Whats causing my sleep maintenance insomnia?

It has been suggested I should stick to one thread to make it easier for people to respond. So I will try.

Trying to work out if I have sleep apnea or what my problem is. Keen for tips.

I have serious sleep maintenance insomnia. I regularly am conscious of waking 2 to 3 times a night and it takes me some time to get back to sleep. Often the final time I cannot get back to sleep. These awakenings happen early in the morning and I often end up having 3 to 5 hours of broken sleep. This causes me to feel tired and stressed and worn out. This has to stop as it is really affecting my quality of life.

I snore sometimes but not very often and not very loud. I dont wake up gasping for air. I dont wake up with headaches. I do wake up with a very sore dry throat and mouth every single time. I mouth breathe almost the entire night. Sometimes my mouth breathing is loud and sometimes rapid. Very rarely snoring though.

I also have a deviated septum and resulting enlarged turbinates which accounts for my mouth breathing.

I had an at home sleep study just over two years ago. It showed 4.2 AHI per hour. So under the minimum 5 AHI score for sleep apnea. I was sceptical about the test so I just did another one. I actually did it for two nights in a row to make sure. This time the first night said AHI 3 per hour. Second night 4 AHI per hour. Again, not meeting sleep apnea criteria. Other key stats from the at home sleep study this time are:

- average heart rate: 63bpm
- highest heart rate: 95bpm
- lowest heart rate: 49bpm
- Average SpO2 (I think this means oxygen) : 95%
- Lowest SpO2: 82% (mild hypoxaemia)
- Desaturation Index (3%): 1.8 dips (3% or greater) per hour

I am also scheduled for septoplasty and turbinate reduction next month. Note, I have hardly any daytime problems with my nose. It is only night time when sleeping it is blocked up. It has been my perception that my nose has caused sleep loss insomnia problems that is the reason I am going for the surgery. But then I started to worry that if I have sleep apnea or something else maybe the awful surgery will be for nothing. I would be completely happy to have the surgery if I was confident it would fix or improve my sleeping significantly. But, I just dont know whether it will.

My dilemma is trying to work out what is causing my insomnia and waking up. is it sleep apnea? Is it my nose being blocked at night? is it something else? Is it likely the surgery will fix or improve my sleep? Or is it something else causing my insomnia altogether?

I am now thinking that it is not sleep apnea. I have now had three at home sleep studies and they all say I dont have it. And that my oxygen levels are fine through the night.

I am thinking it must be my nose. Being heavily blocked at night causing me to wake up early in the morning with bone dry throat, mouth and lips. Its also what makes it harder for me to fall asleep again when I am blocked up.

Lately I am noticing if i force myself to stay in bed I can get back to sleep and get a long sleep. If I fight the propensity to get out of bed. Then I get a longer quantity of sleep Broken a few times but still an ok quantity..

But I really need to get my nose fixed if there is nothing else causing my sleep problems I have scheduled another visit with the ENT prior to my surgery next month to ask him some questions to calm my nerves.

Ok I went to see my ENT today again.

This time I specifically went through my at home sleep apnea tests showing no sleep apnea and spoke of the problems with sleeping. Waking up at night with a completely blocked nose and bone dry sore throat and mouth.

I asked him directly whether it is likely my nose is causing my sleep issues. He said yes absolutely. And I asked if the surgery was likely to improve that. He said yes there is a strong chance that it will

He went through my CT Scans more clearly this time and explained them again. I could see that my septum is severely deviated at the front. Almost like an L shape. It was straighter as he went through the images and he explained that was the back of the septum. He said a bent septum at the front was worse and mine was very bent. The turbinates were swollen. And he also showed sinusitis in my sinuses on the images. Lots of gunk in my sinuses. The turbinate swelling and sinusitis is likely caused by the deviated septum. It must all be getting worse over time, which might explain why my sleep has been getting worse over the last 4 years.

So, I have my answer. I dont have sleep apnea. I have made some apneas and hypopneas. Not enough to be sleep apnea. But all the sleep issues are likely caused by my nose problems. I am scheduled for surgery in less than a week. Terrified. But I think that I need to do it, as I am not sure what else I can do. I dont think I can keep going on with this mouth breathing all night with a completely blocked nose and getting sore throats and dry mouth and waking up all the time.

Last night I was conscious of awakening about 6 times with a completely blocked nose and really sore dry mouth and throat. I have had enough. Have to do something.

The number of awakenings is within a normal range, but the length of time you’re awake sounds like it isn’t. Very best of luck to you with the surgery! I hope it exceeds your expectations.

sleepcrapnea wrote: ↑

Mon May 03, 2021 10:21 pm

I am scheduled for surgery in less than a week. Terrified.

Gramps had turbinate reduction surgery and correction of deviated septum many years ago. He will still tell you it is one of the best things he ever did for himself.

Don't be fearful. You will be taken good care of. You will begin to lead a much healthier life.

Miss Emerita wrote: ↑

Mon May 03, 2021 11:06 pm

The number of awakenings is within a normal range, but the length of time you’re awake sounds like it isn’t. Very best of luck to you with the surgery! I hope it exceeds your expectations.

Thanks! Yes I think its all due to my nose problems and associated effects. Hoping surgery will fix. I think it will

ChicagoGranny wrote: ↑

Tue May 04, 2021 1:32 pm

[
Gramps had turbinate reduction surgery and correction of deviated septum many years ago. He will still tell you it is one of the best things he ever did for himself.

Don't be fearful. You will be taken good care of. You will begin to lead a much healthier life.

Thanks! This is great news it went so well. Yes Im hoping for the best. Will be an amazing change to my life if it works out.

I have a lot of the same symptoms. Minimal AHI, around 5 or less on sleep studies yet I have chronic fatigue. I've had everything checked. Full thyroid panel, testosterone panel, full blood panel, autoimmune panel, lyme, allergies, upper endoscopy. I bought my own bipap, new mattress, supplements, etc all coming out to thousands of dollars with nothing helping. Only issues found is upper GI issues: small hiatal hernia, gastritis, GERD and Barret's esophagus. Also did have nasal congestion due to swelling and sinus infections. I had nasal surgery: turbinate reduction, septoplasty and balloon sinuplasty. It did clear my nose up but my fatigue did not improve. Only thing I can think of is it is upper GI related on my poor sleep, fatigue. Do you have upper GI issues?

Ok I am almost 2 weeks post-op for septoplasty, turbinectomy and FESS.

My nose has been slowly getting better. There has been a lot of inflammation that has needed to die down. The right passage became clear much more quickly. But the left side where the incisions were, has been more swollen, making it more blocked. But it keeps getting better. Right this minute the left is almost as good as the right side. The right side is perfect. The swelling on the left is intermittent. So sometimes more open than others. Still healing. I suspect at the three weeks point the swelling on the left should be completely gone.

I still havent had that elusive good nights sleep from breathing through my nose. Still too much swelling. But last night I did have the best nights sleep since the surgery. So on the incline.

I am now more convinced than ever that the problem has always been my nose. My nose was more blocked than ever post surgery and sleep was next to impossible. This is the case for almost 100 percent of post nose surgery people. Nose blocking has a huge impact on sleep. So, the proof will be in the pudding as to whether I can sleep well once my nose is fully healed. Fingers crossed.

weiss27md wrote: ↑

Wed May 05, 2021 7:33 am

I have a lot of the same symptoms. Minimal AHI, around 5 or less on sleep studies yet I have chronic fatigue. I've had everything checked. Full thyroid panel, testosterone panel, full blood panel, autoimmune panel, lyme, allergies, upper endoscopy. I bought my own bipap, new mattress, supplements, etc all coming out to thousands of dollars with nothing helping. Only issues found is upper GI issues: small hiatal hernia, gastritis, GERD and Barret's esophagus. Also did have nasal congestion due to swelling and sinus infections. I had nasal surgery: turbinate reduction, septoplasty and balloon sinuplasty. It did clear my nose up but my fatigue did not improve. Only thing I can think of is it is upper GI related on my poor sleep, fatigue. Do you have upper GI issues?

I actually dont understand what you mean by GI issues.

Good to hear the surgery’s in the rear view mirror and that your recovery is going well. And it’s promising that you’re already seeing change for the better in your sleep. Keep us posted, would you?

BTW, GI means gastrointestinal here, I think.

Miss Emerita wrote: ↑

Sat May 22, 2021 7:26 pm

Good to hear the surgery’s in the rear view mirror and that your recovery is going well. And it’s promising that you’re already seeing change for the better in your sleep. Keep us posted, would you?

BTW, GI means gastrointestinal here, I think.

Thanks!

Yes sure I will keep you posted. I am 2 weeks post op now. Breathing through my nose is now a bit better than prior to my surgery. But there is still some residual swelling. I think it will take one more week for the swelling to completely die down but I can see the trajectory of improvement.

My sleep is better than earlier in the post op period but is about the same as prior to surgery. I am still breathing through my mouth for most of the night and getting sore throats etc. It might take a while for this to get better though. Again, 3 weeks will be a good time to consider things. Still early in the post op recovery period really.

I dont think I have any gastrointestinal issues.

I am almost 4 weeks post septoplasty, turbinectomy and FESS.

My nose is gradually opening more and more as the swelling reduces. After nasal rinses there are times now when I can breathe completely openly through both nostrils for about 30 to 40 minutes. Feels amazing. But then swelling resumes again a bit. But its a taste of what to come. My nose is now better than it was pre surgery. Although it is of course still very tender. But it is more open. It will gradually get better and better. Complete healing and departure of swelling can take some time.

It has not been a magical overnight fix to my sleep problems. But I am growing increasingly confident that it is working. My sleep quantity is getting better. Like most nights I am now getting 7 to 7.5 hours sleep. And when I awake a couple of times a night I get back to sleep quickly, like from within 2 to 15 minutes. I record my sleep and the sound of it is also getting better and better over time. There is less and less mouth breathing. I hear periods of very quiet sleeping which will be when I am breathing through my nose.

There is still mouth breathing though and I can hear it on my recordings. I hate the erratic sound of it. It sounds as unrestful as it is. But it is reducing. My nose is still very tender so my subconscious will be telling me to breathe through my mouth still even though my nose is gradually getting more open. It is still swollen on the left side too which will also tell my brain to mouth breathe. But this will get better over time I think.

There is a chance once fully healed that I might still mouth breathe out of habit. So I might need to look at measures to stop that. Dont know if I can handle taping my mouth shut. But maybe I can try other things like a chin strap to discourage mouth breathing.

I so hope this fixes my sleeping issues. I feel like it will.

And it it turns out that I do have sleep apnea, despite all the tests saying I dont, at least I will be able to actually use a CPAP! As I will be able to breathe through my nose.

I think time will tell and within a couple of months I will know whether the surgery addressed my sleep problems.

Its now 4.5 months since my septoplasty and turbinate reduction on my nose.

I breathe much better through my nose now. The surgery was not a complete success as I now have some nasal valve collapse on one side from the surgery. But overall, I still breathe much better through my nose.

However, my sleeping is still not fixed. I have to say that it is better though. I dont end up having those horrific nights sleep anymore where I get about 3 or 4 hours sleep. However, it is still not as restful as I think it should be. I still end up consciously waking up 1 to 3 times a night. And I have a sore and dry mouth and throat when it happens. But the difference is now that when I wake up my nose is not blocked and I can allow my mouth to moisten and then get back to sleep again within 10 to 15 minutes, unlike the old days.

I record my breathing at night and I am still doing a lot of mouth breathing. There are though many times while I am breathing through the nose I can hear. But still too much through the mouth. And some snoring, although not a lot. I do hear snorting sounds occasionally. I feel like it is the sore and dry mouth and throat that wakes me up. But I dont understand why I am still mouth breathing sometimes despite being able to nose breathe now. Maybe that suggests sleep apnea because needing a bigger airflow forcing me to mouth breathe.

I have tested negative for sleep apnea every time. But I am wondering whether I have RERA. Is CPAP the treatment for that too? I have only done the at home sleep tests. I am not sure how to get an in lab sleep study which is more comprehensive. I might investigate how to do that. Although, to be honest, it is so much more tolerable now post nose surgery.

You need to get an in lab sleep study or a PES sleep study that is more for UARS. You sound like you have most of the same issues I have. I have chronic fatigue yet sleep studies and all labs come up negative.

sleepcrapnea wrote: ↑

Sun Sep 19, 2021 12:59 pm

Its now 4.5 months since my septoplasty and turbinate reduction on my nose.

I breathe much better through my nose now. The surgery was not a complete success as I now have some nasal valve collapse on one side from the surgery. But overall, I still breathe much better through my nose.

However, my sleeping is still not fixed. I have to say that it is better though. I dont end up having those horrific nights sleep anymore where I get about 3 or 4 hours sleep. However, it is still not as restful as I think it should be. I still end up consciously waking up 1 to 3 times a night. And I have a sore and dry mouth and throat when it happens. But the difference is now that when I wake up my nose is not blocked and I can allow my mouth to moisten and then get back to sleep again within 10 to 15 minutes, unlike the old days.

I record my breathing at night and I am still doing a lot of mouth breathing. There are though many times while I am breathing through the nose I can hear. But still too much through the mouth. And some snoring, although not a lot. I do hear snorting sounds occasionally. I feel like it is the sore and dry mouth and throat that wakes me up. But I dont understand why I am still mouth breathing sometimes despite being able to nose breathe now. Maybe that suggests sleep apnea because needing a bigger airflow forcing me to mouth breathe.

I have tested negative for sleep apnea every time. But I am wondering whether I have RERA. Is CPAP the treatment for that too? I have only done the at home sleep tests. I am not sure how to get an in lab sleep study which is more comprehensive. I might investigate how to do that. Although, to be honest, it is so much more tolerable now post nose surgery.

Sorry I missed this post last month. Did you ever try a strap? Some people like the Knightsbridge Dual strap, which pulls the jaw up but not back. Another idea might be a soft cervical collar.

It seems possible the mouth breathing is now merely habitual and will stop once you break the habit. I wonder whether you could speed that up by making sure you are breathing through your nose during the day.