CPAPtalk.com

MNsleeplessnights wrote: ↑

Fri Apr 20, 2018 9:53 pm

sleep issues

The Oft Overlooked Part of Good CPAP Therapy

- Practice good sleep hygiene (Google it and read several sources; ignore extreme advice.)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps
- Practice total abstinence of caffeine including sources like chocolate (sigh)
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Use the bedroom for sleeping (and sex) only, and make sure the bedroom and bed are comfortable.
- Learn to appropriately handle emotional stress in your life
- Do not listen to your breathing or the sound of the machine as you are falling asleep.
- Distract your mind by thinking of a pleasant, relaxing activity that you enjoy. Thinking of sitting under an umbrella on a quiet beach with a warm gentle breeze works for me.
- If you are awakening at night, do not be too concerned. It is actually a normal part of sleep. (It does become a problem though for people who, when they awaken, become frustrated and have difficulty returning to sleep.)
- Use CPAP software, such as the free SleepyHead, to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems

This is a checklist. Some of the things you already do. Some are easy and can be done right away. Others you can work at over time.

-CG

ChicagoGranny wrote: ↑

Mon Apr 23, 2018 8:39 am

What about this list? Have you gone through the applicable items to see if there are some areas for significant improvement?

The Oft Overlooked Part of Good CPAP Therapy

- Practice good sleep hygiene (Google it and read several sources; ignore extreme advice.)
- Eat a good diet
- Have a regular, moderate exercise program
- Try to avoid daytime naps
- Practice total abstinence of caffeine including sources like chocolate (sigh)
- Review all medicines, vitamins and supplements you are taking to make sure none are interfering with sleep
- Use the bedroom for sleeping (and sex) only, and make sure the bedroom and bed are comfortable.
- Learn to appropriately handle emotional stress in your life
- Do not listen to your breathing or the sound of the machine as you are falling asleep.
- Distract your mind by thinking of a pleasant, relaxing activity that you enjoy. Thinking of sitting under an umbrella on a quiet beach with a warm gentle breeze works for me.
- If you are awakening at night, do not be too concerned. It is actually a normal part of sleep. (It does become a problem though for people who, when they awaken, become frustrated and have difficulty returning to sleep.)
- Use CPAP software, such as the free SleepyHead, to make sure your therapy is optimized
- If you still don't feel or sleep well, make sure you have regular medical checkups to confirm there are no other medical problems

This is a checklist. Some of the things you already do. Some are easy and can be done right away. Others you can work at over time.

-CG

grapeshly wrote: ↑

Sat Apr 21, 2018 2:41 pm

Maybe if I relare my story, you can get some insight.

I definitely have OSA, but it went undiagnosed for about 7 years. I suspected something wasn't right, but several different dictors I went to over that time span did not consider it a possibility. In the earliest stages, one doctor had me do a sleep study, but like yours it was evidently inconclusive. Unlike you, i never saw the test results, so I will never know if it really was inconclusive, or whether my AHI's were borderline. During those 7 years my sleep got worse and worse, to the point where I developed very bad sleep hygiene. After all, why go to bed early if you still feel bad and very tired when you wake up. I am positive that these years of sleep deprivation plus the stresses on my job caused my anxiety levels to increase. I now see that this inability to sleep, and my constant anxiety, all snow-balled into insomnia.

I finally got my diagnosis and my cpap machine, and my sleep improved. I was no longer constantly tired. But my insomnia was still there. I couldn't get drowsy enough to fall asleep, and when I did finally fall asleep, I would wake up at around 4 am and not be able to fall asleep again.

So then I went on a journey to try and figure this out. First I tried cold medications and over-the-counter drugs that caused drowsiness, such as Drammamine. But that would make me feel thick-headed the next day. Besides, using drugs to get good sleep just didn't seem like a solution. I tried meditation, but my monkey mind, caused by my anxiety, made it impossible for me.

In my researches, I found a couple of books that suggested anxiety can be caused by or exacerbated by certain nutritional deficiencies. To make an already long story shorter, I discovered I had a vitamin D defficiency. Vitamin D is actually a hormone, and is necessary for many processes in our bodies to function correctly. In fact most people in North America have this defficiency, since it is very difficult to get enough sunlight to adequately supply you with Vitamin D. Add to this our fear of skin cancer and the sun screens we are warned to wear, getting enough sunshine is even more difficult. I also learned that most people are defficient in Magnesium. This is another element our bodies require for a variety of proceeses. Our foods today don't have enough Magnesium to give us our recommended daily amount! So now I take mega doses of Vitamin D, and 1.5 times the recommended amount of Magnesium daily. One of the things Magnesium does is to relax you. Now I am finally able to get drowsy without resorting to other drugs. I can now also meditate, which I do every evening. And I have gradually calmed down enough to be able to re-learn good sleep hygiene habits. I still wake up at around 4 am some nights, but overall my sleep has improved.

I did more than all this, including improving my diet (whole foods, no gluten, limited carbs, plenty of probiotics), and stopped watching TV so much. Do I really need the nightly news upsetting me? Do I NEED to be bothered by the antics of the Lannisters and the Starks?

Recommended resource material:
https://www.vitamindcouncil.org/about-vitamin-d/
https://www.juliarosscures.com/mood-cure/
https://www.everywomanover29.com
https://www.headspace.com/meditation-10 ... meditation

Pugsy wrote: ↑

Fri Apr 20, 2018 11:04 pm

Some medications can cause insomnia and/or can affect the sleep architecture and even prevent a person from getting much REM stage sleep.

It is possible that the lack of REM was nothing more than not enough sleep to move through the needed sleep stages because you ran out of time.

I had something similar happen to me.
During my diagnostic sleep study even with Ambien I had awful insomnia (which I didn't have at home) and I kept waking up.
I did have a few apnea events during non REM...around 12 per hour but it was REM where things got exciting and it was part of the reason I was having trouble staying asleep. My OSA is 5 times worse in REM stage sleep than in non REM and every time I made it to REM the apnea event would happen and wake me up. So I had very little REM during my diagnostic sleep study.

It wouldn't be impossible for you to have OSA that is markedly worse in REM but usually there is more of an indication of at least something in non REM. In my case the oxygen levels went down to the low 70% even in non rem...the apnea events weren't very numerous but they were pretty darn long to cause the desats.

Would getting a cpap machine help....honestly...I don't know. If your insomnia issues are related to sleep apnea then yeah maybe but I am not so sure that your insomnia is sleep apnea related.
There's a long list of other potential causes for insomnia or crappy sleep than just sleep apnea and the cpap machine can only help if sleep apnea is the problem.
I see it all the time...people wanting/expecting that the cpap machine fixes a problem that is unrelated to sleep apnea and they get upset because cpap doesn't resolve their issues....when all the time they had unrealistic expectations about what cpap can do.

I do understand the hope that the problem is sleep apnea because at least there's a name to what might be our problem and it's fixable.
It's easier to swallow than "we don't know why your sleep is crappy and why you feel crappy".

You didn't get a good complete study with all sleep stages...and what sleep you got was limited. If you had slept better and got some REM..... would the results have been different....we don't know the answer to that question.

I do understand the desire to at least try cpap in the hopes that it helps. Your insurance is unlikely going to want to pay for the machine or equipment/masks, etc because you don't meet criteria for the diagnosis unless they can tie in the arousals and use the RDI instead of AHI.
Worth trying...all they can do is say no.

The arousals...if related to breathing restrictions/reductions in air flow that don't meet the criteria for OA or hyponea might improve with cpap therapy IF...big IF...the arousals are related to breathing issues.
If the arousals are spontaneous and the cause is unknown...cpap most likely won't help.

The arousals are probably more of an issue than the apnea events. Now what is causing the arousals...million dollar question that doesn't always have a nice black and white answer.

MNsleeplessnights wrote: ↑

Mon Apr 23, 2018 1:39 pm

I think my biggest failures on that list would be bad sleep hygiene

MNsleeplessnights wrote: ↑

Mon Apr 23, 2018 1:39 pm

Do you mind explaining why it'd be a bad idea to not listen to breathing while you're trying to fall asleep?

ChicagoGranny wrote: ↑

Mon Apr 23, 2018 3:07 pm

MNsleeplessnights wrote: ↑

Mon Apr 23, 2018 1:39 pm

I think my biggest failures on that list would be bad sleep hygiene

What about your sleep hygiene is poor?

Pugsy wrote: ↑

Fri Apr 20, 2018 11:04 pm

Some medications can cause insomnia and/or can affect the sleep architecture and even prevent a person from getting much REM stage sleep.

It is possible that the lack of REM was nothing more than not enough sleep to move through the needed sleep stages because you ran out of time.

I had something similar happen to me.
During my diagnostic sleep study even with Ambien I had awful insomnia (which I didn't have at home) and I kept waking up.
I did have a few apnea events during non REM...around 12 per hour but it was REM where things got exciting and it was part of the reason I was having trouble staying asleep. My OSA is 5 times worse in REM stage sleep than in non REM and every time I made it to REM the apnea event would happen and wake me up. So I had very little REM during my diagnostic sleep study.

It wouldn't be impossible for you to have OSA that is markedly worse in REM but usually there is more of an indication of at least something in non REM. In my case the oxygen levels went down to the low 70% even in non rem...the apnea events weren't very numerous but they were pretty darn long to cause the desats.

Would getting a cpap machine help....honestly...I don't know. If your insomnia issues are related to sleep apnea then yeah maybe but I am not so sure that your insomnia is sleep apnea related.
There's a long list of other potential causes for insomnia or crappy sleep than just sleep apnea and the cpap machine can only help if sleep apnea is the problem.
I see it all the time...people wanting/expecting that the cpap machine fixes a problem that is unrelated to sleep apnea and they get upset because cpap doesn't resolve their issues....when all the time they had unrealistic expectations about what cpap can do.

I do understand the hope that the problem is sleep apnea because at least there's a name to what might be our problem and it's fixable.
It's easier to swallow than "we don't know why your sleep is crappy and why you feel crappy".

You didn't get a good complete study with all sleep stages...and what sleep you got was limited. If you had slept better and got some REM..... would the results have been different....we don't know the answer to that question.

I do understand the desire to at least try cpap in the hopes that it helps. Your insurance is unlikely going to want to pay for the machine or equipment/masks, etc because you don't meet criteria for the diagnosis unless they can tie in the arousals and use the RDI instead of AHI.
Worth trying...all they can do is say no.

The arousals...if related to breathing restrictions/reductions in air flow that don't meet the criteria for OA or hyponea might improve with cpap therapy IF...big IF...the arousals are related to breathing issues.
If the arousals are spontaneous and the cause is unknown...cpap most likely won't help.

The arousals are probably more of an issue than the apnea events. Now what is causing the arousals...million dollar question that doesn't always have a nice black and white answer.