Latetest SleepyHead report.

Back from giving the final.

Noctuary wrote:

robysue wrote:You need to tell the doctor(s) the extent of your depression nowadays.
...
But you still need to have this conversation with the doc(s) even if you reject the idea of taking antidepressants.

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.

You're caught in a Gordian knot here: The sleep problems make the depression worse and the depression is most likely aggravating the daytime fatigue issues and may very well be making the sleep problems worse. To cut the Gordian knot you may have to work on both problems simultaneously.

Please note: "Treating the depression" does NOT mean that you must start taking medication. You have good reasons for wanting to avoid taking antidepressants. But there are non-drug ways to treat depression, and you may want to investigate them.

Noctuary wrote:

robysue wrote: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.

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.

And yet you keep saying that the sleep problems started with the trip to the hospital. So if the pain wasn't severe and all that happened was that you "freaked out" by reading WebMD, how do you explain the sudden decrease in the quality of your sleep?

Questions: Prior to the "freak out" that resulted in the hospitalization, how were you feeling during the daytime? Lots of energy? Or dragging around like something the cat dragged in? Were you waking up refreshed before that incident? Or were you waking up tired and exhausted? Or was it a mixture---some days you felt "ok" and other days you felt "not so OK"?

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.

As I said before, you need to allow yourself to focus on the positive: You are feeling better than you were now that you are a year into PAPing. You are not where you want to be, but you ARE feeling better. Don't lose sight of that fact.

I'm not saying that you should ignore the fact that you are not feeling as well as you should be feeling. There's more work to be done to make this crazy therapy work for you. But on the other hand, you have some positive results and you can use the fact that you are feeling better to try to keep yourself motivated. (By the time I was PAPing for a whole year, I was finally back to feeling almost as good on PAP as I had felt just before I started PAP; I'd spent a good 6-9 months of that first year of PAPing feeling 100 times worse on PAP than I'd felt in the weeks and months before my diagnostic sleep study was done.)

Noctuary wrote: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.

This is where keeping a sleep journal might be useful. Right now no-one can really tell you why some days you are/were waking up refreshed, but having body fatigue and other days you are/were "wired and tired". And without some data it may be impossible to tease out why this was/is happening.

As for the current and new issue of feeling sleepy, but not being able to get enough sleep: Again, without having some data from a sleep log, it's impossible to answer this question. From the CPAP data you've posted, I've developed a hypothesis that the pressure spikes might be adding to your woes. But whether that's the real cause or not? I don't know and neither do you because you've only just made the change of capping your CPAP pressure. If you get back to the older pattern of refreshed/body fatigue one day and "wired and tired" the next in the next couple of weeks, then you may have solved the most recent problem, but you will still need to address whatever it is that's at the root of the older pattern of refreshed/body fatigue one day and "wired and tired" the next.

Noctuary wrote: 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.

OK. So you've got a problem that is more accurately described as "wake too soon" insomnia.

But from what you've said in your posts, you also have problems falling asleep at the beginning of the night. And you have trouble with middle of the night wakes. In other words, you've got some pretty significant insomnia issues going on. And until you get the insomnia under control, you are not likely to feel very well.

You've been on temazepam for the insomnia, but it's not clear if you take it every night or if you take it 3-4 nights a week or if you take it 1-2 nights a week or if you hardly ever take it. And that's an important piece of data for figuring out what to do about the insomnia. If the temazepam makes a real, positive difference in terms of your sleep, the short-term "solution" might be to take it more frequently, and only after you are no longer experiencing the "wake too early" wakes star to taper back down to taking it less frequently. But if you are already taking temazepam 3-4 times a week or every night, then it may be time to let the doc who prescribed it know that you are still waking up too early and waking up too often in spite of taking the temazepam.

And if you don't actually know whether the temazepam is doing you any good, well then it's time for keeping a sleep journal so that you have some data that you can look at to compare whether the days after you take the temazepam are better, worse, or about the same as the days when you don't take the temazepam.

Noctuary wrote: 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.

Comments:

1) The data you have posted is not consistent with a sleep pattern of someone who works nights: Your bedtimes are all between 10:30pm and 12:30am. And the times the machine is turned off for good range from 6:00AM to 9:00AM. Now, it's possible that you work evenings and sleep those hours. Or it's possible that your CPAP's clock is off. Some CPAPers who work third shift jobs do intentionally set the CPAP clock incorrectly so that their data is not split over two days because they're regularly sleeping past noon. So what is it? Do you work second shift? Or do you work third shift and the CPAP clock is not set to the real time?

2) Sleep hygiene is not something you "worry" about. All sleep hygiene consists of is being aware that certain behaviors tend to help us sleep more consistently and other behaviors tend to aggravate insomnia problems. It's about identifying which things adversely affect your sleep and avoiding them. It's also about identifying which behaviors increase your sleep and finding ways to implement them into your daily life.

Here's a list of some standard good sleep hygiene guidelines pulled from the National Sleep Foundation website:

• Avoid napping during the day. It can disturb the normal pattern of sleep and wakefulness.
• Avoid stimulants such as caffeine, nicotine, and alcohol too close to bedtime. While alcohol is well known to speed the onset of sleep, it disrupts sleep in the second half as the body begins to metabolize the alcohol, causing arousal.
• Exercise can promote good sleep. Vigorous exercise should be taken in the morning or late afternoon. A relaxing exercise, like yoga, can be done before bed to help initiate a restful night's sleep.
• Food can be disruptive right before sleep. Stay away from large meals close to bedtime. Also dietary changes can cause sleep problems, if someone is struggling with a sleep problem, it's not a good time to start experimenting with spicy dishes. And, remember, chocolate has caffeine.
• Ensure adequate exposure to natural light. This is particularly important for older people who may not venture outside as frequently as children and adults. Light exposure helps maintain a healthy sleep-wake cycle.
• Establish a regular relaxing bedtime routine. Try to avoid emotionally upsetting conversations and activities before trying to go to sleep. Don't dwell on, or bring your problems to bed.
• Associate your bed with sleep. It's not a good idea to use your bed to watch TV, listen to the radio, or read.
• Make sure that the sleep environment is pleasant and relaxing. The bed should be comfortable, the room should not be too hot or cold, or too bright.

So read that list. You probably already so some (maybe many) of these things. And you probably don't do some of these things. The idea to start with is to pick the things that make sense to you and start there. For many people, paying attention to a small subset of these guidelines is all that is needed to keep the insomina monster at bay; but identifying which particular things are most crucial can take some time.

In my case, prior to CPAP, I pretty well did everything on this list except for no caffeine too close to bed and have a relaxing bedtime routine. I also didn't pay any attention to trying to maintain a reasonably regular bedtime and a reasonably regular wake up time. Well, 6 months after CPAP-induced Insomnia set in, I had to admit that the PA who told me that I absolutely had to give up caffeine after 10AM and that I needed a regular wake up time and bedtime was right: Those two good sleep hygiene guidelines just happen to be things that my body cares about, even though my mind hates the idea of them. So now, I know I have to pick and choose: If I'm sleeping "good enough" for now, and I choose to ignore my usual bedtime and wake time for a day or two a week, I'll probably be ok. But if I choose to ignore them for 3-5 days in a given week, I'm inviting the insomnia monster to come back into my life. It's my choice. And sometimes, the risk of bit of insomnia is worth putting up with so that I can indulge my desire to stay up all night to finish something and sleep in for a few days in a row. Sometimes it's not worth the risk. But the fact that I know this particular guideline is critical to my body helps me evaluate whether and when to choose to NOT follow it.

Noctuary wrote:Everyday is bad, but the quality is not the same everyday.

I'm going to end this with something that I find myself repeating to my cousin who is living with us right now while trying to straighten out a large number of problems in her life: You need to allow yourself the freedom to notice when things are NOT so bad. Pay attention to the "quality" of how you are feeling. While you think you are feeling bad all the time, some days ARE better (i.e. "less bad") than others. If you can work on increasing the number of "less bad" days, you will eventually feel "less bad". And on the rare times when you actually feel good allow yourself the joy of feeling good, even it you only feel good for a small part of the day. Try to focus on the positive things rather than worrying about all the negative things.

[quote="Noctuary

I take Temazepam every night, 30 mg. I feel groggy today, like a pill groggy.[/quote]

Usual Adult Dose for Insomnia:
15 mg orally before retiring.
The dose range is 7.5 to 30 mg.

I would drop the dose to 15 mg b/c you're topdosing yourself, regardless how you sleep.

You're caught in a Gordian knot here: The sleep problems make the depression worse and the depression is most likely aggravating the daytime fatigue issues and may very well be making the sleep problems worse. To cut the Gordian knot you may have to work on both problems simultaneously.

I'll bring it up my next appointment. I don't know what can be done though.

And yet you keep saying that the sleep problems started with the trip to the hospital. So if the pain wasn't severe and all that happened was that you "freaked out" by reading WebMD, how do you explain the sudden decrease in the quality of your sleep?

I don't know. It has befuddled me for a while now. But I can say the pain wasn't severe, it was just there and I thought I better have it checked. The whole hospital thing could just be a coincidence. However, something I haven't mentioned is that in the preceding year I gained weight. I got into the bad habit of drinking nightly for a few months, drinking beer. More so on the weekends. I didn't weigh myself, because I didn't want to know, but my pants became tighter, some I could not fit into anymore. I have lost weight recently, and the pile of pants I was going to give to goodwill now fit. My belt has slack now too.

Questions: Prior to the "freak out" that resulted in the hospitalization, how were you feeling during the daytime? Lots of energy? Or dragging around like something the cat dragged in? Were you waking up refreshed before that incident? Or were you waking up tired and exhausted? Or was it a mixture---some days you felt "ok" and other days you felt "not so OK"?

I felt fine. However, there was one or two instances where my snoring woke me up, right when I began to drift off.

As I said before, you need to allow yourself to focus on the positive: You are feeling better than you were now that you are a year into PAPing. You are not where you want to be, but you ARE feeling better. Don't lose sight of that fact.

Its definitely better; but its a hard life already due to bad choices and low confidence.

This is where keeping a sleep journal might be useful. Right now no-one can really tell you why some days you are/were waking up refreshed, but having body fatigue and other days you are/were "wired and tired". And without some data it may be impossible to tease out why this was/is happening.

I can do that. But I will also say that it has been a recent change where I just feel the sleepy; not the body fatigue and not the wired and tired. That's why in another thread I mentioned a "new chapter". The tired-sleepy feeling (which feels like how I normally felt before all this on those occasions where I didn't get enough sleep) seems to becoming the norm. I can't help but to wonder if losing weight is making a difference whichever way. Is it making the pressure do something now that it didn't before? I'm going to lose more weight.

As for the current and new issue of feeling sleepy, but not being able to get enough sleep: Again, without having some data from a sleep log, it's impossible to answer this question. From the CPAP data you've posted, I've developed a hypothesis that the pressure spikes might be adding to your woes. But whether that's the real cause or not? I don't know and neither do you because you've only just made the change of capping your CPAP pressure. If you get back to the older pattern of refreshed/body fatigue one day and "wired and tired" the next in the next couple of weeks, then you may have solved the most recent problem, but you will still need to address whatever it is that's at the root of the older pattern of refreshed/body fatigue one day and "wired and tired" the next.

Its like my brain gets oxygen one day, and my body the other. That's probably impossible, but I wonder.

You've been on temazepam for the insomnia, but it's not clear if you take it every night or if you take it 3-4 nights a week or if you take it 1-2 nights a week or if you hardly ever take it. And that's an important piece of data for figuring out what to do about the insomnia. If the temazepam makes a real, positive difference in terms of your sleep, the short-term "solution" might be to take it more frequently, and only after you are no longer experiencing the "wake too early" wakes star to taper back down to taking it less frequently. But if you are already taking temazepam 3-4 times a week or every night, then it may be time to let the doc who prescribed it know that you are still waking up too early and waking up too often in spite of taking the temazepam.

And if you don't actually know whether the temazepam is doing you any good, well then it's time for keeping a sleep journal so that you have some data that you can look at to compare whether the days after you take the temazepam are better, worse, or about the same as the days when you don't take the temazepam.

The doc I'm seeing next week surely won't like Temazepam. He does alternative and conventional medicine.

Here's a list of some standard good sleep hygiene guidelines pulled from the National Sleep Foundation website:
•Avoid napping during the day. It can disturb the normal pattern of sleep and wakefulness.
•Avoid stimulants such as caffeine, nicotine, and alcohol too close to bedtime. While alcohol is well known to speed the onset of sleep, it disrupts sleep in the second half as the body begins to metabolize the alcohol, causing arousal.
•Exercise can promote good sleep. Vigorous exercise should be taken in the morning or late afternoon. A relaxing exercise, like yoga, can be done before bed to help initiate a restful night's sleep.
•Food can be disruptive right before sleep. Stay away from large meals close to bedtime. Also dietary changes can cause sleep problems, if someone is struggling with a sleep problem, it's not a good time to start experimenting with spicy dishes. And, remember, chocolate has caffeine.
•Ensure adequate exposure to natural light. This is particularly important for older people who may not venture outside as frequently as children and adults. Light exposure helps maintain a healthy sleep-wake cycle.
•Establish a regular relaxing bedtime routine. Try to avoid emotionally upsetting conversations and activities before trying to go to sleep. Don't dwell on, or bring your problems to bed.
•Associate your bed with sleep. It's not a good idea to use your bed to watch TV, listen to the radio, or read.
•Make sure that the sleep environment is pleasant and relaxing. The bed should be comfortable, the room should not be too hot or cold, or too bright.

I do everything there except the natural light. I don't like outside unless its night.

I'm going to end this with something that I find myself repeating to my cousin who is living with us right now while trying to straighten out a large number of problems in her life: You need to allow yourself the freedom to notice when things are NOT so bad. Pay attention to the "quality" of how you are feeling. While you think you are feeling bad all the time, some days ARE better (i.e. "less bad") than others. If you can work on increasing the number of "less bad" days, you will eventually feel "less bad". And on the rare times when you actually feel good allow yourself the joy of feeling good, even it you only feel good for a small part of the day. Try to focus on the positive things rather than worrying about all the negative things.

Okay. Thanks for taking so much time on me. You're very nice.

I feel rested, refreshed, but fatigued. Slept 8 hours.

The last time you used your ResMed AutoSet...
was last night (on Thursday, May 14, 2015)
You had an AHI of 2.37, which is considered reasonably good
You machine was on for 8 hours, 27 minutes and 2 seconds.
You had a small but acceptable amount of major mask leakage.
Your pressure was under 11.76cmH2O for 95% of the time.

Noctuary wrote:I feel rested, refreshed, but fatigued. Slept 8 hours.

Even though you are fatigued, count this one as a small victory. The SleepyHead data shows that you were not very restless---at least not until 8:00 or so.

Curiosity: Why the relatively late bedtime for you? Were you not particularly sleepy, even though you were tired? Or was something keeping you up?

And did you take the Temazepam?

robysue wrote:

Noctuary wrote:I feel rested, refreshed, but fatigued. Slept 8 hours.

Even though you are fatigued, count this one as a small victory. The SleepyHead data shows that you were not very restless---at least not until 8:00 or so.

Curiosity: Why the relatively late bedtime for you? Were you not particularly sleepy, even though you were tired? Or was something keeping you up?

And did you take the Temazepam?

I went to bed between 4 and 5 AM. I did take my pill. I feel really good today; I worked out too. If you notice, I dropped my max to 12 cm.

I think I need to change the clock on my APAP.

Noctuary wrote: I went to bed between 4 and 5 AM. I did take my pill. I feel really good today; I worked out too. If you notice, I dropped my max to 12 cm.

I think I need to change the clock on my APAP.

Please do check that CPAP clock. You went to bed last night between 4 and 5, but your data says that you went to bed around 1:30am. So your data is about 3 hours off??

So when your data shows you going to bed between 10:30 and 12:30, you're actually going to bed 1:30 and 3:30???

robysue wrote:

Noctuary wrote: I went to bed between 4 and 5 AM. I did take my pill. I feel really good today; I worked out too. If you notice, I dropped my max to 12 cm.

I think I need to change the clock on my APAP.

Please do check that CPAP clock. You went to bed last night between 4 and 5, but your data says that you went to bed around 1:30am. So your data is about 3 hours off??

So when your data shows you going to bed between 10:30 and 12:30, you're actually going to bed 1:30 and 3:30???

Yes, that is correct.

Sunday morning.

The last time you used your ResMed AutoSet...
was last night (on Saturday, May 16, 2015)
You had an AHI of 1.62, which is considered reasonably good
You machine was on for 9 hours, 16 minutes and 10 seconds.
You had no major mask leaks (maximum was 3.60 L/min).
Your pressure was under 12cmH2O for 95% of the time.

Monday

I feel pretty tired.


The last time you used your ResMed AutoSet...
was last night (on Sunday, May 17, 2015)
You had an AHI of 2.53, which is considered reasonably good
You machine was on for 9 hours, 5 minutes and 12 seconds.
You had a small but acceptable amount of major mask leakage.
Your pressure was under 12cmH2O for 95% of the time.

Noctuary,

Your usage the last two nights has been a bit over 9 hours and the "time in bed" windows (judging from your SH data) is 9.5-10 hours. But how much actual sleep do you think you got during the 9.5-10 hours that you were in bed trying to sleep?

robysue wrote:Noctuary,

Your usage the last two nights has been a bit over 9 hours and the "time in bed" windows (judging from your SH data) is 9.5-10 hours. But how much actual sleep do you think you got during the 9.5-10 hours that you were in bed trying to sleep?

I slept most of that time. I fell asleep rather quickly both nights. I did lay there in the morning for awhile.

The last time you used your ResMed AutoSet...
was last night (on Monday, May 18, 2015)
You had an AHI of 1.29, which is considered reasonably good
You machine was on for 8 hours, 32 minutes and 2 seconds.
You had no major mask leaks (maximum was 4.80 L/min).
Your pressure was under 12cmH2O for 95% of the time.

Noctuary,

I understand that you are not feeling as well as you would like to, but also that you really don't have much idea as to why you are still not feeling well---particularly in light of the fact that your data looks good on paper:

• The AHI's are reasonably low---when you don't have a lot of time spent tossing and turning and dozing lightly with a lot of (potentially misscored) CAs creeping into your data.
• Since lowering your maximum pressure to the 12-13 range, you now seem to NOT be waking up unable to get back to sleep---judging on both what your data looks like and on what you've said about it over the last several days. In particular, you do now seem to be getting 7-9 (or more) hours of sleep each night.

It's worth seeing if the new pressure range allows you to sleep more soundly for the next several weeks and it's worth tracking how you are feeling over that time period to see if there is a slow, but gradual increase in feeling a bit better. But you've been using a PAP for a year, if I recall correctly, and it's also understandable that you're at the stage of saying, "How long does it take?". So it really is time to start looking for other, non-OSA/CPAP-related potential causes for your continuing problems with daytime exhaustion and daytime sleepiness as well as tracking whatever progress you happen to see over the next few weeks.

A simple daily log might help: Yes, you need to track a small bit of the sleep stuff. But you also need to track the medicine you are taking, as well as caffeine and alcohol. And since you've had a long history of depression, you need to track your mood as well as whether you feel rested, refreshed, but still tired/fatigued when you wake up OR feel "wired and tired" when you wake up. I also think you need to keep an eye on your bedtime/wake up times each day. I still think that the varying sleep schedule may be adding to your problems. It's not important that your "regular" sleep window look like a "normal" sleep schedule for someone who works days and has no night owl tendencies. But you may very well find that if you can get bedtime stabilized around 3:30AM and wake up time stabilized around 11:30 or noon, that you'll start feeling better in terms of waking up feeling rested, refreshed, and less tired than you do now.

I also still think you need to work with one of your doctors or a counselor of some sort to figure out some effective, non-drug based ways to manage the depression. It's hard to ignore the potential role that the depression is playing in how you are currently feeling, but at the same time, I do realize that you have had bad experiences with taking drugs to try to manage it.

It's worth seeing if the new pressure range allows you to sleep more soundly for the next several weeks and it's worth tracking how you are feeling over that time period to see if there is a slow, but gradual increase in feeling a bit better. But you've been using a PAP for a year, if I recall correctly, and it's also understandable that you're at the stage of saying, "How long does it take?". So it really is time to start looking for other, non-OSA/CPAP-related potential causes for your continuing problems with daytime exhaustion and daytime sleepiness as well as tracking whatever progress you happen to see over the next few weeks.

I went to a doctor today. I had some blood drawn to see my vit D level, as well as B12. There were other tests he recommended, but I only had so much to spend.

Something has changed in the last couple of weeks. I don't have the flip-flopping of deep fatigue/wired and tired; I simply feel like someone who didn't get enough sleep. This started when I got the new machine, though it could be coincidence. I've also lost at least 10 lbs. Plus lowering the high end of the pressure.

A simple daily log might help: Yes, you need to track a small bit of the sleep stuff. But you also need to track the medicine you are taking, as well as caffeine and alcohol. And since you've had a long history of depression, you need to track your mood as well as whether you feel rested, refreshed, but still tired/fatigued when you wake up OR feel "wired and tired" when you wake up. I also think you need to keep an eye on your bedtime/wake up times each day. I still think that the varying sleep schedule may be adding to your problems. It's not important that your "regular" sleep window look like a "normal" sleep schedule for someone who works days and has no night owl tendencies. But you may very well find that if you can get bedtime stabilized around 3:30AM and wake up time stabilized around 11:30 or noon, that you'll start feeling better in terms of waking up feeling rested, refreshed, and less tired than you do now.

I do usually sleep between those times; I think there has been confusion because of the clock on my machine and laptop. When I work overtime, I may get to sleep a little later. That makes me wonder if I am hearing my neighbor leave and that wakes me somewhat.

If I keep losing weight, how would that play into this? Would I need to lower my pressure more? I plan on losing at least 10 more lbs.