Hammer,
I need to summarize things before I can respond. Please correct me if I have something wrong in my summary.
You sleep well when you take Ambien for one or two nights, but the third night it doesn't work so well. You also don't particularly want to take a sleeping pill every night, but you don't mind taking them 1-2 nights a week. Without the Ambien you wake up 3-4 times; with the Ambien you wake up 0-1 times. You have a regular "time in bed" schedule of 11Pm to 6AM, but you also read in bed before you turn out the light. When you don't take the Ambien, you do have some anxiety/worry that you will wind up "fighting" to get to sleep, and it can take you two to three times as long to fall asleep on a night when you don't take the Ambien. Your biggest insomnia issue right now is more the early morning wakes when you can't get back to sleep, and these happen more when you don't take the Ambien, but they can happen even when you do take the Ambien. Those early morning wakes are often accompanied by dry mouth problems that are significant enough to be a comfort issue.
After the early morning wakes, you typically stay in bed (in an effort to not disturb your wife), but while lying in bed you focus on the fact that you are awake and can't get back to sleep. You also have a tendency to watch the clock when you've woken up and can't get back to sleep. And you worry about how lousy you are going to feel the next day.
You drink two large cups of caffeinated coffee in the morning, and say you can't possibly get going without them. You've cut out the afternoon diet Coke habit, and you are caffeine free after 1pm. You only have the occasional glass of wine with supper, maybe once a week.
You get plenty of exercise, and you've swapped the evening "walk the dog" for the morning "walk the dog". But you don't get outside much, except for that morning "walk the dog". (I presume you walk the dog outside.)
You spend much of the day (like too many of us, including me) sitting in front of a computer. You've got a known thyroid problem that leaves you sensitive to heat and cold, which affects you when you are outside. You used to take Vitamin D, but no longer do that since neither you nor your doc thought it was doing much good.
You are willing to keep a sleep log for a while and gather some data for a week or two, and then evaluate on where to go.
And, of course, you are still feeling pretty lousy even though the data from the CPAP looks good. But you are also self-reporting that you often only get 4 hours of sleep.
Have I got the synopsis pretty accurate?
Now for some specific suggestions for you to try while you're keeping the sleep log.
1) Slightly modify how you take the Ambien. You write:
I usually take it (the Ambien) after not sleeping for 2-3 days or if I’m too wound up to sleep and have an important next day.
I think you may want to not wait for 2-3 sleepless nights before taking the Ambien. I would suggest this instead: If you have a bad night when you don't take the Ambien, go ahead and take the Ambien at the beginning of the next night. In other words, try to use the Ambien to prevent yourself from having 2-3 sleepless nights in a row. This may mean (in the short run) that you are taking Ambien every other night for a while, but it should still keep you to taking no more than 3 Ambiens per week.
The idea here is that when you have 2 or 3 really bad nights in a row, that's going to make you feel really awful on the second and third days. Most people can sort of function after one really bad night, but it's much more difficult to function after 2 or 3 bad nights in a row.
2) Slightly modify the caffeine. Try to make sure that you don't consume any caffeine after 10AM. Also try to switch to medium cups of coffee instead of large ones.
3) Modify your behavior when you do wake up at 3, 4, or 5 AM and you find that you can't get back to sleep. I know you're trying to not disturb your wife, but you write this:
I lay there praying its after 5Am and try to stay in a half awake/half asleep state. This is going to sound a bit crazy, but I try to feel if there is any light entering the room without opening my eyes. If I can’t sense any I try to go back to sleep most times I’m wrong and its only 3AM. I then look at the clock, curse under my breath and ruminate about how crappy I’m going to feel the next day and/or how many hours I am going to have to lay in bed before getting up. I try to stay in bed so as not to wake my wife who has long work days.
Your laying in bed trying to not wake your wife is most likely making it much harder for you to fall back asleep.
Here's what I would suggest that you do:
- Move the clock or at least turn it around so that you can't see it. Resist looking at the clock when you finally open your eyes. All looking at the clock is doing right now is triggering worry, anxiety, and/or anger. And none of those is helpful in getting back to sleep.
- Go ahead and open your eyes when you first wake up. If it's light, congratulate yourself for sleeping 'till dawn, deal with the dry mouth problems (more on that in a bit), and snuggle back down to see if you can get some sleep, or if you know you're not going to get back to sleep, just get up. If it's dark when you open your eyes, tell yourself that you probably just had a normal post-REM wake and that everything in your sleep environment seems "ok". Then deal with the dry mouth problems (if any) and snuggle back down to see if you can get some sleep.
- If you can't get back to sleep in a reasonable amount of time OR if you start ruminating about how crappy you're going to feel or how many hours you have to lay in bed before getting up, you are better off getting out of bed. Yes, right now you're worried that this will wake your wife. But if you quietly just get up, chances are it won't disturb your wife anywhere near as much as you think it will. Once you are out of bed, you can go into another room and do something quiet and relaxing. Reading a book might be a good choice. Sometimes all it takes is getting out of bed long enough to go to the bathroom and chill out for 5 or 10 minutes. Once you are relaxed and feeling sleepy, go back to bed.
4) For the dry mouth problems: Tackle this on multiple fronts. Biotene mouth wash and the XyliMelt mints can help. Keeping yourself well hydrated during the daytime and drinking some water right before bed can help. But when you wake up with the parched mouth, the best thing to do is to get a drink of water. Some people would say keep a bottle of water on the night table. For me, I find that on those rare occasions when I do wake up with dry mouth, I have better luck if I get up, go to the bathroom, and drink as much water as I feel like I want/need before going back to bed.
Your leak lines are acceptable, but not great. You are probably doing a bit of mouth breathing, or it may just be that your tongue falls off the top of the roof of your mouth at times, and that can let air into the mouth. It's that excess air blowing into your mouth that's causing the dry mouth. Since you've had a cold, then that might explain why this didn't use to be as much of a problem. Lots of people who don't normally mouth breathe will do some mouth breathing when they've got a head cold. As your congestion gets better, hopefully you'll quit mouth breathing.
5) Reconsider what you do right at bedtime. Right now you are going to bed, but not necessarily to sleep, at 11PM and the alarm goes off at 6AM that gives you a 7 hour "time in bed" window. You read or watch TV in bed for a while before masking up and turning out the light. The data you've posted indicates that you might mask up as early as 11:10 or it might be as late as midnight. Right now, I would suggest that you avoid watching TV while in bed. Reading is less of a problem, although if you are not getting sleepy after 15-20 minutes, then reading may be keeping you awake later than you think it is. Also consider tracking whether you feel better or worse on nights when you spend a lot of time in bed before masking up and going to sleep.
6) Consider whether the timing of your exercise routine affects your sleep patterns. In general, exercise usually helps people sleep better, but if its done too close to bedtime, then it can key you up and make it more difficult to fall asleep.