So if I'm reading this correct there are three things that are relevant to the middle-of-the-night insomnia issue you're dealing with:dacotto1984 wrote: ↑Sat Sep 24, 2022 6:50 pmyes. even though i do have large leaks during the 4 to 5 hours of continuous sleep, i am not waking up (Thank goodness! at least i have that!). But its that dreaded 5am - 5:30am wake up, going to urinate and not being able to go back to sleep when i get back into the bed. This has been going on for like 2 - 3 months (before the 2-3 months it was worse. i couldn't sleep at all, no matter what i did.. not even sleeping pills helped (trazodone, melantonin, benadryl), the sleeping pills just made everything way worse.robysue1 wrote:The early morning gap
The next most striking thing about your last four days of data is an early morning gap that's about 75-90 minutes long when you're not using the machine. Given your previous posts, I'm assuming this is when you wake up, go to the bathroom, and then can't get back to sleep.
Are you just getting out of bed and doing something else until you get sleepy and then putting the mask back on when you go back to bed? Or are you taking the mask off in hopes of getting back to sleep and then for whatever reason, you finally do put the mask back on?
you need to tell us more about what's going on during that time frame.
I think i am now in my third week, where i can actually lay down in bed at around 11pm - 12am, put the mask on and go to sleep in 30 - 60 minutes (which is a god send) . But its that dreaded 5am wake up that has me going crazy. After i come back from bathroom, ill throw the mask on, close my eyes but then feel my heart kind of elevated... maybe like a bit more of a pump/rush than usual (if that makes any sense).. it feels a little bit like "fear", but not so much to be considered fear (if that makes sense) maybe just a bit of a heart race or something.
1) This dreaded 5am wake started before you started CPAPing. As did the problem of not being able to get back to sleep after you wake up at 5am, sometimes for the whole rest of the night. Sometimes you finally drift back to sleep sometime around 7 am.
2) Before the OSA diagnosis and the start of PAP therapy, a number of sleep medications were tried, but they were not successful. This is not particularly surprising: Sleeping pills are more effective at treating sleep onset insomnia---when you just can't get to sleep at the beginning of the night---than they are at treating sleep maintenance insomnia, which occurs when you can't get back to sleep after successfully falling asleep in the first place.
3) You are noticing weird sensations when you put the mask back on after the dreaded 5am wake and these weird sensations are increasing your worry and anxiety making it even tougher to get back to sleep. The sensations you describe sound like a anxiety attack: Feeling like you've got an elevated heart beat, feeling like your heart is racing, feeling like an unspecified "fear".
It's also worth pointing out that your data indicates that dreaded wake can happen as early as 3:40 (on September 21) or as late as 5:10 am (on September 23). But it also always occurs after a nice, long 5-6 hour CPAP session that at this scale looks like was uninterrupted sleep. That kind of timing indicates this may very well be a (normal) post-REM wake that just gets out of hand. (More on that in a bit.)
So in my opinion, that dreaded early AM wake most likely has little or nothing to do with your PAP therapy since the patter started before you started PAP. And because your PAP therapy shows the OSA is pretty well controlled, I'm not convinced that untreated OSA was the only cause of that wake before you started PAPing because the pattern has continued after the OSA has been brought under control.
In other words, I suspect that the reason the dreaded early AM wake is so troublesome is the fact that you dread it so much: In other words, what I think is happening is that your anxiety takes over as soon as you realize that you have woken up yet again at (roughly) 5am needing to go pee. And the whole time you're out of bed going to the bathroom, your anxiety is working overtime and your brain just can't stop the worry that you will never get back to sleep (again!) from taking over.
And once you do go back to bed, it's a self-fulfilling prophecy: You don't expect to be able to go back to sleep, so the anxiety keeps you from going back to sleep. And the longer in bed you lie there trying to get back to sleep, the more anxious you become and the more you start to notice the racing heart beat. And the more you notice the racing heartbeat, the harder it becomes to tell yourself to just settle down and go back to sleep.
This adds to the evidence that your dreaded early AM wake may be a normal post-REM wake that is just careening way out of proportion due to your anxiety about being awake in the middle of the night.One thing i do notice though.. right before that time when i wake up at 5am, ill kind of have a fearful event happen in my dreams. For example, if im riding a bike, then maybe ill fall off the bike or get scared that ill hit a car and then wake up. Im already getting use to that . But i do notice that does kind of happen... not always, but enough to notice.
So reviewing some information about our so-called sleep cycles is in order: In normal sleep that is not full of interruptions caused by OSA, a typical person cycles through a "full sleep cycle" approximately every 90 minutes. The sleep cycle typically consists of periods of light sleep (Stage 1/2), deep sleep (Stage 3/4), and REM sleep. Stage 1 sleep is roughly the transition to real sleep and is typically pretty short in a normal sleep cycle. And there's a debate about whether there's really a difference between Stage 3 and Stage 4 sleep.
The typical progression of the stages in a full sleep cycle often looks something like this:
Stage 1 (very short) -> Light Sleep -> Deep Sleep -> Light Sleep -> REM
And at the end of the REM cycle? A person typically either wakes up (very briefly), goes to Stage 1 sleep (very briefly) or goes back to Light sleep and the next sleep cycle starts.
Now it's important to note that in a person without insomnia, that post-REM wake (when it occurs) is typically so short that the person doesn't remember it the next morning: We typically only remember wakes that are at least 5 minutes long when we wake up in the morning. Now why would a normal person wake up briefly and then go immediately back to sleep? Well you can think of it this way: The person briefly awakes just to make sure there's nothing that presents some kind of need to get up, realizes that everything is just fine, and then goes back to sleep.
But insomniacs have a tendency to first of all worry excessively when they find themselves awake in the middle night---i.e. an insomniac's brain is screaming, "There must be SOMETHING wrong since I'm AWAKE." Add to that the fact that many insomniacs can confuse Stage 1 and light sleep with wake: Most insomniacs vastly overestimate the time they are actually awake and tossing and turning and trying to get to sleep and consequently also underestimate the amount of sleep they've actually gotten. They also sometimes overestimate how much sleep they actually need in order to "sleep well."
Now add in the fact that in sleep cycles near the beginning of the night, the amount of time in deep sleep is usually longer than the amount of time in REM. As the night progresses, in each subsequent sleep cycle, the amount of deep sleep decreases and the amount of REM sleep increases. So vivid, prolonged dreams (of all types) are more likely to occur in the later sleep cycles.
Now as I mentioned earlier, your dreaded early AM wake seems to occur at the end of 5-6 hours of real sleep. In other words, you're waking up at the end of the 4th full sleep cycle. You've probably just come out of a prolonged REM period with a relatively vivid (but normal) dream. And your bladder is also saying it's full enough to be relieved by going to the bathroom. So you get up to go pee (which extends the length of the wake) and by the time you're back in bed, your anxious, insomniac's brain has taken over and that's what's preventing you from drifting back off to sleep relatively quickly.
Choking dreams are not uncommon for folks with untreated OSA: Each obstructive apnea and each obstructive hypopnea is a mini-suffocation. And for many people, the OSA is much worse during REM sleep, so those mini-suffocations are occurring more frequently to feed the choking dreams.I also noticed that in my dreams, after i sleep around 7am, ill wake up a few times with dreams like im going to choke in something.. like the roof of a house comes falling on me slowly.. or that i travel down a tight corridor or a tunnel that all of a sudden gets tighter and tighter as if im going to get buried alive and choke, ill wake up out of fear
You also write:
I think you are letting your anxiety run wild here. When I look at your data, this is what I see:ill wake up out of fear and after seeing last nights AH events i noticed i have a few events there.. so those dreams might be related to those apneas and my brain trying to scare me awake.
On September 20, the closest events to the 4:20 wake are a pair of RERAs scored around 3:15. Yes, there's a bit of large leaking going on, but those large leaks are still under 40 L/min so they're not likely to be interfering with the machine's ability to track your breathing or detecting OAs and Hs. So the dreaded early AM wake on this night is not tied to any OSA event.
On September 21, the closest event to the 3:40 wake is a hypopnea scored around 2:45. Yes, there is a large leak, but the leak level is only around 35 L/min so it is not likely to be interfering with the machine's ability to track your breathing or detecting OAs and Hs. So the dreaded early AM wake on this night is not tied to any OSA event.
On September 22, the dreaded early morning wake appears to be around 4:10. You turn the machine off and then back on, but don't get back to sleep. You turn the machine off again about 4:20 for what looks like the bathroom break, and then there's the large gap where you're not using the mask after you come back to bed. The nearest event to the 4:10 awake is a RERA at about 3:55. The nearest actual hypopnea is at 3:35. While it's possible that RERA triggered the wake, it's also possible you were already awake and the RERA got scored as part of SWJ. But there's no real evidence that the H at 3:35 had anything to do with the wake.
On September 23, there is an hypopnea scored around 5:00 and you turn the machine off at around 5:10. But the whole CPAP session between 4:15 and 5:10 has characteristics of SWJ breathing. In other words, it would not surprise me if this was a night where you tried to keep the mask on after the 4:15 wake and just never got to sleep. So you turned the machine off at 5:10. And then did what? Lie in bed and fall back into a light sleep without the mask? Or continue to toss and turn? There's no way to tell from the data. It's also worth noting that while there is a RERA scored around 4:10 and you turn the machine 4:15, the SWJ stuff appears to start around the time of the end of the last large leak. Yes, there are a couple of hypopneas scored at the end of that large leak. So it is possible that either the hypopneas or the large leak or both is what triggered an obviously less than restful period of "sleep" with the mask on your nose from roughly 3:40 to 5:15.
This is a actually quite common experience for newbies, particularly newbies with anxiety problems. There is a tendency to wake up and notice, "Hey there's this thing on my face and over my nose and mouth. Is it trying to kill me???"after i wake up, i check to see if im somehow not suffocating in my own mask somehow, my brain might still be trying to throw fear to me to wake me up, perhaps my brain doesnt quite know that there is a mask on my face trying to save my life vs a pillow smothering my face to death, blocking my oxygen.. or perhaps the mask is twisted off and is smothering me or not providing the pressure to open my air ways...
That's part of why us more experienced people tell new CPAPers that it can take a while to learn how to sleep with the mask on your face: Your brain has, in fact, been in a hyper-vigilant mode prepared to wake up up (for 20 seconds or so) to restart the breathing every time you have an obstructive apnea. It's not a big surprise that it can take a while for the brain to relax and realize this new monster clinging so tightly to the face is a friendly monster that is helping you breathe instead of your own airway collapsing and nearly choking you every few minutes.
There are a whole bunch of somewhat conflicting comments I have to make about this. So bear with me.But anyway, yes ill wake up around 5am, urinate, put the mask on for like 10 to 30 minutes, try to sleep, fail, then take off the mask and just concentrate on breathing and relaxing without the mask.. ill just lay there, think, think of future, organize my thoughts, turn to the phone and watch memes, read comments or whatever, then put phone down after 40 minutes, ill quietly and softly put on my mask, relax and luckily, fall asleep (which is a god send).
First, treating insomnia requires teaching your body that being in bed = being asleep. But what you are doing here, particularly when you turn your phone on and start using it for 40 minutes to distract yourself is actually teaching your body that being in bed = not needing to be asleep.
So if you really want to increase the likely hood that your body will go back to sleep quickly after that dreaded early AM wake, you may be better off getting out of bed if you haven't been able to get back to sleep in about 20 minutes. Yes, that sounds awful. But all I'm suggesting is this: When you reach for the phone, go ahead and get up. Move to another room and curl up in a comfy chair and allow yourself to enjoy looking at the memes (maybe even laugh out loud if there's a funny one). Don't start reading comments on anything that might be upsetting. (In other words, avoid reading about politics. Avoid reading about OSA. Avoid reading about hurricanes, earthquakes, etc.). Once you start to feel sleepy go back to bed and see if you can get back to sleep in a timely fashion. If you still can't get back to sleep, get out of bed and repeat the go to another room and distract yourself.
Now I do want to mention: Being on a phone at 5:00 am might not be the best choice of what to do to distract yourself. Screens emit blue light which can be exceptionally disruptive to our melatonin cycles, and hence to sleep. One (partial) fix is to make sure "night" mode is on. It also helps if you change the phone's "light temperature" much further to the orange/red end of the spectrum. There are apps that will do this and some phones will have settings that will do this automatically.
Also, if you are lying in bed for extended periods of time thinking of future and organizing your thoughts, that too can help teach the body that being in bed does not mean being asleep. If you are someone who enjoys journaling, it can be more relaxing (and better for your sleep) to go ahead and get out of bed and write those plans and thoughts down in your journal and then go back to bed when you are feeling sleepy.
Now the down side to this plan for tackling the insomnia associated with that wake is that it is possible that your body (and brain) may decide that it likes being awake in the very quiet early AM hours when everybody else in the house is asleep specifically because you can use that time as me-time: Time for you to do the quiet thinking (or meme-watching on the phone) that you don't have time for during the day. And if that happens, the best thing to do is to simply accept that your body may actually want what is called a divided sleep schedule.
Divided sleep schedules were quite common before the invention of reliable interior lighting in the 1800s: People went to bed when it got dark, woke up a few hours later in the wee hours of the morning and often did various things. (Sex being one of the most common. But quiet prayer and reflection among religious folks was another. And various night time chores was another.) And after being up for an hour or two in the middle of the night people returned to bed when they got sleepy and then woke up when daylight returned a few hours later.
My husband's current sleep patterns follow this pattern: He usually falls asleep hard (with his CPAP) around 9:30 or 10:00 and sleeps well until his "little old man" bladder wakes him up sometime between 3:30 and 4:30. He gets up, goes to pee, then goes downstairs and makes himself some coffee and starts reading business related stuff on his computer. He finds that his mind is fresh and awake and he enjoys the uninterrupted time to do some serious thinking. When he starts to get sleepy around 5:30 or 6:00, he comes back to bed and typically sleeps one more full sleep cycle before getting up for the day. This works for him. His total sleep time is enough to keep him functioning long term---he gets 7.5-8.5 hours of quality sleep per night and he's learned to not worry at all about being up in the middle of the night for an hour or two.
Clock watching feeds the insomnia monster. If at all possible, try to not look at the clock every time you wake up. And try to not look at the clock every few minutes when you are lying in bed trying to get to sleep or trying to get back to sleep after you've gone to the bathroom.Even though i hate the fact that i wake up at this time and i am not able to sleep from 11pm to 7am, i am at least happy that I CAN fall to sleep at some point. Its extremely bittersweet to me.
Before my issues, if i would wake up and 5am. id look at the clock and say, omg, its 5am.. back to sleep.. and go back sleep no issues. Couldn't for the life of me stay up during that time. Now its like, normal and i really dont like that.
it feels like im at the brink of insomnia everytime.
It's worth remembering that you did not have continuous sleep from 11pm to 7 or 8 am before you started CPAP: Your brain was waking up every few minutes for maybe 20 seconds at a time in response to the apneas. But you didn't remember those wakes because they were so short.i just wish i can continous sleep from 11pm to like 7 or 8am like i use to.
It's worth remembering that not everybody needs 8-9 hours of uninterrupted sleep to function long term. Some of us really only need 6.5-7 hours. Other people find out that a divided sleep schedule works fine for them. In other words, you may eventually find that you will settle into a pattern of going to bed between 10 and 11pm, getting up for about 60-90 minutes and doing something you enjoy after that early am wake, and then going back to bed and sleeping another 90 minutes or so after you go back to bed. And that's fine as long as you're functioning during the daytime.