lazer,
First, I agree with Pugsy:
If you do take a nap, mask up. And if you can avoid taking naps altogether it may help you sleep better at night.
But given your long history of pre-CPAP insomnia and the fact that you're on some major medication that can play havoc with your sleep architecture, I think you're going to need to do some serious work to tame the insomnia monster.
In other words, some of why you're still feeling lousy in the day time is poor quality sleep caused by things
other than your mild OSA and your loud snoring. And plain old garden variety insomnia can leave you feeling wiped out. So for you to improve the quality of your sleep (and hopefully) your daytime functioning, you've got to deal with the insomnia as well as the OSA. And until you tame that insomnia monster, you're not going to see much improvement in the quality of your sleep regardless of what you try.
Remember:
Until you are sleeping with the CPAP, the CPAP cannot improve how you feel. And right now, you have issues with
sleeping that go beyond
sleeping with the CPAP.
So I think it's time to start looking at that sleep hygiene much more closely. Not just so that you stand a chance of giving the CPAP an honest trial but also because you've got that long standing history of insomnia, along with history of being on prescription meds that adversely affect sleep architecture.
At various points you write:
I have had an ongoing problem at falling asleep at night (prior to CPAP) in a timely manner and thinking back to last night, the more I put the mask on, the more comfortable and natural it is starting to feel.
Put the CPAP on and still laid there about an hour before falling asleep at maybe midnight?
I try to get to bed generally the same time every night. I am guilty of going to bed early before ready to attempt to sleep and watching the TV with the volume down low. I have done this more so in the recent months because of my fear of never being able to get to sleep if I wait because I can never seem to get directly to sleeping whether I get in bed earlier or do wait until later when feeling even more sleepy.
One consistent with me seems to be come the weekend when off work, I tend to stay in bed for 12-14 hours feeling like I have to "catch up" on sleep missed during the week. Can't say even then that I wake up much more rested than usual but I know it feels good to just stay in bed when I can.
I really thought last night as I was more active in the evening catching up on yardwork and stuff that come bed time, I would be able to get to sleep quicker but that wasn't the case.
The BIG implication of these statements is that you've got a pretty bad case of
sleep onset insomnia. And that you've taught your body that it's perfectly acceptable to lie in bed
awake for long periods of time. And that's a hard lesson to "unlearn." Adding CPAP to the mix just adds yet another stimulus that may be keeping you up a bit longer, but it's hardly the real reason that you find it so tough to fall asleep in a timely fashion when you go to bed.
One hard thing about CBT for insomnia is accepting that you've got to actively train your body to associate
Being in Bed = Time to Sleep. And everything that allows your body to continue to believe that it is ok to lie in bed for hours while awake has to be brought under control. So one critical question you need to ask yourself is this:
Why are you so afraid of not being able to get to sleep if you simply wait until you are appropriately sleepy enough to go to bed?
And several of these statements seem to imply that you don't make much of a distinction between feeling
sleepy and feeling physically
tired or
exhausted. They are not the same feeling. And no matter how
tired you are physically, if your mind is not
sleepy when you go to bed, it can be very, very difficult to get to sleep. Getting some physical exercise everyday is an important part of controlling insomnia, but getting too much exercise in one day can lead to being too tired and too physically exhausted. Think of the stereotypical "terrible two-year old" who gets too wound up and too exhausted to actually take a nap.
I also think that you've got a bad case of what Dr. Krakow calls
the Worries in his book
Sound Sleep, Sound Mind. My guess is that you have a difficult time bringing closure to your day and choosing to not worry about all kinds of things once you go to bed. And that you're currently using the TV and the melatonin in an effort to ignore the fact that you have a hard time keeping your mind from focusing on
worries and
fears when you are lying in bed waiting for sleep to come.
You also write in various posts:
Right now it doesn't really seem like the mask/machine is having a detrimental effect on me falling asleep, it's more of me waking up an hour or two/four later.
I have went from 1mg prescribed xanax to up to 2mg regularly now in the past couple weeks in an attempt to get to sleep better which has helped that some but I still seem to wake up after an hour or four and especially this past nearly one full week now since I've started to give CPAP a go.
45yr old male. Diagnosed with "mild sleep apnea" and heavy snoring. Also have been struggling with depression, anxiety, and never feeling rested during the morning or day. Waking up throughout the nights.
Here is my ongoing problem. I keep waking up sometimes 4 hours later, sometimes as quick as 1 hour later and things just don't seem right. I don't know if it is the mask feeling uncomfortable or the air pressure getting to me either too low or too high but I end up taking it off to get back to sleep for the rest of the night.
Woke up at 2:30 AM and tried to force myself to leave the mask on but being so concerned that I wouldn't get back to sleep and had to be up at 7am for work, ended up taking it off yet again.
I do sleep but at times wake up frequently during the night. NEVER feel rested in the morning and don't want to get out of bed if I don't have to. And I can definitely tell that when my sleep is at the poorest, I am very irritable and just feel plain crappy the following day.
This collection of quotes makes it clear that you are also dealing with a long standing
sleep maintenance insomnia problem. Here again, adding the CPAP doesn't help address this issue and it may have aggravated it, but the CPAP is not apparently the reason why you're having trouble maintaining sleep.
My guess is that your sleep maintenance insomnia has multiple roots. And sleeping meds often do very little to alleviate sleep maintenance insomnia. But many insomniacs have a significant behavior pattern that aggravates their sleep maintenance insomnia:
They pay too much attention to the fact that they've woken up in the middle of the night.
Lots of folks wake up during the night, sometimes even multiple times, and most of them don't have insomnia. It's not uncommon for folks to wake briefly at the end of REM cycles, for example. Lots of folks have to get to full wake to comfortably turn over in bed. Folks wake up because they're hot and need to throw the covers off. Or they're cold and they pull the covers back on. But one critical difference between non-insomniacs and insomniacs is their reaction to waking up in the middle of the night.
The non-inosomniac seldom worries why he/she is awake unless there is some clearly identifiable external cause for the wake. He/she may casually glance at the clock (or not), and most likely rearranges the covers to get more comfortable, perhaps goes to the bathroom, perhaps gets a drink of water, yawns a couple of times and goes back to sleep. The insomniac is likely to be much more
aware he/she is awake and much more
troubled by the fact that he/she is awake. And this often leads to looking at the clock and then
worrying about how soon the alarm clock is going to go off and mentally calculating how
little sleep he/she has gotten during the night, which winds up making the insomniac wake up even more fully.
Non-insomniacs typically don't even remember a wake unless it's lasted at least 5 minutes or so. Insomniacs with sleep maintenance problems may inadvertently encourage themselves to
stay awake long enough to remember the wake---by immediately looking at the clock and starting to focus on how long they've been asleep for example. Or by immediately going into
Why Am I Awake? mode where they start trying to analyze exactly what woke them up when there really was no cause for the wake. Insomniacs may also have a tendency to remember shorter wakes than non-insomniacs.
So what you
choose to do when you wake up in the middle of the night is pretty important for dealing with sleep maintenance insomnia. And the best choice is probably to do nothing for several minutes except snuggle more comfortably in your covers. But that's a hard thing for an insomniac to do. And unfortunately, the longer you spend in bed
awake and
worrying about being awake the harder it can be to get back to sleep. And after about 15-30 minutes of lying in bed awake, you are typically
too alert to get back to sleep. And that's why one of the basic tenants of good sleep hygiene is:
If you're not asleep in about 30 minutes, get out bed, go to a different room, do something soothing and relaxing until you are sleepy enough to get to sleep. This rule is highly counter-intuitive to the typical clock-watching insomniac who's already worried that they'll never get enough sleep to function the next day. But if you just get out of bed for a few minutes to clear the mind, relax for a bit, and allow yourself to get sleepy, you will likely get back to sleep faster than if you had stayed in bed tossing, turning, and worrying about being awake. And this is doubly important if what's keeping you awake is frustration with the machine.
You've written the following about your prescription drugs:
As mentioned, I have also suffered depression, anxiety, and insomnia for the past 6+ years and have been and still am on quite a cocktail of depression and anxiety meds which help somewhat with that but never seem to help with the sleep quality which actually seems worse when my depression and anxiety are in check with the meds.
I actually switched from being on Prozac for a year plus to Effexor earlier this year. I see that is one mentioned that can effect the deeper stages of sleep negatively now. I'm only on 75mg and was considering upping the dose as my mood has not been as in check lately. I'm also on .25 mg of xanax 3x daily and .50 mg at night. I also take 300mg Neurontin 4x daily but usually only remember to take it 3x. I've recently added some 5-htp to the mix at night as it worked for sleep in the past for me but so far not helping much lately.
I know and understand what your saying. Ideally I would like to be off these meds. I did try for a 3 month period at the end of last year. My mood was ok until the holidays then things went sour and my psychiatrist got me going again on the meds. Sleep quality never improved while off the meds though. This has been an ongoing issue with me for as far back as I can remember.
So while these drugs are known for adversely affecting sleep architecture, it's not entirely clear whether they are adversely affecting your sleep. Nonetheless, these drugs are powerful stuff and working with your all your docs is going to be required to get everything balanced. Does the psychiatrist know that your PCP has diagnosed mild OSA and that you are trialing a CPAP?
You've written the following things about your sleep hygiene habits:
I really thought last night as I was more active in the evening catching up on yardwork and stuff that come bed time, I would be able to get to sleep quicker but that wasn't the case.
Although usually when I have a day like today and say I'm going to go home and nap right after work, I just end up laying on the couch semi-awake for an hour or two and never really sleep either.
After my sleep study in January, my doc also indicated to me that he wanted me to lose about 20lbs so he put me on a carbohydrate restricted diet (40-60) net carbs per day. This was quite a change for me as my former regime included a lot of pasta, potatoes, sodas, pop tarts, ect... Well with his advice and a neat weight loss/diet tracking program for my Android called "LoseIt", I have lost 24lbs since Feb 1st and my BMI index is now in the normal range. We were both hopeful this would help with my sleep quality, however it hasn't seemed to make a difference. I have a slight bit more energy during the day which I suppose is the complete avoidance of any unnatural sugars but still don't want to get out of bed in the morning and never feel rested.
I have learned to restrict my caffeine intake to just a coffee in the mornings and sometimes a Pepsi One for lunch but nothing after that. I try to get to bed generally the same time every night. I am guilty of going to bed early before ready to attempt to sleep and watching the TV with the volume down low. I have done this more so in the recent months because of my fear of never being able to get to sleep if I wait because I can never seem to get directly to sleeping whether I get in bed earlier or do wait until later when feeling even more sleepy.
One consistent with me seems to be come the weekend when off work, I tend to stay in bed for 12-14 hours feeling like I have to "catch up" on sleep missed during the week.
We can conclude from these comments that you have
- problems distinguishing between feeling sleepy and feeling tired or exhausted.
- an irregular sleep schedule, even if you try to get to bed about the same time.
- a nap habit that includes inefficient sleep (if any sleep at all).
- a caffeine habit that is controlled enough where theoretically it should not be interfering with your sleep.
- one or more necessary prescribed medications that can seriously interfere with the quality of your sleep, but it's not clear they actually do affect your sleep.
- cleaned up your diet, are now eating healthy, and are now at a healthy weight.
On the positive side: You understand that sleep is intimately tied to other areas of your life and you've had the discipline to lose the weight and change the diet. You should be able to harness that same discipline in an effort to clean up some of the worst parts of your sleep hygiene. You've got the caffeine under control. You understand that physical activity should help the quality of sleep.
But there is still plenty to work on. But the most important thing in my opinion is to establish a pretty rigid sleep schedule. The purpose of the rigid sleep schedule is to help you body get into a circadian rhythm. In other words, to teach your body
when it should be sleepy each day and
when it must be awake each day. And it will also help teach your mind how to distinguish between being sleepy and being tired. The most critical part of a rigid sleep schedule is choosing
the wake up time. It's critical that you pick a time that you can make sure you get up at seven days a week. In other words, until your body is capable of falling asleep and staying asleep at an appropriate time, you cannot allow yourself the luxury of sleeping in on days off.
Once your wake up time is set, then you need to set your bedtime. The usual guideline is to set bedtime about 7-8 hours earlier than wake up time. But you've got to factor in when you usually manage to fall asleep here too. There's no point in going to bed and lying there for an hour before falling asleep. So go to bed when both these conditions are met:
- (1) It is at or after your "bedtime and (2) You feel very, very sleepy
That's the only way to help teach your body and mind to go to sleep when it is time to sleep. And don't watch the tv in bed. Do the tv watching in a different room and only go back to the bedroom when you feel yourself just on the verge of falling asleep anyway.
Get all the CPAP stuff set up before bedtime in order to keep you from waking yourself up just to deal with putting the CPAP stuff together. Get the mask put together, prefit it if possible, fill the humidifier up (when you get one) all well before bedtime. Start your pre-bedtime routine of brushing the teeth, washing the face, putting the Lanisoh on, etc. about 15-30 minutes before your official bedtime. But don't go to bed just because the clock says "bedtime"---wait until your eyes start to get droopy and you are yawning.
And if/when you wake up in the night, try to not look at the clock. Allow yourself a bit of time to get back to sleep naturally. But if you can't, then get out of bed and do something soothing and relaxing.
Finally, I think you'd gain a lot by working through
Sound Sleep, Sound Mind because I really think that while the loud snoring and the mild OSA are likely contributing to your bad sleep, the insomnia is the real monster here. And until you get that insomnia monster under control, I don't think your sleep will dramatically improve regardless of what you do.