Hello Old Friends - I Need Help

CollegeGirl, I struggle with the same issues. For the last twenty years, since i was around ten years old, I have had trouble falling asleep. One of my favorite things to do is to stay up really, really late so that I just feel wiped out when I go to bed. I realize now that this is simply a way of avoiding the dreaded 'three hours of tossing and turning before falling asleep' phenomenon. I was recently diagnosed with OSA and have been struggling with using my xPAP equipment ever since. For someone who has a hard time falling asleep, wearing all of this equipment just makes it even worse. And when I do have a semi-decent night of sleep, I end up having a harder time falling asleep the next night because I am not as wiped out. But I am working on it, and am much more comfortable with my gear these days.

Delayed sleep phase syndrome is real, and it sounds like we both have it. Some things you should try:

1. Go for a walk in the morning. Yes, before work. Yes, that requires getting up even earlier. Hell, but sometimes you just need to suck it up and do it. You should go for a 30 minute walk every morning - this is helpful for numerous reasons but most importantly, it helps set your biological clock. This is the natural way to get 'light therapy' and IMHO beats staring into a light box, which I've also done.

2. Quit caffeine, nicotine, and any and all uppers/downers/etc. It will take two weeks for you to physically recover from the physiologic addiction to uppers (depending on your body and your use of substances).

3. Get off the computer at night. Stay away from TV, laptops, handheld game consoles, iPhones, etc. Beginning two hours before bed, you should find something relaxing or boring to do. This can be reading a book, doing work, crossword puzzles, sitting outside enjoying the whether, whatever. Just stay away from electronic screens of all sorts.

4. Wake up at the same time every single day no matter what. Even if that means your day will be ruined because you only got two hours of sleep. This can take a few weeks to fully adjust to, but IMHO it is the single most important way to get your body's natural clock synced up with the rest of the world. It requires commitment and and at times, a Herculean discipline, but it is essential.

You can do everything else right, but if you have delayed sleep phase syndrome and violate (4) by sleeping in, you will be trading a week of crappier days for one less painful day and thus, screwing yourself over.

Finally, throw that "I'm disabled" crap right out the window. That's just self-pity and defeatism. It's a way of shirking responsibility, particularly to yourself. You owe it to yourself to follow through on an effective plan to treat your DSPS. Coming in to work late after your boss has given you several months to get your personal life taken care of is unacceptable. Unless you have narcolepsy, you most certainly can wake up whenever you want. Set several alarms at different places in your room. I do this when I am afraid of oversleeping. As soon as you get out of bed to shut the alarms off, leave the bedroom and don't consider for even a moment the possibility of returning to bed. Problem solved.

Follow the points above and after a few weeks, you'll be set. You will still have nights where you can't go to sleep until late, and you will just have to suffer the next day for it. But if you stick to the plan, most days you'll feel well, and you won't lose your job. Win-win.

The closer I stick to the above plan, the better treated my DSPS. As soon as I start feeling bad for myself and give in to the snooze button, I throw the whole system off and it's harder to fall asleep the next night and the vicious cycle gains speed. Time to do right by yourself (and your employer) and step it up.

I'm too tired to wade through all the responses--I was up late writing a novel (I'm not a writer), and searching for a soldier that I sent a care package to when I was in 2nd grade. So, I can relate.

Many of the things I do wrong have been mentioned -- no computers or bright lights at night, no stimulating activities, sleep hygiene, don't stay in bed if you're not asleep after 20 minutes, no eating late at night, a small dose of melatonin (e.g., .5 to 1mg) 6 hours before the time you usually get tired, bright light for 45 minutes first thing in the morning, read only very boring things before bed, etc. These are some of the many things you can do to "try" to reset your clock. In aggregate, and in theory, they should improve your insomnia. Maybe your sleep onset insomnia is due to your apnea, and it can result in shifts in your peak melatonin toward the am hours. However, to some extent whether you're a "night owl" or an "early bird" is genetically determined, and you can make small changes, but it's possible your natural inclination may be to go to bed late.

Was Ambien or another sleep aid mentioned in this thread? This is the most robust solution to your problem. You take it and you fall asleep. The end. (Unless you take it and stay on the computer to pen a novel and search for dead people...) Seriously, you should do all the right things (see above), but this is the fastest way to a solution to your problem.

Well, it's been about six weeks of going to bed earlier (for the most part) and there are still things I'm doing wrong, but I must be doing something right, too, because I've been on time to work every day of those six weeks.

About three weeks ago, I also implemented Den's suggestion of moving to a fixed pressure instead of auto mode. I'd meant to do it at the start of those six weeks, but I kept forgetting to do it. It may be my imagination... but I think I am really and truly feeling a difference. I'm starting to have small amounts of energy again... something I haven't seen in a very long time. It's amazing to me that even after five years of CPAP and this board, I can still learn things that make such a vast difference in my therapy.

Thank you, Den, and thank you to the rest of you who gave me such excellent suggestions! The one thing I still need to do is force myself to get up at the same time on weekends. I'm getting closer.

CollegeGirl wrote:Well, it's been about six weeks of going to bed earlier (for the most part) and there are still things I'm doing wrong, but I must be doing something right, too, because I've been on time to work every day of those six weeks.

About three weeks ago, I also implemented Den's suggestion of moving to a fixed pressure instead of auto mode. I'd meant to do it at the start of those six weeks, but I kept forgetting to do it. It may be my imagination... but I think I am really and truly feeling a difference. I'm starting to have small amounts of energy again... something I haven't seen in a very long time. It's amazing to me that even after five years of CPAP and this board, I can still learn things that make such a vast difference in my therapy.

Thank you, Den, and thank you to the rest of you who gave me such excellent suggestions! The one thing I still need to do is force myself to get up at the same time on weekends. I'm getting closer.

You're welcome, Ginny.
Sorry to hear you waited that long to try it......but, glad to hear you may be feeling improvements from it.
Please keep in touch and let me know how you're doing (feeling) after more time elapses.

Best wishes,

Den

I'll be honest -- I thought there was no way it could help as I had tried it at a few different pressures for a couple of weeks at a time back when I first switched from an inadequate cpap pressure to an auto. But I saw no difference. I think I was still so new to an adequate pressure my body just hadn't had time to recover enough for me to be anything but exhausted. It just goes to show you - if you aren't feeling great yet, even after it's been five years, it may be worth trying switching things up again.

That's a good point CG. Other factors influence our experience at different times, and who knows if the experience would be the same during another time frame. I know there have been times when nothing could please me, as my sleep was so crappy I was hypersensitive to every little irritation. Now I think there are even masks that I HATED that I think if revisited the experience wouldn't be so negative. I had been on here a couple years before I broke down and used a chin strap.

There's lots of good advice about sleep hygiene posted by others. The ONLY thing I could add is the advice to get a dog. Dogs demand to be fed at the same time every day, and if you can set that time to be the time YOU need to get up for work, it's guaranteed that the dog-alarm will have no sleep button!