Insomnia: Melatonin + 5-HTP + Tryptophan

Jeff, have you checked your data to see if there's any correlation between your big wakeups and apnea, leak rate, or pressure?

I've noticed that now that I'm able to sleep longer, I sometimes wake up on my back after several hours. On some of these nights, I also have a really ugly cluster of events, about 15 minutes fighting for each breath. I don't have an oximeter, but I doubt my O2 levels are staying up during that. This does not seem to be disturbing the rest of my sleep. But if something like that is happening to you, I wouldn't be too shocked if your adrenal glands remained on guard the rest of the night, and you never made it back to deep sleep, especially if the wakeup is from positional apnea and you stay in that position.

Otter wrote:Jeff, have you checked your data to see if there's any correlation between your big wakeups and apnea, leak rate, or pressure?

I've noticed that now that I'm able to sleep longer, I sometimes wake up on my back after several hours. On some of these nights, I also have a really ugly cluster of events, about 15 minutes fighting for each breath. I don't have an oximeter, but I doubt my O2 levels are staying up during that. This does not seem to be disturbing the rest of my sleep. But if something like that is happening to you, I wouldn't be too shocked if your adrenal glands remained on guard the rest of the night, and you never made it back to deep sleep, especially if the wakeup is from positional apnea and you stay in that position.

A few months back I was checking ResScan often to see what was happening during the big wake up and I would see one or more events at that time. It's one of the reasons I knew I had to look at the clock when I knew it was the big wake up, so that I knew what time it was for checking the ResScan reports per that time the next day to see what was going on. That's also the time frame when I asked my doctor if I could see a sleep doctor to discuss these findings (I think I've already described how that process fell apart).

Typically I'm on my right side when I wake up, usually comfortable. Often I remember a dream fragment and it will be a pleasant enough dream, but may have me doing some exertion, like getting on a bicycle and trying to turn the crank by pedaling, after being told by the fellow who lent the bike to me that it is hard to initially get the crank turning (so I wonder if mild exertion in the dream is enough to stir me from sleep). I am also disappointed that I don't try to remember more of the dream before I realize that I also have dry mouth at this big wake up, which is usually the only time I have it during the night these days. In fact it is one of the ways I've come to know it is the big wake up happening - if I don't have dry mouth then it is usually just a brief wake up and I know I'll fall back off soon, so I can relax back to sleep easier. If I have the dry mouth, even though I keep my water mug by the bed I usually don't need to drink from it for the dry mouth; I have found that I can usually summon up enough saliva in to eliminate the dry mouth, and if and when I eventually fall back to sleep again and wake up at any point I don't experience dry mouth again that night.

I know the supine position is bad for me, as in bringing on snoring and more apnea events, and i believe i do have myself trained to stay off my back all night long. I do slip a little now and then, but very rarely these days do I ever wake up other than on my side, and most often my right side.

I should also report that I have been using the L-Tryptophan 1000 mg nightly since 07/17/2011 in place of the 5-HTP. I do not know if this makes sense or not, but I feel like it is possible that the L-T may be helping me clam down even more during the day than I was feeling from the 5-HTP. That would make sense, right, that the additional serotonin would help calm things like the adrenal glands? Largely gone now is the persistent tight knot in my stomach, and some energy levels that were like over an over wound spring. I miss that energy thing during some of my workouts - it seems like I have to actually work a little harder to get things done rather than just have this energy switch in the "on" position if that make sense. But I am still able to get out and do the workouts at will, and am seeing physical and mental improvements for my efforts, so I have to say it is good. I want to keep a careful eye on this concept in case adding more serotonin with the L-T might somehow eventually make me too relaxed, so that I stop getting my workouts done. I am also in the process of losing weight, much needed for better long term health. I am 2/3 of the way to my goal weight. So I'm in that positive cycle right now where working out a little harder helps lose some weight, losing some weight helps me workout a little harder, etc. Getting the insomnia at least this much back under control has helped regain some of the needed mental and physical edge for the workouts, and the workouts themselves also help ease the insomnia some nights. Last night wasn't so good after the big wake up around 4:25 AM. It was fragmented sleep after that, but I had a productive day today any way, and the panic attacks are way down in the stressful situations as I know I have under control to the best of my ability that which I can have under control, and the rest I need to ride with as best I can. As I type this, I find myself wishing for a better night's sleep tonight. And I wish that for everyone here as well.

Jeffster wrote:

Otter wrote:Jeff, have you checked your data to see if there's any correlation between your big wakeups and apnea, leak rate, or pressure?

A few months back I was checking ResScan often to see what was happening during the big wake up and I would see a cluster of events at that time. ...

Typically I'm on my right side when I wake up, usually comfortable. Often I remember a dream fragment and it will be a pleasant enough dream, but ... I realize that I also have dry mouth at this big wake up, which is usually the only time I have it during the night these days. In fact it is one of the ways I've come to know it is the big wake up happening - if I don't have dry mouth then it is usually just a brief wake up and I know I'll fall back off soon, so I can relax back to sleep easier.

The plot thickens concerning those "big wakes"---the ones that continues to disturb you have all the following important properties:

• There are sometimes/often clusters of events shortly before the wake
• You are dreaming just before the wake.
• You have a dry mouth at the wake ...

Sounds like you're getting into a pretty intense REM cycle and either during or before that REM cycle, your mouth opens which increases the air blowing through your mouth and drys it out, the fact that you're in REM leads to a cluster of events, and the events together with the dry mouth wake you up.

Now I know that you're signature says you're using a FFM. But even in a FFM, opening your mouth for a prolonged period of time allows additional air to be flowing through the mouth even if it doesn't affect the pressure on the upper airway. And if my hypothesis is correct, then figuring out a way to keep the mouth closed may partially fix the problem. And show the doc the evidence of the clusters and see if he'll go along with a slight increase in pressure to see if that helps break up the event clusters.

Thanks for the input, robysue! I just corrected my post from last night since I didn't have a cluster of events at the big wake up when I looked in ResScan today. I had only two central events right around the time of 4:55 AM, each lasting for 13 seconds. It's hard to be certain since I think I have the data skew thing going on within ResScan since I've never cleaned my SD card. If the skew can be shifted to the right by 20 to 30 minutes after 14 or so months, then those two central events could be part of the 4:55 AM big wake up.

I think I should wipe my SD card clean to correct the skew problem to better see new results, but I am a bit unsure about how best to do it. Can someone tell me if this is an OK way to do it: put the SD card in my F drive of my laptop, open it up, select the DATALOG folder and four files, and delete them. Remove SD card from laptop and put back in S9. Will the S9 then reformat the SD card and it will work OK after that?

But yes, last night I still got the dry mouth and was dreaming at the big wake up time. So I'd say yes, that REM is playing a part in the big wake up. But it is interesting to have the apnea events be just central at that point, not obstructive or hypopnea. Leak rate was 0.0 at the time of the big wake up (though it had been higher a couple of hours earlier). Minute Ventilation seems to have gotten more active after the 4:00 hour, going from an approx. 5 - 6 range before 4:00 AM to a wider approx. 6 - 14 range from 4:00 AM on through final mask off around 7:30 AM, but I'm not certain what that category means.

My AHI readings for last night were: Obstructive: 0.0, Central: 0.8, Unknown: 0.0, Hypopnea index: 0.3, AHI: 1.1

And robysue, at the risk of taking my own thread OT and over a cliff, I want to tell that many years ago I actually sat on the edge of the American Falls at Niagara. The Army Corps of Engineers had dammed the river to turn off the flow over the American Falls to study if anything could be done to slow or stop the rock deterioration. I went up there with some buddies, we didn't know the falls would be turned off. I had my guitar with me and in those days was always looking for interesting places to play. It was night time, no one was around but my buddy with me, so I walked over the low rail with guitar in hand, walked out to the edge, sat down letting my legs hang over the edge, and proceeded to play the guitar and sing. My fingers got pretty cold and stiff pretty fast, half way through the first song, so I gave up at that point. One of those lucky to still be alive things, stupid, but unique to my own existence. Since the falls are nearby to you and you were just up there for your birthday I wanted to get that story out again and share it with you and the forum.

Jeffster wrote:Thanks for the input, robysue! I just corrected my post from last night since I didn't have a cluster of events at the big wake up when I looked in ResScan today. I had only two central events right around the time of 4:55 AM, each lasting for 13 seconds. It's hard to be certain since I think I have the data skew thing going on within ResScan since I've never cleaned my SD card. If the skew can be shifted to the right by 20 to 30 minutes after 14 or so months, then those two central events could be part of the 4:55 AM big wake up.

An easy idea for dealing with the infamous ResScan data shift: When you wake up at night, turn your CPAP OFF and then ON. If it's off for even as little as 30 seconds, there will be an obvious break in the wave form data. And of course, the apneas themselves are visible on the wave form too. This will also take care of any discrepancy between the bedroom clock and the S9's clock.

EDITED TO ADD: And for some folks who desat, a "cluster of two" apneas right on top of each other is enough to cause a serious desat and hence an arousal.

And robysue, at the risk of taking my own thread OT and over a cliff, I want to tell that many years I actually sat on the edge of the American Falls at Niagara. The Army Corps of Engineers had damned the river to turn off the flow over the American Falls to study if anything could be done to slow or stop the rock deterioration. I went up there with some buddies, we didn't know the falls would be turned off. I had my guitar with me and in those days was always looking for interesting places to play. It was night time, no one was around but my buddy with me, so I walked over the low rail with guitar in hand, walked out to the edge, sat down letting my legs hang over the edge, and proceeded to play the guitar and sing. My fingers got pretty cold and stiff pretty fast, half way through the first song, so I gave up at that point. One of those lucky to still be alive things, stupid, but unique to my own existence. Since the falls are nearby to you and you were just up there for your birthday I wanted to get that story out again and share it with you and the forum.

Quite a story! The "the American Falls were turned off" to fix them is told over and over to tourists. It's great to see a first hand account of one who got to walk up and sit on that edge when they were turned off.

Hope you find some decent quality sleep of your own in dealing with your insomnia monster! I think between the two of us with our very different approaches, the newbies with insomnia problems can get lots of information about both approaches and to help them make to make an informed decision of what they want to try when battling their own insomnia monster.

robysue wrote, "Hope you find some decent quality sleep of your own in dealing with your insomnia monster! I think between the two of us with our very different approaches, the newbies with insomnia problems can get lots of information about both approaches and to help them make to make an informed decision of what they want to try when battling their own insomnia monster."

That's a good thought, robysue. I hope some of what I've written in this thread, along with what others have written here, can provide useful info to newbies and others with insomnia problems.

I'm still trying to figure so much of it out myself.

I know some of what you have written on this forum and your blog has helped me, robysue, even though my approach to battling my insomnia monster as described in this thread is different from yours.

Jeffster wrote:Thanks for the input, robysue! I just corrected my post from last night since I didn't have a cluster of events at the big wake up when I looked in ResScan today. I had only two central events right around the time of 4:55 AM, each lasting for 13 seconds. It's hard to be certain since I think I have the data skew thing going on within ResScan since I've never cleaned my SD card. If the skew can be shifted to the right by 20 to 30 minutes after 14 or so months, then those two central events could be part of the 4:55 AM big wake up.

If you expand the time scale, you can see where the apneas actually occur. An apnea makes a flat spot on the flow trace. Only the ones that are least 10 seconds long get marked. The little wiggles in the flat spot are the S9 checking your airway with FOT pulses. The event markers are supposed to be at the end of the event, if they aren't, reformatting the card will fix it. Or just use Sleepyhead. It's still in alpha, but Jedimark found a different set of timestamps that don't get skewed.

I think I should wipe my SD card clean to correct the skew problem to better see new results, but I am a bit unsure about how best to do it. Can someone tell me if this is an OK way to do it: put the SD card in my F drive of my laptop, open it up, select the DATALOG folder and four files, and delete them. Remove SD card from laptop and put back in S9. Will the S9 then reformat the SD card and it will work OK after that?

Some people report that deleting all files fixes skew. That did not work for me. I reformat the card using SD Formatter.

V3.0 supports many types of cards.
https://www.sdcard.org/consumers/formatter_3/

V2.0 supports the cards that the S9 uses and works with more operating systems.
http://panasonic.jp/support/global/cs/s ... ter20.html

In options, choose "full format, erase off". If your laptop supports the flash erase feature, you can turn that on too, but with most card readers, all that will get you is an error.

I also "delete all data" in the s9 clinician's setup menu, before I put the card back in, but I do that every day anyway, so I'm not sure if that's necessary to deskew. While you're at it, you may as well powercycle (unplug) the s9 before you put the card back in. I've found the firmware on my machine to be quite buggy, and I don't really trust it not to mess up a reformatted card if it's been running for a while. Turning the machine off and on again will make sure it has a clear head when you insert the card.

Any further thoughts or information on the big wakeups? I think it might help if you posted some data for a few nights with BWUs, and told us about what time that happened. It doesn't sound like the BWUs are directly related to apnea, but there may be some clues in the traces.

BTW, central apneas right before you log a BWU probably just mean you were already awake.

Thanks Otter for all the info! I'll give one of those SD Formatter versions a try. I'm in Vista so I guess the 2.0 or the 3.0 would work for me.

I'm looking at last night's results in ResScan right now and seeing some interesting stuff. I think I had more than one BWU last night, like 2 or 3 in a row. When I look at ResScan, I can see a spike in mask leak at that time climbing from 0.0 up to 39.6 over a 20 minute period then drops like a rock back to 0.0. I have one OA and one CA event next to each other 10 minutes before period, 10 seconds each. The AHI blue line is not even on the chart until those two events, where it comes in at 2.0, stays there 30 minutes or so while the leak rate spikes, then goes to 0.0 at the same time the leak rate drops back to 0.0. Pressure climbs up from my low setting 0f 13 to 13.8 minutes before the leak rate starts climbing, but then settles slowly downward to 13.2 at the leak rate peak.

I think I need to study Minute Ventilation as the patterns get much more pronounced in the hour leading up to all this, then get subdued during the leak rate climb, then pick up again right at the moment the leak rate falls back to 0.0 and stay that active until the end of the sleep session.. I think the shape of the pattern of the wave form would tell me something about my Sleep Disordered Breathing, but I need to go find again where I read about that.

I saw that "delete all data" in the s9 clinician's setup menu yesterday when I went in to reset time. It makes me wonder, maybe I could do just that instead of reformatting the card to fix the skew? I wasn't sure what data it was going to delete, like maybe my pressure settings, etc. on the machine, so I didn't try it. I just looked in the S9 Clinician Manual and I see the command listed there, but not a definition of what it will delete.

The S9 clock had gone slow by 20 minutes (maybe from having it unplugged for a few trips over time - it's internal battery lost a little time here and there?). I don't know if I've ever reset time since getting the S9 14 months ago. It makes me wonder, does the machine automatically reset for Daylight Savings Time? I'm guessing not, so I need to remember to manually change that when we switch back. I've only used ResScan sporadically over time, but every morning I check the Sleep Report on the S9 display to see how I did.

I should go figure out how to get some reports posted here for you and all to see regarding the BWUs. I've saved some help threads on that. I know I can get PDF out of ResScan, then I have to get that to what, JPG format and post that on a photo website, and then link it here in a thread?

Jeffster wrote:I saw that "delete all data" in the s9 clinician's setup menu yesterday when I went in to reset time. It makes me wonder, maybe I could do just that instead of reformatting the card to fix the skew? I wasn't sure what data it was going to delete, like maybe my pressure settings, etc. on the machine, so I didn't try it. I just looked in the S9 Clinician Manual and I see the command listed there, but not a definition of what it will delete.

It deletes:
_ All usage statistics and compliance data (except hours in year, which is the motor hours and can't be deleted)
_ All summary data and averages.
_ All your detailed data if you've got the card in the machine. (With the card in, deleting can take a while, and sometimes it hangs.)

It does not delete any of your settings, but if you want to keep the stats going, I'd try just formatting the card and rebooting the S9 first.

Jeffster wrote:The AHI blue line is not even on the chart until those two events, where it comes in at 2.0, stays there 30 minutes or so while the leak rate spikes, then goes to 0.0 at the same time the leak rate drops back to 0.0.

The AHI line resets to 0 at beginning of every hour if I recall correctly. So the AHI graph's highest points are right before the hour mark and give you an idea of how bad (or good) each individual hour was. So that AHI dropping to 0.0 as the leak subsides is just coincidence.

Otter wrote, "I think it might help if you posted some data for a few nights with BWUs, and told us about what time that happened."

What's the best way to do this? I'm in Windows Vista and run ResScan 3.13.018.

Any help with report format would be appreciated too, like, make it a full 10 hours, or zoom in to an hour that shows better details of the time say a half hour before and after a big wake up, etc.?

I did get my SD card reformatted yesterday with the 3.0 version, and then unplugged the S9 and replugged it then put the card in.

I'd post both the whole night and a detail view. Not sure the best way to go about that, though, since I never managed to convince Resscan to install on xp x64.

Otter wrote:I'd post both the whole night and a detail view. Not sure the best way to go about that, though, since I never managed to convince Resscan to install on xp x64.

I started a new thread with a whole night and detail view here:

viewtopic.php?f=1&t=67753&p=630149#p630149