I can't fall asleep, nothing works.

avi123 wrote:

CatherineF wrote:I have major problem with sleeping with CPAP. I can't fall asleep no matter what. I've tried trazodone, mirtazapine, didn't help. After Ambien I slept for 4 hours, but I can't take it due to my GERD and previous addiction. I am still trying CBT but I am so sleep depreived that I am not able to lay down with my mask for 2-4 hours with no sleep at all. I am taking the mask off and then fall asleep and here my experiments with CBT ends :/ I've tried some herbs - no help. Now I am trying to lay down with CPAP during the day, it is quite comfortable, Swift FX mask is really cool. But still i can't fall asleep with it. I don't know why? Because of my nervous system overactivity? I am nervous and anxious, lately much more due to sleep deprivation. I really don't know what to do. I can't take benzodiazepines, it would cause more apnea episodes. All Z-drugs are not an answer for me (zolpidem, zopiclone etc).

Please tell me I will get use to CPAP...

And your previous addiction was.......................?

If she was like me, she got addicted to the Ambien. But I found the 2nd time around after a couple of years of being away from it, I no longer have that problem. It doesn't work really well unless I take 20mg but even then I don't get the buzz I got when I first started taking it. But if she has an addictive personality she should probably continue staying away from it.

I have onset insomnia same as you can't fall asleep for nothing and I do take ativan and it does nothing for me....

proctor78 wrote:I have onset insomnia same as you can't fall asleep for nothing and I do take ativan and it does nothing for me....

Me too and when I asked what I could do for that they told me "nothing" especially when I told 'em what happens when I take Ambien which is supposed to work within 30 minutes. Fun world we have to "sleep" in, eh??

Jodi

PS, were you responding to my initial post from a way back?? If so, sorry about the repeat

CatherineF,

I bid you a sad welcome into the CPAP&Insomnia club as its honorary president. You can click on my Taming the CPAP Induced Insomnia Monster essay for a long list of tips and suggestions that I've learned about while fighting my own insomnia monster.

CatherineF wrote:I have major problem with sleeping with CPAP. I can't fall asleep no matter what. I've tried trazodone, mirtazapine, didn't help. After Ambien I slept for 4 hours, but I can't take it due to my GERD and previous addiction. I am still trying CBT but I am so sleep depreived that I am not able to lay down with my mask for 2-4 hours with no sleep at all.

Can you please describe what specific things you are trying as part of the CBT. It will help me make some reasonable suggestions on what you might be able to try IF I know what you are already doing CBT-wise. As a start, I would say that you should NEVER be lying in bed for 2--4 hours without sleeping. Night after night of lying in bed that long with the mask on and NOT sleeping is very likely FEEDING the insomnia a very rich and fattening diet. A major piece of CBT for bedtime insomnia is to make yourself get out of bed (repeatedly if necessary) when you've been in bed for 20 or 30 minutes and have NOT been able to fall asleep.

I am taking the mask off and then fall asleep and here my experiments with CBT ends :/

Please remember this: Every time you allow yourself to CONSCIOUSLY make the decision to take the mask off and get to sleep you are UNDERMINING all the hard work you are trying to do with the CBT. Because every time you choose this behavior you are allowing your conscious mind, your unconscious mind, and your body to continue to believe that you don't really need to make CPAP work for you.

I've tried some herbs - no help. Now I am trying to lay down with CPAP during the day, it is quite comfortable, Swift FX mask is really cool. But still i can't fall asleep with it. I don't know why? Because of my nervous system overactivity? I am nervous and anxious, lately much more due to sleep deprivation. I really don't know what to do. I can't take benzodiazepines, it would cause more apnea episodes. All Z-drugs are not an answer for me (zolpidem, zopiclone etc).

I understand the "nervous system overactivity" since I'm highly sensitive myself and a whole bunch of CPAP stimuli used to really, really bug me (and some of them still do). But---IF you use the dang machine EVERY NIGHT, ALL NIGHT (or rather for the ENTIRE time you ARE SLEEPING), then the body DOES begin to acclimate to the new new so to speak. But it takes time---as in months and months, not just a few weeks. And it does take NOT UNDERMINING the necessity to get used to the new new by giving up for the night at 3:00 or 4:00 AM and taking the mask off in the wee hours of the AM just to get some sleep.

Please tell me I will get use to CPAP...

I can only tell you my own story: I started CPAP in late September 2010. And the insomnia and severe daytime dysfunctionality started to develop by my third night on CPAP. The daytime sleepiness and brain fog I endured from September 23 through the end of 2010 was far worse than I've ever experienced in my entire life. But since New Year's Day 2011, I've slowly, but surely been crawling out of that black hole. There have been multiple setbacks---mostly triggered by medication for my OTHER chronic condition---i.e. migraines.

And finally, after 10 months into doing xPAP therapy and now that both my migraines and migraine medication side effects have been under control since early June, I am finally beginning to feel as well as I did BEFORE starting CPAP on most days in terms of pain, mood, and energy levels, but not yet in terms of cognitive functioning. And on a few days each week, I am genuinely feeling better than I did pre-CPAP in terms of daytime pain and overall mood and energy. On most nights I can sleep from 2:00 or 3:00 AM until about 8:00 or 9:00 AM with only 2 or 3 wakes, which are NOW usually short wakes. I'm averaging around 4 1/2 to 5 1/2 hours of sleep per night. I'm starting to wake up feeling "almost refreshed" on most days and "genuinely refreshed" maybe once or twice a week. So in that sense, my insomnia is now "under control." It still acts up on regular basis---once every week or two I have a horrible night of "can't stand the mask and can't sleep until it's pushing 5:00AM" based bedtime insomnia, but the frequency of these bedtime insomnia attacks has gone way, way down. And in the last couple of months, the daytime brain fog is finally start to lift. In short, I feel as though I am finally (after 10 long months) beginning to get my life back.

Has it been worth it? Well, intellectually I know that having the apnea under control is a good thing for my body's health. Getting rid of (most) of the daily hand and foot pain that I used to have has been a wonderful consequence of xPAP therapy. The fact that I'm beginning to wake up feeling somewhat refreshed on a pretty regular basis is positive---I used to wake up really refreshed EVERY morning even as recent as 5 or 6 years ago and it's nice to have that feeling coming back. (I wasn't waking up particularly refreshed the last 2 or 3 years before my sleep test was done.) Right now those are the only positive changes that xPAP has made and they've been so subtle in coming that without my journals I'm not sure I would have recognized them as consequences of xPAP. And I know that while I can currently handle my sleep from 3:00 to 9:00 schedule just fine as a college professor who's not teaching this summer, I am worried about how to transition back to a more normal bedtime/wake up time schedule since my efforts to do so are still highly problematic in the sense that they tend to cause the insomnia monster to wake up and become more active.

Dojers wrote:

proctor78 wrote:I have onset insomnia same as you can't fall asleep for nothing and I do take ativan and it does nothing for me....

Me too and when I asked what I could do for that they told me "nothing" especially when I told 'em what happens when I take Ambien which is supposed to work within 30 minutes. Fun world we have to "sleep" in, eh??

Dojers and proctor78,

I also bid the two of you a sad welcome into the CPAP&Insomnia Club.

Dojers, you are correct: 'Tis indeed a "fun"---as in strange---world we have to sleep in now that we're in Hosehead Land. And 'tis very easy to get discouraged in the face of a major Bedtime Insomnia Monster---one who tells you night after night: What's the point of going to bed since you won't sleep anyway because you've got a six foot hose attached to your nose?

For some folks Ambien or other prescription sleep medications can help. But it's unfortunately true that they don't work for all of us. In addition to maybe finding some drug-free ideas to try in my Taming the CPAP Induced Insomnia Monster, you might also want to pick up a copy of Sound Sleep, Sound Mind by Dr. Barry Krakow. He's got some very sound, concrete advice on what to do about insomnia (sans drugs) as well as a good discussion of CPAP and sleep apnea and how they can interact/cause insomnia.

Best of luck

I am going to try to answer all your posts. Thank you for such contribution

Dojers: Valerian root makes me more anxious, it doesn’t help. I don’t think I suffer from claustrophobia either, breathing with CPAP when I am awake is pretty easy and even quite relaxing for me.

Archangle: I am trying to lay down with CPAP when I watch TV or read books. It is comfortable for me. I’ve been trying for 10 nights only and I will keep trying, I know I have to. And I believe I will get use to this sooner or later. I can’t eat anything before bed because of my night GERD problems (this is also the reason I can’t take take zolpidem – it makes it worst :/)

Mike 6977: I am glad that you are lowering your doses, I’ve been taking sleep meds for 4 years, I am clean for 1,5 year now and I don’t want to use them again. It is a very good idea with excercies, I am trying to do this lately, this interval training is very good and I was doing this last year very often. The only problem now is totally lack of strength, but I am still trying to exercise…

Xenablue: Hmm I would try this but I don’t have tv in my bedroom, neither computer, but maybe it is a good idea, conflicting with cognitive behavioral therapy for insomnia, but it could be helpful

BrianinTN: I’m sorry you have such problems with CPAP  Are you planning some surgeries for SA? Isn’t ASV more easily tolerable?

Cflame1: I am going to try melatonine, I feel my circadian rhythm is disrupted, I may have DSPS (delayed sleep phase syndrome), agomelatine is new med for such problems but it is expensive, though it would work well for me I suppose

HerbyPeg: I am drinking camomille tea and Melissa tea. Exactly I cant use valerian root, it makes me more anxious, essential oils makes me nauseous But thank you for advices

Avi123: Perhaps I shouldn’t call this an addiction, I was talking about my sleeping meds issue. I’ve been using them for 4 years. I had terrible insomnia and without any pill I just couldn’t fall asleep. For 1,5 year now I am clean, I got over it by myself so maybe it wasn’t an addiction, because it wasn’t so hard to throw it away?

Ozij: I know that such CBT is a good idea. And I would really want to do this. But what should I do when I have to go to work in the morning and I am so sleep deprived that my eyes aches, my heart bits irregularly and I am so tired and have such enormous brain fog that I can barely get up? If I would find out that I have apnea, say 2 years ago when I was not so tired CPAP-CBT would be more easy to introduce to my life.

Proctor78: Is your problem apnea or UARS?

Robysue: Your blog is perfect and many wise advices everyone with this problem can find there. Thank you for it. And thank you for telling me your story. Do you know why brain fog happened to you after CPAP use? Because of shortening of sleep due to CPAP induced insomnia? Were you on BiPAP from the beginning? Maybe it is easily tolerated? Maybe I should get a BiPAP to tolerate therapy better?

Thank you guys for all your posts, I am so happy that I’ve found this place. I wish you all best of luck and health

xenablue wrote:I've never had much trouble falling asleep, but when I started on CPAP it was a whole different matter. I felt claustrophobic, restricted, hot and a bit panicky that I wasn't getting enough air.

Someone on here suggested putting the mask on at times OTHER than when you're ready to lay down to sleep. Times such as watching TV or reading, so that you can get comfy and used to wearing the mask - even during the day when you have no intention of sleeping. Just to get comfy with the gear.

For the past 8-months since Dx, this is what I've done every night. My ritual before sleep has always been to watch a DVR'd episode of Jeopardy, so I hose up first, then as I'm watching TV mess with my mask until it's comfy and I'm breathing without being conscious of it. Occasionally I'm still not relaxed or ready for sleep so watch some more TV for a few minutes.

Watching TV or reading takes my mind off the mask and breathing, so that by the time I'm tired enough for sleep everything's working and falling asleep is easy.

Cheers,
xena

I had Xena's experience for my first few months. It takes time for your sleeping mind to realize its safe sleeping with the mask and hose. I kept a pulse oximeter on for nearly every night those first few months. I could always tell when I took off my mask because the SPO2 plummeted and my heart rate jumped up and down in synchronicity. That convinced me that sleeping without the mask was not sleep but harming me. I hate it that I cannot just fall asleep on the couch but, that is life. The good news is that eventually, with persistence, you will find you can sleep.

My own routine is get calm out in the living room as needed. When you go to sleep, first mask up with no hose attached, if you can stand that for a couple minutes you are calm enough. Then turn on your unit, then when it starts blowing, attach the hose to your mask.

I find it helps if you have a BIPAP to have an IPAP a few cm-H2O above the EPAP. Mask fit is important. Get it as loose as it can be and still seal under pressure. The good masks have an inner flexible silicon seal that is pressure driven so they seal to your face best when the mask is loose. If the mask is too tight, not only does that make it feel stuffy and hard to breath but it also does not seal as well. Finally, if you can stand it and not mouth breath, a nasal mask is not as scary IMHO as a full face mask. Many of us learn the trick of keeping air from going out the mouth and maintaining that while sleeping. Others try taping and chin straps. I'll tell you I was so freaked out by having to wear a mask that I insisted it be a nasal mask because I figured if it stopped working while I was asleep then surely I would open my mouth and breath. I slept with the light on for many nights at first. So, just realize, some of us have been there too and we are rooting for you.

Ozij: I know that such CBT is a good idea. And I would really want to do this. But what should I do when I have to go to work in the morning and I am so sleep deprived that my eyes aches, my heart bits irregularly and I am so tired and have such enormous brain fog that I can barely get up? If I would find out that I have apnea, say 2 years ago when I was not so tired CPAP-CBT would be more easy to introduce to my life.

If you had broken your ankle, and had to stay in bed for a week to let it heal, would you still go to work?
Ditto if you had a concusion.

You have a medical problem, consider taking time off from work to handle it. An extended weeked, which will give you 3 nights.

Great suggestions. Like Catherine, I'm having a heckuva time falling asleep once I get the mask on. I wait until I absolutely can't stay awake one second longer, then mask up. Then I wake up. When I do doze, it's just that...dozing. Maybe Stage 1 sleep all night? Until I take the mask off around 3 a.m. and fall asleep without it.

Will try the reading/TV trick tonight....

CatherineF wrote:Thanks for answers. This sleep onset insomnia only happens when I have mask on my nose. Without it I am falling asleep in less than 5minutes. And I really want to use CPAP, but I don't know how. Benzo are rarely good choice, I've been taking them often in the past. I don't want to come back to it either. I will try some herbs like gotu cola, brahmi and theanine, maybe it will help me soothe my nervous system, along with mahnesium it may work...

Since the sleep onset insomnia only happens when you have the mask on then it's probably more about heightened awareness of the mask focusing your attention away from sleep. IMHO. So, if that is the case then perhaps you can try focusing elsewhere to keep the mask from being the focus. Would you feel good about visualization - such as visualizing favorite experiences, places, moments, . . .?

Best wishes!

If you can read in bed (and you like reading of course) lose yourself in a good book - by the time you're ready to put it down, you and your face should be used to the mask and you can lay down and go to sleep.

Rest well and good luck!!

Dojers wrote: when I asked what I could do for that they told me "nothing" especially when I told 'em what happens when I take Ambien which is supposed to work within 30 minutes.

You can climb the drug ladder, if there's a time when you HAVE to go to sleep.

Along with the ambien, take 1 mg of clonazapam. Twenty minutes later, drink two glasses of wine. Then head directly to bed.

Not recommended for long-term use.

Hi Catherine,
I read your CRY !… that sounds you must be real tiered so now and then. My husband did not know he had s.apnea too. The doctor, advised a cpap, tried and ran away, and finnaly he went for nose stiffeners… He used some but all of them where no good to hard, hurts etc. now we did find the so called Nasitubes, did the job the best. dont know the name is right as we don't have the packaging anymore.. if needed i can look for it in my bill of amazon. They are made from soft silicone. Real soft and no irritation at all !! You can use them when your tiered of your mask for a while, as it makes you breathing through your nose quite easy. One thing.. you need only to sleep on your side. That’s one of the most important part. while sleeping on your side, your tongue cant block your wind pipe any more, so no apneas anymore… hehe
please let me know if i must look for it..
Love to you sis. [/color]

Mike6977 wrote: You can climb the drug ladder, if there's a time when you HAVE to go to sleep.

Along with the ambien, take 1 mg of clonazapam. Twenty minutes later, drink two glasses of wine. Then head directly to bed.

Not recommended for long-term use.

Just don't pull a Karen Quinlan.


My best solution to insomnia (unrelated to CPAP) was losing weight and exercising at least an hour a day, but not within a few hours of bedtime. But situations differ.

Lately i found a very simple and so far effective way of calming my mind, dealing with anxiety and doing some light meditaion before sleep.
Breathing: The Master Key to Self Healing by Andrew Weil (audio).
Following the breathing exercises described by Andrew Weil helps put me in a calm and relaxed mood. And the bonus is the inhale exhale of the CPAP machine really helps with some of the final breathing/meditation exercises before i fall asleep.