doc(s) even if you reject the idea of taking antidepressants.

Noctuary wrote:But this condition of sleep apnea, or whatever is causing my poor sleep, literally came on overnight. I had been sleeping well for years, then one day I woke up feeling terrible. This was incidentally a few days after I went to the hospital for pains in my shoulders and neck (it wasn't a heart attack after all). I often wonder if I caught something there.

There are at least five things that may need to be teased out of your medical history and your current sleep problem symptoms:

1) The role of your OSA in terms of your sleep problems prior to your OSA diagnosis. Here's the thing: OSA does not "come on overnight". Nor is OSA something you can "catch" from being in the hospital. OSA is a chronic condition that develops over time, and the symptoms usually develop slowly---so slowly that many people with OSA simply redefine what "normal for them" means through the years without ever really realizing just how bad their sleep is. And there is also a fair amount of variability in how severe the OSA symptoms are from person to person. Some people with OSA strongly suspect that apnea is a problem and know they're not sleeping well and have horrible daytime fatigue and sleepiness, and when the sleep study is done, their OSA turns out to be rather mild with an AHI around 10. Other people have no clue that they've got OSA, don't seem to have many symptoms and think they sleep very well each night, but because their bedpartner complains of snoring, they have a sleep test done and it shows very severe OSA (AHI >> 30) and significant O2 desats. So you have to understand that when you say you had been "sleeping well for years", that may be true---in the sense of how your sleep felt subjectively in the sense of your having had no memory of night time wakes and having had enough energy to get through your days, but at the same time it may have been objectively bad in terms of what was actually happening to your body each and every night.

2) Is there is some specific cause (other than untreated OSA) for the sudden seemingly overnight deterioration in the quality of your sleep? Pain can trigger sleep problems. Perhaps the severe pain that lead you to going to the hospital (in fear that it was a heart attach?) may have been the trigger for the sudden deterioration in the subjective quality of your sleep. But if that was the trigger, then the question becomes: Why didn't the sleep return to normal after you got the good news that the pain was NOT a heart attack? Perhaps your sleep didn't recover because the bad sleep that was triggered by the pain allowed your body and mind to start noticing the damage being done by the OSA each night. Perhaps the hospitalization for the pain triggered some severe anxiety, which has lead to on-going sleep problems. Perhaps the hospitalization has lead to a worsening of the depression, and the depression symptoms are now manifesting themselves in terms of bad sleep for the first time.

3) The timing between the sudden decrease in sleep quality, your diagnostic sleep test and its results, and the initiation of CPAP therapy; and how each of these things has affected your on-going problems with depression. While its clear to you what the order of events is, it's not yet clear to me. (I admit: I've not taken the time to re-read all your posts, and the answer is most likely there.) It seems to me from what I've been reading that the order of events is:

• The hospitalization with the pain that turned out to NOT be a heart attack.
• A sudden decrease in sleep quality.
• The diagnostic sleep test, with results that showed you have OSA. (Why were you referred for a sleep test? How bad is the untreated OSA?)
• Starting CPAP, with the results being a further deterioration in the quality of your sleep.
• A relatively recent increase in middle-of-the-night wakes with the inability to get back to sleep, along with wake-too-early wakes.

And along with the on-going deterioration of the sleep quality, you've been dealing with an increase in the depression symptoms and in the daytime fatigue.

4) The role of APAP in agravating your current sleep problems. There is some evidence that pressure increases may be triggering wakes or at least increasing the restlessness you have during the night time. And unfortunately, when you wake up in the middle of the night, you have a tough time getting back to sleep. Capping the max CPAP pressure at the lowest level that keeps the OSA under control may help prevent pressure spikes from triggering wakes. But there's more to high quality sleep than just "not waking up." Still, preventing the wakes is an important part of the solution to your overall sleep problems.

5) The role your long-term depression problems might have in terms of your current bad sleep problems. Yes, I know: You've been depressed for years, but you've also been sleeping well for years. But the thing is, as you get older and/or as the depression gets worse, the way the depression manifests itself in your daily life can change. It's possible that after the hospitalization and the pain-induced short-term sleeping problems, that the depression started to manifest itself in terms of bad sleep quality. And that after starting CPAP to address the OSA problems, the depression-related bad sleep problems didn't resolve because they're rooted in the depression, not the OSA. So treating the OSA is good for the body (in terms of preventing furhter OSA-related damage), but has not resulted in fixing your overall sleep problems because the problems you are most noticing are caused by the depression and not the OSA or CPAP.


Finally, there's this: It may be time to stop worrying about the cause of the current sleep difficulties, and start working on fixing the sleep problems. That will require a shift in mind set (which is hard to do) and a shift in expectations (which is also hard to do). In particular:

A) Set reasonable, achievable interum goals in regards to your sleep quality. You need to face the fact that nothing is going to be a "magic bullet" and fix all your sleep problems in a very short time frame. Rather, you need to have some achievable goals that mark steps in the right direction. And you need to allow yourself to celebrate small victories, even if you are still feeling pretty lousy most of the time. If you have a night where you only wake up once or twice, but you're able to get back to sleep, that's progress even if you don't feel much better during the following daytime. So allow yourself the luxury of celebrating that progress instead of fixiating on the fact that you still feel pretty bad during the daytime.

B) Continue working on finding a pressure that controls the OSA but also does not seem to trigger or increase the night time wakes and overall restlessness. By itself this probably won't make much difference in terms of how you feel, but if you don't do this, you won't ever get to where you want to be. In math speak: Finding a good pressure range is a necessary condition for fixing your problems, but it is not a sufficient condition for fixing your problems.

C) Start working on addressing sleep hygiene issues.

• You need to establish a regular wake up time, regardless of how little or how much sleep you get the night before. Yes, it makes for some really bad days, but this is critical in training your body to understand that Time in bed = time to sleep.
• Work on figuring out an appropriate bedtime for yourself. If you never get more than 6 hours of sleep, there's very little reason to go to bed 8 hours before your designated wake up time. Spending a lot of time in bed not sleeping is exhausting and can make you feel wiped out the next morning. If you only get 6 hours of sleep on your best nights, then bedtime should be about 6.5-7 hours before wake up time.
• Clarify how the doctor intends for you to take the Temazepam, and take it as directed. If the Temazepam stops working or seems to be ineffective, let the doctor know what's happening.
• Work on other sleepy hygiene issues: Try to limit or eliminate caffeine after noon. Pay attention to when you eat supper and what kinds of things you choose to eat for late night snacks. Try to limit/eliminate using electronic gadgets during the last hour or two before going to bed. Don't use the bedroom for anything other than sleeping and sex.

D) Work on addressing the depression issues. If the depression has increased substantially since starting CPAP, then some of your ongoing symptoms are likely caused by the increased depression. How to address the depression issues is something you must decide, prefereably in consultation with a doctor whom you trust.

Noctuary wrote:The last time you used your ResMed AutoSet...
was last night (on Wednesday, May 13, 2015)
You had an AHI of 3.38, which is considered technically "treated"
You machine was on for 7 hours, 6 minutes and 1 seconds.
You had no major mask leaks (maximum was 15.60 L/min).
Your pressure was under 12cmH2O for 95% of the time.

I slept six hours or so, but feel so sleepy. I dropped my upper level down to 12cm last night, but I feel like I didn't get into deep sleep. Recently I have lost about 8 lbs.; I don't know if that would have any effect.

Question: Did you take the temazepam last night or not? It's important to track whether taking the temazepam is doing anything positive for you in terms of sleep continuity.

That said, let's look at some important ideas:

Self-reported amount of sleep is 6 hours of sleep in a 7.1 hour "time in bed" window. That's a self reported sleep efficiency of 6/7.1 = 84.5%. That's not horrible, but it's not great either. Still, it does represent a real, measurable step forward when compared to the sleep efficiency of the nights you posted when you were using APAP 8-20 and experiencing some hour long wakes in the middle of the night. Compare this data to that posted at the beginning of this thread: viewtopic.php?f=1&t=105578&st=0&sk=t&sd=a) and this thread: viewtopic.php?f=1&t=105512&st=0&sk=t&sd=a . You've made some real progress even if you're not yet feeling that progress in terms of how you feel during the daytime.

There's a slight uptick in the overall AHI, but the cluster of events scored after 5:00 might be SWJ, and if you take out the CAI, the obstructive event index (OAI + HI) is still very low. In other words, a max pressure of 12cm might very well be enough to keep the obstructive events under control.

There's less obvious variability in the Flow Rate curve, so that probably means you didn't have a whole lot of short wakes during the night. Moreover, it doesn't look to me like you had any 50+ minute long periods of obvious restlessness and wakefulness. That too is progress, even if you are very sleepy today.

As for feeling like you never got into deep sleep: There's no way to verify how much deep sleep you may have gotten from just the CPAP data. In other words, you may be right. Or you might be wrong. We just don't know from the CPAP data. However, if we assume that you are right and that you got no deep sleep, the fact that you got six hours of reasonably continuous sleep, even if most or all of it is light sleep, is a step forward. It takes time for the body to fully adjust to CPAP. And yes, I know that you've already put several months into adjusting. But it seems like your sleep problems are deeper than just CPAP adjustment issues and it's possible that either those other issues are interfering with your ability to get into deep sleep OR those other issues are making it harder for the body to fully adjust to CPAP and so the CPAP is still causing microarousals that are interfering with your ability to get a good night's sleep.

Which came first: The temazepam prescription or the start of CPAP therapy?

Regardless of which came first, I'd talk to the doc who prescribed the temazepam if I were you. While hypnotics are typically intended for short term use for transient, severe insomnia, there are times when they are an important tool for dealing with chronic, severe insomnia problems. However, it's important that both the doc and the patient understand what the goals of the drug therapy are and what the exact instructions on taking the drug are.

CPAP came first. Before this disease came, I slept great. Then literally overnight I could not get good sleep. I would fall asleep, but wake up exhausted. Now, for whatever reason, I can't fall asleep wearing the mask. So I take meds.

You need to tell the doctor(s) the extent of your depression nowadays.

Seriously: Regardless of how you wish to treat your depression symptoms, you need to be open with your doctor(s) about the extent of those symptoms. Untreated or undertreated depression can lead to both daytime fatigue and nighttime sleep problems. If the depression has gotten worse since you've been put on CPAP, that's an important thing that the doc needs to be made aware of. Yes, I can understand that you may be very reluctant to tell the doctor about the worsening depression because you are worried about having unwanted medication being pushed as a solution. But you still need to have this conversation with the doc(s) even if you reject the idea of taking antidepressants.

You need to tell the doctor(s) the extent of your depression nowadays.

Whatever depression I have is now caused by fatigue and the awareness that this fatigue won't relent. I can't see how any treatment of depression will help, in fact their "pills" have in the past been ineffective with unpleasant side effects. If I could sleep my depression would lift remarkably.

2) Is there is some specific cause (other than untreated OSA) for the sudden seemingly overnight deterioration in the quality of your sleep? Pain can trigger sleep problems. Perhaps the severe pain that lead you to going to the hospital (in fear that it was a heart attach?) may have been the trigger for the sudden deterioration in the subjective quality of your sleep. But if that was the trigger, then the question becomes: Why didn't the sleep return to normal after you got the good news that the pain was NOT a heart attack? Perhaps your sleep didn't recover because the bad sleep that was triggered by the pain allowed your body and mind to start noticing the damage being done by the OSA each night. Perhaps the hospitalization for the pain triggered some severe anxiety, which has lead to on-going sleep problems. Perhaps the hospitalization has lead to a worsening of the depression, and the depression symptoms are now manifesting themselves in terms of bad sleep for the first time.

The pain wasn't severe. I was freaked out by reading WebMD, a common thing I understand. But I was fine for a couple of days after my visit.

) The timing between the sudden decrease in sleep quality, your diagnostic sleep test and its results, and the initiation of CPAP therapy; and how each of these things has affected your on-going problems with depression. While its clear to you what the order of events is, it's not yet clear to me. (I admit: I've not taken the time to re-read all your posts, and the answer is most likely there.) It seems to me from what I've been reading that the order of events is:
The hospitalization with the pain that turned out to NOT be a heart attack.
A sudden decrease in sleep quality.
The diagnostic sleep test, with results that showed you have OSA. (Why were you referred for a sleep test? How bad is the untreated OSA?)
Starting CPAP, with the results being a further deterioration in the quality of your sleep.
A relatively recent increase in middle-of-the-night wakes with the inability to get back to sleep, along with wake-too-early wakes.

I brought up the possibility of sleep apnea to my doctor, who then ordered the sleep study. And overall it has been beneficial. In the months before therapy I was so weak I couldn't clean the house, bills went unpaid, I hated even taking a shower; my dreams were blank. I also had auditory and closed eye hallucinations. I am better now, but still really tired all the time and I can't conceive life like this year rolling onto year. Only lately (weeks) have I had the problem of feeling sleepy/not getting enough sleep. Before it was the pattern of refreshed/body fatigue one day and "wired and tired" the next.

4) The role of APAP in agravating your current sleep problems. There is some evidence that pressure increases may be triggering wakes or at least increasing the restlessness you have during the night time. And unfortunately, when you wake up in the middle of the night, you have a tough time getting back to sleep. Capping the max CPAP pressure at the lowest level that keeps the OSA under control may help prevent pressure spikes from triggering wakes. But there's more to high quality sleep than just "not waking up." Still, preventing the wakes is an important part of the solution to your overall sleep problems.

Its not really waking up in the middle of the night, its more at the end; getting like 5 hours of not deep sleep. Or today when it was about six hours. Still feel unrested. I lowered the max last night to 12 and still didn't sleep well.

5) The role your long-term depression problems might have in terms of your current bad sleep problems. Yes, I know: You've been depressed for years, but you've also been sleeping well for years. But the thing is, as you get older and/or as the depression gets worse, the way the depression manifests itself in your daily life can change. It's possible that after the hospitalization and the pain-induced short-term sleeping problems, that the depression started to manifest itself in terms of bad sleep quality. And that after starting CPAP to address the OSA problems, the depression-related bad sleep problems didn't resolve because they're rooted in the depression, not the OSA. So treating the OSA is good for the body (in terms of preventing furhter OSA-related damage), but has not resulted in fixing your overall sleep problems because the problems you are most noticing are caused by the depression and not the OSA or CPAP.

Maybe. But again, the pain wasn't intense or even really bad. I just believed internet hype. It was actually muscle soreness from lifting. But I got freaked.

I'm not going to do the sleep hygiene thing; that would just be more things for me to worry about. Trust me on that. I work nights and go to sleep two to three hours after I get home. I sleep until I can't anymore.

I am calling my alternative doctor today; he would be more inclined to take the things you told me seriously (depression, etc.)

Thank you for taking the time to reply. You are very kind.

edit:
Let me add this. Today I feel like I simply didn't get enough sleep. For months, as I said above, I would alternate between feeling refreshed with a deep body fatigue and days when I would feel wired and tired. This thing I have now which has become regular is feeling like a normal person who didn't get enough sleep. I don't have the body fatigue nor the wired and tired feeling. Now a few days ago my AHI was 0.9; I felt very refreshed when I awoke, but I had the body fatigue. As the night wore on it got worse. So what I'm experiencing lately is a new thing, just tiredness.

Everyday is bad, but the quality is not the same everyday.

Noctuary wrote:I've been depressed all my life but have mostly slept well.

Noctuary wrote:I also had auditory and closed eye hallucinations

Noctuary wrote:I've looked at sleep hygiene and I already do all those things.

Noctuary wrote:I'm not going to do the sleep hygiene thing

Noctuary wrote:Its not anxiety.

Noctuary wrote:I can't fall asleep...So I take meds.

Noctuary wrote:I am calling my alternative doctor today

Jay Aitchsee wrote:

Noctuary wrote:I've been depressed all my life but have mostly slept well.

Noctuary wrote:I also had auditory and closed eye hallucinations

Noctuary wrote:I've looked at sleep hygiene and I already do all those things.

Noctuary wrote:I'm not going to do the sleep hygiene thing

Noctuary wrote:Its not anxiety.

Noctuary wrote:I can't fall asleep...So I take meds.

Noctuary wrote:I am calling my alternative doctor today

I can cherry pick too and ignore contexts; I choose not to.

Noctuary wrote:Before this disease came, I slept great. Then literally overnight I could not get good sleep. I would fall asleep, but wake up exhausted.

OSA does NOT develop overnight. Seriously, you don't just develop OSA overnight.

That said: Sometimes a life event can push one over the edge into noticing symptoms that were there all along. My guess still is that before the hospitalization you thought you were sleeping much better than you actually were. And somehow, the fear that induced you to go to the hospital also somehow "reset" your body's ability to ignore what was happening to your body every night.

Noctuary wrote:

Which came first: The temazepam prescription or the start of CPAP therapy?

CPAP came first. Before this disease came, I slept great.

and

Noctuary wrote:I brought up the possibility of sleep apnea to my doctor, who then ordered the sleep study. And overall it has been beneficial. In the months before therapy I was so weak I couldn't clean the house, bills went unpaid, I hated even taking a shower; my dreams were blank. I also had auditory and closed eye hallucinations. I am better now, but still really tired all the time and I can't conceive life like this year rolling onto year.

These two statements are self-contradictory: If you were this weak, then your sleep was NOT great.

Some observations:

You say that you are "better now, but still really tired all the time." You need to focus on the "I feel better now" and less on the "but still really tired all the time and I can't conceive life like this year rolling onto year[s]." What I mean by this is: You are allowing yourself to lose sight of the fact that you do feel somewhat better. It's not that CPAP is not doing anything to help you; it's that CPAP is not working "fast enough" to meet your expectations and hopes. That's an important distinction, and it's important to not lose sight of the fact that you are beginning to feel better.

Some of us are just plain unlucky enough to have really severe adjustment problems. The fact that CPAP triggered some real insomnia issues for you is a piece of really bad luck---I know: I've been there, done that, and have the scars to prove it. Heck, it will be 5 years this summer since I started CPAP, and I'm currently waging my Third War on CPAP-induced Insomnia. I don't mean to scare you with that statement. When my insomnia is properly contained, I sleep much better now with the CPAP than I did before starting CPAP: I can wake up feeling refreshed and rested; I have more energy and much less daily pain; and it's easier to manage my chronic migraines, my TMJ, and my chronic tension headaches. But if anything allows the insomnia to get out of control, I start to feel pretty miserable within a couple of weeks. And the longer I try to ignore the insomnia, the worse it gets. But I've also noticed: The more time I dwell on how the CPAP caused the insomnia, the angrier I get, and the angrier I get, the stronger the insomnia monster becomes. If I simply accept that fact that CPAP seems to increase my tendency to have too many microarousals as a fact and work on addressing the how to prevent/minimize the number of microarousals, I can keep the insomnia under control and I tend to feel better because I'm sleeping better. And, unfortunately, for me, that has meant that I've had to accept that I need to take prescription sleeping medication more frequently that I would like to. It's taken me a very long time to get to that acceptance. But my sleep log data doesn't lie and nor does the CPAP data: If I don't take the sleeping medicine when I really need to, I don't sleep very well. If I don't take it for a week or more when I am not sleeping very well, my sleep patterns get more and more distorted and I feel less and less well. And if they get too far out of whack? Well it's back to "take the damn pill every night for a couple of weeks regardless of whether I think I'm going to sleep without it" because that's the only thing that will prevent the insomnia monster from gaining a lot of traction.

I'll write more later, but I have to go give a final exam right now.

These two statements are self-contradictory: If you were this weak, then your sleep was NOT great.

Its not contradictory. I was weak after the onset of bad sleep. It was months before I got diagnosed. Even with that I would still fall asleep. When I got the CPAP I got the medication as a help. Whereas before I could fall asleep even with the onset of this condition, it was after CPAP that I had difficulty falling asleep.

You say that you are "better now, but still really tired all the time." You need to focus on the "I feel better now" and less on the "but still really tired all the time and I can't conceive life like this year rolling onto year[s]." What I mean by this is: You are allowing yourself to lose sight of the fact that you do feel somewhat better. It's not that CPAP is not doing anything to help you; it's that CPAP is not working "fast enough" to meet your expectations and hopes. That's an important distinction, and it's important to not lose sight of the fact that you are beginning to feel better.

Its been a year though.

Some of us are just plain unlucky enough to have really severe adjustment problems. The fact that CPAP triggered some real insomnia issues for you is a piece of really bad luck---I know: I've been there, done that, and have the scars to prove it. Heck, it will be 5 years this summer since I started CPAP, and I'm currently waging my Third War on CPAP-induced Insomnia. I don't mean to scare you with that statement. When my insomnia is properly contained, I sleep much better now with the CPAP than I did before starting CPAP: I can wake up feeling refreshed and rested; I have more energy and much less daily pain; and it's easier to manage my chronic migraines, my TMJ, and my chronic tension headaches. But if anything allows the insomnia to get out of control, I start to feel pretty miserable within a couple of weeks. And the longer I try to ignore the insomnia, the worse it gets. But I've also noticed: The more time I dwell on how the CPAP caused the insomnia, the angrier I get, and the angrier I get, the stronger the insomnia monster becomes. If I simply accept that fact that CPAP seems to increase my tendency to have too many microarousals as a fact and work on addressing the how to prevent/minimize the number of microarousals, I can keep the insomnia under control and I tend to feel better because I'm sleeping better. And, unfortunately, for me, that has meant that I've had to accept that I need to take prescription sleeping medication more frequently that I would like to. It's taken me a very long time to get to that acceptance. But my sleep log data doesn't like and nor does the CPAP data: If I don't take the sleeping medicine when I really need to, I don't sleep very well. If I don't take it for a week or more when I am not sleeping very well, my sleep patterns get more and more distorted and I feel less and less well. And if they get too far out of whack? Well it's back to "take the damn pill every night for a couple of weeks regardless of whether I think I'm going to sleep without it" because that's the only thing that will prevent the insomnia monster from gaining a lot of traction.

I'm not angry at the CPAP for the induced insomnia (if that is the case). I am perfectly fine with taking meds to help go to sleep, even if I'm addicted.